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You must continue to pay your Medicare Part B Premium. This information is not a complete description of benefits. Contact the plan for more information. Benefits, premium and/or co-payments/co-insurance may change on January 1 of each year. Limitations, co-payments, and restrictions may apply. The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary.

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.

This information is available for free in other languages. Please call the plan customer service number at
1-877-213-1821 TTY/TDD 711. They 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 1-877-774-8592 (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).

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.

This information is available for free in other languages. Please call the plan customer service number at
1-877-213-1821 TTY/TDD 711. They 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.

Not connected with or endorsed by the U.S. Government or the Federal Medicare Program.

Y0096_WEB_IL_KBF16 Accepted 01302016 Pending 2016.