| Administrator: | Highmark BlueCross BlueShield |
| Group Number: | PPO Plan - 16175, Medicare Supplement Plan - 16198 |
| Pre-enrollment: | (Not active until enrolled) |
| Member Services: Customer Service Hours: Nurseline, Condition Assistance Programs, Complex Case Management (SHPS): |
888.778.8334 7:00 am - 7:00 p.m. Central Time (866) 988.WELL (9355) |
| Medical Plan: | PPO Plan and Post 65 Medicare Supplemental Plan |
| Pre-enrollment Provider Search: | 800.810.BLUE |
| Member Website: | http://www.highmarkbcbs.com Use this Web site to:
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| Summary Plan Description: | View the Retiree Medical Summary Plan Description |
| Claim Forms: | In-Network: No Form Required Out-of-Network: Medical Claim Form |