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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 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.
Last Updated 04162015 Y0096_WEB_IL_KBF15 Pending