ABOUT THIS PLAN The benefits, limitations, exclusions and other provisions in this booklet are subject to the terms of Premera Blue Cross's contract with the Group named on its Face Page. This booklet is a part of that contract. It replaces any other group Medicare supplement certificate you may have received. This certificate of coverage is an important document and should be kept in a safe place. The Group has delegated authority to Premera Blue Cross to use its expertise and judgment as part of the routine operation of the plan to reasonably apply the terms of the contract for making decisions as they apply to specific eligibility, benefits and claims situations. This does not prevent you from exercising rights you may have under applicable law to appeal or bring a civil lawsuit challenging any eligibility or claims determinations under the contract, including our exercise of our judgment and expertise. This plan is delivered in and governed by the laws of Washington. You may not be enrolled in this plan if it duplicates benefits provided under another Medicare Supplement plan or a Medicare Advantage plan. This plan does not duplicate benefits paid by Medicare. The deductible and coinsurance amounts paid by this plan will automatically change when Medicare’s deductible and coinsurance requirements change. Kip Haffner Senior Vice President, Medicare Premera Blue Cross