These are the Optional Supplemental Benefits you can buy.

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These are the Optional Supplemental Benefits you can buy. If you are enrolled in Allwell Medicare, you have the choice to customize and enhance your coverage with optional supplemental benefits. For an additional monthly premium of $26, you can take advantage of these great benefits. Comprehensive Dental Buy-up Package Comprehensive Dental Services Annual benefit maximum $1,000 Includes: Diagnostic services, restorative services, endodontics, periodontics, extractions, prosthodontics, oral/maxillofacial surgery and non-routine services. You must use a network provider for this plan Y0020_19_7963TEMP_FINAL_9130_M Accepted 08122018

This information is not a complete description of benefits. Call 1-855-565-9519 (TTY: 711) for more information. The actual complete terms and conditions of the health plan are set forth in the applicable Evidence of Coverage document. From October 1 to March 31, you can call us 7 days a week from 8 a.m. to 8 p.m. From April 1 to September 30, you can call us Monday through Friday from 8 a.m. to 8 p.m. A messaging system is used after hours, weekends, and on federal holidays. Allwell is contracted with Medicare for HMO, HMO SNP and PPO plans, and with some state Medicaid programs. Enrollment in Allwell depends on contract renewal. FLY023903EK00 (8/18)

Section 1557 Non-Discrimination Language Notice of Non-Discrimination Allwell complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Allwell does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Allwell: Provides free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, accessible electronic formats, other formats). Provides free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages. If you need these services, contact Allwell s Member Services telephone number listed for your state on the Member Services Telephone Numbers by State Chart. From October 1 to March 31, you can call us 7 days a week from 8 a.m. to 8 p.m. From April 1 to September 30, you can call us Monday through Friday from 8 a.m. to 8 p.m. A messaging system is used after hours, weekends, and on federal holidays. If you believe that Allwell has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by calling the number in the chart below and telling them you need help filing a grievance; Allwell s Member Services is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Offce for Civil Rights, electronically through the Offce for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019 (TTY: 1-800-537-7697). Complaint forms are available at http://www.hhs.gov/ocr/offce/file/index.html. Member Services Telephone Numbers by State Chart State Telephone Number and Plan Type Arizona 1-800-977-7522/1-877-935-8020 (HMO and HMO SNP) (TTY: 711) Arkansas 1-855-565-9518 (HMO) (TTY: 711) Florida 1-844-293-2636 (HMO); 1-877-935-8022 (HMO SNP) (TTY: 711) Georgia 1-844-890-2326 (HMO); 1-877-725-7748 (HMO SNP) (TTY: 711) Illinois 1-855-766-1736 (HMO) (TTY: 711) Indiana 1-855-766-1541 (HMO and PPO); 1-833-202-4704 (HMO SNP) (TTY: 711) Kansas 1-855-565-9519 (HMO); 1-833-402-6707 (HMO SNP) (TTY: 711) Louisiana 1-855-766-1572 (HMO) (TTY: 711) Mississippi 1-844-786-7711 (HMO); 1-833-260-4124 (HMO SNP) (TTY: 711) Missouri 1-855-766-1452 (HMO); 1-833-298-3361 (HMO SNP) (TTY: 711) New Mexico 1-844-810-7965 (HMO SNP) (TTY: 711) Ohio 1-855-766-1851 (HMO); 1-866-389-7690 (HMO SNP) (TTY: 711) Pennsylvania 1-855-766-1456 (HMO); 1-866-330-9368 (HMO SNP) (TTY: 711) South Carolina 1-855-766-1497 (HMO and HMO SNP) (TTY: 711) Texas 1-844-796-6811 (HMO); 1-877-935-8023 (HMO SNP) (TTY: 711) Wisconsin 1-877-935-8024 (HMO SNP) (TTY: 711) ALL_19_8450FLY_C_ACCEPTED_08012018

Section 1557 Non-Discrimination Language Multi-Language Interpreter Services

Allwell is contracted with Medicare for HMO, HMO SNP and PPO plans, and with some state Medicaid programs. Enrollment in Allwell depends on contract renewal. FLY020520ZK00 (8/18)

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