... Arkansas BlueCross BlueShield An Independent Licensee of the Blue Cross and Blue Shield Association

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THE SILVER&FIT®

SOMETHING FOR EVERYONE!™

EXERCISE&HEALTHY AGING PROGRAM:

Did you know that as a Silver&Fit member you can go to a fitness center or YMCA for only $25?

It’s true! Some have classes designed for older adults that

you might like. They may also offer dance or yoga studios

and/or swimming pools.*

Don’t want to go to a fitness center? No problem!

You can enroll in the Home Fitness program (for only

$10 per year) and choose up to 2 home fitness kits each

benefit year. These kits may include DVDs, guides, and

other items to help you get fit on your own terms.

All members can also get:

» Healthy Aging classes 4 times a year (online or by mail)

» The Silver Slate® newsletter 4 times a year (online, by email, or by mail)

» The Silver&Fit Connected!™ program, a fun and easy way to track your exercise at a fitness center or through a wearable fitness

device or app and earn rewards*

» Other web tools like a fitness center search, challenges, and online classes

*Services that call for an added fee are not part of the

Silver&Fit program.

Website: www.SilverandFit.com

Silver&Fit Phone Number: Toll-free 1.888.797.8051 (TTY/TDD: 711)

Hours: Monday – Friday, 5 a.m. – 6 p.m. Pacific Time

Fitness center or YMCA to collect annual member fee of $25

Fitness Card Member Information

*Rewards subject to change; purchase of a wearable fitness device or application may be required and is not reimbursed by the Silver&Fit program.

Member Name:

Date of Birth: (month/day)

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Get Started! Pay your annual member fee of $25 directly to the 4 fitness center or YMCA. If you are or would like to

1 Go to www.SilverandFit.com. be a member of 24 Hour Fitness, BFit, Gold’s Gym or LA Fitness, visit us online at

2 Register to use the website. www.SilverandFit.com to pay your annual member fee.

3 Choose a fitness center or YMCA, or sign up for the Home Fitness program.

5 If you prefer, you can call toll-free 1.888.797.8051 (TTY/TDD: 711), Monday through Friday, 5 a.m.

Note: Annual member fees cannot to 6 p.m. Pacific Time to find a fitness center or be refunded. YMCA near you or to enroll into the Home Fitness

program and pay your $10 annual member fee.

Talk to your doctor before you start or change your exercise routine.

Your use of the Silver&Fit Connected! program serves as your consent for American Specialty Health Fitness, Inc. (ASH Fitness) to receive information about your tracked activity and to use that data to process and administer available rewards to you under the program. The Silver&Fit program is provided by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH). All programs and services are not available in all areas. The people in this piece are not Silver&Fit members. Something for Everyone, Silver&Fit, Silver&Fit Connected!, the Silver&Fit logo, and The Silver Slate are trademarks of ASH. This information is not a complete description of benefits. Contact your health plan for more information. Not all YMCAs participate in the network. Please check the searchable directory on the Silver&Fit website to see if your location participates in the program.

The Silver&Fit® program is a product of American Specialty Health Fitness, Inc. an independent company that does not provide Arkansas Blue Cross and Blue Shield products or services. American Specialty Health Fitness, Inc. is solely responsible for the benefits provided by the Silver&Fit® program. Medi-Pak insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. To be eligible for Medi-Pak, you must be enrolled in Medicare Part A and Part B and reside in the state of Arkansas. Plans are guaranteed renewable, premium rates are subject to change upon thirty (30) days’ written notice. Medi-Pak insurance has terms and conditions that may affect coverage. For costs and complete details of the coverage, contact Arkansas Blue Cross and Blue Shield. Our Company complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-844-662-2276. CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-844-662-2276.

Fitness Center/YMCA Information

Customer Service: 1.888.797.8051 (TTY/TDD: 711) Monday – Friday, 5 a.m. – 6 p.m. Pacific Time

The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH).

This Silver&Fit fitness card is not transferable. Use of this card by anyone other than the person named herein is prohibited. This card and photo ID must be shown when the Silver&Fit member is admitted into the fitness center or YMCA. This card is the property of ASH Fitness.

M950-712E-BCBSAR 06/18 Enrollment Flier © 2018 American Specialty Health Incorporated. All rights reserved.

NON-DISCRIMINATION AND LANGUAGE ASSISTANCE NOTICE

NOTICE: Our Company complies with applicable federal and state civil rights laws and does not discriminate, exclude, or treat people differently on the basis of race, color, national origin, age, disability, or sex.

We provide free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters, written information in various formats (large print, audio, accessible electronic formats, other formats), and 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 our Civil Rights Coordinator.

If you believe that we have 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:

Civil Rights Coordinator601 Gaines Street, Little Rock, AR 72201Phone: 1-844-662-2276; TDD: 1-844-662-2275

You can file a grievance in person, by mail, or by email. If you need help filing a grievance our Civil Rights Coordinator 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 Services200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201Phone: 1-800-368-1019; TDD: 1-800-537-7697

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

ATTENTION: Language assistance services, free of charge, are available to you. Call 1-844-662-2276.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-844-662-2276.

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 1-844-662-2276.

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-844-662-2276.

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-844-662-2276 번으로 전화해 주십시오.

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PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-844-662-2276.

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-844-662-2276.

ملاحظة: إذا كنت تتحدث العربية، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. إتصل بالرقم 1-844-662-2276.

ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-844-662-2276.

ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-844-662-2276.

UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-844-662-2276.

ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-844-662-2276.

ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-844-662-2276.

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。1-844-662-2276 まで、お電話にてご連絡ください。

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-844-662-2276.

توجه: اگر به زبان فارسی صحبت می کنيد، خدمات و کمک های زبانی رایگان برای شما موجود است. برای کسب اطلاعات بيشتر، با شماره 2276-662-844-1 تماس بگيرید.

સુચના: જો તમે ગુજરાતી બોલતા હો, તો નિ:શુલ્ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોિ ્કરો 1-844-662-2276.

ध्यान दें: यदि आप �हिी बोलते हैं तो आपके ललए मुफत में भाषा सहायता सेवाएं उपलब्ध हैं। 1-844-662-2276 पर कॉल करें।

LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-844-662-2276.

انتباہ: اگر آپ اردو بولتے ہیں تو، آپ کے لئے زبان کی مدد کی خدمات بلا معاوضہ دستیاب ہیں۔ 2276-662-844-1 پر کال کریں۔

ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ ້ າພາສາ ລາວ, ການບໍ ລິ ການຊ່ວຍເຫຼື ອດ້ານພາສາ, ໂດຍບໍ່ ເສັຽຄ່າ, ແມ່ນມີ ພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-844-662-2276.

LALE: Ñe kwōj kōnono Kajin Ṃajōḷ, kwomaroñ bōk jerbal in jipañ ilo kajin ṇe aṃ ejjeḷọk wōṇāān. Kaalọk 1-844-662-2276.