PPO II - EmblemHealth

2013 Evidence of Coverage for PPO II) II
January 1 – December 31, 2013
Evidence of Coverage:
Your Medicare Health Benefi ts and Services and Prescription Drug Coverage as a
Member of PPO II (PPO)
Th is booklet gives you the details about your Medicare health care and prescription drug coverage
from January 1 – December 31, 2013. It explains how to get coverage for the health care services and
prescription drugs you need. Th is is an important legal document. Please keep it in a safe place.
Th is plan, PPO II, is off ered by Group Health Insurance (GHI)/EmblemHealth. (When this Evidence
of Coverage says “we,” “us,” or “our,” it means GHI/EmblemHealth. When it says “plan” or “our plan,” it
means PPO II.)
Group Health Incorporated (GHI) is a Medicare Advantage organization and a prescription drug plan
with a Medicare contract. GHI is an EmblemHealth company.
Th is information is available for free in other languages. Please contact our Customer Service number
at 1-866-557-7300 for additional information. (TTY users should call 1-866-248-0640). Hours are
Monday - Sunday 8:00 am to 8:00 pm. Customer Service also has free language interpreter services
available for non-English speakers.
Esta información está disponible gratis en otros idiomas. Por favor comuníquese con nuestro número de
Servicio al cliente llamando al 1-866-557-7300 para información adicional. (Los usuarios de TTY deben
llamar al 1-866-248-0640). Las horas son de lunes a domingo, entre 8:00 am y 8:00 pm. Servicio al
cliente también ofrece servicios de intérpretes de idiomas gratis para los que no hablan inglés.
Th is information is also available in alternate formats such as large print and Braille. Please call
Customer Service at the above numbers for more information.
Benefi ts, formulary, pharmacy network, premium, deductible, and/or copayments/coinsurance may
change on January 1, 2014.
H5528_123133 Accepted
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