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An Amendment and Summary of Material Modifications (SMM) to the Summary Plan

Description for the Health Savings Plan (HSP) for CVS Health

Effective June 1, 2018

This document is intended to notify you of important plan changes to the HSP for CVS Health administered by Blue Cross and Blue Shield of Illinois, which are effective as of June 1, 2018, unless otherwise noted. This SMM supplements the June

1, 2016 Summary Plan Description (SPD) and June 1, 2017 SMM.

Except as amended by this SMM, all terms, conditions, limitations and exclusions of the SPD as modified by the 2017

SMM will remain in full force and effect. In the event of any discrepancy between this SMM and the SPD as modified by

the 2017 SMM, the provisions of this SMM shall govern.

Last Updated June 2018

Part One – Overview of Modifications to the SPD

1. The Health Savings Account section of the SPD is updated to reflect the IRS limits for annual contributions for 2018 ($3,450 for individual coverage, and $6,900 for family coverage) and to explain that the IRS limits may change in future years.

2. Coverage for Routine Hearing Exams with a Participating Provider is expanded to 100% coverage, no deductible. Additional details are provided for coverage of Diagnostic Hearings Evaluations.

3. Coverage for Preventive Immunizations expanded to include Immunizations required for travel.

4. The COBRA Administrator contact information is updated to reflect the following COBRA Administrator:

CVS Health myHR Service Center PO Box 64059 The Woodlands, TX 77387-4059 1-888-694-7287

5. The Plan’s subrogation and reimbursement terms are updated to reflect administration by Benefit Recovery Group.

6. A change in the description of Eligible Charge and Maximum Allowance to clarify the process for determining the reimbursement level for Non-Participating Providers.

7. The Plan’s rules regarding assignment of benefits is clarified.

The above modifications are effective June 1, 2018. Details on each of the above modifications, including SPD section(s) impacted, are provided under Part Two of this SMM.

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Part Two – SMM Details

1. The Contributing to Your HSA section of the SPD (beginning on page 25) and the 2017 SMM will be updated to reflect the Internal Revenue Services (IRS) limits for annual HSA contributions for 2018 and to explain these IRS limits may change in future years.

As a result, the Contributing to Your HSA section of the SPD on page 25 and page 2 of the 2017 SMM are replaced in their entirety as follows:

Contributing to your HSA You and CVS Health may contribute to your HSA. Each Plan Year running June 1 through May 31, CVS Health will make a tax-free contribution to your HSA based on your annual base salary and whether you cover yourself only or yourself and any dependent, as noted below.

Annual Contribution Annual Base Salary Individual Family $35,000 or less $1,000 $2,000 $35,001 – $80,000 $750 $1,500 $80,001 – $150,000 $500 $1,000 Greater than $150,000 $250 $500

Note: Annual contributions shown are for enrollment for the full Plan Year of June 1 through May 31.

The CVS Health contribution will be made each pay cycle in which you participate in the Health Savings Plan option.

Keep in Mind To receive the CVS Health contribution, you must open your HSA with ConnectYourCare, CVS Health’s HSA administrator, when you enroll in the Health Savings Plan option. Opening an HSA is quick and easy to do, and you don’t need to make a deposit to open an account. You can also open an HSA with another financial institution instead of ConnectYourCare; however, you will not be able to receive CVS Health contributions or make pre-tax payroll contributions unless you have an open ConnectYourCare HSA.

The IRS limits the amount that may be contributed to your HSA each year, which varies depending on whether you have individual coverage or family coverage. For 2018, the IRS limits are $3,450 for individual coverage and $6,900 for family coverage. Also, starting in the year in which you turn age 55, you can also make up to an extra $1,000 annual catch-up contribution. The annual contribution limits are indexed for inflation, and so may change in future years.

There is no “use it or lose it” rule that applies to your HSA, so any balance left at the end of the year remains in your HSA, available for future expenses.

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2. The HSP will cover Routine Hearing Exams performed by Participating Providers at 100% coverage, no deductible. Additional information on the coverage of Diagnostic Hearing Evaluations is provided. As a result, the Benefits Highlights chart on page 33 of the SPD is amended as follows to update coverage of routine hearing examinations to 100% coverage, no deductible and to address Diagnostic Hearing Evaluations:

Percentage of Eligible Expenses Plan Pays

Service Participating

Provider

Non-Participating Provider

Outpatient Care

Hearing Examination

Limited to 1 exam per year

100% coverage, no deductible Not covered

Diagnostic Hearing Evaluation

No frequency limitations

80% after deductible 50% after deductible

Refer to the 2017 SMM for information relating to the coverage of examinations for the prescription or fitting of hearing aids.

The Routine Hearing Examination section at the top of page 48 of the SPD is replaced with the following: Hearing Examinations Benefits will be provided for one routine hearing examination every year with Participating Providers.

Benefits will be provided for diagnostic hearing evaluations (for example examinations that follow routine exams) with Participating Providers and Non-Participating Providers as set forth in the Benefit Highlights, with no annual visit limits.

3. The HSP will expand coverage for Preventive Immunizations to include those needed or required for travel. Travel immunizations will be covered at 100% of allowances, not subject to deductible. There will be no coverage when obtained from a non-participating provider if a participating provider is available.

As a result, the Preventive Care Services section on pages 53 and 54 of the SPD is amended to include the following section at the end for coverage for travel immunizations:

Immunizations required for Travel

Covered services shall include immunizations needed for business or personal travel.

Examples of covered travel immunizations included are Anthrax, Cholera, Meningococcal polysaccharide, Typhoid, Yellow Fever, Japanese Encephalitis and other travel immunizations that are required based on travel destination.

Members are encouraged to call customer service to locate a participating provider or to obtain approval to use a non-participating provider if a participating provider is not available.

The Prescription Drugs (Including Specialty Medications) section of Exclusions on page 81 of the SPD is amended to replace the bullet that reads “immunizations related to travel and work ” with the following:

Immunizations related to work unless needed for business travel.

4. The contact information for the COBRA Administrator referenced within the document will be changed to:

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COBRA Administrator

CVS Health myHR Service Center PO Box 64059 The Woodlands, TX 77387-4059 1-888-694-7287

The above update is made to the SPD for COBRA Contact Information (page 91) and COBRA Administrator (page 127).

5. The Subrogation and Reimbursement provisions are revised to reflect the administration of those terms by the Benefit Recovery Group. Page 111 of the Subrogation and Right of Reimbursement section of the SPD is amended by adding the following language to the beginning of the section:

The subrogation and right of reimbursement rules described below are administered by the Benefit Recovery Group. Benefit Recovery Group P.O. Box 172207 Memphis, TN 38187-2207

Phone: 1-866-384-4051 Fax: 1-901-380-0692

6. The SPD is updated to clarify the process for calculating the Eligible Charge (applicable to

Providers other than Professional Providers) and the Maximum Allowance (applicable to Professional

Providers) for Non-Participating Providers.

As a result, the SPD is updated as follows:

Eligible Charge section of the SPD (page 135) and the 2017 SMM (Under Part Two, section 6)

ELIGIBLE CHARGE.....means (a) in the case of a Provider, other than a Professional Provider, which has a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield Plan to provide care to you at the time Covered Services are rendered, such Provider’s Claim Charge for Covered Services and (b) in the case of a Provider, other than a Professional Provider, which does not have a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield Plan to provide care to you at the time Covered Services are rendered, will be the lesser of:

(i) the Provider’s billed charges, or;

(ii) Blue Cross and Blue Shield of Illinois non-contracting Eligible Charge. Except as otherwise provided in this section, the non-contracting Eligible Charge is developed from base Medicare reimbursements, and is calculated based on a percentage of reimbursement of the Medicare Fee Reimbursement Schedule for Professional, Inpatient & Outpatient. The percentage of Medicare reimbursement for a particular period may vary by geographic location and it is available from Blue Cross Blue Shield of Illinois upon request. The base Medicare reimbursement rate will exclude any Medicare adjustment(s) which is/are based on information on the Claim.

Notwithstanding the above, the non-contracting Eligible Charge for Coordinated Home Care Program Covered Services will be 50% of the Non-Participating Provider’s standard billed charge for such Covered Services.

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When a Medicare reimbursement rate is not available for a Covered Service or is unable to be determined on the information submitted on the Claim, the Eligible Charge for Non-Participating Providers will be 50% of the Non-Participating Provider’s standard billed charge for such Covered Service.

Blue Cross and Blue Shield of Illinois will utilize the same Claim processing rules and/or edits that it utilizes in processing Participating Provider Claims for processing Claims submitted by Non-Participating Providers which may also alter the Eligible Charge for a particular service. In the event Blue Cross and Blue Shield of Illinois does not have any Claim edits or rules, Blue Cross and Blue Shield of Illinois may utilize the Medicare claim rules or edits that are used by Medicare in processing the Claims. The Eligible Charge will not include any additional payments that may be permitted under the Medicare laws or regulations which are not directly attributable to a specific Claim, including, but not limited to, disproportionate share payments and graduate medical education payments.

Any change to the Medicare schedule used for developing reimbursement amounts will be implemented by Blue Cross and Blue Shield of Illinois within 145 days after the effective date that such change is implemented by the Centers for Medicaid and Medicare Services, or its successor.

Maximum Allowance section of the SPD (page 139)

MAXIMUM ALLOWANCE.....means (a) the amount which Participating Professional Providers have agreed to accept as payment in full for a particular Covered Service. All benefit payments for Covered Services rendered by Participating Professional Providers will be based on the Schedule of Maximum Allowances which these Providers have agreed to accept as payment in full. (b) For Non-Participating Professional Providers, the Maximum Allowance will be the lesser of:

(i) the Provider’s billed charges, or;

(ii) Blue Cross and Blue Shield of Illinois non-contracting Maximum Allowance. Except as otherwise provided in this section, the non-contracting Maximum Allowance is developed from base Medicare reimbursements, and is calculated based on a percentage of reimbursement of the Medicare Fee Reimbursement Schedule for Professional, Inpatient & Outpatient. The percentage of Medicare reimbursement for a particular period may vary by geographic location and it is available from Blue Cross Blue Shield of Illinois upon request. The base Medicare reimbursement rate will exclude any Medicare adjustment(s) which is/are based on information on the Claim.

Notwithstanding the above, the non-contracting Maximum Allowance for Coordinated Home Care Program Covered Services will be 50% of the Non-Participating Professional Provider’s standard billed charge for such Covered Services.

When a Medicare reimbursement rate is not available for a Covered Service or is unable to be determined on the information submitted on the Claim, the Maximum Allowance for Non-Participating Professional Providers will be 50% of the Non-Participating Professional Provider’s standard billed charge for such Covered Service.

Blue Cross and Blue Shield of Illinois will utilize the same Claim processing rules and/or edits that it utilizes in processing Participating Professional Provider Claims for processing Claims submitted by Non-Participating Professional Providers which may also alter the Maximum Allowance for a particular service. In the event Blue Cross and Blue Shield of Illinois does not have any Claim edits or rules, Blue Cross and Blue Shield of Illinois may utilize the Medicare claim rules or edits that are used by Medicare in processing the Claims. The Maximum Allowance will not include any additional payments that may be permitted under the Medicare laws or regulations which are not directly attributable to a specific Claim, including, but not limited to, disproportionate share payments and graduate medical education payments.

Any change to the Medicare schedule used for developing reimbursement amount will be implemented by Blue Cross and Blue Shield of Illinois within 145 days after the effective date that such change is implemented by the Centers for Medicaid and Medicare Services, or its successor.

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7. The Plan’s rules on assignment are clarified.

As a result, the “Payment of Claims and Assignment of Benefits” section under General Provisions on page

148 is replaced in its entirety as follows:

When you see a network provider they will usually bill Blue Cross and Blue Shield of Illinois directly. When you see an out-of-network provider, Blue Cross and Blue Shield of Illinois may choose to pay you or to pay the provider directly, but you have no authority or right to obligate Blue Cross and Blue Shield of Illinois to make a direct payment to the provider. Unless Blue Cross and Blue Shield of Illinois has agreed to do so in writing and to the extent allowed by law, Blue Cross and Blue Shield of Illinois will not accept an assignment or transfer of rights under the plan to a provider or facility, including with respect to:

Any benefits due; Any right to receive payments; Any claim you make for damages resulting from a breach, or alleged breach, of the terms of

the plan; or

Any claim for breach of fiduciary duty. Any attempt to assign, transfer, anticipate, alienate, sell, pledge, encumber, charge, levy upon or otherwise dispose of any rights, benefits, or causes of action under the plan shall be void and unenforceable. The plan does not create any right or legal relationship or third-party beneficiary status between the plan sponsor or plan administrator and any health care providers.

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The following notice is added to the end of the SPD:

Notice of Nondiscrimination

CVS Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race,

color, national origin, age, disability, or sex. CVS Health does not exclude people or treat them differently

because of race, color, national origin, age, disability, or sex.

CVS Health:

Provides free aids and services to people with disabilities to communicate effectively with us, such as:

– Qualified sign language interpreters

– Written information in other formats (large print, audio, accessible electronic formats, other formats)

Provides free language services to people whose primary language is not English, such as:

– Qualified interpreters

– Information written in other languages

If you need these services, contact Deanna Szczesny-Williams.

If you believe that CVS Health 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 with: Deanna Szczesny-Williams, HR Shared Services – Benefits, 695 George Washington Road, Mail Code – HR695, Lincoln, RI 02865, 847-559-3808 (telephone), 401-216-3536 (fax), deanna.szczesny-williams@CVSHealth.com (email). You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Deanna Szczesny-Williams is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for

Civil Rights, electronically through the Office 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, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Albanian: KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa

pagesë. Telefononi në 1-847-559-3808 (TTY: 711).

Amharic: ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ

ሚከተለው ቁጥር ይደውሉ 1-847-559-3808 (መስማት ለተሳናቸው: 711).

mailto:deanna.szczesny-williams@CVSHealth.comhttps://ocrportal.hhs.gov/ocr/portal/lobby.jsf/http://www.hhs.gov/ocr/office/file/index.html

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Arabic:

)رقم هاتف الصم والبكم: 3808-559-847-1ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 711.)

Armenian: ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝ Եթե խոսում եք հայերեն, ապա ձեզ անվճար կարող են տրամադրվել լեզվական աջակցության ծառայություններ: Զանգահարեք 1-847-559-3808 (TTY (հեռատիպ)՝ 711):

Assyrian: ܐܵܢ ܐܸܢ: ܙܼܘܵܗܪ

ܲܚܬܘ

ܲܢ ܹܟܐ ܼܐ

ܲܡܸܙܡܼܝܬܘ ܐ ܼܗܲ

ܵܝܵܐ ܸܠܵܫܢ

ܵܪܲܬܘ

ܵܢ ،ܐ

ܲܢ ܵܡܨܼܝܬܘ

ܲܒܠܝܼܬܘ

ܹܬܐ ܕܼܩܲ ܐ ܸܚܠܼܡܲܵܪܬ ܝܼܲ

ܐ ܕܼܗܲܵܐܼܝܬ ܒܸܠܵܫܢ

ܵܵܓܢ ܢ. ܼܡܲ

ܲܠ ܩܪܘ ܼܥܲ

ܐܵ (TTY: 711) 3808-559-847-1 ܸܡܢܵܝܢ

Bassa: Dè ɖɛ nìà kɛ dyéɖé gbo: Ɔ jǔ ké m̀ [Ɓàsɔ́ɔ̀-wùɖù-po-nyɔ̀] jǔ ní, nìí, à wuɖu kà kò ɖò po-poɔ̀ ɓɛ́ìn m̀ gbo kpáa. Ɖá 1-847-559-3808 (TTY:711)

Bengali: লক্ষ্য করুনঃ যদি আপদন বাাংলা, কথা বলতে পাতেন, োহতল দনঃখেচায় ভাষা সহায়ো পদেতষবা উপলব্ধ

আতে। ফ ান করুন ১-847-559-3808 (TTY: 711)। Bisayan: ATENSYON: Kung nagsulti ka og Cebuano, aduna kay magamit nga mga serbisyo sa tabang sa lengguwahe, nga walay bayad. Tawag sa 1-847-559-3808 (TTY: 711).

Burmese:

1-847-559-3808 (TTY: 711)

Cambodian: ប្រយ័ត្ន៖ បរើសិនជាអ្នកនិយាយ ភាសាខ្មែរ, បសវាជនួំយខ្ននកភាសា បោយមិនគិត្ឈ្ន លួ

គឺអាចមានសំរាររ់ំបរ ើអ្នក។ ចូរ ទូរស័ព្ទ 1-847-559-3808 (TTY: 711)។ Catalan: ATENCIÓ: Si parleu Català, teniu disponible un servei d”ajuda lingüística sense cap càrrec. Truqueu al 1-847-559-3808 (TTY o teletip: 711). Chamorro: ATENSIÓN:Yanggen un tungó [I linguahén Chamoru], i setbision linguahé gaige para hagu dibatde ha . Agang I 1-847-559-3808 (TTY: 711). Cherokee: Hagsesda: iyuhno hyiwoniha [tsalagi gawonihisdi]. Call 1 – 847-559-3808 (TTY: 711)

Chinese: 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-847-559-3808（TTY：

711）。

Choctaw: ANOMPA PA PISAH: [Chahta] makilla ish anompoli hokma, kvna hosh Nahollo Anompa ya pipilla hosh chi tosholahinla. Atoko, hattak yvmma im anompoli chi bvnnakmvt, holhtina pa payah: 1-847-559-3808 (TTY: 711). Dinka: PIŊ KENE: Na ye jam në Thuɔŋjaŋ, ke kuɔny yenë kɔc waar thook atɔ̈ kuka lëu yök abac ke cïn wënh cuatë piny. Yuɔpë 1-847-559-3808 (TTY: 711) Dutch: AANDACHT: Als u nederlands spreekt, kunt u gratis gebruikmaken van de taalkundige diensten. Bel 1-847-559-3808 (TTY: 711). Farsi: اگر به زبان فارسی گفتگو می کنيد، تسهيالت زبانی بصورت رايگان برای شما فراهم می باشد. با توجه : 1-847-559-3808 (TTY: 711) تماس بگيريد.

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French: ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-847-559-3808 (ATS : 711). French-Creole: ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-847-559-3808 (TTY: 711). Fulfulde: MAANDO: To a waawi [Adamawa], e woodi ballooji-ma to ekkitaaki wolde caahu. Noddu 1-847-559-3808 (TTY: 711). German: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-847-559-3808 (TTY: 711). Greek: ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται δωρεάν. Καλέστε 1-847-559-3808 (TTY: 711). Gujarati:

સુચના: જો તમે ગજુરાતી બોલતા હો, તો નન:શુલ્ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો 1-847-559-3808 (TTY: 711). Hawaii: E NĀNĀ MAI: Inā hoʻopuka ̒ oe i ka ̒ ōlelo [hoʻokomo ̒ ōlelo], loaʻa ke kōkua manuahi iā ̒ oe. E kelepona iā 1-847-559-3808 (TTY: 711).

Hindi: ध्यान दें: यदद आप द िंदी बोलते ैं तो आपके दलए मुफ्त में भाषा स ायता सेवाएिं उपलब्ध ैं। 1-847-559-3808 (TTY:

711) पर कॉल करें। Hmong: LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-847-559-3808 (TTY: 711). Ibo: Ntị: Ọ bụrụ na asụ Ibo, asụsụ aka ọasu n’efu, defu, aka. call 1-847-559-3808 (TTY: 711). Ilocano: PAKDAAR: Nu saritaem ti Ilocano, ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para kenyam. Awagan ti 1-847-559-3808 (TTY: 711). Indonesian: PERHATIAN: Jika Anda berbicara dalam Bahasa Indonesia, layanan bantuan bahasa akan tersedia secara gratis. Hubungi 1-847-559-3808 (TTY: 711). Italian: ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-847-559-3808 (TTY: 711).

Japanese: 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-847-559-3808（TTY:711）まで、お電話にてご連絡ください。 Karen:

1-847-559-3808 (TTY: 711). Kirundi: ICITONDERWA: Nimba uvuga Ikirundi, uzohabwa serivisi zo gufasha mu ndimi, ku buntu. Woterefona 1-847-559-3808 (TTY: 711).

Korean: 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-847-559-

3808 (TTY: 711)번으로 전화해 주십시오.

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Kurdish:

1- 847-559-قهسه دەکهيت، خزمهتگوزاريهکانی يارمهتی زمان، بهخۆڕايی، بۆ تۆ بهردەسته. پهيوەندی به کوردیئاگاداری: ئهگهر به زمانی 3808 (TTY (711 .بکه

Lao: ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວ ້ າພາສາ ລາວ, ການບໍລິການຊ່ວຍເຫ ຼື ອດ້ານພາສາ, ໂດຍບ່ໍເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້ທາ່ນ. ໂທຣ 1-847-559-3808 (TTY: 711). Marshallese: LALE: Ñe kwōj kōnono Kajin Ṃajōḷ, kwomaroñ bōk jerbal in jipañ ilo kajin ṇe aṃ ejjeḷọk wōṇāān. Kaalọk 1-847-559-3808 (TTY: 711). Navajo: Díí baa akó nínízin: Díí saad bee yáníłti’go Diné Bizaad, saad bee áká’ánída’áwo’dę́ę́’, t’áá jiik’eh, éí ná hólǫ́, kojį’ hódíílnih 1-847-559-3808 (TTY: 711.)

Nepali: ध्यान ददनु ोस्: तपारं्इले नेपाली बोल्नुहुन्छ भने तपारं्इको दनम्ति भाषा स ायता सेवा रू दनिःशुल्क रूपमा उपलब्ध छ ।

फोन गनुु ोस् 1-847-559-3808 (दिदिवार्इ: 711) । Norwegian: MERK: Hvis du snakker norsk, er gratis språkassistansetjenester tilgjengelige for deg. Ring 1-847-559-3808 (TTY: 711). Oromo: XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-847-559-3808 (TTY: 711). Pennsylvania-Dutch: Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 1-847-559-3808 (TTY: 711). Pohnpeian: Ni songen mwohmw ohte, komw pahn sohte anahne kawehwe mesen nting me koatoantoal kan ahpw wasa me ntingie [Lokaiahn Pohnpei] komw kalangan oh ntingidieng ni lokaiahn Pohnpei. Call 1-847-559-3808 (TTY: 711). Polish: UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-847-559-3808 (TTY: 711). Portuguese: ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-847-559-3808 (TTY: 711).

Punjabi: ਧਿਆਨ ਧਿਓ :ਜੇ ਤੁਸ ੀਂ ਪੰਜਾਬ ਬੋਲਿੇ ਹੋ ,ਤਾੀਂ ਭਾਸ਼ਾ ਧ ਿੱਚ ਸਹਾਇਤਾ ਸੇ ਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਿ ਹੈ। 1- 847-559-3808

(TTY: 711) 'ਤੇ ਕਾਲ ਕਰੋ। Romanian: ATENȚIE: Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență lingvistică, gratuit. Sunați la 1-847-559-3808 (TTY: 711). Russian: ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-847-559-3808 (телетайп: 711). Samoan: MO LOU SILAFIA: Afai e te tautala Gagana fa'a Sāmoa, o loo iai auaunaga fesoasoan, e fai fua e leai se totogi, mo oe, Telefoni mai: 1- 847-559-3808. Serbo-Croatian: OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 1-847-559-3808 (TTY- Telefon za osobe sa oštećenim govorom ili sluhom: 711). Spanish: ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-847-559-3808 (TTY: 711).

PLEASE KEEP THIS NOTICE WITH YOUR SUMMARY PLAN DESCRIPTION

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Swahili: KUMBUKA: Ikiwa unazungumza Kiswahili, unaweza kupata, huduma za lugha, bila malipo. Piga simu 1-847-559-3808 (TTY: 711). Tagalog: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-847-559-3808 (TTY: 711).

Teluga: శ్రద్ధ పెట్టండి: ఒకవేళ మీరు తెలుగు భాష మాటా్లడుతున్న ట్యాితే, మీ కొరకు తెలుగు భాషా సహాయక

సేవలు ఉచితంగా లభిసా్తయి. 1-847-559-3808 (TTY: 711) కు కాల్ చేయండి.

Thai: เรียน: ถา้คุณพูดภาษาไทยคุณสามารถใชบ้รกิารช่วยเหลอืทางภาษาไดฟ้ร ี โทร 1-847-559-3808 (TTY: 711). Tongan: FAKATOKANGA’I: Kapau ‘oku ke Lea-Fakatonga, ko e kau tokoni fakatonu lea ‘oku nau fai atu ha tokoni ta’etotongi, pea teke lava ‘o ma’u ia. Telefoni mai 1-847-559-3808 (TTY: 711). Trukese: MEI AUCHEA: Ika iei foosun fonuomw: Foosun Chuuk, iwe en mei tongeni omw kopwe angei aninisin chiakku, ese kamo. Kori 1-847-559-3808 (TTY: 711). Turkish: DİKKAT: Eğer Türkçe konuşuyor iseniz, dil yardımı hizmetlerinden ücretsiz olarak yararlanabilirsiniz. 1-847-559-3808 (TTY: 711) irtibat numaralarını arayın. Ukrainian: УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером 1-847-559-3808 (телетайп: 711). Urdu: 3808-559-847-1خبردار: اگر آپ اردو بولتے ہيں، تو آپ کو زبان کی مدد کی خدمات مفت ميں دستياب ہيں ۔ کال کريں (TTY: 711).

Vietnamese: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-847-559-3808 (TTY: 711). Yiddish: 1אויפמערקזאם: אויב איר רעדט אידיש, זענען פארהאן פאר אייך שפראך הילף סערוויסעס פריי פון אפצאל. רופט-847-559-3808 (TTY: 711). Yoruba: AKIYESI: Ti o ba nso ede Yoruba ofe ni iranlowo lori ede wa fun yin o. E pe ero ibanisoro yi 1-847-559-3808 (TTY: 711).