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i <br /> •,w V <br /> In the pursuit of health' <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 PPO Plan with a Medicare contract. . <br /> Y0011 31917 0913R2 EGWP C: 09/2013 5 <br />