attached to and made part of Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. Preferred Blue PPO Preferred Provider Plan Subscriber Certificate R13-7043 (2021) to be attached to HMO-PPO Page 1 hppo13-7043 Rider Prescription Drugs This rider modifies the terms of your health plan. Please keep this rider with your Subscriber Certificate for easy reference. The outpatient benefits described in your Subscriber Certificate for certain covered drugs have been changed. This health plan will provide full benefits for certain drugs used to treat depression. For these covered drugs, you pay nothing. For a complete list of these covered drugs, refer to the Blue Cross Blue Shield HMO Blue drug list. If your health plan has a separate drug deductible, it will not apply to the covered drugs described in this rider. If this is the case, the drug deductible will be described in the Schedule of Benefits for your plan option and/or any riders that apply to your coverage in this health plan. For more information on the covered drugs and/or supplies described above, you can call the Blue Cross Blue Shield HMO Blue customer service office. The toll free phone number to call is shown on your ID card. A Blue Cross Blue Shield HMO Blue customer service representative can help you find out the cost share you will pay for a specific covered drug or supply. Or, you can also go online and log on to the Blue Cross Blue Shield HMO Blue Web site at www.bluecrossma.org. All other provisions remain as described in your Subscriber Certificate.