prescriptions. 
Review the formulary to make sure your drugs are covered.  
Understanding Important Rules 
You must continue to pay your Medicare Part Bpremium. This premium is normally taken out of your 
Social Security check each month. 
Benefits, premiums and/or copayments/co-insurance may change on January 1, 2024. 
Except in emergency or urgent situations, we do not cover services by out-of-network providers 
(doctors who are not listed in the provider directory).