Page 38 - Omega Benefits Guide
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For more information about Medicare prescription drug coverage:

                     Visit www.medicare.gov
                     Call you State Health Insurance Assistance Program (see the inside
                       back cover of you copy of the “Medicare & You” handbook for their
                       telephone number) for personalized help Call 1-800-MEDICARE or
                       (1-800-633-4227). TTY users call 1-877-486-2048.

               If you have limited income and resources, extra help paying for Medicare

               prescription drug coverage is available. For information about this extra
               help, visit Social Security on the web at www.socialsecurity.gov, or call
               them at 1-800-772-1213. TTY users call 1-800-325-0778.


                  Remember: Keep this Creditable Coverage notice. If you decide to join one

                  of the Medicare drug plans, you may be required to provide a copy of this

                  notice when you join to show whether or not you have maintained
                 creditable coverage and, therefore, whether or not you are required to pay
                 a higher premium (a penalty).


               Date: October 25, 2017

               Name of Entity/Sender: Omega Construction, Inc.
               Contact- Position/Office: Greg Marshall /CFO

               Address: 394 Shellybrook Drive Pilot Mountain, NC 27041

               Phone Number: 336-368-5156

                  According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a

                  valid OMB control number.  The valid OMB control number for this information collection is 0938-0990.  The time required to complete
                  this information collection is estimated to average 8 hours per response initially, including the time to review instructions, search existing
                  data resources, gather the data needed, and complete and review the information collection.  If you have comments concerning the
                  accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA
                  Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.


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