etouhc.com. If you aren't clear about any of the olded terms used in this form, see the Glossary. You can view the Glossary at www.cciio.cms.gov or zww.dol.gov/ebsa/healthreform or cal11-866-487-2365 to request a copy. /6F 1 of 8 III II IIIIIII IIII III II EFTA00316274 A • Copayments are fixed dollar amounts (for exa