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© 2024 Premera Blue Cross is an Independent Licensee of the Blue Cross Blue Shield Association serving businesses and residents of Alaska and Washington state, excluding Clark County. Premera Blue Cross complies with applicable Federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, or sexual orientation. Premera Blue Cross headquarters are located at 7001 220th St SW, Mountlake Terrace, WA 98043. Enrollment in Premera Blue Cross depends on contract renewal. For accommodation of persons with special needs at sales meetings, call 888-868-7767 (TTY/TDD: 711), April 1 to September 30, Monday through Friday, 8 a.m. to 8 p.m.; October 1 to March 31, seven days a week, 8 a.m. to 8 p.m. (Pacific). Complete this form to file a complaint about your Medicare health or drug plan. Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. 1-800-MEDICARE is available 24 hours a day, 7 days a week, except some federal holidays. If applicable, please provide your agent or broker's name used for enrollment.

**These programs are not insurance and may be discontinued at any time. †On behalf of Premera Blue Cross, FitOn Health is an independent company which provides the fitness program. Fitness Membership provided by FitOn Health.

*Plans start as low as $53 per month on High Deductible Plan G (HDG) and using automatic funds transfer for monthly payments, but you could pay less if you qualify for a spousal discount. Find the spousal discount form here. Regular premium for HDG without AFT is $58 per month.

WAMSWEB-ACQ 055364 (07-20-2024)