| Assigned number | Title | Release date Sort ascending | Language | Available to order |
|---|---|---|---|---|
| F-01283 | Notification of Non-Covered Benefit Letter Template - Model (Word) | 12/01/2022 | English | No |
| F-01283AR | Notification of Non-Covered Benefit Letter Template - Model, Arabic (Word) | 12/01/2022 | Arabic | No |
| F-01283CM | Notification of Non-Covered Benefit Letter Template - Model, Chinese (Simplified) (Word) | 12/01/2022 | Chinese (Simplified) | No |
| F-01283H | Notification of Non-Covered Benefit Letter Template - Model, Hmong (Word) | 12/01/2022 | Hmong | No |
| F-01283L | Notification of Non-Covered Benefit Letter Template - Model, Laotian (Word) | 12/01/2022 | Lao | No |
| F-01283SE | Notification of Non-Covered Benefit Letter Template - Model, Serbo-Croatian (Word) | 12/01/2022 | Serbo-Croatian | No |
| F-01283SO | Notification of Non-Covered Benefit Letter Template - Model, Somali (Word) | 12/01/2022 | Somali | No |
| F-01283S | Notification of Non-Covered Benefit Letter Template - Model, Spanish (Word) | 12/01/2022 | Spanish | No |
Last revised October 13, 2026