blue cross community health plans over-the-counter benefits · 214 stomach relief (pink bismuth)...

14
IL_BCCHP_BEN_OTCBenefits19 Approved 09242019 237727.1219 Blue Cross Community Health Plans SM Department of Healthcare & Family Services Customer Service 1-877-860-2837 TTY/TDD: 711 www.bcchpil.com 1st Quarter 2020 Over-the-Counter Benefits Blue Cross Community Health Plans

Upload: others

Post on 15-Mar-2020

2 views

Category:

Documents


0 download

TRANSCRIPT

IL_BCCHP_BEN_OTCBenefits19 Approved 09242019 237727.1219

Blue Cross Community Health PlansSM

Department of Healthcare & Family Services

Customer Service 1-877-860-2837 TTY/TDD: 711

www.bcchpil.com

1st Quarter 2020

Over-the-Counter Benefits

Blue Cross Community Health Plans

Blue Cross Community Health PlansSM

Thank you for being a Blue Cross Community Health Plans member. As a member of this Plan, you are able to order Plan-approved Over-the-Counter (OTC) products one time every quarter at no cost to you. • Quarter 1: January-March

• Quarter 2: April-June

• Quarter 3: July-September

• Quarter 4: October-December

You will have a fixed dollar amount to use each quarter. To find out how much is available to you, you can call Member Services at 1-877-860-2837 (TTY 711), 24 hours a day, seven (7) days a week, or refer to your Member Handbook.

To order your OTC products:Call Member Services at 1-877-860-2837 (TTY 711), 24 hours a day, seven (7) days a week. Tell the Customer Service Representative (CSR) that you would like to place an OTC order, and let them know which items you would like. Your order will be shipped to the address you provided within 7-10 days.• You will need your Member ID number.

• For multiple orders, please submit separate orders for each member of a household.

• The order total may not exceed the fixed dollar amount set by Blue Cross Community Health Plans.

• Any remaining balance will not roll over to the next quarter. If you do not place an order in a quarter, the benefit for that quarter will be lost.

• OTC products are intended to help with a health or medical need and are for member use only.

• Because of the nature of the items, returns are not accepted.

• Catalog items and prices may change throughout the year.

• Damaged products should be reported within 30 days. Please call Member Services.

• Only one order may be placed each quarter. Multiple orders throughout the quarter will not be allowed.

If you have any questions or concerns about your OTC benefit, please call Member Services at 1-877-860-2837 (TTY 711), 24 hours a day, seven (7) days a week.

1

Blue Cross Community Health Plans Product CatalogANTACIDS, ANTI-DIARRHEALS, AND LAXATIVESPRODUCT NUMBER

PRODUCT DESCRIPTION COMPARE TO SIZE PRICE

253 ANTACID CHEWABLES TUMS 72 CT $ 5.00 45 ANTI-NAUSEA LIQUID FOR

ADULTS & CHILDRENEMETROL 4 OZ $ 5.00

34 BISACODYL ENTERIC COATED LAXATIVE

DULCOLAX 100 CT $ 7.00

216 BISMATROL 262MG CHEWABLE TABLETS

PEPTO BISMO 30 CT $ 5.00

97 CASTOR OIL 4 OZ $ 5.00

81 CLEARLAX UNFLAVORED POWDER POLYETHYLENE GLYCOL 3350 14 DAYS

MIRALAX 8.2 OZ $10.00

32 DOCUSATE SODIUM STOOL SOFTENER 100MG

COLACE 100 CT $ 7.00

52 ENEMA SALINE LAXATIVE FLEET ENEMA TWIN 4.5 OZ $ 3.00

30 FIBER METHYLCELLULOSE CAPLETS

CITRUCEL 100 CT $10.00

18 FIBER POWDER (NON-PSYLLIUM) SUGAR FREE

BENEFIBER POWDER SUGAR FREE

8.6 OZ $10.00

54 GAS RELIEF XS SIMETHICONE 125 MG SOFTGELS

GAS-X EXTRA STRENGTH

20 CT $ 5.00

77 LACTOSE INTOLERANT FAST ACTING CAPLETS

LACTAID FAST ACT 60 CT $10.00

220 LAXATIVE (SENNA 8.6MG) PLUS + STOOL SOFTENER (DOCUSATE 50MG)

PERI-COLACE 100 CT $ 7.00

57 LOPERAMIDE HCL ANTI-DIARRHEAL 2MG

IMODIUM A-D 24 CT $ 5.00

112 MILK OF MAGNESIA PHILLIPS 12 OZ $ 5.00 126 MINERAL OIL USP 16 OZ $ 5.00 79 NATURAL PSYLLIUM FIBER

CAPSULESMETAMUCIL CAPSULES

160 CT $10.00

210 NATURAL PSYLLIUM HUSK POWDER SUGAR FREE

CITRUCEL 10 OZ $11.00

117 OMEPRAZOLE 20 MG DELAYED RELEASE TABLETS

PRILOSEC 42 CT $30.00

95 CITRATE MAGNESIUM REGULAR LEMON

10 OZ $ 3.00

2

214 STOMACH RELIEF (PINK BISMUTH) REG 262MG

PEPTO BISMO 237ML $ 5.00

137 SENNA LAXATIVE 8.6 MG TABLETS

SENOKOT 100 CT $ 6.00

CHILDREN'S CARE69 BABY BATH WASH J&J BABY WASH 15 OZ $ 5.00 70 BABY LOTION J&J BABY LOTION 15 OZ $ 5.00 71 BABY OIL J&J BABY OIL 3 OZ $ 4.00 72 BABY POWDER J&J BABY POWDER

MILD15 OZ $ 4.00

73 BABY SHAMPOO J&J BABY SHAMPOO 15 OZ $ 4.00

148 CHILD ACETAMINOPHEN 160 MG SUSPENSION LIQ (AGE 2-11)

TYLENOL CHILDREN 4 OZ $ 5.00

149 CHILDREN'S ACETAMINOPHEN 80 MG CHEW

TYLENOL CHILDREN JUNIOR

30 CT $ 4.00

254 CHILDREN'S ANIMAL SHAPES FLINTSTONES CHEWABLES

60 CT $ 5.00

166 CHILDREN'S CETIRIZINE 1 MG/1 ML SUSP (2 YEARS OLD+)

ZYRTEC SUSP 4 OZ $ 8.00

38 CHILDREN'S COLD & ALLERGY (PHENY/BROM) SUSP (6 YEARS OLD & OVER)

DIMETAPP COLD & ALLERGY

4 OZ $ 5.00

39 CHILDREN'S COLD & COUGH (DEXTRO/PHENYE/BROM) SUSP (6 YEARS OLD & OVER)

DIMETAPP COLD & COUGH ELIXIR

4 OZ $ 5.00

84 CHILDREN'S IBUPROFEN 100 MG/5ML ORAL SUSP (AGE 2-11)

ADVIL/MOTRIN CHILDREN

4 OZ $ 6.00

87 CHILDREN'S MUCUS RELIEF COUGH GUAIFENESIN 100 MG/DEXTRO 5 MG SUSP (4 YEARS OLD +)

MUCINEX CHILDREN 4 OZ $ 5.00

85 IBUPROFEN 100 MG JR STRENGTH CHEW TABS

ADVIL/MOTRIN CHILDREN

24 CT $ 6.00

150 INFANTS' ACETAMINOPHEN 160MG/5ML (AGE 2-3)

INFANT TYLENOL 160MG/5ML

1 OZ $ 6.00

COUGH, COLD, AND ALLERGY165 CETIRIZINE 10 MG ALLERGY

TABLETSZYRTEC 90 CT $12.00

3

16 CHILDREN'S DIPHENHYDRAMINE 12.5 MG/5ML LIQUID (AGE 6-11 YRS)

BENADRYL ALLERGY 4 OZ $ 5.00

161 DAYTIME COLD & FLU MULTI SYMPTOM SOFTGELS

VICKS DAYQUIL COLD/FLU

16 CT $ 5.00

160 DAYTIME COLD AND FLU MULTI SYMPTOM NON DROWSY SYRUP

VICKS DAYQUIL COLD/FLU

8 OZ $ 6.00

127 DEXTROMETHORPHAN 20 MG/ GUAIFENESIN 200 MG DM COUGH SYRUP, EXPECTORANT

ROBITUSSIN DM 4 OZ $ 5.00

129 DEXTROMETHORPHAN 20 MG/ GUAIFENESIN 400 MG PER 10ML, COUGH SYRUP, EXPECTORANT

ROBITUSSIN DM MAX 4 OZ $ 5.00

131 DEXTROMETHORPHAN/GUAIFENESIN/PHENYLEPHRINE COUGH SYRUP

ROBITUSSIN CF 4 OZ $ 5.00

128 DIABETIC TUSSIN DM DEXTROMETHORPHAN 20 MG/ GUAIFENESIN 200 MG PER 10ML

ROBITUSSIN DM SUGAR FREE

4 OZ $ 5.00

15 DIPHENHYDRAMINE ANTIHISTAMINE 25 MG

BENADRYL ALLERGY ULTRATAB

24 CT $ 5.00

130 GUAIFENESIN 200 MG COUGH SYRUP, EXPECTORANT

ROBITUSSIN MUCUS + CHEST CONGESTION

4 OZ $ 5.00

257 GUAIFENESIN COUGH EXPECTORANT 400 MG TABLET

MUCINEX NON NBE 30 CT $10.00

256 GUAIFENESIN COUGH EXPECTORANT DM 400 MG/20 MG TABLET

MUCINEX DM NON NBE

30 CT $10.00

31 LORATADINE 10 MG TABLET CLARITIN 30 CT $ 6.00 140 NASAL DECONGESTANT PE

10 MG NON DROWSY TABLETS

SUDAFED PE 18 CT $ 5.00

4 NASAL SPRAY ORIGINAL 12-HOUR

AFRIN ORIGINAL 1 OZ $ 5.00

162 NIGHT TIME COLD & FLU MULTI SYMPTOM ORIGINAL SYRUP

VICKS NYQUIL COLD/FLU

8 OZ $ 6.00

163 NIGHT TIME COLD & FLU MULTI SYMPTOM SOFTGELS

VICKS NYQUIL COLD/FLU

16 CT $ 5.00

205 SALINE NASAL SPRAY OCEAN SPRAY 44 ML $ 5.00 4

156 SINUS CONGESTION + PAIN (HEADACHE) DAY/NIGHT COMBO PK COOL CPLT

TYLENOL SINUS CONG & PAIN DAY/NIGHT COMBO

20 CT $ 5.00

164 VAPOR CHEST RUB VICKS 3.53 OZ $ 5.00

DENTAL120 DENTAL FLOSS UNWAXED

UNFLAVORED 100 YDSREACH UNWAXED-UNFLAVORED

1 PK $ 3.00

121 DENTAL FLOSS WAXED 100 YDS

REACH WAXED 1 PK $ 3.00

212 DENTAL FLOSS WAXED MINT 100 YDS

REACH WAXED MINT 1 PK $ 3.00

133 DENTURE BRUSH HANDLE SEA BOND DENTURE BRUSH

1 PK $ 3.00

44 DENTURE CLEANING TABLETS

POLIDENT/EFFERDENT

40 CT $ 5.00

219 DENTURE CREAM EFFERGRIP/FIXODENT/POLYGRIP/POLIDENT

2.4 OZ $ 8.00

173 GUM STIMULATOR HANDLE GUM 1 UNIT $ 4.00 174 GUM STIMULATOR REFILL

3/PACKGUM 1 UNIT $ 3.00

107 KIDS TOOTHBRUSH 2PK $ 3.00 172 KIDS TOOTHPASTE AQUAFRESH KIDS 4.6 OZ $ 5.00 55 MINT FLOSSERS W/ PICK G-U-M 90 CT $ 3.00

258 MINT FLOSSERS W/PICK (SMALL PACK)

GUM 50 CT $ 2.00

132 MOUTHWASH SCOPE 250 ML $ 4.00

33 TOOTHBRUSH COLGATE 2 PK $ 3.00

171 TOOTHPASTE AIM/COLOGATE 5.5 oz $ 5.00 EYE CARE

89 ARTIFICIAL TEARS EYE DROPS

MURINE TEARS 0.5 OZ $ 5.00

263 EYE DROPS REDNESS RELIEVER

VISINE ADVANCED RELIEF

0.5ML $ 5.00

FIRST AID MEDICAL SUPPLIES14 ALCOHOL SWABS 70%

STERILE (PREP PADS)BD ALCOHOL 100 CT $ 3.00

167 BLOOD PRESSURE AUTO W/ARM CUFF (11.75"-16.5")

1 UNIT $30.00

201 BLOOD PRESSURE AUTOMATIC WRIST

1 UNIT $30.00

5

59 BUTTERFLY CLOSURES (1 3/4" X 3/8") BANDAID

J & J BAND-AID BUTTERFLY CLOSURES

10 CT $ 3.00

255 DIGITAL THERMOMETER WITH PROBE COVERS

1 UNIT $ 5.00

17 DIPHENHYDRAMINE CREAM BENADRYL CREAM EXTRA STRENGTH

1 OZ $ 5.00

102 EPSOM SALT 1 LB $ 5.00 68 FLEXIBLE FABRIC BANDAID J & J FLEXIBLE

FABRIC30 CT $ 4.00

113 HEMORRHOIDAL CREAM PREPARATION H 1.8 OZ $ 5.00 114 HEMORRHOIDAL OINTMENT PREPARATION H 2 OZ $ 5.00 226 HEMORRHOIDAL PADS TUCKS PAD 100 CT $ 7.00 115 HEMORRHOIDAL

SUPPOSITORIESPREPARATION H 12 CT $ 5.00

100 HOT/COLD GEL PACK 1 CT $ 5.00

35 HYDROCORTISONE 1% CREAM

CORTAID 1 OZ $ 5.00

101 INSTANT ICE COMPRESS 1 CT $ 4.00

61 LARGE ADHESIVE BANDAID J & J BAND-AID LARGE ADHESIVE PADS

10 CT $ 4.00

106 MINI FIRST AID KIT 1 KIT $ 5.00

93 PROBE COVERS 30 CT $ 2.00

64 ROLLED GAUZE 2" X 2.5 YDS J & J FIRST AID ROLLED GAUZE

1 CT $ 2.00

65 ROLLED GAUZE 3" X 2.5 YDS J & J FIRST AID ROLLED GAUZE

1 CT $ 3.00

62 SHEER BANDAID J & J BAND-AID SHEER STRIPS ASSORTED SIZES

60 CT $ 5.00

91 TRIPLE ANTIBIOTICOINTMENT MAXIMUM STRENGTH

NEOSPORIN PLUS 1 OZ $ 7.00

90 TRIPLE ANTIBIOTIC OINTMENT ORIGINAL STRENGTH

NEOSPORIN 1 OZ $ 5.00

67 WATERPROOF ADHESIVE TAPE

J & J FIRST AID WATERPROOF TAPE

1 CT $ 4.00

60 WATERSHIELD BANDAID J & J BAND-AID CLEAR WATER BLOCK PLUS

30 CT $ 4.00

PAIN RELIEVERS155 ACETAMINOPHEN PAIN

RELIEF RS 325 MGTYLENOL REGULAR 100 CT $ 5.00

6

157 ACETAMINOPHEN PAIN RELIEF XS 500 MG

TYLENOL EXTRA STRENGTH

100 CT $ 6.00

153 ARTHRITIS ACETAMINOPHEN 650 MG

ARTHRITIS TYLENOL 100 CT $10.00

11 ASPIRIN 325 MG ENTERIC SAFETY COATED

ECOTRIN/BAYER 100 CT $ 5.00

222 ASPIRIN 81 MG CHEW TABS BAYER/ST JOSEPH CHEWABLE

36 CT $ 2.00

12 ASPIRIN 81 MG CHEW TABS BAYER/ST JOSEPH CHEWABLE

(3X36) 108CT

$ 6.00

13 ASPIRIN 81 MG ENTERIC SAFETY COATED TABLETS

BAYER 120 CT $ 5.00

6 EFFERVESCENT PAIN RELIEVER

ALKA-SELTZER 36 CT $ 5.00

225 HEADACHE(MIGRAINE) RELIEF EXTRA STRENGTH

EXCEDRIN EX STRENGTH

100 CT $ 7.00

3 IBUPROFEN 200 MG ADVIL 100 CT $ 7.00

247 IBUPROFEN AND DIPHENHYDRAMINE 200MG/38MG

ADVIL IBUPROFEN PM 40 CT $10.00

10 MUSCLE PAIN RELIEVING CREAM

BENGAY/ASPERCREME

3 OZ $ 5.00

5 NAPROXEN SODIUM 220 MG ALEEVE 100 CT $ 7.00 154 PAIN RELIEF PM

ACETAMINOPHEN XS 500 MG/ DIPHENHYDRAMINE 25 MG

TYLENOL PM 50 CT $ 5.00

211 TYLENOL EXTRA STRENGTH 500 MG CAPLETS ADULTS

TYLENOL EXTRA STRENGTH 500MG

100 CT $15.00

PERSONAL CARE202 BATH DIGITAL SCALE 1 UNIT $30.00

74 COTTON BALLS JUMBO SIZE JOHNSON & JOHNSON COTTON BALLS

100 CT $ 3.00

119 COTTON SWABS QTIPS 300 CT $ 4.00 37 EAR WAX DROPS DEBROX 0.5 OZ $ 5.00 36 EAR WAX REMOVER BULB 1 OZ $ 3.00

125 LICE KILLING SHAMPOO RID 4 OZ $10.00 124 LICE TREATMENT KIT 3 PIECE RID 1 KIT $15.00 260 UNDERPADS 23X47 15 CT $10.00

SKIN CARE78 ATHLETE'S FOOT

ANTIFUNGAL CLOTRIMAZOLE 1% CREAM

LOTRIMIN AF ANTIFUNGAL CREAM

0.5 OZ $ 7.00

40 FOOT POWDER DR. SCHOLL'S FOOT POWDER

7 OZ $ 5.00

7

118 HAND SANITIZER PURELL 2 OZ $ 2.00 145 MEDICATED ANTIFUNGAL

FOOT POWDER SPRAYTINACTIN 4.6 OZ $ 7.00

22 MEDICATED CALAMINE LOTION

CALADRYL 6 OZ $ 5.00

159 PETROLEUM JELLY JAR VASELINE 13 OZ $ 5.00 SUPPORTIVE CARE

177 ANKLE BRACE LARGE 1 UNIT $10.00 176 ANKLE BRACE MEDIUM 1 UNIT $10.00 175 ANKLE BRACE SMALL 1 UNIT $10.00 188 ARM SLING ADULT W/PAD 1 UNIT $10.00 262 BACK BRACE SUPPORT 1 UNIT $30.00 190 COMPRESSION KNEE HIGHS

FOR WOMEN LARGE 8-15MMHG

1 PAIR $10.00

191 COMPRESSION KNEE HIGHS FOR WOMEN MEDIUM 8-15MMHG

1 PAIR $10.00

181 ELASTIC KNEE SUPPORT LARGE

1 UNIT $10.00

182 ELASTIC KNEE SUPPORT MEDIUM

1 UNIT $10.00

183 ELASTIC KNEE SUPPORT SMALL

1 UNIT $10.00

184 ELASTIC KNEE SUPPORT X-LARGE

1 UNIT $10.00

193 MEDICAL COMPRESSION STOCKING LARGE 20-30MMHG

1STOCKING

$15.00

206 NICOTINE GUM 2MG NICORETTE 50 CT $30.00 207 NICOTINE GUM 4MG NICORETTE 50 CT $30.00 179 SPORT KNEE BRACE

ADJUSTABLE 1 UNIT $15.00

187 SPORT WRIST BRACE ADJUSTABLE

1 UNIT $10.00

189 WRIST BRACE WRAP AROUND 1 UNIT $ 7.00 VITAMINS, MINERALS, AND MISCELLANOUS

26 ADULT 50+ MULTI-VITAMIN TABLETS

CENTRUM® ADULTS 50+

100 CT $ 9.00

168 CALCIUM 500MG OSCAL 60CT $ 5.00 169 CALCIUM 500MG W/VIT D OSCAL W/VIT D 60 CT $ 5.00 170 CALCIUM CARBONATE 600MG CALTRATE 600 60 CT $ 6.00

23 CALCIUM CARBONATE 600MG W/ VIT-D TABS

CALTRATE 600 + D 60 CT $ 5.00

8

29 CALCIUM CITRATE 600MG + D CITRACAL PLUS W/ VIT-D

60 CT $ 6.00

50 FERROUS SULFATE IRON SUPPLEMENT 325MG TABLETS

FEOSOL 100 CT $ 5.00

197 FOLIC ACID 400MCG TAB 250 CT $ 5.00 27 MEN'S MULTI-VITAMIN

TABLETSONE-A-DAY MEN'S 100 CT $ 8.00

198 VITAMIN D3 1000 UNITS CHOLECALCIFEROL 100 CT $ 5.00 WOMENS HEALTH

259 BLADDER PADS FOR WOMEN PREVAIL FOR WOMEN 48 CT $15.00 24 PANTY LINERS UNSCENTED

INDIVIDUALLY WRAPPED 22 CT

CAREFREE TO GO LINERS UNSCENTED

22 CT $ 5.00

7 LONG MAXI WITH WINGS ALWAYS LONG SUPER MAXI WITH WINGS

16 CT $ 6.00

82 MICONAZOLE 3 COMBO W/ DISPOSABLE APPLICATORS + TUBE

MONISTAT 3 0.32 OZ $12.00

47 ONE STEP PREGNANCY TEST EPT 2 CT $ 7.00 199 PRENATALS VITAMINS 100 CT $ 7.00 138 REGULAR MAXI PADS STAYFREE 24 CT $ 5.00

142 REGULAR TAMPONS TAMPAX PEARL 20 CT $ 5.00 139 SUPER MAXI PADS 24 CT $ 5.00 143 SUPER TAMPON TAMPAX SUPER

BIODEGRADABLE UNSCENTED

20 CT $ 5.00

8 ULTRA THIN WITH WINGS PADS

ALWAYS ULTRA THIN MAXI WITH WINGS

18 CT $ 6.00

28 WOMEN'S MULTI-VIT TABLETS ONE-A-DAY WOMEN'S 100 CT $ 8.00

9

To ask for supportive aids and services, or materials in otherformats and languages for free, please call,

1-877-860-2837 TTY/TDD:711.

Blue Cross and Blue Shield of Illinois complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Blue Cross and Blue Shield of Illinois does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Blue Cross and Blue Shield of Illinois:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:○ Qualified sign language interpreters○ Written information in other formats (large print, audio, accessible electronic formats, other formats)

• Provides free language services to people whose primary language is not English, such as:○ Qualified interpreters○ Information written in other languages

If you need these services, contact Civil Rights Coordinator.

If you believe that Blue Cross and Blue Shield of Illinois has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:Civil Rights Coordinator, Office of Civil Rights Coordinator, 300 E. Randolph St., 35th floor, Chicago, Illinois 60601, 1-855-664-7270, TTY/TDD: 1-855-661-6965, Fax: 1-855-661-6960, [email protected] can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Civil Rights Coordinator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and 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 or phone at:

U.S. Department of Health and Human Services200 Independence Avenue, SW

Room 509F, HHH BuildingWashington, D.C. 20201

1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

10

English: ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-877-860-2837 (TTY/TDD: 711).

Español (Spanish): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-860-2837 (TTY/TDD: 711).

繁體中文 (Chinese): 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-877-860-2837 (TTY/TDD: 711).

Tagalog (Tagalog – Filipino): PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-877-860-2837 (TTY/TDD: 711).

Français (French): ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-877-860-2837 (ATS : 711).

Tiếng Việt (Vietnamese): CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-877-860-2837 (TTY/TDD: 711).

Deutsch (German): ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-877-860-2837 (TTY/TDD: 711).

한국어 (Korean): 주의: 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다.1-877-860-2837 (TTY/TDD: 711)번으로전화해주십시오.

Русский (Russian): ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступныбесплатные услуги перевода. Звоните 1-877-860-2837 (телетайп: 711).

العربیة (Arabic):

(رقم ھاتف الصم 778-068-7382-1ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم ).117والبكم:

�हदं� (Hindi): ध्यान द�: य�द आप �हदं� बोलते ह� तो आपके �लए मुफ्त म� भाषा सहायता सेवाएं उपलब्ध ह�। 1-877-860-2837 (TTY/TDD: 711) पर कॉल कर�।

Italiano (Italian): ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-877-860-2837 (TTY/TDD: 711).

�જુરાતી (Gujarati): �ચુના: જો તમે �જુરાતી બોલતા હો, તો િન:�લુ્ક ભાષા સહાય સેવાઓ તમારા માટ� ઉપલબ્ધ છે.

ફોન કરો 1-877-860-2837 (TTY/TDD: 711).

اُرُدو (Urdu): خبردار: اگر آپ اردو بولتے ،ہیں تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال کریں

1-877-860-2837 (TTY/TDD: 711).

Polski (Polish): UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-877-860-2837 (TTY/TDD: 711).

λληνικά (Greek): ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθε

σή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι

οποίες παρέχονται δωρεάν. Καλέστε 1-877-860-2837 (TTY/TDD: 711).

11

12

If you have any questions, please call Member Services at 1-877-860-2837 (TTY/TTD: 711). We are available 24 hours a day, seven (7) days a week.

Illinois Client Enrollment Services will send you information about your health plan choices when it is time for you to make a health plan choice and during your Open Enrollment period.

Blue Cross Community Health Plans is provided by Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association.

Blue Cross Community Health PlansSM

Department of Healthcare & Family Services

Over-the-Counter Benefits

Blue Cross Community Health Plans