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© 2023 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.

Premera Blue Cross is an HMO plan with a Medicare contract.

CMS ID: Y0134_PBC3735_M - Last updated 5-08-2023

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