Contract Disclaimers

Blue Cross & Blue Shield of Rhode Island is an HMO plan with a Medicare contract. Enrollment in Blue Cross & Blue Shield of Rhode Island depends on contract renewal.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. [Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance] may change on January 1 of each year.

Blue Cross & Blue Shield of Rhode Island is an independent the licensee of the Blue Cross and Blue Shield Association.

Blue Cross & Blue Shield of Rhode Island will not deny, limit, or condition the coverage or furnishing of benefits to individuals eligible to enroll in a BlueCHiP for Medicare plan offered by BCBSRI on the basis of any factor that is related to health status (with certain End-Stage Renal Disease (ESRD) exceptions regarding enrollment).

Medicare Beneficiaries may also enroll in BlueCHiP for Medicare through CMS' Online Enrollment Center located at http://www.medicare.gov.

H4152_2014website697 Approved