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Medicare Part D Cross-ReferenceWellness Program DisclosureYour group health plan is committed to helping you achieve your best health. Rewards for participating in a wellnessprogram are available to all eligible employees. If you think you might be unable to meet a standard for a rewardunder this wellness program, you might qualify for an opportunity to earn the same reward by different means.Contact human resources and we will work with you (and, if you wish, with your doctor) to find a wellness programwith the same reward that is right for you in light of your health status.Your Rights and Protections Against Surprise Medical BillsWhen you get emergency care or get treated by an out-of-network provider at an in-network hospital orambulatory surgical center, you are protected from surprise billing or balance billing. In these cases, you should notbe charged more than your plan%u2019s copayments, coinsurance and/or deductible.If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federallaw gives you more choices about your prescription drug coverage. Please see page [38] for more details.What is %u201cbalance billing%u201d (sometimes called %u201csurprise billing%u201d)?When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment,coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit ahealth care facility that isn%u2019t in your health plan%u2019s network.Out-of-network%u201d describes providers and facilities that haven%u2019t signed a contract with your health plan to provideservices. Out-of-network providers may be allowed to bill you for the difference between what your plan pays andthe full amount charged for a service. This is called %u201cbalance billing.%u201d This amount is likely more than in-network costsfor the same service and might not count toward your plan%u2019s deductible or annual out-of-pocket limitSurprise billing%u201d is an unexpected balance bill. This can happen when you can%u2019t control who is involved in your care%u2014like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedlytreated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on theprocedure or service.You are protected from balance billing for:Emergency servicesIf you have an emergency medical condition and get emergency services from an out-of-network provider orfacility, the most they can bill you is your plan%u2019s in-network cost-sharing amount (such as copayments, coinsurance,and deductibles). You can%u2019t be balance billed for these emergency services. This includes services you may get afteryou%u2019re in stable condition, unless you give written consent and give up your protections not to be balanced billed forthese post-stabilization services.38Certain services at an in-network hospital or ambulatory surgical centerWhen you get services from an in-network hospital or ambulatory surgical center, certain providers there may beout-of-network. In these cases, the most those providers can bill you is your plan%u2019s in-network cost-sharing amount.This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon,hospitalist, or intensivist services. These providers can%u2019t balance bill you and may not ask you to give up yourprotections not to be balance billed.If you get other services at these in-network facilities, out-of-network providers can%u2019t balance bill you, unless you givewritten consent and give up your protections.You%u2019re never required to give up your protections from balance billing. You also aren%u2019t required to get out-ofnetwork care. You can choose a provider or facility in your plan%u2019s network.