January 1, 2017 December 31, 2017

SUPERIOR VISION PROVIDER DIRECTORYParamount Elite Supplemental Vision Benefit

PARAMOUNT ELITE IS AN HMO PLAN WITH A MEDICARE CONTRACT.Enrollment in Paramount Elite depends on contract renewal.

This directory is for Paramount Elites service area, which includes the following counties: Allen, Cuyahoga, Defiance, Erie, Fulton, Henry, Lake, Lorain, Lucas, Medina, Ottawa, Sandusky, Williams, and Wood counties, Ohio; and Lenawee and Monroe counties, Michigan.

Paramount Elite will furnish upon request a complete directory of our entire Superior Vision plan provider network. You may use any Superior Vision provider in this Medicare directory (Northwest Ohio/Southeast Michigan and Northeast Ohio).

For more information, please contact Paramount Elite Member Services at 1-800-462-3589 (TTY/TDD users 1-888-740-5670), Monday through Friday, 8:00 a.m. to 8:00 p.m., or visit http://www.paramounthealthcare.com/medicareplans. From October 1 to February 14, you may call 8:00 a.m. to 8:00 p.m., 7 days per week. You may also visit the Superior Vision website at http://www.superiorvision.com for the most current information about participating providers.

The provider network may change at any time. You will receive notice when necessary.

H3653_2017_Superior_Vision_NM Updated August 2016

Paramount Elite (HMO)

Multi-Language Interpreter Services

English ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-800-462-3589 (TTY: 1-888-740-5670).

Albanian: KUJDES: Nse flitni shqip, pr ju ka n dispozicion shrbime t asistencs gjuhsore, pa pages. Telefononi n 1-800-462-3589 (TTY: 1-888-740-5670).

Arabic:

1-008-264-9853 ) . :

.)0765-047-888-1 :

Bengali: , ,

-800-462-3589 (TTY: -888-740-5670)

Chinese: 1-800-4623589 (TTY1-888-740-5670

Cushite: XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-800-462-3589 (TTY: 1-888-740-5670).

Dutch: AANDACHT: Als u nederlands spreekt, kunt u gratis gebruikmaken van de taalkundige diensten. Bel 1-800-462-3589 (TTY: 1-888-740-5670).

French: ATTENTION : Si vous parlez franais, des services d'aide linguistique vous sont proposs gratuitement. Appelez le 1-800-462-3589 (ATS : 1-888-740-5670).

German: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfgung. Rufnummer: 1-800-462-3589 (TTY: 1-888-740-5670).

Italian: ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-800-462-3589 (TTY: 1-888-740-5670).

Japanese: 1-800-462-3589TTY:1-888-740-5670

Paramount Elite is an HMO Plan with a Medicare contract.Enrollment in Paramount Elite (HMO) depends on contract renewal.

H3653_2017_MLI2 Accepted

Korean: : , . 1-800-462-3589 (TTY: 1-888-740-5670) .

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 1-800-462-

3589 (TTY: 1-888-740-5670).

Polish: UWAGA: Jeeli mwisz po polsku, moesz skorzysta z bezpatnej pomocy jzykowej.

Zadzwo pod numer 1-800-462-3589 (TTY: 1-888-740-5670).

Romanian: ATENIE: Dac vorbii limba romn, v stau la dispoziie servicii de asisten

lingvistic, gratuit. Sunai la 1-800-462-3589 (TTY: 1-888-740-5670).

Russian: : ,

. 1-800-462-3589 (: 1-888-740-5670).

Serbo-Croatian: OBAVJETENJE: Ako govorite srpsko-hrvatski, usluge jezike pomoi

dostupne su vam besplatno. Nazovite 1-800-462-3589 (TTY- Telefon za osobe sa oteenim

govorom ili sluhom: 1-888-740-5670).

Spanish: ATENCIN: si habla espaol, tiene a su disposicin servicios gratuitos de asistencia

lingstica. Llame al 1-800-462-3589 (TTY: 1-888-740-5670).

Syriac:

:

1-800-462-3589 (TTY: 1-888-740-5670).

Tagalog: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo

ng tulong sa wika nang walang bayad. Tumawag sa 1-800-462-3589 (TTY: 1-888-740-5670).

Ukrainian: ! ,

. 1-800-462-3589

(: 1-888-740-5670).

Vietnamese: CH : Nu bn ni Ting Vit, c cc dch v h tr ngn ng min ph dnh

cho bn. Gi s 1-800-462-3589 (TTY: 1-888-740-5670).

NOTICE OF NONDISCRIMINATION AND ACCESSIBILITY: DISCRIMINATION IS AGAINST THE LAW

Paramount Elite (HMO) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Paramount Elite does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Paramount Elite: 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 Paramount Elite Member Services at 1-800-462-3589 or, for TTY users, 1-888-740-5670, 8:00 a.m. to 8:00 p.m., Monday through Friday. From October 1 through February 14, we are available 8:00 a.m. to 8:00 p.m. seven days per week.

If you believe that Paramount Elite 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. You can file a grievance in person or by mail, fax, or email.

Paramount Elite Member Services 1901 Indian Wood Circle, Maumee, OH 43537 Phone: 419-887-2525 Toll Free: 1-800-462-3589 TTY: 1-888-740-5670 Fax: 419-887-2047 Email: ParamountMemberServices@ProMedica.org

If you need help filing a grievance, Paramount Elite 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, 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, DC 20201, 1-800-868-1019, 800-537-7697 (TDD).Show citation box Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

H3653_2017_nondiscrim Accepted

Paramount Elite is an HMO Plan with a Medicare contract. Enrollment in Paramount Elite (HMO) depends on contract renewal.

http://www.hhs.gov/ocr/office/file/index.htmlhttps://ocrportal.hhs.gov/ocr/portal/lobby.jsfmailto:ParamountMemberServices@ProMedica.org

SUPERIOR VISION PROVIDER DIRECTORY

FOR PARAMOUNT ELITE ENHANCED VISION BENEFIT

PARAMOUNT ELITE ENHANCED MEDICAL & DRUG (HMO) MEMBERSPARAMOUNT ELITE ENHANCED MEDICAL ONLY (HMO) MEMBERS

Ohio MichiganAllen, Cuyahoga, Defiance, Erie, Fulton, Henry, Lake, Lorain, Lucas, Medina, Ottawa,

Sandusky, Williams, and Wood counties, Ohio; and Lenawee and Monroe counties, Michigan

Insured Plans Underwritten by National Guardian Life Insurance Company

The following symbols appear under each provider listing. Check the listing for the provider you have selected to be certain that the services and products you need are available.GL Eyeglasses are available at this location.CL Contact lenses are available at this location.** Services are not available at this location.

Provider Directory Disclaimer: Superior Vision Services makes every effort to ensure that the information about our provider network and directory is accurate as of the date of printing. As our provider network is constantly growing and as a providers status may occasionally change, Superior Vision Services recommends that members call our Customer Services Department at 1-800-507-3800 to verify a providers current participation in the network. We also suggest that members visit http://www.superiorvision.com to locate and learn about our providers.Please note: The providers listed are those providers who should be used for the Enhanced Vision Hardware Benefit (contact lenses, eyeglass frames and eyeglasses lenses).

Last Updated 7/2016

List of Network Providers

Allen Cuyahoga 1 Ohio

Ohio

Allen

Fishbaugh Family Eyecare Bankey OD, AmyServices: GL CL825 W Market St, Ste 201Lima, OH 45805(419) 227-20201301 N Cable RdLima, OH 45805(419) 227-2020

Fishbaugh Family Eyecare Dietz OD, AndreaServices: GL CL825 W Market St, Ste 201Lima, OH 45805(419) 227-20201301 N Cable RdLima, OH 45805(419) 227-2020

Fishbaugh Family Eyecare Fishbaugh OD, MichaelServices: GL CL1301 N Cable RdLima, OH 45805(419) 227-2020

Fishbaugh Family Eyecare Jerwers OD, DarcieServices: GL CL825 W Market St, Ste 201Lima, OH 45805(419) 227-2020

JCPenney OpticalServices: GL CL2400 Elida RdLima, OH 45805(419) 331-8950

LensCraftersServices: GL CL2400 Elida RdLima, OH 45805(419) 331-5100

Michael J Rader OD Rader OD, MichaelServices: GL CL2155 Allentown RdLima, OH 45805(419) 228-3800

Philip J Shetler OD next to LensCrafters Shetler OD, PhilipServices: ** CL2400 Elida RdLima, OH 45805(419) 331-4040

Ronald L Evilsizor OD Evilsizor OD, RonaldServices: GL CL2155 Allentown RdLima, OH 45805(419) 228-3800

Sears OpticalServices: GL CL2400 Elida RdLim