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In the pursuit of health <br />Benefits <br />Vaccines (Medicare -covered) <br />HI8� WelfesBenefit; <br />BlueMedicareGroup=PPO* Plan1 <br />In -Network / Out -of -Network <br />• $0 Copayment for influenza vaccine <br />• $0 Copayment for pneumococcal vaccine <br />• $0 Copayment for hepatitis B vaccine <br />Fitness <br />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 />Y0011_31874 0414R4 EGWP C 06/2014 6 <br />