Healthy Blue Living SM HMO. Meeting your Healthy Blue Living weight-management requirement

Similar documents
Fitbit Walking Challenge Participant Guide

Fitbit Walking Challenge Team Leader Guide

始まりのブザーが鳴るまで問題冊子 解答用紙に手を触れずに

平成 29 年度金沢学院大学入学試験問題 3 月 17 日 ( 金 ) Ⅰ 注意事項解答用紙に 英語 と記入 マークしてから解答してください 問題は1ページから8ページまであります 問題は持ち帰ってもよいですが コピーして配布 使用するのは法律で禁じられています

常葉大学短期大学部一般入学試験前期日程 1. 試験開始の合図があるまで 問題用紙 解答用紙の中を見てはいけません

GET REWARDED. by connecting your fitness device to Go365 COMPATIBLE FITNESS DEVICES GCHJHTFEN 1217

スマイルフォトブック : S サイズ 24 ページの見本です この見本は データ量を抑えるために低画質にて保存しています 入稿の際は画質を圧縮無しの高画質で保存してください

A. 次の問い ( 問 1~ 問 3) において, 下線部の発音がほかの三つの場合と異なるものを, それ B. 次の問い ( 問 4, 問 5) において, 第一アクセント ( 強勢 ) の位置がほかの三つの場合と異な ぞれ 1~4 の中から一つずつ選びなさい

( 工 経営情報 国際関係 人文 応用生物 生命健康科 現代教育学部 )

National Diet Library 2011

GET REWARDED. by connecting your fitness device to Go365 COMPATIBLE FITNESS DEVICES GCHJHTFEN 0318

Commercial Metal 5-Tier Plans

リオ オリンピック参加資格取得 ( ロード男子 ) < 個人ロード > ワールド国別ランキング国別あたり選手数計 1-5 位 5 名 25 名 6-15 位 4 名 40 名

The Map of the Listed Areas of War Risk Navigation Limitations

The 2017 Pfizer Spring Challenge

Minutes SAN GABRIEL VALLEY SERVICE COUNCIL Regular Meeting

Japan Fest Year 2016 Board Members

Development of Sirocco Fan Featuring Dragonfly Wing Characteristics

国際スポーツクライミング協会 INTERNATIONAL FEDERATION OF SPORT CLIMBING IFSC

The Complete 100 Day Dash Guide Updated May 7, 2013

Minutes SAN FERNANDO VALLEY SERVICE COUNCIL Regular Meeting

平成 30 年度一般入学試験 B 日程学科試験問題 ( コミュニケーション英語 Ⅰ Ⅱ)

Ensuring the Safety and Health of Technical Intern Trainees Involved in Cultivation Agriculture

Certificate of Accreditation

Notice of Negative Formulary Changes (List of Covered Drugs)

A Decision Making Method using Wants Chain Analysis for Business-model Design

Walkadoo TM Frequently Asked Questions

Ruby for one day game programming camp for beginners

川のながれ River Flows. Outline

PIR Sensor partial withdrawal(japan produced item)

v.s. (GW) USD ( 07)/Wp 0.6 USD/Wp 1.8 MW

Shohei Juku Aikido Canada

NATIONAL STEPS CHALLENGE TM SEASON 4 STEP UP TO TAKE OFF WITH SINGAPORE AIRLINES GROUP CHALLENGE FREQUENTLY ASKED QUESTIONS

コミュニケーション英語 Ⅲ 英語表現 Ⅰ 英語表現 Ⅱ) 試験時間 120 分 文学部, 教育学部, 法学部, 理学部, 医学部, 工学部 3. 試験開始後, この冊子又は解答紙に落丁 乱丁及び印刷の不鮮明な箇所などがあれば, 手を挙げて監督者に知らせなさい

2015 EMPLOYEE HEALTH & WELLNESS PROGRAM

The Potential Effects of the Tokyo 2020 Olympic and Paralympic Games on Physical Activity Participation at the Population Level

Shohei Juku Aikido Canada

Survey on Professional Baseball

Walkadoo Frequently Asked Questions

Contemporary Attitudes Towards the Senpai-Kōhai Relationship

Rapid Estimation of Water Content of Sour Natural Gases

ITF SCORER ONLINE TRAINING SETUP

HOW TO RESET CLOCK ON FITBIT DOCUMENT

Preliminary report on west-to-south movement rate of juvenile southern bluefin tuna determined by acoustic tagging in Western Australia

SUUNTO CORE USER GUIDE

CHALLENGE CLUB 2Gr.Time Attack 2 回目 Sector Time Chart

自動運転に関するいくつかの論点 ー SAE J3016(2016 年版 ) を中心にー 筑波大学副学長 理事 稲垣敏之.

Distributions of Road Spaces in Tokyo Ward Area While Focusing on Pedestrian Spaces

GolfLogix: Golf GPS. User Guide for: iphone 3G & 3GS. Version 1.0. Software Release 1.0

2011 年東北地方太平洋沖地震の強震動生成のための震源モデル (2011 年 8 月 17 日修正版 )

2019 LPGA PRO TEST APPLICATION FACT SHEET

TRAINING PROJECT IN JAPAN FOR CAMBODIAN YOUTH CLIMBERS

HOW TO USE THE URBI APP. A brief guide to using the urbi app

Water Vapor Delivery for Thin Film Vacuum Processes Said Boumsellek Implant Sciences Corp., San Diego, California, USA

Information for Runners

Challenge! Open Governance 2017 Application Form for Citizens & Students

The report for 2012 MOBILE SUB CENTER (Training Camp) at BANGKOK THAILAND And Thailand National Championships (Track round 5)

ANIMANIA FESTIVAL WORLD COSPLAY SUMMIT AUSTRALIAN TEAM PRE-SELECTION 2008 PORTFOLIO Please submit your portfolio to:

この英語の試験は 文法 / 語彙 / 長文読解と聞き取りの 2 つの部分からなり 時間は全部で 100 分です ( 説明を含む ) 試験開始から 70 分で文法 / 語彙 / 長文読解 そして残りの約 30 分で聞き取りテストを行います 受験番号氏名

Conflict Minerals Reporting Template (CMRT)

人の認知 判断の特性と限界を考慮した 自動走行システムと法制度の設計

BiiSafe Buddy User Guide

HEMT. Outlook for GaN HEMT Technology 常信和清 吉川俊英 増田哲 渡部慶二. あらまし GaN HEMT High Electron Mobility Transistor GaN HEMT. Abstract

QUICK GUIDE HOW TO USE THE AMWELL APP

Japan-America Society of Minnesota. The Tsūshin is a membership publication of the Japan America Society of Minnesota. June 2012 VOL. 21, No.

Japan America Society of Minnesota

Q. Will I be able to change to Combo plan if I am still within contract?

LifeBeat should be worn during daytime as well as night time as it can record activity levels as well as sleep patterns.

Global Leadership Training Programme in Africa 2016

Baseball-science meets practice

With these exceptional golfing privileges, there is no better golfing partner than your Visa Premium card

BURAsl Ultegra Fulcrum Racing 5 LG. NAZARÉsl Ultegra 8000

2019 Formulary Annual Notice of Change

1 前提となる背景的事実や出来事について答えることが難しい 2 前提となる背景的事実や出来事について答えることができる 2 前提 発問 3 中心の命題 ( イイタイコト ) について答えることができる 3 命題 発問 4 背後の理由や詳細情報などの展開について答えることができる 4 展開 発問

Awa Odori Lingo! Japanese Lesson

Development of Electric Fan Propeller Featuring Chestnut Tiger Butterfly Wing Characteristics

Efficient harvest and management of mangrove crab Scylla paramamosain in Gau Island, Fiji

Shohei Juku Aikido Canada

Ishibashi Soundscape

Report on Post Tsunami Survey along the Myanmar Coast for the December 2004 Sumatra-Andaman Earthquake

Japan America Society of Minnesota

FAQs. General. There are many ways to get information about us:

We are delighted that the 9th JSKA World Championships will be held in St. Petersburg, Russia.

REPORT. By Continental Cycling Center Shuzenji

Golfshot: Golf GPS. ios VERSION 3.1+

আল-ফ রক ন AlFurqan 1. পরম কলয ণময স সন স সন র ব ন দ র প রস ফয ল র গ রনৎ অব ণ কমরম ন, ম স সবশ বজগম র জমনয ক র হয,

আল ম ম ন ন AlMominoon

Technology. Using Bluetooth

HOW DO I REGISTER FOR SKATE SASKATOON PROGRAMS?

PADI ReActivate FAQs

NE2R757GT-P6 Pb-free Reflow Soldering Application RoHS Compliant

APPENDIX. 8. Voting window is from December 25, 2016 (11:00:00 AM ET) January 16, 2017 (11:59:59 PM

Golfshot Plus. ios VERSION 5.1+

Resource Sharing in the Japanese Libraries. Dr. Nobuhiko Kikuchi Kansai-kan of the National Diet Library

F A C U L T Y JOURNAL OF INTERDISCIPLINARY RESEARCH IN HUMAN AND SOCIAL SCIENCES UNIVERSITY OF TSUKUBA (JAPAN)

GolfLogix: Golf GPS. User Guide for: BlackBerry Curve. Version 1.0. Software Release , 8330, 8350i, 8800, 8820, 8830, 8900

Using the Internet to Improve Physical Activity

PDF - HOW TO CHANGE FITBIT BANDS

Japan America Society of Minnesota

Ribbon cut on new Tahlequah CNG station

Transcription:

C o n fi d e n c e c o m e s w i t h e v e r y c a r d. Healthy Blue Living SM HMO If your body mass index is 30 or more, you have two options: Weight Watchers Page 1 Steps walking program, powered by WebMD Page 4 Meeting your Healthy Blue Living weight-management requirement

Two options to reach a healthy weight You re receiving this booklet because your Blue Care Network Qualification Form shows that your body mass index is 30 or more. To earn the enhanced level with lower out-of-pocket costs, sign up for Weight Watchers or the Steps walking program, powered by WebMD, within the first 120 days of your plan year. We ll cover the cost of one program for as long as you participate, although some restrictions apply. From the date you enroll, you ll need to participate until we receive an updated qualification form showing your BMI is below 30. Make sure you don t stop participating at any time because you may drop to the standard level; this includes next plan year, too, as long as you re still a Healthy Blue Living member. If you choose not to participate or you don t meet the program requirements, everyone on your contract will be placed at the standard level for the rest of your plan year. You ll have the same great Healthy Blue Living plan, but with higher out-of-pocket costs. Being on time can save you money Many members drop to the standard level because they don t complete requirements on time. Confirm you re enrolled by: Logging in to your account at bcbsm.com. Click My Coverage, then To-do List. Or calling the Customer Service number on the back of your Blue Care Network member ID card. Blue Care Network is committed to helping you achieve your best health status. Rewards for participating in our wellness program, Healthy Blue Living, are available to all contract holders who meet all qualification requirements. If you think you might be unable to meet a standard or requirement for a reward under this wellness program, you might qualify for an opportunity to earn the same reward by different means. You can work with your BCN primary care physician to find an alternative that s right for you in light of your health status. Consult with your Blue Care Network primary care physician before starting any regular exercise or weight-management program. WebMD Health Services is an independent company supporting Blue Care Network by providing health and wellness services. Weight Watchers is an independent company that provides weight-management services to Blue Care Network members.

Option 1: Weight Watchers For more than 40 years, Weight Watchers has helped millions of people around the world lose weight. Blue Care Network offers this program to BCN contract holders who have a body mass index of 30 or more to help them become healthier and work toward earning the enhanced level. To be at the enhanced level, what do I need to do to meet the Weight Watchers requirement? Attend 11 of 13 weekly meetings per session. Participate until we have an updated qualification form from your doctor showing your BMI dropped below 30. Do I need to re-enroll if I want to participate in Weight Watchers again? No. If your qualification form still shows you have a BMI of 30 or more, you can continue in Weight Watchers without re-selecting it; we ll automatically re-enroll you. This only applies if you participated in Weight Watchers for the whole benefit year and met the requirements. We ll start the re-enrollment process as soon as we receive your new qualification form. Blue Care Network won t reimburse you if you attend before you re re-enrolled. How do I enroll in Weight Watchers? There are two Weight Watchers groups. The home or work ZIP code you provide determines which one you ll join. Enrollment options vary slightly based on the Weight Watchers group, but both offer telephone registration. To sign up online: 1. Log in to your account at bcbsm.com. 2. Click on the My Coverage tab. 3. Click on To-do List. 4. Click the weight management program link in the Health Measure Follow-up box. 5. Select the button for Weight Watchers. 6. Enter your preferred ZIP code. 7. Click Submit. 8. Your Healthy Blue Living code will appear on the screen, and you ll have the option to register by calling a toll-free number or by visiting a website. For your records, write down your code. Make sure you attend a meeting within one week of signing up. You ll receive confirmation within a few business days by email or through vouchers, depending on which Weight Watchers plan you re with, which is based on the ZIP code you provide. If your Weight Watchers plan provides vouchers, which are documents to validate your sessions are prepaid by Blue Care Network, expect to receive them by U.S. mail in seven to 10 business days. Bring them to your first meeting. If the vouchers don t arrive in the mail by the time you attend your first meeting, the meeting leader will still allow you to participate as long as they re on order. 1

Option 1: Weight Watchers (continued) To sign up by phone: If you don t have internet access, Customer Service will help you get the information you need to enroll. Call the Customer Service number on the back of your Blue Care Network member ID card. A representative will register you. You ll receive confirmation by mail in three to five business days. If your Weight Watchers group uses vouchers, you ll receive them by mail in seven to 10 business days. Make sure you attend a meeting within one week of signing up. How is attendance tracked? You re responsible for taking your Weight Watchers member booklet with you to each meeting and making sure the Weight Watchers staff accurately records your attendance. Weight Watchers sends your attendance report to Blue Care Network. How do I re-enroll upon completing my first 13-week session? There are two ways to re-enroll in your next session as long as you ve attended 11 out of 13 weekly meetings per session: Method 1 Weight Watchers staff will validate your participation and help you re-enroll. Weight Watchers will direct you to your account at bcbsm.com for your HBL code. If you don t have internet access, call the Customer Service number on the back of your BCN member ID card to obtain your HBL code. Call Weight Watchers toll-free and provide your HBL code to enroll in the next 13-week session. If your Weight Watchers plan provides vouchers, expect to receive them by mail in seven to 10 business days. Method 2 Your Weight Watchers staff will confirm if you re eligible for re-enrollment and will automatically enroll you or ask if you d like to enroll in the next 13-week session. What happens if I don t attend 11 out of 13 meetings? If you re unable to meet the attendance requirement for the Weight Watchers program, you and everyone else on your contract will drop to the standard level. You ll have the same great Healthy Blue Living plan, but with higher out-of-pocket costs. Before your sign-up deadline, check that your account at bcbsm.com shows you ve enrolled in Weight Watchers. Or check by calling the Customer Service number on the back of your BCN member ID card. 2

You ll have the option of continuing Weight Watchers by paying the membership fee at the discount rate. This is available by logging in to your account at bcbsm.com and then clicking Member Discounts with Blue365 on the right side of the page. At the start of your next plan year, if your updated qualification form shows your body mass index is still 30 or more, you ll be able to enroll in one of our weight-management program options. How do I find the Weight Watchers location closest to me? During your registration process, by phone or online, Weight Watchers will help you locate the meeting group closest to your home or work using the ZIP code you provide. Choose the location that works best for your schedule. What if I m traveling and can t attend my weekly meeting? There are Weight Watchers locations all across the country. To find a meeting place on a different day or near your travel destination, go to weightwatchers.com*, check with your meeting staff or call Weight Watchers. What if I m already enrolled in Weight Watchers? Continue attending your regular meetings. We ll pick up the tab starting on the date you officially sign up for Weight Watchers through your account at bcbsm.com or our Customer Service department. We won t reimburse you for sessions attended before joining our program. What if I need to pick a different meeting location? Call Weight Watchers or visit weightwatchers.com*. Do I have an alternative to Weight Watchers? Yes. The Steps walking program, powered by WebMD, is available if you have internet access and can commit to walking an average of 5,000 daily steps for each three-month period. See Option 2 in this guide. Can I attend Weight Watchers online? No, Weight Watchers online isn t available for Healthy Blue Living members. Weight Watchers International syncs up with top activity monitors Weight Watchers International is giving its members more resources to reach their health goals. Its app syncs with Fitbit, Jawbone and other devices that track activity. Note: All Weight Watchers groups in Michigan aren t part of Weight Watchers International. Check your group s affiliation. *Blue Care Network does not control this website or endorse its general content. 3

Option 2: Steps walking program, powered by WebMD The Steps walking program is an easy and convenient way for you to track the number of steps you take each day. It features a Fitbit Zip Wireless Activity Tracker. Blue Care Network covers the cost of the Zip device as long as you sign up for the program and order the device through your account at bcbsm.com or Customer Service. Several other Fitbit devices are available to purchase at a discounted price. The Steps program is only compatible with Fitbit devices. Other tracking devices will not work with this program. Sync the activity tracker with your smartphone, tablet or personal computer to track your steps. To be at the enhanced level, what do I need to do to meet the Steps walking program requirement? Achieve an average of 5,000 steps per day for each three-month period from when you start the program. Wear the Fitbit activity tracker. Sync your steps data wirelessly with the Fitbit app and in the Blue Cross Health & Wellness site, powered by WebMD. To get to the site, log in to your account at bcbsm.com and then click on the Health & Wellness tab at the top of the page. Participate until we have an updated qualification form from your doctor showing your body mass index is below 30. You can track your activity anytime by logging in as a member at bcbsm.com and clicking the Health & Wellness tab. Do I need to re-enroll if I want to participate in the Steps program again? No. If your updated qualification form shows you have a BMI of 30 or more, you can continue in the Steps program without re-selecting it; we ll automatically re-enroll you. This only applies if you participated in the Steps program for the whole benefit year and met the requirements. We ll start the re-enrollment process as soon as we receive your updated qualification form. You won t receive a new Fitbit device. You ll need to use the same device as your previous plan year. However, if your Fitbit device is lost or damaged, call the Customer Service number on the back of your BCN member ID card to see if you re eligible for a replacement device. Will all pedometers or activity trackers work with the Steps walking program? No. You must use a Fitbit device for the Steps walking program. See the bottom of this page and the top of Page 5 to learn how to order your Fitbit activity tracker. How do I get started with the Steps walking program? 1. Log in to your account at bcbsm.com. 2. Click on the My Coverage tab. 3. Click on To-do List. 4. Click the weight management program link in the Health Measure Follow-up box. 4

5. Select the Steps walking program. This will take you to the Blue Cross Health & Wellness site. 6. Click the Rewards tab at the top of the page. 7. Click Order Now in the Don t miss a Step! box. Your promo code will be provided under the Order Now button. Write it down and save it. 8. You ll be redirected to the Fitbit online store. Follow the instructions to select your Fitbit device and complete the order. 9. Once you complete your Fitbit order, you ll receive an order confirmation by email. Keep this information for your records. Once your device has shipped, you ll receive another email with your tracking number. You ll receive your Fitbit activity tracker by mail in five to seven business days. Instructions in the box will help you set it up on your mobile app or computer. Why do I need to sync my Fitbit device with the Blue Cross Health & Wellness site? And how do I sync it? Once you create a Fitbit account by following the instructions that came with the device, you must sync your Fitbit device with the Blue Cross Health & Wellness site. This is how we ll be able to track your steps and see if you re meeting the steps requirement. To sync your Fitbit account with the Blue Cross Health & Wellness site: 1. Set up and create a Fitbit account for your device by following the instructions that came with the device. 2. Once you ve set up and registered your device, log in to your member account at bcbsm.com. 3. Click on the Health & Wellness tab to enter the Blue Cross Health & Wellness site. 4. Click on the Health Record tab. 5. Select Device and App Connection Center. The page will display all the devices and apps that can be synced with the site. 6. Scroll down the page and click Fitbit, then click on Connect Account and follow the instructions to sync your Fitbit. 7. After your accounts are linked, your steps will automatically upload to the Blue Cross Health & Wellness site. 8. To view the health measures you re tracking on the Blue Cross Health & Wellness site, click on the Health Record tab and then select Health Trackers. For help syncing your devices and apps, call the Customer Service number on the back of your Blue Care Network member ID card. 5

Option 2: Steps walking program, powered by WebMD Will my computer, smartphone or tablet work with the Steps walking program? The Fitbit Zip syncs automatically and wirelessly to tablets, computers, and more than 150 ios, Android and Windows smartphones using Bluetooth 4.0 wireless technology. It syncs with: Windows Vista and later Mac OS X 10.6 and up iphone 4S and later ipad 3 generation and later Leading Android and Windows devices How is my participation tracked? We check your number of steps every three months from the day you start the program. If your account shows that you re averaging 5,000 steps every day, you re meeting the weight-management requirement. It s your responsibility to make sure your steps are being properly synced to the Blue Cross Health & Wellness site. To learn how to sync your Fitbit account with the Blue Cross Health & Wellness site, see Page 5. To earn or keep the enhanced level with lower out-of-pocket costs, you must participate until we have an updated qualification form from your doctor showing your body mass index is below 30. How do I upload my steps data? If you re using your smartphone or tablet, open the Fitbit app periodically to allow your steps data to refresh. We recommend every night before you go to bed. If your Fitbit device is within 20 feet of your smartphone or tablet when the app is open, your device s data will automatically sync to your WebMD Steps walking program tracker. If you re using the plugged-in dongle (provided with the Fitbit activity tracker for your computer s USB port), your steps will automatically load when your computer is on and you re within 20 feet of it. As a reminder, you ll need to create a Fitbit account and then sync it with the Blue Cross Health & Wellness site. For directions, see Page 5. Make sure your steps are properly uploading within one week of receiving your Fitbit device. To confirm that your steps are recording, log in to your account at bcbsm.com; click the Health & Wellness tab, then click the Health Record tab and select Health Trackers to view your steps. How long does it take to set up my account and Fitbit activity tracker? Allow 10 minutes to complete the registration process. After you receive your Fitbit activity tracker, allow 15 minutes to set up your device. Your Fitbit kit contains everything you need to register and activate your device. How often should I wear my Fitbit activity tracker? To average 5,000 steps each day, we recommend wearing your activity tracker every day from the time you wake up in the morning until you go to bed at night. 6

(continued) What happens if I don t meet the 5,000 daily steps average during each three-month period? At the end of each three-month period, if your daily average is below 5,000 steps, you and everyone else on your contract will drop to the standard level for the rest of your plan year. You ll have the same great Healthy Blue Living plan, but with higher out-of-pocket costs. At the start of your next plan year, if your updated qualification form shows your BMI is 30 or more, Blue Care Network will cover the cost for you to enroll in one of the two weight-management program options. Who can answer technical questions about my Fitbit activity tracker? Call Fitbit Participant Support at 1-844-534-8248, email CWsupport@fitbit.com or go to help.fitbit.com/cwsupport* for faster issue resolution if you have technical questions about: Your activity tracker not counting steps The screen doesn t engage when tapped Inaccurate step count Activity tracker isn t syncing to the Fitbit software Broken activity tracker What if I m traveling and can t upload my Fitbit activity tracker data? Connecting to the Steps walking program is easy when you use the Fitbit app on your mobile device and a Bluetooth wireless connection. Your steps will automatically load if your activity tracker is within 20 feet of your smartphone, tablet or computer. If you re using a computer, make sure your dongle is plugged in to your computer s USB port. If you re using the app, make sure you open the app periodically to allow your steps to refresh. What if I lose or damage my Fitbit activity tracker? Call the Customer Service number on the back of your BCN member ID card to see if you re eligible for a replacement device. Do I have an alternative to the Steps walking program? Yes. You can participate in Weight Watchers. See Option 1 at the beginning of this guide. *Blue Care Network does not control this website or endorse its general content. 7

ܩܝܝ We speak your language If you, or someone you re helping, needs assistance, you have the right to get help and information in your language at no cost. To talk to an interpreter, call the Customer Service number on the back of your card. Si usted, o alguien a quien usted está ayudando, necesita asistencia, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al número telefónico de Servicio al cliente, que aparece en la parte trasera de su tarjeta. إذا كنت أنت أو شخص آخر تساعده بحاجة لمساعدة فلدیك ا حقل في الحصول ع ىل المساعدة والمع تلوما الضروریة بلغتك دون أیة تكلفة. للتحدث إ ىل مترجم اتصل برقم خدمة العملاء الموجود على ظھر بطاقتك. 如果您, 或是您正在協助的對象, 需要協助, 您有權利免費以您的母語得到幫助和訊息 要洽詢一位翻譯員, 請撥在您的卡背面的客戶服務電話 ܝ ܚܕ ܦܪܨܘܦܐ ܕܗܝܘܪܘܬܘܢ ܣܢ ܝܬܘܢ ܗ ܝ ܪܬܐ ܐ ܢ ܐܚܬܘܢ, ܢ ܐ ܘܡܘܕܥܢܘܬܐ, ܪܬ ܐܚܬܘ ܐܝܬܠܘܟ ܘܢ ܗܩܘܬ ܕܩ ܒܠ ܝܬܘܢ ܗ ܝ ܠܗܡܙܡܬܐ ܥ ܡ ܚܕ ܡܬܪܓܡܢܐ ܩܪܘܢ ܥ ܠ ܐ ܘܢ ܕ ܛܝ ܡܐ. ܢ ܒܠ ܫ ܢܘܟ ܬܠܝܦܘܢ ܡܢ ܝܢܐ ܥ ܠ ܚ ܨܐ ܕܦܬܩܘ ܟ ܘܢ. Nếu quý vị, hay người mà quý vị đang giúp đỡ, cần trợ giúp, quý vị sẽ có quyền được giúp và có thêm thông tin bằng ngôn ngữ của mình miễn phí. Để nói chuyện với một thông dịch viên, xin gọi số Dịch vụ Khách hàng ở mặt sau thẻ c ủa quý vị. Nëse ju, ose dikush që po ndihmoni, ka nevojë për asistencë, keni të drejtë të merrni ndihmë dhe informacion falas në gjuhën tuaj. Për të folur me një përkthyes, telefononi numrin e Shërbimit të Klientit në anën e pasme të kartës tuaj. 만약귀하또는귀하가돕고있는사람이지원이필요하다면, 귀하는도움과정보를귀하의언어로비용부담없이얻을수있는권리가있습니다. 통역사와대화하려면귀하의카드뒷면에있는고객서비스번호로전화하십시오. য দ আপন র, ব আপ ন স হ যয কর ছন এমন ক র, স হ যয য় জন হয়, ত হ ল আপন র ভ ষ য় বন ম লয স হ যয ও তথয প ওয় র অ ধক র আপন র র য় ছ ক ন একজন দ ভ ষ র স থ কথ বল ত, আপন র ক ডর র পছ ন দওয় হক সহ য়ত ন র কল করন Jeśli Ty lub osoba, której pomagasz, potrzebujecie pomocy, masz prawo do uzyskania bezpłatnej informacji i pomocy we własnym języku. Aby porozmawiać z tłumaczem, zadzwoń pod numer działu obsługi klienta, wskazanym na odwrocie Twojej karty. Falls Sie oder jemand, dem Sie helfen, Unterstützung benötigt, haben Sie das Recht, kostenlose Hilfe und Informationen in Ihrer Sprache zu erhalten. Um mit einem Dolmetscher zu sprechen, rufen Sie bitte die Nummer des Kundendienstes auf der Rückseite Ihrer Karte an. Se tu o qualcuno che stai aiutando avete bisogno di assistenza, hai il diritto di ottenere aiuto e informazioni nella tua lingua gratuitamente. Per parlare con un interprete, rivolgiti al Servizio Assistenza al numero indicato sul retro della tua scheda. ご本人様 またはお客様の身の回りの方で支援を必要とされる方でご質問がございましたら ご希望の言語でサポートを受けたり 情報を入手したりすることができます 料金はかかりません 通訳とお話される場合はお持ちのカードの裏面に記載されたカスタマーサービスの電話番号までお電話ください Если вам или лицу, которому вы помогаете, нужна помощь, то вы имеете право на бесплатное получение помощи и информации на вашем языке. Для разговора с переводчиком позвоните по телефону отдела обслуживания клиентов, указанному на обратной стороне вашей карты. Ukoliko Vama ili nekome kome Vi pomažete treba pomoć, imate pravo da besplatno dobijete pomoć i informacije na Vašem jeziku. Da biste razgovarali sa prevodiocem, pozovite broj korisničke službe sa zadnje strane kartice. Kung ikaw, o ang iyong tinutulungan, ay nangangailangan ng tulong, may karapatan ka na makakuha ng tulong at impormasyon sa iyong wika ng walang gastos. Upang makausap ang isang tagasalin, tumawag sa numero ng Customer Service sa likod ng iyong tarheta. Important disclosure Blue Cross Blue Shield of Michigan and Blue Care Network comply with Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. Blue Cross Blue Shield of Michigan and Blue Care Network provide free auxiliary aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and information in other formats. If you need these services, call the Customer Service number on the back of your card. If you believe that Blue Cross Blue Shield of Michigan or Blue Care Network has failed to provide services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance in person, by mail, fax, or email with: Office of Civil Rights Coordinator, 600 E. Lafayette Blvd., MC 1302, Detroit, MI 48226, phone: 888-605-6461, TTY: 711, fax: 866-559-0578, email: CivilRights@bcbsm.com. If you need help filing a grievance, the Office of Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health & Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail, phone, or email at: U.S. Department of Health & Human Services, 200 Independence Ave, S.W., Washington, D.C. 20201, phone: 800-368-1019, TTD: 800-537-7697, email: OCRComplaint@hhs.gov. Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. 8

Find us online: bcbsm.com news.bcbsm.com facebook.com/mibcn ahealthiermichigan.org twitter.com/bcbsm youtube.com/bcbsmnews Blue Care Network is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. CB 16085 OCT 17 R069632