Seniors

Sign up for updates!

Subscribe for important news and information from WPS.

What You Should Know About Coronavirus Disease


WPS is actively monitoring the current international and domestic environment for COVID-19 as well as the related risks so we can prepare accordingly. On this page, you’ll find links to information about COVID-19, related news, and information on what WPS is doing to help our customers.

Note: The content below is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

To help slow the spread of COVID-19, the federal government recently passed guidelines making at-home testing more accessible.

Free tests

The federal government’s free at-home COVID test program was suspended on Sept. 2, 2022, due to lack of funding from Congress. For more information, please visit www.covid.gov/tests/faq.

On Sept. 1, 2022, the Wisconsin Department of Health Services announced a new program allowing residents to request up to five COVID tests at no cost. For more about this program or to request free test kits, go to the Say Yes! COVID Test website.

Over-the-counter (OTC) at-home COVID-19 tests are not covered for all Medicare members. However, the Department of Health and Human Services has free testing programs available.

If you have Medicare:

Effective April 2022, people who have Medicare Part B will be able to get up to eight (8) COVID-19 over-the-counter (OTC) tests each calendar month until the end of the COVID-19 public health emergency.

  • You will need to show your Medicare Red, White, and Blue card to get your tests.
  • You will not have to pay for the test as long as you go to an eligible pharmacy or health care provider.
  • You will not be charged at the pharmacy or health care provider.
  • There are no claims to submit to WPS as you will be covered in full at the pharmacy or health care provider.
  • If you want more than eight tests, you will be charged by the pharmacy or health care provider. These tests (over eight) will not be covered by Medicare and therefore NOT covered by WPS.
  • A box could contain more than one test—if so, only eight tests are paid. Example: if an OTC testing box contains two tests, you can get four boxes at no charge.

This new initiative enables payment from Medicare directly to participating eligible pharmacies and other health care providers to allow Medicare beneficiaries to receive tests at no cost. This is in addition to the two sets of four free at-home COVID-19 tests Americans can continue to order from COVIDTests.gov.

Please use the following link to find participating pharmacies: medicare.gov/medicare-coronavirus.

National pharmacy chains participating in this initiative include:

  • Albertsons Companies, Inc.
  • Costco Pharmacy
  • CVS
  • Food Lion
  • Giant Food
  • The Giant Company
  • Hannaford Pharmacies
  • H-E-B Pharmacy
  • Hy-Vee Pharmacy
  • Kroger Family of Pharmacies
  • Rite Aid Corp.
  • Stop & Shop
  • Walgreens
  • Walmart

Purchasing tests with no upfront costs

This coverage will apply until the end of the public health emergency. In accordance with new requirements, WPS Health Insurance and WPS Health Plan will cover the costs of certain OTC home testing kits for individual and group customers (excluding Medicare supplement customers). See the chart below for the list of covered home testing kits.

When the tests are ordered or administered by a health care provider following an individualized clinical assessment, there is no limit on the number of tests—including at-home tests—that are covered. This includes people who need testing due to underlying medical conditions. Without a doctor’s prescription, we will cover up to eight OTC tests per individual per rolling 30 days.

  • Starting Jan. 28, if you’re enrolled in WPS Health Insurance or WPS Health Plan and Express Scripts is your pharmacy benefits manager (PBM), you can purchase up to eight OTC COVID-19 test kits per rolling 30 days through Express Scripts. You have two options:
    • Mail Order via ESI portal
      Log into the portal and select "Order at-home COVID-19 tests" under Quick Links. A new screen will open to allow you to select the customer you are ordering for, verify shipping and contact information, and acknowledge the tests are for personal use only.
    • An in-network pharmacy checkout
      Purchase your test kits at an in-network pharmacy at the pharmacy checkout with your WPS Health Insurance or WPS Health Plan insurance card. There is a combined limit of eight OTC tests per individual per rolling 30 days.

To find an in-network pharmacy, log into the Express Scripts member portal and search for in-network pharmacies. The cost of the test will run through your pharmacy benefit like any prescription drug. There is no cost-sharing (copay or out-of-pocket expense).

Test kits eligible for reimbursement

If you get your test kits at an out-of-network pharmacy or purchase them at a retail register at an in-network pharmacy, you will need to submit a claim form for reimbursement (up to $12/test). Note that the reimbursement is based on number of tests and kits may come with a varied number of tests in them.

If you have a pharmacy benefits administrator other than Express Scripts, please contact them for questions on reimbursement.

National Drug Code (NDC) Brand Name Package Size Quantity
11877001140 BINAXNOW COVID-19 AG SELF TEST (KIT) 2
00111070752 COVID-19 AT-HOME TEST (KIT) 1
00111070772 COVID-19 AT-HOME TEST (KIT) 4
56964000000 ELLUME COVID-19 HOME TEST (KIT) 1
82607066026 FLOWFLEX COVID-19 AG HOME TEST (KIT) 1
82607066027 FLOWFLEX COVID-19 AG HOME TEST (KIT) 2
82607066028 FLOWFLEX COVID-19 AG HOME TEST (KIT) 5
56362000589 IHEALTH COVID-19 AG HOME TEST (KIT) 2
56362000590 IHEALTH COVID-19 AG HOME TEST (KIT) 5
08337000158 INTELISWAB COVID-19 HOME TEST (KIT) 2
60006019166 ON-GO COVID-19 AG AT HOME TEST (KIT) 2
14613033968 QUICKVUE AT-HOME COVID-19 TEST (KIT) 5
14613033972 QUICKVUE AT-HOME COVID-19 TEST (KIT) 2

What is COVID-19?

It’s a new coronavirus strain that causes respiratory illness. Originating in Wuhan City, China, the virus has infected thousands of people worldwide and caused deaths. Cases have now been reported around the world. The World Health Organization named the disease caused by the new coronavirus on Feb. 11, 2020. The new name is COVID-19, short for “coronavirus disease 2019.”

What are the symptoms of COVID-19?

Common signs of infection include:

  • Respiratory symptoms
  • Fever
  • Cough
  • Shortness of breath
  • Breathing difficulties

In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure, and death.

People with heart and lung disease or weakened immune systems, as well as infants and older adults, are at higher risk for lower respiratory tract illness.

How is COVID-19 spread?

Human coronaviruses are usually spread from an infected person to others through the air by coughing and sneezing and through close personal contact, such as touching or shaking hands.

Find out more:

  • Wash your hands often with soap and water for at least 20 seconds, especially before eating and after going to the bathroom, blowing your nose, coughing, or sneezing.
  • If you do not have soap and water, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Avoid close contact with people who are sick.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

Is a COVID-19 test covered by my insurance?

The Department of Health and Human Services (HHS) is providing up to 50 million free, at-home tests to community health centers and Medicare-certified health clinics for distribution at no cost to patients and community members. You can learn more about this program here.

HHS also has established free community-based pharmacy testing sites around the country. The Biden-Harris Administration is purchasing 500 million at-home, over-the-counter tests to be distributed for free to Americans who want them, with the initial delivery starting in January 2022. There is a website where all Americans can request at-home tests for home delivery—for free.

For people covered by original fee-for-service Medicare, Medicare pays for COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, with no beneficiary cost sharing when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional. People with Medicare can access one lab performed test without cost-sharing per patient per year without an order. Effective April 2022, people who have Medicare Part B will be able to get up to eight (8) COVID-19 over-the-counter (OTC) tests each calendar month until the end of the COVID-19 public health emergency.

What if I need to be hospitalized for COVID-19?

Medicare covers all medically necessary hospitalizations.

Who at WPS can I call with questions about COVID-19 and my Medicare supplement insurance plan?

You can call the number on the back of your ID card for answers.

Will there be coverage for the COVID-19 vaccine?

Vaccines are an essential and highly effective way to prevent infectious disease in large populations. WPS will cover immunizations as directed.

Are medical supplies such as masks, gloves, and disinfectants covered?

Most of these supplies are not currently covered by Medicare or insurance plans in general.

Can I use telehealth services to get care for COVID-19?

Due to recent guidance from the Centers for Medicare & Medicaid Services, Medicare and our WPS Medicare supplement insurance plans will cover telehealth benefits through a medical provider (not Teladoc® at this time) for as long as it is covered by Medicare.

New benefits added to WPS health plans

Your health coverage has been boosted with new benefits! Check out the list below and feel free to call Customer Service using the phone number on your customer ID card if you have any questions.

Note: Self-funded group health plans have the option to select these benefits. If you are enrolled under a self-funded employer plan, check with your group leader to see if these benefits are covered. If you are a group leader, you can contact your WPS account manager with questions.

  • Coverage for furloughed employees: The work exception for employees covered under group health plans ended Dec. 31, 2020.
  • Prior authorization: Prior authorization requirements for services related to the diagnostic testing (including antibody testing) and treatment of COVID-19 are waived through July 15, 2022, or until the end of the Federal Public Health Emergency. We recommend that individuals contact us regarding inpatient hospitalizations. If you have any questions, please call the phone number on your customer ID card.

Is the COVID-19 test covered under my health plan?

To help slow the spread of COVID-19, the federal government recently passed guidelines making at-home testing more accessible. WPS Health Insurance and WPS Health Plan will cover the costs of home testing kits in accordance with the new requirements.

If you have health coverage through WPS, you can buy at-home tests—online or at a store—and be reimbursed according to the regulation. Everyone enrolled in group (fully insured and self-insured), individual, short-term, or family health plans is eligible for this program beginning Jan. 15, 2022. For people who have Medicare Part B, Medicare will cover up to eight (8) COVID-19 over-the-counter (OTC) tests each calendar month. The Department of Health and Human Services also has free community testing programs.

This coverage will apply until the end of the public health emergency.

  • You will be able to purchase up to eight tests per rolling 30 days for each person with coverage
  • There is no limit on the number of tests, including at-home tests, that are covered when the tests are ordered or administered by a health care provider following an individualized clinical assessment. That includes people who need testing due to underlying medical conditions.

Starting on January 28, 2022, for everyone enrolled in group (fully insured and self-insured), individual, short-term, or family health plans, tests are available through ExpressScripts at participating network pharmacies. You can use this reimbursement form or purchase the tests through the in-network pharmacy with your insurance card.

Starting on Jan. 19, 2022, the website COVIDTests.gov will provide tests at no cost, including no shipping fee.

  • COVID-19 testing is covered at 0% cost sharing if physician-ordered through October 13, 2022 or through the federal health emergency, whichever is later.
    • Telehealth related to COVID-19 testing: Services have 0% cost sharing through July 15, 2022 or through the federal health emergency, whichever is later.
    • COVID-19 antibody testing: Physician-ordered in vitro antibody testing for COVID-19 is now covered at $0 cost sharing through July 15, 2022 or through the federal health emergency, whichever is later.

If I need to see a doctor for COVID-19, is that covered?

WPS will waive prior authorization requirements, and cover with no out-of-pocket costs to the customer, COVID-19 diagnostic laboratory testing and health care costs associated with provider visits for testing (e.g., office visits, urgent care visits, hospital visits, emergency room visits, etc.) for all fully insured policyholders and for self-funded plan policyholders where the group has instructed us to provide this coverage. This coverage applies for both in-network and out-of-network providers. This enhanced benefit will apply through October 13, 2022 or through the federal health emergency, whichever is later.

Can telehealth services be used to get care for COVID-19?

In most cases, telehealth services are available to WPS customers and their dependents to answer questions about the virus, evaluate their risk, and provide support by phone or video call if they develop symptoms. While self-funded groups with our Freedom Essentials plan will be able to opt out of this coverage, all other self-funded group health plans must opt in to this coverage change. Self-funded groups should get in touch with us right away to ensure they have the telehealth benefit they want for their employees.

This benefit enhancement will go through the federal public health emergency or July 15, 2022, whichever is later.

  • For WPS Medicare supplement insurance customers: Due to recent guidance from the Centers for Medicare & Medicaid Services, Medicare and our Medicare supplement insurance plans will cover telehealth benefits through a medical provider (not Teladoc at this time) for as long as it is covered by Medicare.

Will cost-sharing apply to Teladoc visits for services not related to COVID-19?

For telehealth services not related to COVID-19 testing, Teladoc® is our preferred provider. For customers with health plans that are not HSA-qualified High-Deductible Health Plans (HDHP), WPS will waive copays for telehealth services for any condition provided by Teladoc providers. If a customer has an HSA-qualified HDHP, deductibles and coinsurance will still apply. While self-funded groups with our WPS Freedom Essentials plan will be able to opt out of this coverage, all other self-funded group health plans must opt in to this coverage change. Self-funded groups should get in touch with us right away to ensure they have the telehealth benefit they want for their employees. This benefit enhancement will go through Dec. 31, 2021.

Starting Jan. 1, 2022, the Teladoc copay for short-term plans is $55. Fees billed by our approved telehealth provider are subject to change.

If I may be quarantined, can I get a larger supply of my prescription medications?

There is no change in the way prescription drug coverage is administered. However, we encourage the use of home delivery for medications when available to help maintain social distancing. Early refills are also available. WPS will allow early refills for both 30-day supplies and 90-day supplies of retail and home delivery prescriptions. Note that not all medications are approved for extended supplies and the amount of the refill will vary depending on the number of refills remaining on the prescription.

What is covered if I’m quarantined?

Your WPS health plan covers all medically necessary services based on the terms of your policy. There is no coverage for housing, food, and other items.

What if I need to be hospitalized for COVID-19?

Hospitalizations are covered under the terms of your health plan.

Who at WPS can I call with questions about COVID-19 and my WPS insurance plan?

You can call our Customer Support team using the number on your customer ID card.

Will there be coverage for the COVID-19 vaccine?

Vaccines are an essential and highly effective way to prevent infectious disease in large populations. WPS will cover immunizations as directed.

Are medical supplies such as masks, gloves, and disinfectants covered?

Most of these supplies are not currently covered by insurance plans in general.

New benefits added to WPS health plans

WPS coverage has been boosted with new benefits! Check out the list below and refer your clients to our Customer Service if they have questions. They can call the phone number on their WPS ID card.

Note: Self-funded group health plans have the option to select these benefits. Group members should check with their group leader to see if these benefits are covered. Group leaders who have questions can contact their WPS account manager.

  • Coverage for furloughed employees: The work exception for employees covered under group health plans ended Dec. 31, 2020.
  • Prior authorization: Laboratory testing for COVID-19 or COVID-19 antibodies do not require prior authorization. Prior authorization for treatment of COVID-19 is waived through July 15, 2022, or through the federal health emergency, whichever is later.

Is the COVID-19 test covered under a customer's health plan?

WPS will waive any cost-sharing for federally approved in vitro diagnostic tests which are used for the detection or diagnosis of the virus that causes COVID-19, including antibody testing. For some employers, WPS is only the claims administrator for their self-funded health plan, not the insurer. In these situations, it is the decision of the employer to determine how this will be covered. Self-funded clients will be able to opt in to coverage changes and will be contacted by the WPS Account Management team. This benefit enhancement ends the later of the end of the federal public health emergency or July 15, 2022, whichever is later.

The IRS has indicated that a health plan that otherwise satisfies the requirements to be an HSA qualified High-Deductible Health Plan (HDHP) may provide health benefits associated with the testing of COVID-19 without a deductible, or with a deductible below the minimum deductible (self-only or family) for an HDHP. An individual covered by the HDHP will not be disqualified from being an eligible individual because they received COVID-19 testing. This will apply to in-vitro diagnostic testing and related services on or after Jan. 1, 2020, with respect to plan years beginning on or before Dec. 31, 2021.

WPS customers can buy at-home tests—online or at a store—and be reimbursed according to the regulation. Everyone enrolled in group (fully insured and self-insured), individual, short-term, or family health plans is eligible for this program beginning Jan. 15, 2022. For people who have Medicare Part B, Medicare will cover up to eight (8) COVID-19 over-the-counter (OTC) tests each calendar month. The Department of Health and Human Services also has free community testing programs.

  • WPS customers will be able to purchase up to eight tests per rolling 30 days for each person with coverage
  • There is no limit on the number of tests, including at-home tests, that are covered when the tests are ordered or administered by a health care provider following an individualized clinical assessment. That includes people who need testing due to underlying medical conditions.

Starting on January 28, 2022, for everyone enrolled in group (fully insured and self-insured), individual, short-term, or family health plans, tests are available through ExpressScripts at participating network pharmacies. You can use this reimbursement form or purchase the tests through the in-network pharmacy with your insurance card.

Starting on Jan. 19, 2022, the website COVIDTests.gov will provide tests at no cost, including no shipping fee.

  • COVID-19 testing is covered at 0% cost sharing if physician-ordered through October 13, 2022 or through the federal health emergency, whichever is later.
    • Telehealth related to COVID-19 testing: Services have 0% cost sharing through July 15, 2022 or through the federal health emergency, whichever is later.
    • COVID-19 antibody testing: Physician-ordered in vitro antibody testing for COVID-19 is now covered at $0 cost sharing through July 15, 2022 or through the federal health emergency, whichever is later.

Is a COVID-19 test covered by Medicare or a WPS Medicare supplement insurance plan?

For people who have Medicare Part B, Medicare will cover up to eight (8) COVID-19 over-the-counter (OTC) tests each calendar month.

The Department of Health and Human Services (HHS) is providing up to 50 million free, at-home tests to community health centers and Medicare-certified health clinics for distribution at no cost to patients and community members. You can learn more about this program here.

HHS also has established free community-based pharmacy testing sites around the country. The Biden-Harris Administration is purchasing 500 million at-home, over-the-counter tests to be distributed for free to Americans who want them, with the initial delivery starting in January 2022. There is a website where all Americans can request at-home tests for home delivery—for free.

For people covered by original fee-for-service Medicare, Medicare pays for COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, with no beneficiary cost sharing when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional. People with Medicare can access one lab performed test without cost-sharing per patient per year without an order. The Department of Health and Human Services also has free community testing programs.

If a customer needs to see a doctor for COVID-19, is that covered?

WPS will waive prior authorization requirements, and cover with no out-of-pocket costs to the customer, COVID-19 diagnostic laboratory testing and health care costs associated with provider visits for testing (e.g., office visits, urgent care visits, hospital visits, emergency room visits, etc.) for all fully insured policyholders and for self-funded plan policyholders where the group has instructed us to provide this coverage. This coverage applies for both in-network and out-of-network providers. This enhanced benefit will apply through October 13, 2022 or through the federal health emergency, whichever is later.

What if a Medicare beneficiary needs to be hospitalized for COVID-19?

Medicare covers all medically necessary hospitalizations.

If a customer is concerned about being quarantined, can the customer get a larger supply of prescription medications?

There is no change in the way prescription drug coverage is administered. However, we encourage the use of home delivery for medications when available to help maintain social distancing. Early refills are also available. WPS will allow early refills for both 30-day supplies and 90-day supplies of retail and home delivery prescriptions for both fully insured and self-funded groups. Note that not all medications are approved for extended supplies and the amount of the refill will vary depending on the number of refills remaining on the prescription.

What is covered if a customer is quarantined?

Each WPS health plan covers all medically necessary services based on the terms of the policy. There is no coverage for housing, food, and other items.

What if a customer needs to be hospitalized for COVID-19?

Hospitalizations are covered under the terms of the health plan.

Who at WPS can customers call with questions about COVID-19 and their WPS insurance plan?

WPS individual and group health plan customers can call our Customer Support team using the number on their customer ID card. WPS Medicare supplement insurance customers can call the number on the back of their ID card.

Will there be coverage for the COVID-19 vaccine?

Vaccines are an essential and highly effective way to prevent infectious disease in large populations. WPS will cover immunizations as directed.

Are medical supplies such as masks, gloves, and disinfectants covered?

Most of these supplies are not currently covered by insurance plans in general.

New benefits added to WPS health plans

WPS coverage has been boosted with new benefits! Check out the list below and refer your patients to our Customer Service if they have questions. They can call the phone number on their WPS ID card.

Note: Self-funded group health plans have the option to select these benefits. Group members should check with their group leader to see if these benefits are covered. Group leaders who have questions can contact their WPS account manager.

  • Coverage for furloughed employees: The work exception for employees covered under group health plans ended Dec. 31, 2020.
  • Prior authorization: Laboratory testing for COVID-19 or COVID-19 antibodies do not require prior authorization. Prior authorization for treatment of COVID-19 is waived through July 15, 2022, or through the federal health emergency, whichever is later.
  • COVID-19 testing is covered at 0% cost sharing if physician-ordered through October 13, 2022 or through the federal health emergency, whichever is later.
    • Telehealth related to COVID-19 testing: Services have 0% cost sharing through July 15, 2022 or through the federal health emergency, whichever is later.
    • COVID-19 antibody testing: Physician-ordered in vitro antibody testing for COVID-19 is now covered at $0 cost sharing through July 15, 2022 or through the federal health emergency, whichever is later.

How does COVID-19 impact the filing of a claim or appeal?

Each Provider Agreement contains provisions related to the timely filing of claims and appeals. In order to allow our Provider partners to focus their efforts on responding to the national health crisis and caring for their patients and our customers, WPS will waive the enforcement of certain Provider Obligations:

  • Timely filing limits will not be enforced for claims submitted between July 20, 2020, and Dec. 31, 2020. This applies to both new claims and claims that were resubmitted due to corrections. We reinstated contractual timely filing limits as of January 1, 2021.
  • Timely filing limits for all provider appeals are waived for the remainder of 2020. Please note that Member Grievances are governed by the customer’s certificate of coverage and are not included in this extension. We reinstated contractual timely filing limits as of January 1, 2021.
  • Providers who had already received Prior Authorization for procedures and services that have been canceled or postponed due to the COVID-19 crisis will be granted an additional 90 days to perform the procedure or service without needing to obtain another Prior Authorization.
  • Are there changes to how telehealth services work?

    We have temporarily expanded our coverage of telehealth and telemedicine services to allow providers to render important health care services while protecting both patients and caregiving staff from avoidable exposure to COVID-19. Review our temporary telehealth policy.

    Will waiving the cost sharing for COVID-19 testing on an HSA-qualified High-Deductible Health Plan (HDHP) disqualify the individual from being able to make tax-favored contributions to an HSA account?

    Fully insured groups: No. On March 11, 2020, the IRS released a notice that allows insurers to provide health benefits associated with the testing for COVID-19 (Coronavirus Disease 2019) without first applying the HDHP's applicable deductible. As stated in the notice, this is true until further guidance is issued.

    Self-funded groups: WPS will make this change to self-funded groups upon receipt of written confirmation.

    What if a practitioner needs to work at a different location?

    Many providers have asked for flexibility in moving practitioners between service locations during the crisis. We have temporarily modified our process to allow practitioners to provide care at any location within the same entity (as defined by a single tax ID), even if that practitioner was not previously registered to that address. Please continue to provide roster updates as normal.

    How does WPS handle practitioners with licenses in other states?

    We acknowledge the CMS 1135 waiver for state licensing, which temporarily allows out-of-state practitioners to provide services if they are licensed in another state. In the State of Wisconsin, organizations must follow the provisions outlined in the Wisconsin Department of Health Services Emergency Orders #16 and #20, found at evers.wi.gov/Documents/COVID19/EMO16-DSPSCredentialingHealthCareProviders.pdf and dsps.wi.gov/Documents/EmergencyOrder20.pdf.

Stimulus check scams

The Internal Revenue Service urges taxpayers to be on the lookout for a surge of scam phone calls and email phishing attempts about the coronavirus, or COVID-19. The schemes are related to the economic impact payments being issued by the U.S. government.

Read the news release

COVID-19 test kits

Beware of solicitors who try to sell you a coronavirus disease (COVID-19) test kit.

Do not give out personal information

If you are called by anyone other than your attending physician, please do not provide personal or health-related information. Never give your bank or credit card information to any solicitor over the phone.

   

Will there be coverage for the COVID-19 vaccine?

Vaccines are an essential and highly effective way to prevent infectious disease in large populations. WPS will cover immunizations as directed.


Given the rapidly evolving nature of this disease, the above guidance is subject to change.

Is your doctor in your network?


WI_COVIDLP_2004
JO17320
34974-100-2004