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Temporary Benefits Addendum

This Temporary Benefits Addendum amends your current MedicareBlue Supplement benefits policy ("Benefits Policy") as described below. Please review this Temporary Benefits Addendum and keep it with your Benefits Policy.

Waiver of Cost-Shares for Covered COVID-19 Treatment Services
Start Date of the Benefit: February 4, 2020
End Date of the Benefit: June 16, 2020

To the extent not already covered by Original Medicare Part A and Part B ("Medicare") or your Benefits Policy, your deductible, coinsurance, and/or copayment will be waived for Covered COVID-19 Treatment Services rendered from February 4, 2020 through June 16, 2020. For purposes of this temporary benefit enhancement, "Covered COVID-19 Treatment Services" means treatment services that are payable by Medicare and for which COVID-19 is identified as a diagnosis.

Waiver of Cost-Shares for Covered COVID-19 Inpatient Treatment Services
Start Date of the Benefit: June 17, 2020
End Date of the Benefit: December 31, 2020

To the extent not already covered by Medicare or your Benefits Policy, your deductible, coinsurance, and/or copayment will be waived for Covered COVID-19 Inpatient Treatment Services rendered from June 17, 2020 through the End Date of the Benefit. For purposes of this temporary benefit enhancement, "Covered COVID-19 Inpatient Treatment Services" means inpatient treatment services that are payable by Medicare and for which COVID-19 is identified as a diagnosis.

Waiver of Cost-Shares for Telehealth Services
Start Date of the Benefit: March 16, 2020
End Date of the Benefit: August 31, 2020

To the extent not already covered by Medicare or your Benefits Policy or waived by your provider, your deductible, coinsurance, and/or copayment will be waived for telehealth services that are payable by Medicare and were rendered from March 16, 2020 through August 31, 2020.

All other terms and provisions of your Benefits Policy, including any amendments we may have issued previously, remain unaltered and in effect.

David S. Brown
Executive Vice President, Chief Financial Officer and Treasurer
Wellmark Blue Cross and Blue Shield of South Dakota