Senior Blue®

MedicareSupplement

Coverage

M-51570 10/05

Senior Blue....

Iowa’s ChoiceSince 1939, Wellmark Blue Cross and Blue Shield of Iowa has

been providing quality health insurance to the people of Iowa.

We’re known for our experience, reliability and dedication to

Iowans. That’s why so many Iowans choose Wellmark Blue Cross

and Blue Shield for their Medicare Supplement coverage.

Senior Blue — A Step Ahead

Senior Blue Medicare Supplement plans help pay for health care expenses

that aren’t covered by Medicare. There are deductible, copayment and

coinsurance gaps in Medicare coverage that can quickly add up. With Wellmark

Blue Cross and Blue Shield of Iowa, you have access to flexible, affordable plans

that help pay for these Medicare gaps.

With Senior Blue, you’ll receive:

• Stability and security—Wellmark Blue Cross and Blue Shield of Iowa is

known for financial strength. We received an “A” (Excellent) rating from

A.M. Best Company1 and an A+ (Strong) rating from Standard & Poor’s.2

• Personal customer service—We have an entire customer service unit

devoted just to helping our Senior Blue members. You can count on us

for friendly, courteous service.

• Worldwide acceptance—Your Senior Blue coverage follows you anywhere

in the United States. When you select Plan C, E, or F, you even receive

emergency coverage outside of the United States.

When you enroll in Senior Blue, you’re automatically a member of our Blue Plus

Club.SM This club offers special discounts on items like prescription drugs, vision

services, hearing equipment, fitness club memberships and more!

1 A.M. Best Company, July 2005

2 Standard & Poor’s, July 2005

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Coverage Without the Hassle

Insurance doesn’t have to be complicated. That’s why we invite you to check out our

Senior Blue Medicare Supplement plans.

Provider Choice

You can receive services from any physician, hospital or medical facility. You may want to

receive care from providers who participate with Medicare since they agree to accept

Medicare-approved amounts as full payment on Medicare claims, except for applicable

deductibles and copayments.

No Waiting PeriodsThere are no waiting periods, even if you have existing health problems. With Senior Blue,

you are covered immediately on the date your policy begins.

No Medical Exams

Applying for Senior Blue coverage is quick and easy. We won’t ask you to complete a

medical exam or answer pages of questions. Your acceptance is based upon “yes” and

“no” answers to three or four simple health questions.

If you enroll during your six-month guaranteed enrollment period,3 or if you apply for

Plan A or guaranteed-issue Plan C, you don’t even have to answer any health questions.

No Claim Forms

Tired of filling out claim forms? Then Senior Blue is for you. With Senior Blue, those days

of worrying about confusing claim forms or keeping track of paperwork are over. Simply

present your Senior Blue identification card when you visit your local doctor’s office or

other medical facility. Your provider will file your claim automatically for you.

Guaranteed Renewable Coverage

As long as you pay your premiums when due, your coverage is guaranteed.

We will not cancel your policy even if you develop health problems.

3 Acceptance is guaranteed during the six-month guaranteed enrollment period which begins

the first day of the first month you are age 65 or older and enrolled in Medicare Part B

(medical insurance).

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Senior Blue Plan Benefits

Medicare Supplement plan benefits do not vary between insurance companies. We offer

five standardized plans. Senior Blue can help you pay for deductibles, copayments and

some services not covered by Medicare.

We Offer 5 Standard Medicare Supplement Plans

Plan A is our most economical coverage. It provides basic benefits, including Medicare’s

Part A hospital and Part B medical co-payments, and your first three pints of blood

each year.

Plan C covers the basic benefits just described, plus Medicare’s Part A and Part B

deductibles, skilled nursing copayments and foreign travel emergencies.

Plan E includes many of the same benefits as Plan C, but also covers preventive care not

covered by Medicare. This includes some annual physical and preventive tests and services

ordered by your physician when not covered by Medicare.

Plan F is our most popular plan. It also includes the same benefits as Plan C, plus it

provides benefits for the difference between what the doctor charges and what Medicare

approves (this is important if your physician charges more than Medicare’s eligible

expense).

4Please refer to your Senior Blue Outline of Coverage for additional information.

Items Not Covered by Medicare Covered by Senior Blue

A C E F L

Part A Hospital Services

Part A Deductible (75%)

Copayment for days 61-90 in a hospital

Copayment for days 91-150 in a hospital

100% of Medicare-allowable expenses for additional 365 days after Medicare hospital benefits stop completely

Calendar year blood deductible (first 3 pints of blood)if the deductible (75%)is not met by the replacement of blood

Copayment for 21-100 days in a skilled nursing facility(75%)

Part B Physician and Medical Services

$124.00 Part B deductible

20% of Medicare-approved amount after $124.00 Part B deductible is met (75%)

100% of Medicare Part B excess charges

Additional Benefits Not Covered by Medicare

First $124.00 of Medicare-approved amounts for Durable Medical Equipment

Benefits for medically necessary emergency care received in a foreign country

Out-of-Pocket Annual Limit ($2,000)

Plan L offers most of the same benefits as Plans A, C, E and F, but is designed to offer lower

monthly premiums, which means certain copayments are higher so you may pay a greater

share of some costs. There are also set limits to your out-of-pocket costs in any given year.

Use this chart to determine which plan best meets your needs.

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Blue Plus ClubSM

Discounts & ServicesHelping you stay healthy is important to us. That’s why we offer programs

and services to make it easier for you to take an active role in your overall

well-being. As a Senior Blue Medicare Supplement member, you are eligible

to participate in our Blue Plus Club, which gives you access to a variety of

discounts and services, at no additional cost, that are designed to help you

stretch your health care dollars.

The Blue Plus Club includes:

• WellScript® Prescription Drug Discount Program

• Vision exams, eyewear, laser surgery

• Hearing exams and hearing aids

• Complementary medicine including chiropractic, acupuncture, massage

therapy, dietetic counseling and others

• Vitamin supplements and other natural products

• Cosmetic surgery

• Durable Medical Equipment

• Accidental Death & Dismemberment coverage

Blue Plus Club — You’ll Be Glad You’re A Member

The Blue Plus Club program is designed to save you time so that you can enjoy

yourself. Be sure to read the Blue Plus Club brochure to learn step-by-step how to use

each element of the core program. We’ve tried to cover all of the bases, but if you still

have questions, you can call the vendor phone numbers listed in the brochure.

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How to Apply for Senior BlueApplying for Senior Blue is easy and won’t take much time. If you have questions

regarding the enrollment process, call us at 1-800-336-0505, or contact your local

authorized Wellmark Blue Cross and Blue Shield of Iowa agent.

Eligibility Requirements

To enroll in Senior Blue, you must:

• Be a resident of Iowa;

• Be enrolled in Medicare Part A and Part B; and

• Not be covered by another Medicare supplement policy at the time this policy is

issued, unless you intend to replace your other policy.

Choose Your Senior Blue Plan

Please read the Senior Blue Outline of Coverage carefully. It’s included with this

brochure.

• Determine which of the five plans—A, C, E, F or L—is best for you.

• Calculate your monthly premium using the table in the Outline of Coverage.

The premiums are shown by age category and benefit plan.

Easy Payment Options

Premium payments may be made on a calendar month*, calendar quarter, semi-annual

calendar year or calendar year basis. For example, a monthly premium would be for the

first day of a month through the last day of such month. A quarterly payment would be

for any calendar quarterly period, such as January 1 through March 31. A semi-annual

payment would be for the period of either January 1 through June 30 or July 1 through

December 31. An annual premium would be for January 1 through December 31 of the

applicable year.

You may choose to have your payments automatically withdrawn from

your checking or savings account. If you want premiums automatically

withdrawn from your account, attach a voided check to the application.

Ask your insurance agent or Wellmark representative if it’s necessary for

you to send a payment with your application.

* The monthly payment option is available only when premiums are

automatically withdrawn from your checking or savings account.

Submit Your Enrollment Materials

Complete, sign, and mail the following items to us.

• Application Form — Please use an ink pen to complete the application. Keep the

last copy for your records.

• “Notice to Applicant Regarding Replacement of Medicare Supplement

Insurance” (white copy) — Return this form only if you are replacing a current

Medicare supplement policy with a Senior Blue policy.

A few tips to ensure Prompt and Accurate Claims Filing

Promptly and Accurately

That's how you want your health care claims processed. And that’s what you get when

you have a Senior Blue Medicare Supplement plan from Wellmark Blue Cross and Blue

Shield of Iowa.

Filing Medicare Claims First

Federal regulations require that all health care providers fill out and submit Medicare

claim forms to the Medicare office serving the state where the services are performed.

You don't have to do anything.

Medicare Supplement Benefits

We will process your claim for Medicare Supplement benefits when we receive an

Explanation of Medicare Benefits (EOMB) from the Medicare office. How that EOMB gets

to us depends on where you receive the services.

Here are a few tips about filing, so you can help us help you

Iowa Providers

Since you are a Wellmark Blue Cross and Blue Shield of Iowa member, your EOMB is

automatically transferred from Medicare to us, in most cases. When your doctor, clinic,

hospital or other provider is in the state of Iowa, you do not have to do anything.

The Medicare office in Iowa sends your claim directly to Wellmark. Once we have

processed your claim, you will receive an Explanation of Benefits (EOB) from us.

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The EOB shows what amount was paid by Medicare,

what amount was paid by us, and the balance due,

if any.

Providers Outside of Iowa

If you receive health care services when you are

in another state, the provider will submit your

Medicare claim to the Medicare office in the state

where you receive services. Some out-of-state

Medicare offices do not transfer the claim to us. Once

a claim is processed by a Medicare office in another

state, you will receive an EOMB. Examine the section

of the EOMB marked “Notes.”You may find a mes-

sage stating: This information is being sent to your

private insurer. If this message is present, your EOMB

will be sent to us automatically. If there is no message

like this, you need to send the EOMB to us so we can

process your Medicare supplement benefits. You do

not need to complete a claim form, just send us

the EOMB.

Before you send the EOMB to us, be sure that your

Wellmark Blue Cross and Blue Shield of Iowa

identification number and mailing address is shown

accurately on the EOMB form. Please remember,

you may want to keep a copy of the EOMB for your

own records.

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Friendly, Efficient Customer ServiceYou can count on friendly, efficient customer service from Wellmark Blue Cross and Blue

Shield of Iowa customer service centers. Whenever you call one of our customer service

centers, you can help us better serve you.

• Have your identification (ID) number ready because that's one of the first

questions your customer service representative will ask you. We'll also need to verify

your date of birth and home address.

• If you are calling about a claim or another document, have that document

available so you can refer to it as you talk with your customer service representative.

Whatever your reason for calling on us, you'll talk with someone who cares about your

questions and is professionally trained to help you.

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Call Toll Free: 1-800-245-6106

TTY/TDD users should call 1-888-781-4262 or 515-235-4212OR Contact one of these Wellmark Blue Cross and Blue Shield of Iowa Customer Service Centers:

Cedar Rapids625 First Street S.E., Suite 150Cedar Rapids, IA 52401319-294-5933800-373-5348

Des Moines601 Locust Street2nd FloorDes Moines, IA 50309800-245-6106

Other important numbers you may need:Medicare Part A and Part B1-800-MEDICARE (633-4227)TTY/TDD users should call 1-887-486-2048

Social Security Administration1-800-772-1213TTY/TDD users should call 1-800-325-0778

Senior Health Insurance Information Program (SHIIP)1-800-351-4664

Blue Cross,® Blue Shield,® the Cross® and Shield® symbols, Senior Blue,® and You Just Can’t Beat The Blues®

are registered marks and Blue Plus ClubSM and Blue RxSM are service marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.

Wellmark® and WellScript® are registered marks of Wellmark, Inc.

Wellmark Blue Cross and Blue Shield of Iowa is an Independent Licensee of the Blue Cross and Blue Shield Association