2014 Outline of Medicare Supplement Coverage Cover Page (1 of 2) Plans A, F & N Basic Benefits:

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1 Anthem Blue Cross and Blue Shield Ohio Administrative Office: P.O. Box , San Antonio, TX Toll Free Telephone Number: Benefit Chart of Medicare Supplement Plans Sold for Effective Dates On or After June 1, 2010 This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make Plan A available. Some plans may not be available in your state. Plans shown in gray are available for purchase. Plans noted with a triangle are Medicare Select Plans and contain the same benefits, except for restrictions on your use of hospitals. Basic, including 100% Part B 2014 Outline of Medicare Supplement Coverage Cover Page (1 of 2) Plans A, F & N Basic Benefits: Hospitalization Part A plus coverage for 365 additional days after Medicare benefits end. Medical Expenses Part B (generally 20% of Medicare-approved expenses) or copayments for hospital outpatient services. Plans K, L and N require insureds to pay a portion of Part B or copayments. Blood First three pints of blood each year. Hospice Part A. Plan A B C D F F* 1 G K L M N Basic, Basic, Basic, Basic, Basic, Hospitalization Hospitalization Basic, including including including including including and preventive and preventive including 100% 100% 100% 100% 100% care paid care paid 100% Part B Part B Part B Part B Part B at 100%; other at 100%; other Part B * basic benefits basic benefits paid at 50% paid at 75% Part A Skilled Nursing Facility Part A Part B Foreign Travel Emergency Skilled Nursing Facility Part A Foreign Travel Emergency Skilled Nursing Facility Part A Part B Part B Excess (100%) Foreign Travel Emergency Skilled Nursing Facility Part A Part B Excess (100%) Foreign Travel Emergency 50% Skilled Nursing Facility 50% Part A Out-of-pocket limit $4,940; paid at 100% after limit reached 75% Skilled Nursing Facility 75% Part A Out-of-pocket limit $2,470; paid at 100% after limit reached Skilled Nursing Facility 50% Part A Foreign Travel Emergency Basic, including 100% Part B, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing Facility Part A Foreign Travel Emergency * Plan F also has an option called a high deductible Plan F. This high deductible plan pays the same benefits as Plan F after one has paid a calendar year $2,140 deductible. Benefits from high deductible Plan F will not begin until out-of-pocket expenses exceed $2,140. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan s separate foreign travel 2014 emergency Outline of deductible. Medicare Supplement Coverage 1 1 High Plan F is not available. WPOOC001M(Rev. 9/13)-OH

2 Anthem Blue Cross and Blue Shield Ohio Administrative Office: P.O. Box , San Antonio, TX Toll Free Telephone Number: Premium Information Plans A, F & N Effective January 1, 2014 Premiums are subject to change. About Your Premium Here s some important information, before we get started: Premiums are subject to change on or after the Renewal Date in accordance with the terms of the Policy. Renewal Date is defined as generally January 1, subject to state approval. Your Premium Billing Preference does not guarantee your premium for any specific time period. Any state-approved premium changes will be applied starting on your next Renewal Date following your Coverage Effective Date, regardless of your Premium Billing Preference. The selected Premium Billing Preference will take effect on the first day of payment period which immediately follows your Coverage Effective Date. For example, if your Coverage Effective Date is September 1 and you pick the Quarterly Premium Billing Preference, Quarterly premium billing will start on October 1; if you select the Annual Premium Billing Preference, Annual premium billing will start on January 1. Any premiums billed for the period of time from your Coverage Effective Date to the start of your selected Premium Billing Preference will be prorated to reflect the Premium Billing Preference selected. We, Anthem, can only raise your premium if we raise the premium for all plans like yours in this State. We will recalculate your age each year to determine your new attained age. Your premium may increase annually at your plan renewal based upon your new attained age. Find Your Monthly Premium We re here to help you make choices to match your coverage needs. First, you ll need to locate your premium. Premiums (and future changes to premiums) are determined by several factors, including age, gender, plan, and the costs of medical services and supplies. After locating your monthly premium, you ll refer to individual plan pages. These pages will provide details of coverage and benefits, for comparison purposes. Don t miss out on a chance to SAVE! These optional discounts are offered for all of the following Premium Tables, for ages 65 and over. Save $2 on your monthly premium! Enroll in our Automatic Bank Draft or Electronic Fund Transfer (EFT) program and you will save $2 on your monthly premium. (To enroll, simply complete the Premium Payment Form.) OR Save $48 by paying your premium for the entire year! (Note: Based on the policy effective date, the discount may be pro-rated the first year.) Save 5% when more than one member in the household enrolls in a Medicare Supplement plan with us. The discount is for policies with effective dates of June 1, 2010 or after and available to those members who occupy the same housing unit. LET S BEGIN 2014 Outline of Medicare Supplement Coverage 2

3 Anthem Blue Cross and Blue Shield Ohio Administrative Office: P.O. Box , San Antonio, TX Toll Free Telephone Number: Monthly Premium Plans A, F & N Effective July 1, 2014 Premiums are subject to change. Find your Premium (continued) Premium is based upon your age and plan. Age* Plan A Plan F Plan N 65 $ $ $ * Attained age at the time of enrollment Outline of Medicare Supplement Coverage 3

4 Anthem Blue Cross and Blue Shield Ohio Administrative Office: P.O. Box , San Antonio, TX Toll Free Telephone Number: Monthly Premium Plans A, F & N Effective January 1, 2014 Premiums are subject to change. Find your Premium Select Plans Select Plans require use of a network hospital. Premium is based upon your age, gender and plan. Area 1 Area 2 Age* Male Female Plan F Plan N Plan F Plan N 65 $ $ $ $ Age* Male Female Plan F Plan N Plan F Plan N 65 $ $ $ $ Area 1 includes: all zip codes not in Cuyahoga county. * Attained age at the time of enrollment. Area 2 includes the following ZIP codes: 44017, 44022, 44040, 44070, , 44149, , 44181, , , * Attained age at the time of enrollment Outline of Medicare Supplement Coverage 4

5 Anthem Blue Cross and Blue Shield Ohio Administrative Office: P.O. Box San Antonio, TX Toll Free Telephone Number: Disclosure Page Plans A, F & N Disclosures Use this outline to compare benefits and premiums among policies. Medicare deductibles and amounts are effective as of January 1, Medicare may change their amounts annually. Read Your Policy Very Carefully This is only an outline describing your policy s most important features. The policy is your insurance contract. You must read the policy itself to understand all of the rights and duties of both you and Anthem. Right to Return Policy If you find that you are not satisfied with your policy, you may return it to us at our Administrative Office: P.O. Box , San Antonio, TX 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. Policy Replacement If you are replacing another health insurance policy, do NOT cancel it until you have actually received your new policy and are sure you want to keep it. Notice This policy may not fully cover all of your medical costs. Neither Anthem nor its agents are connected with Medicare. This outline of coverage does not give all the details of Medicare coverage. Contact your local Social Security Office or consult Medicare and You for more details. Complete Answers are Very Important When you fill out the application for the 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 the application carefully before you sign it. Be certain that all information has been properly recorded. Retain this outline for your records Outline of Medicare Supplement Coverage 5

6 Plan A MEDICARE (PART A) SERVICES PER BENEFIT PERIOD * A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. Services Medicare Pays Plan Pays You Pay Hospitalization* Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days All but $1, st thru 90 th day All but $304 a day $304 a day 91 st day and after: While using 60 lifetime reserve days Once lifetime reserve days are used: Additional 365 days All but $608 a day $608 a day 100% of Medicare eligible expenses $1,216 (Part A Beyond the additional 365 days All costs Skilled Nursing Facility Care* You must meet Medicare s requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital First 20 days All approved amounts 21 st thru 100 th day All but $152 a day Up to $152 a day 101 st day and after All costs Blood First 3 pints 3 pints Additional amounts 100% Hospice Care You must meet Medicare s requirements, including a doctor s certification of terminal illness All but very limited copayment/ for outpatient drugs and inpatient respite care Medicare copayment/ ** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy s Core Benefits. During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. ** 2014 Outline of Medicare Supplement Coverage 6

7 Plan A MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR * Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year. Services Medicare Pays Plan Pays You Pay Medical Expenses In or Out of the Hospital and Outpatient Hospital Treatment, such as physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $147 of Medicare Approved Amounts* $147 (Part B Remainder of Medicare Approved Amounts Generally 80% Generally 20% Part B Excess Charges Above Medicare Approved Amounts All costs Blood First 3 pints All costs Next $147 of Medicare Approved Amounts* Remainder of Medicare Approved Amounts 80% 20% Clinical Laboratory Services Tests for Diagnostic Services 100% PARTS A & B Home Health Care Medicare Approved Services Medically necessary skilled care services and medical supplies Durable medical equipment: First $147 of Medicare approved amounts* Remainder of Medicare approved amounts 100% 80% 20% $147 (Part B $147 (Part B 2014 Outline of Medicare Supplement Coverage 7

8 Plan F MEDICARE (PART A) SERVICES PER BENEFIT PERIOD * A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. Services Medicare Pays Plan Pays You Pay Hospitalization* Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days All but $1,216 $1,216 (Part A 61 st thru 90 th day All but $304 a day $304 a day 91 st day and after: While using 60 lifetime reserve All but $608 a day $608 a day days Once lifetime reserve days are used: Additional 365 days 100% of Medicare eligible expenses ** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy s Core Benefits. During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. ** Beyond the additional 365 days All costs Skilled Nursing Facility Care* You must meet Medicare s requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital First 20 days All approved amounts 21 st thru 100 th day All but $152 a day Up to $152 a day 101 st day and after All costs Blood First 3 pints 3 pints Additional amounts 100% Hospice Care You must meet Medicare s requirements, including a doctor s certification of terminal illness All but very limited copayment/ for outpatient drugs and inpatient respite care Medicare copayment/ 2014 Outline of Medicare Supplement Coverage 8

9 Plan F MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR * Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year. Services Medicare Pays Plan Pays You Pay Medical Expenses In or Out of the Hospital and Outpatient Hospital Treatment, such as physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $147 of Medicare Approved Amounts* $147 (Part B Remainder of Medicare Approved Amounts Generally 80% Generally 20% Part B Excess Charges Above Medicare Approved Amounts 100% Blood First 3 pints All costs Next $147 of Medicare Approved Amounts* $147 (Part B Remainder of Medicare Approved Amounts 80% 20% Clinical Laboratory Services Tests for Diagnostic Services 100% PARTS A & B Home Health Care Medicare Approved Services Medically necessary skilled care services and medical supplies Durable medical equipment: First $147 of Medicare approved amounts* Remainder of Medicare approved amounts OTHER BENEFITS NOT COVERED BY MEDICARE Foreign Travel Not Covered by Medicare Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA 2014 Outline of Medicare Supplement Coverage 9 100% $147 (Part B 80% 20% First $250 each calendar year $250 Remainder of Charges 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum

10 Plan N MEDICARE (PART A) SERVICES PER BENEFIT PERIOD * A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. Services Medicare Pays Plan Pays You Pay Hospitalization* Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days All but $1,216 $1,216 (Part A 61 st thru 90 th day All but $304 a day $304 a day 91 st day and after: While using 60 lifetime reserve All but $608 a day $608 a day days Once lifetime reserve days are used: Additional 365 days 100% of Medicare eligible expenses ** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy s Core Benefits. During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. ** Beyond the additional 365 days All costs Skilled Nursing Facility Care* You must meet Medicare s requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital First 20 days All approved amounts 21 st thru 100 th day All but $152 a day Up to $152 a day 101 st day and after All costs Blood First 3 pints 3 pints Additional amounts 100% Hospice Care You must meet Medicare s requirements, including a doctor s certification of terminal illness All but very limited copayment/ for outpatient drugs and inpatient respite care Medicare copayment/ 2014 Outline of Medicare Supplement Coverage 10

11 Plan N MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR * Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year. Services Medicare Pays Plan Pays You Pay Medical Expenses In or Out of the Hospital and Outpatient Hospital Treatment, such as physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $147 of Medicare Approved $147 (Part B Amounts* Remainder of Medicare Approved Amounts Generally 80% Balance, other than up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense. Part B Excess Charges Above Medicare Approved Amounts All costs Blood First 3 pints All costs Next $147 of Medicare Approved Amounts* Remainder of Medicare Approved Amounts 80% 20% Clinical Laboratory Services Tests for Diagnostic Services 100% Up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense. $147 (Part B (Continued) 2014 Outline of Medicare Supplement Coverage 11

12 Plan N MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR (Continued) PARTS A & B Services Medicare Pays Plan Pays You Pay Home Health Care Medicare Approved Services Medically necessary skilled care services and medical supplies Durable medical equipment: First $147 of Medicare approved amounts* Remainder of Medicare approved amounts OTHER BENEFITS NOT COVERED BY MEDICARE Foreign Travel Not Covered by Medicare Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA 100% 80% 20% First $250 each calendar year $250 Remainder of Charges 80% to a lifetime maximum benefit of $50,000 $147 (Part B 20% and amounts over the $50,000 lifetime maximum 2014 Outline of Medicare Supplement Coverage 12

13 Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company. Independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

14 S ASHLAND COUNTY, OH OHIO DEFIANCE COUNTY, OH OHIO ASHLAND COUNTY Samaritan Regional Health System 1025 Center St Ashland, OH ASHTABULA COUNTY Ashtabula County Medical Center 2420 Lake Ave Ashtabula, OH BUTLER COUNTY Bethesda Hospital Inc 3055 Hamilton Mason Rd Hamilton, OH Bethesda Hospital Inc 3125 Hamilton Mason Rd Hamilton, OH Mccullough Hyde 110 N Poplar Oxford, OH Mercy Hospital Fairfield 3000 Mack Rd Fairfield, OH CLERMONT COUNTY Mercy Hospital Clermont 3000 Hospital Dr Batavia, OH COSHOCTON COUNTY Coshocton County Memorial Hospital 1460 Orange St Coshocton, OH CRAWFORD COUNTY Galion Community Hospital 269 Portland Way S Galion, OH CUYAHOGA COUNTY Cleveland Clinic 9500 Euclid Ave Cleveland, OH Euclid Hospital Lakeshore Cleveland, OH Fairview General Hospital Lorain Ave Cleveland, OH Hillcrest Hospital 6780 Mayfield Rd Cleveland, OH Lakewood Hospital Detroit Ave Lakewood, OH Lutheran Medical Center 1730 W 25th St Cleveland, OH Marymount Hospital Mccracken Rd Cleveland, OH Parma Comm General Hospital 7007 Powers Blvd Cleveland, OH South Pointe Hospital Harvard Rd Warrensvl Hts, OH Southwest General Hospital E Bagley Rd Cleveland, OH REHABILITATION Cleveland Clinic Childrens Rehab Hospita 2801 Martin Luther King Jr Dr Cleveland, OH DEFIANCE COUNTY Defiance Regional Medical Center 1200 Ralston Ave Defiance, OH FOR THE MOST UP-TO-DATE INFORMATION CALL THE CUSTOMER SERVICE NUMBER LISTED ON YOUR MEMBER ID CARD OR VISIT 1 THIS LISTING WAS COMPILED AS OF APRIL ANTHEM HAS MADE REASONABLE EFFORTS TO VALIDATE THAT THIS DIRECTORY OF PROVIDERS IS UP TO DATE AND ACCURATE. PLEASE CALL THE PROVIDER PRIOR TO SCHEDULING AN APPOINTMENT TO VERIFY THAT THE PROVIDER CONTINUES TO BE PART OF THE NETWORK. ANTHEM SHALL NOT BE LIABLE FOR ANY LOSSES, DAMAGES, OR UNCOVERED CHARGES AS A RESULT OF USING THIS PROVIDER DIRECTORY OR RECEIVING CARE FROM A PROVIDER LISTED IN THIS DIRECTORY.

15 S DELAWARE COUNTY, OH OHIO LORAIN COUNTY, OH DELAWARE COUNTY Ohio State University Hospital 6515 Pullman Dr Lewis Center, OH ERIE COUNTY Firelands Regional Medical Center 1111 Hayes Ave Sandusky, OH FAIRFIELD COUNTY Fairfield Medical Center 401 N Ewing St Lancaster, OH FRANKLIN COUNTY Arthur James Cancer Inst 1145 Olentangy River Rd Columbus, OH Arthur James Cancer Inst 300 W 10th Ave Columbus, OH Doctors Hospital 5100 W Broad St Columbus, OH Dublin Methodist Hospital 7500 Hospital Dr Dublin, OH Grant Medical Center 111 S Grant Ave Columbus, OH Ohio State University Hospital 1492 E Broad St Columbus, OH Ohio State University Hospital 410 W 10th Ave Columbus, OH Riverside Methodist Hospital 3535 Olentangy River Rd Columbus, OH FULTON COUNTY Fulton County Health Center 725 S Shoop Ave Wauseon, OH HAMILTON COUNTY Bethesda Hospital Inc Montgomery Rd Cincinnati, OH Bethesda Hospital Inc Montgomery Rd Cincinnati, OH Good Samaritan Hospital 375 Dixmyth Ave Cincinnati, OH Mercy Franciscan Hospital Mt Airy 2446 Kipling Ave Cincinnati, OH Mercy Franciscan Hospital Western Hills 3131 Queen City Ave Cincinnati, OH Mercy Hospital Anderson 7500 State Rd Cincinnati, OH HOLMES COUNTY Joel Pomerene Memorial Hospital 981 Wooster Rd Millersburg, OH LORAIN COUNTY Emh Regional Medical Center 254 Cleveland Ave Amherst, OH Emh Regional Medical Center 630 E River St Elyria, OH FOR THE MOST UP-TO-DATE INFORMATION CALL THE CUSTOMER SERVICE NUMBER LISTED ON YOUR MEMBER ID CARD OR VISIT 2 THIS LISTING WAS COMPILED AS OF APRIL ANTHEM HAS MADE REASONABLE EFFORTS TO VALIDATE THAT THIS DIRECTORY OF PROVIDERS IS UP TO DATE AND ACCURATE. PLEASE CALL THE PROVIDER PRIOR TO SCHEDULING AN APPOINTMENT TO VERIFY THAT THE PROVIDER CONTINUES TO BE PART OF THE NETWORK. ANTHEM SHALL NOT BE LIABLE FOR ANY LOSSES, DAMAGES, OR UNCOVERED CHARGES AS A RESULT OF USING THIS PROVIDER DIRECTORY OR RECEIVING CARE FROM A PROVIDER LISTED IN THIS DIRECTORY.

16 S LUCAS COUNTY, OH OHIO SUMMIT COUNTY, OH LUCAS COUNTY Bay Park Community Hospital 2801 Bay Park Dr Oregon, OH Flower Memorial Hospital 5200 Harroun Rd Sylvania, OH Mercy St Charles Hospital 2600 Navarre Ave Oregon, OH St Lukes Hospital 5901 Monclova Rd Maumee, OH Toledo Hospital 2142 N Cove Blvd Toledo, OH REHABILITATION St Lukes Hospital 5901 Monclova Rd Maumee, OH MAHONING COUNTY Northside Medical Center 500 Gypsy Ln Youngstown, OH St Elizabeth Boardman Health Center 8401 Market St Boardman, OH St Elizabeth Health Center 1044 Belmont Ave Po Box 1790 Youngstown, OH MENTAL HEALTH/SUBSTANCE ABUSE FACILITY Belmont Pines Hospital 615 Churchill-hubbard Rd Youngstown, OH REHABILITATION Greenbriar Rehabilitation Hospital 8064 South Ave Ste 1 Boardman, OH MEDINA COUNTY Lodi Community Hospital 225 Elyria St Lodi, OH Medina General Hospital 1000 E Washington St Medina, OH PICKAWAY COUNTY Berger Health System 600 N Pickaway St Circleville, OH PORTAGE COUNTY Robinson Memorial Hospital 6847 N Chestnut St Ravenna, OH SENECA COUNTY Fostoria Community Hospital 501 Van Buren St Fostoria, OH STARK COUNTY Affinity Medical Center 875 8th St Ne Massillon, OH Alliance Community Hospital 200 E State St Alliance, OH Mercy Medical Center 1320 Mercy Dr N W Canton, OH SUMMIT COUNTY Akron General Medical Center 400 Wabash Ave Akron, OH FOR THE MOST UP-TO-DATE INFORMATION CALL THE CUSTOMER SERVICE NUMBER LISTED ON YOUR MEMBER ID CARD OR VISIT 3 THIS LISTING WAS COMPILED AS OF APRIL ANTHEM HAS MADE REASONABLE EFFORTS TO VALIDATE THAT THIS DIRECTORY OF PROVIDERS IS UP TO DATE AND ACCURATE. PLEASE CALL THE PROVIDER PRIOR TO SCHEDULING AN APPOINTMENT TO VERIFY THAT THE PROVIDER CONTINUES TO BE PART OF THE NETWORK. ANTHEM SHALL NOT BE LIABLE FOR ANY LOSSES, DAMAGES, OR UNCOVERED CHARGES AS A RESULT OF USING THIS PROVIDER DIRECTORY OR RECEIVING CARE FROM A PROVIDER LISTED IN THIS DIRECTORY.

17 S SUMMIT COUNTY, OH OHIO RANDOLPH COUNTY, IN Cleveland Clinic 8701 Darrow Rd Twinsburg, OH Crystal Clinic Orthopaedic Center Llc 444 N Main St Akron, OH Edwin Shaw Rehab 330 Broadway St E Cuyahoga Falls, OH Summa Barberton Citizens Hospital 155 5th St Barberton, OH Summa Health System 444 N Main St Akron, OH Summa Health System 525 E Market St Akron, OH Summa Western Reserve Hospital rd St Cuyahoga Falls, OH TRUMBULL COUNTY St Joseph Health Center 667 Eastland Ave Se Warren, OH Trumbull Memorial Hospital 1350 E Market St Warren, OH REHABILITATION Hillside Rehabilitation Hospital 8747 Squires Ln Ne Warren, OH TUSCARAWAS COUNTY Trinity Hospital Twin City 819 N 1st St Dennison, OH WARREN COUNTY Atrium Medical Ctr One Medical Center Dr Middletown, OH WAYNE COUNTY Aultman Orrville Hospital 832 S Main St Orrville, OH INDIANA ADAMS COUNTY Adams Memorial Hospital 1100 Mercer Ave Decatur, IN ALLEN COUNTY Parkview Regional Medical Center Parkview Plaza Dr Fort Wayne, IN Parkview Regional Medical Center 2200 Randallia Dr Fort Wayne, IN REHABILITATION Parkview Hospital Inc 2200 Randallia Dr Fort Wayne, IN DE KALB COUNTY Dekalb Memorial Hospital Inc 1316 E 7th St Auburn, IN RANDOLPH COUNTY St Vincent Randolph Hospital 473 E Greenville Ave Winchester, IN FOR THE MOST UP-TO-DATE INFORMATION CALL THE CUSTOMER SERVICE NUMBER LISTED ON YOUR MEMBER ID CARD OR VISIT 4 THIS LISTING WAS COMPILED AS OF APRIL ANTHEM HAS MADE REASONABLE EFFORTS TO VALIDATE THAT THIS DIRECTORY OF PROVIDERS IS UP TO DATE AND ACCURATE. PLEASE CALL THE PROVIDER PRIOR TO SCHEDULING AN APPOINTMENT TO VERIFY THAT THE PROVIDER CONTINUES TO BE PART OF THE NETWORK. ANTHEM SHALL NOT BE LIABLE FOR ANY LOSSES, DAMAGES, OR UNCOVERED CHARGES AS A RESULT OF USING THIS PROVIDER DIRECTORY OR RECEIVING CARE FROM A PROVIDER LISTED IN THIS DIRECTORY.

18 S STEUBEN COUNTY, IN OHIO KENTON COUNTY, KY STEUBEN COUNTY Cameron Memorial Comm Hospital Inc 416 E Maumee St Angola, IN KENTUCKY BOONE COUNTY St Elizabeth Healthcare 4900 Houston Rd Florence, KY KENTON COUNTY St Elizabeth Healthcare 1 Medical Village Dr Edgewood, KY St Elizabeth Healthcare 1500 James Simpson Jr Way Covington, KY BOYD COUNTY Our Lady Of Bellefonte 1000 Saint Christopher Dr Ashland, KY CAMPBELL COUNTY St Elizabeth Healthcare 85 N Grand Ave Fort Thomas, KY FOR THE MOST UP-TO-DATE INFORMATION CALL THE CUSTOMER SERVICE NUMBER LISTED ON YOUR MEMBER ID CARD OR VISIT 5 THIS LISTING WAS COMPILED AS OF APRIL ANTHEM HAS MADE REASONABLE EFFORTS TO VALIDATE THAT THIS DIRECTORY OF PROVIDERS IS UP TO DATE AND ACCURATE. PLEASE CALL THE PROVIDER PRIOR TO SCHEDULING AN APPOINTMENT TO VERIFY THAT THE PROVIDER CONTINUES TO BE PART OF THE NETWORK. ANTHEM SHALL NOT BE LIABLE FOR ANY LOSSES, DAMAGES, OR UNCOVERED CHARGES AS A RESULT OF USING THIS PROVIDER DIRECTORY OR RECEIVING CARE FROM A PROVIDER LISTED IN THIS DIRECTORY.

19 Adams Memorial Hospital Index Trumbull Memorial Hospital A Adams Memorial Hospital... 4 Affinity Medical Center... 3 Akron General Medical Center... 3 Alliance Community Hospital... 3 Arthur James Cancer Inst... 2 Ashtabula County Medical Center... 1 Atrium Medical Ctr... 4 Aultman Orrville Hospital... 4 B Bay Park Community Hospital... 3 Belmont Pines Hospital... 3 Berger Health System... 3 Bethesda Hospital Inc... 1, 2 C Cameron Memorial Comm Hospital Inc... 5 Cleveland Clinic... 1, 4 Cleveland Clinic Childrens Rehab Hospita... 1 Coshocton County Memorial Hospital... 1 Crystal Clinic Orthopaedic Center Llc... 4 D Defiance Regional Medical Center... 1 Dekalb Memorial Hospital Inc... 4 Doctors Hospital... 2 Dublin Methodist Hospital... 2 E Edwin Shaw Rehab... 4 Emh Regional Medical Center... 2 Euclid Hospital... 1 F Fairfield Medical Center... 2 Fairview General Hospital... 1 Firelands Regional Medical Center... 2 Flower Memorial Hospital... 3 Fostoria Community Hospital... 3 Fulton County Health Center... 2 G Galion Community Hospital... 1 Good Samaritan Hospital... 2 Grant Medical Center... 2 Greenbriar Rehabilitation Hospital... 3 H Hillcrest Hospital... 1 Hillside Rehabilitation Hospital... 4 J Joel Pomerene Memorial Hospital... 2 L Lakewood Hospital...1 Lodi Community Hospital...3 Lutheran Medical Center...1 M Marymount Hospital...1 Mccullough Hyde...1 Medina General Hospital...3 Mercy Franciscan Hospital Mt Airy...2 Mercy Franciscan Hospital Western Hills...2 Mercy Hospital Anderson...2 Mercy Hospital Clermont...1 Mercy Hospital Fairfield...1 Mercy Medical Center...3 Mercy St Charles Hospital...3 N Northside Medical Center...3 O Ohio State University Hospital...2 Our Lady Of Bellefonte...5 P Parkview Hospital Inc...4 Parkview Regional Medical Center...4 Parma Comm General Hospital...1 R Riverside Methodist Hospital...2 Robinson Memorial Hospital...3 S Samaritan Regional Health System...1 South Pointe Hospital...1 Southwest General Hospital...1 St Elizabeth Boardman Health Center...3 St Elizabeth Health Center...3 St Elizabeth Healthcare...5 St Joseph Health Center...4 St Lukes Hospital...3 St Vincent Randolph Hospital...4 Summa Barberton Citizens Hospital...4 Summa Health System...4 Summa Western Reserve Hospital...4 T Toledo Hospital...3 Trinity Hospital Twin City...4 Trumbull Memorial Hospital...4 6