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In the pi.irsLdt of health' ! <br /> - • <br /> Vaccines (Medicare-covered) In-Network/Out-of-Network <br /> • $0 Copayment for influenza vaccine <br /> • $0 Copayment for pneumococcal vaccine <br /> y 'jam/V,'ci�� • $0 Copayment for hepatitis B vaccine <br /> < 1 � �!"���� {tJ2'f� t= a`- jT"��� a 7' 4 —�a .Nuffill, <br /> tHea &�Wel)ny enefit`� r w5�r . ' '. � MW �' �Tf sY:.. <br /> Fitness Free membership through SilverSneakers <br /> BlueMedicare Group PPO out-of-pocket maximum includes all covered health services member <br /> cost share rendered in/out of network on a calendar year basis. Supplemental services and Part <br /> D costs are not applied to out-of-pocket maximum. <br /> Medicare Part B -the premium provided under this plan excludes the Medicare Part B premium <br /> payments. (Members must continue to pay the Medicare Part B premium unless paid by <br /> Medicaid or another third party.) <br /> Florida Blue is a Medicare Advantage organization With a Medicare contract. Enrollment in <br /> Florida Blue depends on contract renewal. <br /> e <br /> Y0011_31874 0414134 EGWP C: 06/2014 6 <br /> 108 <br />