TAILIEUCHUNG - SUPPLEMENT TO ORIGINAL MEDICARE PLAN

No person has the right to receive any benefits of this Plan following termination of coverage, except as specifically provided under the Benefits After Termination or Continuation of Coverage provisions in this Evidence of Coverage booklet. Benefits of this Plan are available only for services and supplies furnished during the term the Plan is in effect, and while the benefits you are claiming are actually covered by this Plan. Reimbursement may be limited during the term of this Plan as specifically provided under the terms in this booklet. Benefits may be modified or eliminated upon subsequent years’ renewals of this. | Supplement to Original Medicare Plan Preferred Provider Organization CalPERS Evidence of Coverage Effective January 01 2007 - December 31 2007 HOW TO REACH US Important For all members outside of the United States contact the operator in the country you are in to assist you in making a toll-free number call. CUSTOMER SERVICE For medical claims status benefit information identification cards booklets or claim forms call or visit on-line Customer Service Department Blue Cross of California 1-877-737-7776 1-818-234-5141 outside the continental . 1-818-234-3547 TDD Web site MEDICAL CLAIMS AND CORRESPONDENCE Please mail your medical claims and correspondence to PERSCare Supplemental Plan Blue Cross of California . Box 60007 Los Angeles CA 90060-0007 PRESCRIPTION DRUG PROGRAM For information regarding the Retail Pharmacy Program or Mail-Order Program call or visit on-line Medco Health Solutions Inc. 1-800-939-7091 1-800-497-4641 outside the continental . Web site ELIGIBILITY AND ENROLLMENT For information concerning eligibility and enrollment contact the Health Benefits Officer at your agency active or the CalPERS Office of Employer and Member Health Services retirees . You also may write Office of Employer and Member Health Services CalPERS . Box 942714 Sacramento CA 94229-2714 Or call 888 CalPERS 225-7377 916 795-3240 TDD MEDCALL Your Plan includes MedCall a 24-hour nurse assessment service to help you make decisions about your medical care. You can reach a specially trained registered nurse who can address your health care questions by calling MedCall at 1-800-700-9185. Registered nurses are available to answer your medical questions 24 hours a day seven days a week. Be prepared to provide your name the patient s name if you re not calling for yourself the subscriber s identification number and the patient s phone number. ADDRESS CHANGE Active Employees To report an address change active employees should complete and .

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