DISCLOSURES

Use this outline to compare benefits and premiums among policies.

READ YOUR POLICY VERY CAREFULLY

This is only an outline describing our policy's most importance features. The policy is your insurance contract. A policy must be read to understand all of the rights and duties of the policyholder and Mountain State.

RIGHT TO RETURN POLICY

If you find that you are not satisfied with your policy, you may return it to Mountain State Blue Cross Blue Shield, Post Office Box 1948, Parkersburg, WV 26102. If you send the policy back to us within 30 days after you receive it, we will treat the policy as if it had never been issued and return all of your payments.

Notice

This policy may not fully cover all of your medical costs. Mountain State is not connected to Medicare. This outline of coverage does not give all the details of Medicare coverage. Contact your local Social Security office or review The Medicare Handbook for more details.

COMPLETE ANSWERS ARE VERY IMPORTANT

When you fill out an application for a new policy, be sure to answer truthfully and completely all questions about your medical and health history. The company may cancel your policy and refuse to pay any claims if you leave out or falsify important medical information.

Review an application carefully before you sign it. Be certain that all information has been properly recorded.

If you have any questions about Medical coverage, please call 304-424-7770 in Parkersburg, WV or 1-800-385-1985. You may also e-mail us at msbcbsMedSup@msbcbs.com

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