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Frequently Asked Questions

 

Contents

About MedSave.com Services

    Who uses MedSave.com?

    How does MedSave.com work?

    What can't MedSave.com do?

    Why use MedSave.com?

    All I want is a quote on insurance...

    I already have insurance...

    What happened to Fortis Health plans?

About the Medical Insurance Plans

    What is a "deductible"?

    What is "co-insurance" and how does it work?

    What about Co-payments?

    How do I reach customer service?

    What is covered under the medical insurance plans at MedSave.com?

    What is not covered in the medical insurance plans?

    What is a pre-existing medical condition?

    How do I get health insurance to cover a pre-existing medical condition?

    How do I get maternity coverage?

    What about quality of coverage?

    Why use short term or limited term medical insurance?

    Is this an HMO?

    Which doctors can I use?

    How much does it cost?

    Why is the coverage so inexpensive?  What's the catch?

    Is everyone eligible?

    I do not know how to answer the eligibility questions

    Are these insurance companies reputable?

    Why doesn't this site list the names of insurance companies or any details of the coverage?

    Are there limitations on the coverage?

    How fast can I get coverage?

    What if I change my mind, cancel the coverage or want a refund of payment?

    What are the payment options?

    What if I need coverage for a longer period of time?

OnlineAdviserTM Services

    How do I know MedSave.com is reputable?

    What is OnlineAdviser service?

Medical Savings Accounts

    What about "Medical Savings Accounts"?

PPO Discount Plans

    Where can I find the discount plan fee schedule?

    Why should I enroll in a discount plan if I do not know the amount of the discount I will receive?

    What happened to the free discount prescription drug plan?

 


About MedSave.com Services

Who uses MedSave.com?

MedSave.com primarily serves people who buy their own health insurance including those who are changing jobs, starting a business, self-employed individuals, recent graduates, or small businesses that want to partially self-insure with a high deductible policy and a Health Reimbursement Account (HRA) Plan or Health Savings Account (HSA) to cut insurance costs. 

1 in 6 Americans are not covered by insurance for at least part of the year, according to the 2000 U.S. census data.  Most of these people are in temporary situations - recently graduated or starting a new business, between jobs, waiting for group coverage, etc.  Most of these people are eligible for easy and affordable coverage under a short term medical insurance plan.  Permanent individual or group medical plans are available at a higher price.

How Does MedSave.com Work?

MedSave.com is a free online service providing fast, professional and reliable benefits search and enrollment. 

Professional personal assistance is available at a fee as needed from OnlineAdviserTM service.  OnlineAdviserTM requests are individually handled by a benefits specialist and a response that best matches your unique situation are handled within one business day.

What MedSave.com Can NOT Do

MedSave.com is not an insurance company or insurance agency.  MedSave.com does not set the premium prices, determine the coverage details, decide who is eligible, etc.  These are determined only by the company that offers the specific plan.  Also, we cannot access information on an insurance policy that is in force, including coverage information, payment records or claims information.  IF YOU NEED TO OBTAIN IN-FORCE POLICY INFORMATION, CHANGE COVERAGE OR CANCEL COVERAGE, PLEASE CONTACT THE PLAN ADMINISTRATOR OR MEMBER SERVICES OFFICE DIRECTLY.

Why Use MedSave.com?

MedSave.com is the only online health insurance service using OnlineAdviserTM to provide fast professional service at at a level unmatched by other firms.  MedSave.com is one of the few benefits firms providing personal service in all 50 states and the District of Columbia. 

All I want is a quote on insurance...

All of the insurance plans listed at MedSave.com provide standard rates online.  Prices are not provided by OnlineAdviserTM telephone service.  

I already have insurance...

Small business benefit plans like the Section 125 Cafeteria Plan, Healthcare Reimbursement Accounts (HRA) or Medical Savings Accounts (MSA) can integrate with any existing benefit or insurance plans.  For example, you may want to keep an existing HMO plan for some employees in your new MedSave.com flexible benefit plan.  Or you may want to keep your existing Medical Savings Account with another custodian when switching medical insurance plans.  

For most small businesses, it is not necessary to change your existing insurance plan in order to offer an additional more efficient benefit option, so this is often the more desirable approach from a management perspective.  In most cases the goal is to offer a more customized benefits package with more options to fit specific needs of the owner and the employees.  The actual result is greater efficiency and a higher overall level of satisfaction with the benefits. 

For individuals and businesses, the value of your health plan can be enhanced by adding a PPO discount savings plan from www.ehealthdiscountplan.com without changing your health insurance plan.  Discount plans range from $100 to $200 per household per year but can save thousands in medical, dental and eye care bills. 

What happened to Fortis Health plans?

Fortis is now "Assurant Health".  MedSave.com no longer provides enrollment support for these products.


About the Medical Insurance Plans

What is a "deductible"?

The deductible is the amount of claims on the insurance policy that you pay before any insurance comes into effect.  In other words, you pay the total amount of bills up to the deductible with no help from your insurance.  Once the total amount of bills reaches the policy deductible, the insurance policy steps in.

Selecting an insurance deductible with a deductible is a smart way to save money on insurance premiums.  Raising an insurance policy deductible by $500, for example, typically saves more than $600 in premium, so this is almost always a smart decision.

The deductible is typically determined on a calendar year basis or the life of the policy (whichever is shorter).  

Deductibles are further broken down and defined as "per person", "per family", "per year", per policy" or "per cause".  Usually two of these are linked together.  For example, a popular deductible choice in medical insurance today is "$500 per person per year".  In this case the maximum deductible for a family of 4 would be $2,000 per calendar year (4 x $500).

Here is an example of how a policy deductible works: For example, if you incur medical bills of $80 for a prescription drug, $1200 for doctor office visits and $200 for lab tests, then simply add them up for a total of $1480 covered medical expenses.  If policy deductible is $500, then you pay the first $500 and the insurance covers the next $980  ($1480 minus $500).

What is "co-insurance" and how does it work?

Co-insurance is the portion of your total medical claims, above the deductible, that you might pay if the medical provider does not "accept assignment" of your insurance.  

The common formula of "80/20 to $5,000" was developed generations ago by the Blue Cross associations for traditional medical insurance plans.  Many variations are used today and a "50/50 to $2500" co-payment formula has become more popular in recent years.

In the "80/20 to $5,000" co-insurance, for example, this means that you pay 20% of the first $5,000 of claims above the deductible.  Your maximum expense for co-insurance in this example is $1000 ($5000 x 20%). 

The "deductible" plus the "co-insurance" taken together are typically referred to as your "maximum out-of-pocket expense".

In MSA plans, the maximum co-payment is limited by tax law (and adjusted annually) which overrides the basic co-payment formula hat would otherwise apply in the insurance policy.

In practical experience, more than 95% of medical providers will take assignment of your medical claims after you pay the policy deductible and accept this insurance assignment as full payment.  In this case the patient does not need to be concerned about co-payment.

What about co-payments?

"Co-payment" is the term used by HMOs and managed care plans to set the amount a patient pays when visiting a doctor, buying a prescription or using an emergency room.  The private individual medical insurance plans at MedSave.com generally DO NOT use co-payments because all covered medical expenses are lumped together and paid based on the policy deductible and co-payment as described above.

How do I reach Customer Service?

Find contact information for each insurance or benefits company listed at www.KymberlyMorrison.com/contact.htm .

MedSave.com can not access information about in-force insurance policies nor offer advice that would be considered speaking for or "interpreting" an insurance policy.  Always direct these types of questions directly to the insurance company.

Each provider has its own customer service number for billing and claims.  That number is listed in your benefit plan documentation.  You should use this direct customer service number after your new plan is started.

Some additional contact information for the various insurance companies and benefit plans is listed online at www.KymberlyMorrison.com on the "Contact Information" page.

What is covered under the medical insurance plans at MedSave.com?

All insurance plans cover "ordinary and necessary medical expenses".  Usually this means what an average M.D. would prescribe for a specific situation.   This typically includes doctors visits, prescription drugs, lab tests, hospital charges, and ambulance.  Insurers typically defer to American Medical Association standards even though not all medical care providers fall under AMA

What is not covered in the medical insurance plans?

Pre-existing medical conditions are not covered.  Maternity expenses are not covered.  Expenses that are not "medical expenses" are not covered (for example dental expenses are not medical expenses).  

Expenses that you voluntarily opt for that are not prescribed by a doctor man not meet the "ordinary and necessary standard".  For example, you might discover that a weekly spinal manipulation helps your golf game and eases back pain, but this might not meet the standard of "ordinary and necessary".

When an insurer cannot easily determine whether an expense is "ordinary and necessary" then often the policy states that only a limited benefit is covered.  For example, outpatient counseling is usually limited to a specific dollar amount and number of visits.  This limitation does not mean that you can be cured for that specified number of medical visits, but rather that the insurer is limiting its financial responsibility to that dollar amount. 

What is a pre-existing medical condition?

A pre-existing medical condition is a health issue that started before your current insurance.  Usually this is evidenced by notations in your medical records.  Examples of medical expenses frequently not covered as pre-existing medical conditions are long term prescription drugs and seasonal allergy treatments.

How do I get health insurance to cover a pre-existing medical condition?

There are six ways to cover pre-existing medical conditions:

1) Enroll in an employer-provided group insurance plan.  These employer-sponsored plans include coverage for pre-existing medical exclusions for new employees and for current employees who enroll after the initial eligibility period as long as you have met the one-time waiting period or meet the plan's requirement for immediate coverage of pre-existing medical conditions.  In the worst case, you only need to meet the waiting period one time as long as you maintain continuous insurance coverage.  For example, if you left one individual health plan and then switched a month later to a 10 month short term medical plan and then to your employer-provided group plan, then the group health plan would immediately cover pre-existing medical conditions because you maintained "continuity of coverage".  Otherwise, there might be a waiting period before the new plan 

This type of group coverage is not available to all businesses.  See the qualifying criteria listed on the "Group Health Plan" link on each state where these benefits are offered.

2)  Enroll in an "open enrollment" or "assigned risk" plan. These plans are likely to be available to everyone in the state, but some plans have waiting periods before picking up coverage for pre-existing medical conditions.  For example, if you are covered for 18 months under a short term medical plan and then switch a Blue Cross plan, you meet the required "continuous coverage" that allow the pre-existing medical condition to be covered immediately.  Otherwise, you would need to wait 18 months for the Blue Cross plan to pick up the cost of your pre-existing medical condition.

The procedures vary from state to state, but most states have at least one open enrollment plan.  These plans are generally not available on the Internet.  Many Blue Cross Associations offer this type of coverage.  See the "Blue Cross" link from your state benefits page or contact your state insurance department for more information on locating this type of health plan.  MedSave.com does not provide enrollment support for these plans.  Enrollment support may also be available through the health plan's member service department.

3)  Enroll in COBRA coverage.  This only applies if you are leaving a group insurance plan for a "qualifying reason" like termination of employment.  This only applies if your former employer has more than 20 employees.  COBRA coverage does not apply to small businesses with less than 20 employees.

4)  Enroll in a PPO Health Discount Plan like www.ehealthdiscountplan.com .  These discount plans cover pre-existing all medical conditions and are available to everyone.  This is not insurance.  These plans help process medical claims and reduce out-of-pocket costs. 

5) Enroll in a Health Savings Account (HSA), Health Reimbursement Account (HRA) or other uninsured health plan if available through your employer.  This is not insurance.  These plans are usually designed to cover pre-existing medical conditions but the benefit may be limited to the amount defined by the employer.  These plans are often combined with a PPO Health discount plan above to cover the out-of-pocket portion of bills not paid by the discount plan.  More information on these plans may be found on the specific state page at MedSave.com.

6)  Stay with the same health insurance company.  When you change from one insurance plan to another with the same health insurance company, you will usually receive a "Waiver of Pre-existing Conditions Limitation" certificate with your new policy.  For example, if you switch from a full coverage group plan to catastrophic individual plan offered by the same company, you still keep your coverage for pre-existing medical conditions that would otherwise not be covered.

How do I get maternity coverage?

If you need individual health insurance that includes maternity coverage, please use the link on your state benefit page to link directly to your local Blue Cross Association.  These plans handle their own enrollments directly through their own local member support staff.  This almost always turns out to be the best option available for individuals who expect to incur maternity expenses in the near future.

Although maternity coverage is available in some commercial health insurance plans, it is never the best option.  It adds more than two hundred dollars per month to the cost, has a long waiting period before benefits are eligible and has a large deductible that must be paid separately and in addition to your regular policy deductible.  In short, it is not a good deal.

What About Quality of Coverage?

MedSave.com considers the quality of coverage as the primary consideration when recommending a medical insurance plan.  All health insurance plans at MedSave.com must cover ordinary and necessary medical expense with any doctor or hospital of your choice and include a stated maximum financial risk to the policyholder.  Coverage limits must be high enough to satisfy any reasonable possible medical situation.

Beyond these factors, evaluating overall the quality of health plans is not an exact science.  Our determination of quality is based on six factors: 1) published surveys results ("For Broker's Only" and "Consumer Reports", 2) market share, 3) complaints filed with insurance departments of insurance, 4) use of "internal limits" in defining what is covered by the policy, 5) use of managed care provisions that restrict freedom of choice, and 6) observations, comments and complaints from MedSave.com users.  

Since 1997, MedSave.com has compiled data on consumer complaints about health insurance plans during the normal course of business of fielding user inquiries.  While this data is not scientifically valid, it does provide us with a significant tool to help us with health plan recommendations.

Why use short term or limited term medical insurance?

In the past, most medical plans were renewable year after year as long as we needed them.  But with costs rising substantially each year, most people changed health plans every few years anyway.  Most plans today are issued with the expectation that you will replace them in less than 3 years.  These plans are known as "short tem medical plans" or "STM" even if you keep them for many years.  There are other advantage of STM plans:

1.  faster and easier, with coverage issued immediately.  There are no medical exams, medical records, lab tests, agent interviews, etc.  You can even print out your enrollment card online.

2.  less expensive.  The average premium is about half of the comparable premium for other types of medical coverage.

3.  less restrictive coverage. There are no managed care features, no networks, and no required pre-authorization.

4.   health plans change frequently.  A plan that was a great deal last year is not likely the best deal today.  It makes no sense to investigate coverage now for a plan that you won't need until next year.  In most cases, the current plans will be replaced by a new policy form with new coverage, rates, eligibility, etc.

6.  avoids claims disputes.  In most cases the items excluded by STM plans would also be excluded from many other traditional medical plans, but you may not be aware of it until after a claim investigation is completed.  With STM, you have a much better chance of knowing what is covered in advance.  STM is legally much less complicated than other health plans.

7.  satisfaction rates are higher.  Our customers have reported a higher level of satisfaction with STM plans than any other type of health plan.

8.  more widely available.  Almost everybody (with the short list of exceptions) will qualify for this type of coverage.  If you don't qualify for STM then you probably would not qualify for other privately issued health insurance plans.

9.  MedSave.com offers conversion to permanent coverage to qualifying individuals approaching the end of their eligibility for short term coverage.  The premiums will be a bit higher, but most people can continue uninterrupted coverage at the end of the STM plan.

The majority of Americans who buy individual medical insurance will keep that insurance plan for less than two years.  MedSave.com offers assistance in changing to another permanent coverage if the need for health insurance still exists at the end of the STM coverage.  Individual medical insurance plans are expected to change dramatically in the next 12-24 months in terms of coverage, price and availability, so it is difficult to make specific plans for coverage more than a month in advance.

Is this an HMO?

No.  The health plans listed at MedSave.com are indemnity type insurance plans that allow you to obtain covered services at any medical provider of your choice.  Some plans use optional preferred provider (PPO) type  coverage only.  There is no provider network in these plans and no authorization or referral is required to obtain treatment.  You are covered for any doctor or hospital across the U.S.

MEDSAVE.COM DOES NOT PROVIDE ENROLLMENT SUPPORT FOR HMO PLANS INCLUDING BLUE CROSS/BLUE SHIELD, LIFEWISE, KAISER, AARP, HUMANA, UNICARE OR OXFORD.

Which Doctors Can I use?

MedSave.com health insurance plans can be used with any doctor or hospital anywhere in the United States.  There is no provider list or required referral.  Some plans also include international coverage.

How much does it cost?

Premiums are usually much less than other types of coverage but will vary by location, sex, age, length of coverage and method of payment. So it is impossible to list rates for everyone here on the Web site.  But generally these plans cost about half the price of traditional medical insurance. A premium chart will be sent with your application.

Premium rates are calculated online for most plans.  

Some plans are priced based on a brief online request through OnlineAdviserTM service and then the rates are sent by email.  Group plan pricing requires a written request and group census.  Please see the Group Proposal Request Form.

Why is the medical coverage so inexpensive?  What's the catch?

MedSave.com focuses on health plans with a lower premiums.  These plans are generally available only to those without significant medical history.    These plans do not cover pre-existing medical conditions so the coverage is usually only about half the price of other plans.  

Is everyone eligible?

Everyone is eligible for international travel insurance coverage and the PPO discount plans.

People with serious pre-existing medical conditions are not eligible for short term medical coverage or commercial individual health insurance. 

Eligibility for permanent medical coverage varies on a case-by-case basis depending on state and federal law.

The following states do not allow short term medical coverage: NJ, NY, MA, RI, VT.

Group plans are available in most states to every full time employee of a business but the qualifications for the business to qualify for this type of coverage are very strict.  Please see the Group Proposal Request Form for details.

I do not know how to answer the eligibility questions

An insurance company will not make a determination whether the answer to a medical question is "yes" or "no" because that is based on your own medical history. If you answer the question "no" the coverage is issued. If you answer "yes" the coverage is not issued. Regardless of whether you answer "yes" or "no" the policy excludes coverage for pre-existing conditions. If you intentionally lie on an insurance application, the coverage may be rescinded. If you use your best judgment and make a mistake, then the revision action does not apply.

Are these insurance companies reputable?

All of the companies listed on MedSave.com have solid financial ratings and better than average consumer reputations, we believe, as compared as a whole with the nation's other large health care providers.  

It is important to realize that health insurance companies have a slightly different scale of ratings from third party rating services than life insurance companies.  This is due to the inherent differences between health insurance and life insurance.  For example, an A. M. Best rating of A+ is considered the "standard" for the best life insurance companies but an A. M. Best rating of A- is considered the highest rating for health insurance companies since health insurance companies are generally not eligible for an A+ rating de to the nature of the market and the universal practices of the health insurance industry. 

Why doesn't this site list the specific names of insurance companies or any details of the coverage?

MedSave.com's policy is to remain "generic" with regard to online content and not endorse any product or company by name.  Adequate information on all products and insurance companies is available on the various products' commercial Web sites.  The OnlineAdviserTM service is able to recommend one specific health plan over another based on the information you provide.

Are there limitations on the coverage?

Yes, all health insurance policies have some limitations on the coverage.  The limitations and exclusions are clearly listed on the application materials and in the policy.  Some of the most important exclusions in most policies are: 1) Pre-existing medical conditions, 2) Medical expenses  outside the U. S., 3) Expenses not medically necessary, 4) maternity expenses.

How fast can I get coverage?

Coverage can be effective at one minute after midnight following receipt of your signed application and payment through regular U. S. mail, E-mail, online enrollment, or by fax.  Your issued insurance policy and insurance ID cards are mailed back to you usually on the same day as we receive your application.

What if I change my mind, cancel the coverage or want a refund of my payment?

You can always cancel any insurance coverage by calling or writing directly to the insurance company.  MedSave.com is not authorized to accept a request to cancel coverage..  During the first 10 days of a policy*, you will receive a full refund of premium less any application charge.  If you cancel coverage after the 10 day period you do not get a refund of previously paid premiums.  

You can, of course, stop the coverage by simply discontinuing the payment of premiums.  This is often the preferred method of stopping coverage.

INTERNATIONAL TRAVEL PLANS DO NOT OFFER A 10 DAY REFUND PROVISION.  Due to their unique nature, premiums for travel medical plans are not refundable.

Application fees or processing fees charged by some plans are not part of the insurance premium and are not refundable.

What are the payment options?

Billing may be either "monthly" or "single pay".  You can pay by check, money order, or major credit card (VISA, MC, Amex, Discover).  All payment are made only through regular mail (not over the Internet!) the same as any other type of insurance, so your credit card information and personal financial information is safe.

It is significantly less expensive to pay for 2 to 6 months of coverage in advance.  But if you do not know how long you will need coverage then a monthly premium payment method is best.

What if I need coverage for a longer period of time?

Short term medical plans can be re-written as often as you wish for an unlimited total length of coverage.  Some states may have laws that limit the number of times you may enroll for this coverage. 

MedSave.com can help with an application for permanent medical insurance after you are no longer eligible for short term medical insurance.

How do I know MedSave.com is reliable?

MedSave.com is operated by Freedom Benefits Association; owned by Web Designs www.KymberlyMorrison.com.  MedSave.com is one of the oldest online enrollment services established in 1997 with hundreds of thousands of users in all states.  It is easy to check with your local Better Business Bureau and Department of Insurance to verify the absence of any consumer complaint or regulatory action against us.  (We suggest you should do this quality check with any financial service firm you are considering).

Since community and professional association reputation is often the best indicator of a business's professionalism, you may wish to check out Freedom Benefits and Health Insurance by contacting the leaders of other well-known reputable national organizations that may offer a source of reference.  (Of course, not all of the members or official will know us, but most, we think, will offer a good reference based on general reputation.  For privacy reasons, we may not specify which members are customers).

Creative Enterprise Small Business Directory 

Financial Planning Magazine Online

National Association of the Remodeling Industry 

Rotary International 

National Dog Groomers Association

Ocean City Chamber of Commerce

SmallBusiness.com (publications only)

Neither Health Insurance , Freedom Benefits nor MedSave.com have received any unresolved consumer complaints and no complaint has ever been filed with any type of government or consumer agency.   We are doing all we can to "play fair" to protect our clients as well as our own good reputation.

What is OnlineAdviser service?

OnlineAdviser is a network of independent financial advisers who provide free support to the users of Web sites that identified by the OnlineAdviser logo. Some advisers are hired by the site, others volunteer their time. The intention is to add an additional level of service to a Web site that otherwise intended to be "self-serve".


Medical Savings Accounts (MSA) and Health Savings Accounts (HSA)

What about "Medical Savings Accounts" (MSA) and "Health Savings Accounts" (HSA)?

The Health Savings Account program replaced the Medical Savings Account program effective beginning January 2004.  BEFORE you can open a MSA or HSA account, you must have the qualifying high-deductible insurance in place.  More information is available at www.healthsavngsaccount-hsa.com.  It generally takes about 3 weeks to pre-qualify, price, enroll and deliver an issued HSA type insurance plan.  Pricing and details are available by submitting an online request.  Most of these insurance plans are handled by telephone interview rather than using online enrollment.  

Generally, HSA plans are available to healthy self-employed individuals and small businesses with an established payroll.  HSA plans are not available in the following states: AK, HI, KY, ME, NC, NJ, NY, RI, UT, VT, WA.

Health Savings Accounts are usually free, no-load and easy to set up and administer.  The HSA generally has no set-up or administration fee and is included with your HSA-qualified insurance plan.  More elaborate types of HSA accounts have set-up and monthly administration fees.  These accounts may include a VISA/debit card.  Both accounts allow you to select from a few no-load mutual funds just like a self-directed IRA account.  MedSave.com helps open the basic HSA account and then the HSA administrator will help show the investment options after the MSA account is open.  See the HSA account forms on the Forms Page for more details.


Health Reimbursement Accounts (HRA)

What are HRAs?

HRAs are the latest method preferred by small businesses to provide health benefits to employees.  These benefit plans help the business lower health costs and avoid the restrictions otherwise placed by group insurance regulations and insurance company requirements.  After a one-time set-up expense, these plans can be easily self-administered by most small firms.  For more information, see the articles at www.KymberlyMorrison.com


PPO Discount Plans

Where can I find the PPO discount plan fee schedule?

The discount plans at MedSave.com offered use a fee schedule where doctors, dentists, hospitals, pharmacies and other medical providers across the country have entered into a contract with the PPO network to accept a lower amount of payment from PPO member patients than they would charge to cash-paying patients.  Part of that contract is the promise of the PPO not to make that specific compensation information available to the public.  Of course, PPO members are given this information on a need-to-know basis.  PPO networks manage this issue by making the fee schedule available only to members.

Why should I enroll in a discount plan if I do not know the amount of the discount I will receive?

The PPO networks offers at a month trial membership so that you can review the discount fee schedule that applies to your unique situation. This is the only way to accurately calculate the savings your will achieve.

 What happened to the free discount prescription drug plan?

The free discount drug program is still available from DrugCard America. Click here to order a discount drug card without support. If you have questions, www.ehealthdiscountplan.com offers a discount drug plan that costs about $90 per year that includes member support for those who have questions before enrollment or while using benefits.


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