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"Important Anti-Discrimination Information"

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You must continue to pay your Medicare Part B premium. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Limitations, copayments, and restrictions may apply.

Medicare Supplement Insurance Plan Notice:

Not connected with or endorsed by the U.S. Government or Federal Medicare Program. Medicare Supplement insurance plans are offered by Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.

Important Plan Information:

This information is available for free in other languages. Please call our Customer Service number at 1-888-285-2249 (TTY/TDD users should call 711). We are open between 8 a.m. and 8 p.m., local time, 7 days a week. If you are calling from February 15 through September 30, alternate technologies (for example, voicemail) will be used on the weekends and holidays.

En Español:

Esta información está disponible en otros idiomas de forma gratuita. Comuníquese a nuestro número de Servicio al cliente al 1-877-774-8592 (los usuarios de TTY/TDD deben llamar al 711). Nuestro horario es de 8:00 a.m. a 8:00 p.m., hora local, los 7 días de la semana. Si usted llama del 15 de febrero al 30 de septiembre, durante los fines de semana y feriados, se usarán tecnologías alternas (por ejemplo, correo de voz).

Medicare Part D Plan Notice:

Prescription drug plan provided by Blue Cross and Blue Shield of Illinois, which refers to HCSC Insurance Services Company (HISC), an Independent Licensee of the Blue Cross and Blue Shield Association. A Medicare-approved Part D sponsor. Enrollment in HISC's plan depends on contract renewal.

Medicare Advantage Plan Notice:

HMO, HMO-POS and PPO plans available in Cook, DuPage, Kane and Will counties. HMO, HMO-POS and PPO plans are provided by Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. HCSC is a Medicare Advantage organization with a Medicare contract. Enrollment in HCSC's plans depends on contract renewal.

Out-of-network/non-contracted providers are under no obligation to treat Blue Cross Medicare Advantage (PPO)® members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

ILSSI2017

Last updated 6.1.17 "Y0096_WEB_IL_SSI17a Accepted 111716"

WCU2-2016-BCBS

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1-855-740-2227

TTY/TDD 711

This information is available for free in other languages. Please call our Customer Service number at 1-877-213-1821 (TTY/TDD users should call 711). We are open between 8 a.m. and 8 p.m., local time, 7 days a week. If you are calling from February 15 through September 30, alternate technologies (for example, voicemail) will be used on the weekends and holidays.

En Espanol

Esta información está disponible en otros idiomas de forma gratuita.Comuníquese a nuestro número de Servicio al cliente al 1-877-213-1821 (los usuarios de TTY/TDD deben llamar al 711). Nuestro horario es de 8 a.m. a 8 p.m., hora local, los 7 días de la semana. Si usted llama del 15 de febrero al 30 de septiembre, durante los fines de semana y feriados, se usarán tecnologías alternas (por ejemplo, correo de voz).

Blue Cross MedicareRx P.O. Box 3897 Scranton, PA 18505

Blue Cross Medicare Advantage P.O. Box 4555 Scranton, PA 18505

Blue Medicare Supplement 1000 E. Warrenville Road Naperville, IL 60563

To verify your recent enrollment, check the status of a claim or ask questions about your existing coverage, please contact Customer Service at:

Prescription Drug Plans: 1-888-285-2249 TTY/TDD: 711

Medicare Advantage Plans: 1-877-774-8592 TTY/TDD: 711

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