SEPTEMBER 2018 • LONGISLANDPRESS.COM 57
Medicare + Medicaid =
More Benefits for You!
You may be eligible for additional
money-saving benefits including:
• Monthly Over-the-Counter (OTC) Card
(to pay for items like OTC medications,
toothpaste, incontinence supplies,
and more)
• Transportation
• Flexible Spending Dollars
• Dental
• Care Management support
• Top-quality doctors and hospitals
• Discounts for hearing devices*
MEDICARE HEALTH INSURANCE
JOHN L SMITH
Medicare Number/Número de Medicare
HOSPITAL (PART A) 01-01-2018
Medicaid/Common Benefit
Identification Card (CBIC) NEW
OR
For a complete listing of plans available in your service area, contact the plan. The benefit information
provided is a brief summary, not a complete description of benefits. For more information, contact the plan.
Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/
or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare
Part B premium. Out-of-network services may require more out-of-pocket expense than in-network services.
Benefit restrictions apply. Fidelis Legacy Plan is an HMO plan with a Medicare contract. Enrollment in Fidelis
Legacy Plan depends on contract renewal. *Fidelis Legacy Plan partners with TruHearing for discounted
purchases of hearing devices.
Call us today! 1-800-860-8707 TTY: 711
Monday–Friday, 8:00 a.m.–8:00 p.m. from February 15–September 30
Monday–Sunday, 8:00 a.m.–8:00 p.m. from October 1–February 14
@fideliscare www.fideliscare.org H3328_FC 17123 Accepted
Name/Nombre
1XX0-XX0-XX00
Coverage starts/Cobertura empieza
MEDICAL (PART B)
01-01-2018
Entitled to/Con derecho a
SAMPLE
Medicare Card NEW
OR
/www.fideliscare.org
