INTRODUCTION The contract consists of your approved application, this certificate of coverage ("booklet"), the completed and signed Group Master Application, the group contract documents, and any endorsements or riders. (An endorsement is a form signed by an officer of Premera Blue Cross that adds or changes provisions of the contract.) The following sections of this booklet will be especially helpful to you: • How To Contact Us – Our Web site, phone numbers, mailing addresses and other information is on the back cover of this booklet • Benefits — What this plan covers • What This Plan Does Not Cover — Services and supplies that are either limited or not covered under this plan. • How To File A Claim — Step-by-step instructions on how to send us a claim • How To Appeal A Claim Decision — How you can request us to reconsider our decision on a claim • Definitions — Terms that have specific meanings in this plan. Example: In this booklet, the words you and your mean the person covered by this plan. Only you are eligible for its benefits. The words we, us, and our mean Premera Blue Cross, also referred to as "Premera." Medicare Resources You will also find it helpful to refer to 3 pieces of information. • Medicare’s handbook, Medicare And You, which explains your Medicare benefits. You can get a copy from the Internet or at any Social Security Office. • The Outline of Medicare Supplement Coverage that we provide. This is a summary of what Medicare and this plan cover. • Medicare’s Choosing A Medigap Policy guide that we provide. 2 Group Plan G/Dis