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.
 
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. [Benefits, premium and/or co-payments/co-insurance] may change on January 1 of each year.
 
The [formulary, pharmacy network, and/or provider network] may change at any time. You will receive notice when necessary.
 
Blue Cross & Blue Shield of Rhode Island is an independent 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.

Last updated: 01/01/2018

H4152_2018web5 Approved