MEDICARE PLANS

Anthem Blue Cross PPO Medicare Plan Without Prescription Drugs*

This plan is offered to those who have Medicare-coordinated health insurance that covers prescription drugs through a non-UC plan (another employer or former employer).  You may enroll in this plan if:

• All covered members are enrolled in Medicare, and
• Documentation of enrollment in group health insurance plan is provided. (Coverage cannot be a Medicare Advantage or Medicare Advantage Prescription Drug plan.)

For enrollment information, contact the UC Customer Service Center (1-800-888-8267) or your local Health Care Facilitator.

Notice regarding Walgreens and prescription benefit

Plan Rates for 2012:

• Self: $0.00; Part B Reimbursement: $96.40
• Self + Adult: $0.00 ; Part B Reimbursement: $192.80
• Self + Family: $0.00; Part B Reimbursement: $289.20

Anthem Blue Cross is the trade name of Blue Cross of California . Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is registered trademark of Anthem Insurance Companies, Inc. The Blue Cross names and symbols are registered marks of the Blue Cross Association.