Claims Administrators Information for Lockheed Martin Corporation retirees



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Claims Administrators Information for Lockheed Martin Corporation retirees This notice constitutes a Summary of Material Modifications (SMM) and provides you with the names, addresses, member services telephone numbers, and Web site addresses for Lockheed Martin Corporation retiree claims administrators and insurance carriers. Please note that this information may change from time to time and is updated periodically. Please keep this notice with your Summary Plan Descriptions (SPDs). If you have any questions, please contact the Lockheed Martin Employee Service Center at: 866-562-2363 Toll-free calls in the U.S. 201-242-4397 International callers 800-833-8334 Hearing impaired Customer service representatives are available Monday through Friday 8 a.m. to 8 p.m. Eastern time, except on holidays. LMC-GL7 G08CAI101

MEDICAL The Lockheed Martin Total Health Plan (plan 069); Medicare Plus Plan (plan 075); Medicare Plus Catastrophic Plan (plan 076); Medicare Supplement Plan (plan 019); Medicare Eligible Retiree Medical Plan (plan 029); Medical Indemnity Plan (022); Preferred Provider Organization (PPO) (plans 099 and 399) These plans are Self Insured and may be available to non-represented and certain formerly represented employees. Aetna Member Services # 888-562-8111 Mailing Address P.O. Box 14586, Lexington, KY 40512-4586 International Indemnity Plan (IIP) This plan is Self Insured and may be available to non-represented and certain formerly represented employees. CIGNA International Expatriate Benefits (plan 011) Member Services # 800-441-2668 or 302-797-3100 Mailing Address P.O. Box 15050, Wilmington, DE 19850-5050 www.cigna.com/cieb Mental Health and Substance Abuse Mental health and substance abuse benefits are Self Insured. The Health Plan Report (HPR) for a medical plan indicates whether CIGNA Behavioral is the claims administrator for mental health and substance abuse benefits. CIGNA Behavioral Health Member Services # 800-455-8187 Mailing Address P.O. Box 44639, Eden Prairie, MN 55344-4639 www.cignabehavioral.com Prescription Drugs The prescription drug benefit is Self Insured. The Health Plan Report (HPR) for a medical plan indicates whether Caremark is the claims administrator for prescription drug benefits. Caremark (formerly PharmaCare) Member Services # 888-562-3784 Mailing Address P.O. Box 2860, Pittsburgh, PA 15230-2860 www.pharmacare.com 1

Designated Provider Network (DPN) and Point of Service (POS) for formerly represented and certain non-represented retirees These plans are Self Insured. The Health Plan Report (HPR) for a medical plan indicates whether Caremark or CIGNA Behavioral Health is the claims administrator for prescription drugs or mental health and substance abuse benefits. Colorado CIGNA, Colorado (plan 102) Member Services # 800-244-6224 Mailing Address P.O. Box 182223, Chattanooga, TN 37422-7223 www.cigna.com Connecticut Aetna, Connecticut (plan 147) Member Services # 888-562-8111 Mailing Address P.O. Box 14586, Lexington, KY 40512-4586 District of Columbia CIGNA, Mid-Atlantic (plan 107) Member Services # 800-244-6224 Mailing Address P.O. Box 182223, Chattanooga, TN 37422-7223 www.cigna.com Florida CIGNA, Florida (plan 103) Member Services # 800-244-6224 Mailing Address P.O. Box 182223, Chattanooga, TN 37422-7223 www.cigna.com Louisiana Aetna, New Orleans (plan 231) Member Services # 888-562-8111 Mailing Address P.O. Box 14586, Lexington, KY 40512-4586 CIGNA, New Orleans (plan 106) Member Services # 800-244-6224 Mailing Address P.O. Box 182223, Chattanooga, TN 37422-7223 www.cigna.com 2

Maine CIGNA, Maine (plan 227) Member Services # 800-244-6224 Mailing Address P.O. Box 182223, Chattanooga, TN 37422-7223 www.cigna.com Maryland CIGNA, Mid-Atlantic (plan 107) Member Services # 800-244-6224 Mailing Address P.O. Box 182223, Chattanooga, TN 37422-7223 www.cigna.com Massachusetts Aetna, Boston (plan 148) Member Services # 888-562-8111 Mailing Address P.O. Box 14586, Lexington, KY 40512-4586 Mississippi Aetna, Gulfport (plan 179) Member Services # 888-562-8111 Mailing Address P.O. Box 14586, Lexington, KY 40512-4586 New Jersey/New York/Pennsylvania Aetna, New Jersey/New York/Pennsylvania (plan 146) Member Services # 800-455-5222 New York Aetna, New York (plan 214) Member Services # 888-562-8111 Mailing Address P.O. Box 14586, Lexington, KY 40512-4586 3

CDPHP (Capital District Physicians Health Plan, Inc.) (plan 145) Member Services # 800-250-5319 Mailing Address Patroon Creek Corporate Center, 1223 Washington Ave. Albany, NY 12206-1057 www.cdphp.com Ohio Aetna, Northeast (plan 207) Member Services # 888-562-8111 Mailing Address P.O. Box 14586, Lexington, KY 40512-4586 Aetna (plan 398) Member Services # 888-562-8111 Mailing Address P.O. Box 14586, Lexington, KY 40512-4586 Rhode Island CIGNA, Rhode Island (plan 228) Member Services # 800-244-6224 Mailing Address P.O. Box 182223, Chattanooga, TN 37422-7223 www.cigna.com Texas Aetna, TX (plans 143 & 144) Member Services # 888-562-8111 Mailing Address P.O. Box 14586, Lexington, KY 40512-4586 Virginia CIGNA, Mid-Atlantic (plan 107) Member Services # 800-244-6224 Mailing Address P.O. Box 182223, Chattanooga, TN 37422-7223 www.cigna.com 4

Health Maintenance Organizations (HMOs) and Managed Care Plans The HMO and Managed Care Plans are generally guaranteed under a contract or policy issued by the HMO, Senior HMO, or Managed Care Plan except as noted. These plans may be available to non-represented and represented retirees. Alabama Blue Cross Blue Shield, Alabama, PPO (plan 234) Member Services # 800-628-3988 Mailing Address P.O. Box 9907, Columbus, GA 31908 www.bcbsga.com Arizona Aetna, Arizona, HMO (plan 250) (Self Insured) Member Services # 800-455-5222 Aetna, Arizona, Senior HMO (plan 724) CIGNA, Arizona, Senior HMO (plan 627) Member Services # 800-627-7534 Mailing Address P.O. Box 38639, Phoenix, AZ 85069 www.cignasenioraz.com PacifiCare, Arizona, HMO (plan 379) Member Services # 800-347-8600 Mailing Address Customer Service Dept., P.O. Box 60125, Phoenix, AZ 85072 www.pacificare.com Secure Horizons, Arizona, Senior HMO (plan 801) Member Services # 888-866-8306 Mailing Address P.O. Box 52078, Phoenix, AZ 85072-2078 www.securehorizons.com Arkansas Health Advantage, HMO (plan 232) Member Services # 866-254-3969 Mailing Address P.O. Box 8069, Little Rock, AR 72203-8069 www.healthadvantage-hmo.com 5

California Blue Cross of California, HMO (plan 307) Member Services # 866-863-0484 Mailing Address P.O. Box 60007, Los Angeles, CA 90060 www.bluecrossca.com Blue Cross of California, Senior HMO (plan 607) Member Services # 800-225-2273 Mailing Address P.O. Box 60007, Los Angeles, CA 90060 www.bluecrossca.com HealthNet, Northern California, HMO (plan 319) Member Services # 800-522-0088 Mailing Address P.O. Box 14702, Lexington, KY 40512 www.healthnet.com HealthNet, Southern California, HMO (plan 320) Member Services # 800-522-0088 Mailing Address P.O. Box 14702, Lexington, KY 40512 www.healthnet.com HealthNet, Northern & Southern California, Senior HMO (plans 719 & 720) Member Services # 800-275-4737 Mailing Address P.O. Box 10198, Van Nuys, CA 91410 www.healthnet.com Kaiser Permanente, Northern California, HMO (plan 259) Member Services # 800-464-4000 or 800-390-3510 Mailing Address Claims Dept., P.O. Box 12923, Oakland, CA 94604-2923 Kaiser Permanente, Northern California, Senior HMO (plan 659) Member Services # 800-443-0815 or 800-464-4000 Mailing Address Claims Dept., P.O. Box 12923, Oakland, CA 94604-2923 Kaiser, Permanente, Southern California, HMO (plan 258) Member Services # 800-464-4000 Mailing Address Claims Administration, P.O. Box 7004, Downey, CA 90242-7004 Kaiser, Permanente, Southern California, Senior HMO (plan 658) Member Services # 800-443-0815 or 800-464-4000 Mailing Address Claims Administration, P.O. Box 7004, Downey, CA 90242-7004 6

PacifiCare Signature Value, Central Coast, HMO (plan 375) Member Services # 800-624-8822 Mailing Address Customer Service Dept., P.O. Box 6006, Cypress, CA 90630 www.pacificare.com PacifiCare Signature Value Advantage, HMO (plan 355) Member Services # 800-624-8822 Mailing Address Customer Service Dept., P.O. Box 6006, Cypress, CA 90630 www.pacificare.com Secure Horizons, Southern California, Senior HMO (plan 755) Member Services # 800-228-2144 Mailing Address P.O. Box 489 M/S CY48-117, Cypress, CA 90630-0489 www.securehorizons.com Colorado HMO Blue Advantage (plan 242) Member Services # 866-863-0484 Mailing Address P.O. Box 60007, Los Angeles, CA 90060 www.anthem.com Kaiser Permanente, Colorado, HMO (plan 252) Member Services # 800-632-9700 or 303-338-3600 Mailing Address P.O. Box 373150, Denver, CO 80237 Kaiser Permanente, Colorado, Senior HMO (plan 652) Member Services # 303-338-3600 Mailing Address Kaiser Permanente, Claims Dept., P.O. Box 373150, Denver, CO 80237 PacifiCare, Colorado, HMO (plan 286) Member Services # 800-877-9777 Mailing Address Customer Service Dept., P.O. Box 4266, Greenwood Village, CO 80155-4266 www.pacificare.com Secure Horizons, Colorado Springs, Denver, Northern & Pueblo Colorado, Senior HMO (plans 686, 802, 804 & 805) Member Services # 800-771-4347 Mailing Address P.O. Box 6770, Englewood, CO 80919 www.securehorizons.com 7

District of Columbia Aetna, District of Columbia, Senior HMO (plan 718) Aetna, Mid-Atlantic, HMO (plan 309) (Self Insured) Member Services # 800-455-5222 Kaiser Permanente, Mid-Atlantic, HMO (plan 254) Member Services # 800-777-7902 or 301-468-6000 Mailing Address P.O. Box 6233, Rockville, MD 20849 www.kp.com Kaiser Permanente, Mid-Atlantic, Senior HMO (plan 654) Member Services # 800-777-7902 or 301-468-6000 Mailing Address P.O. Box 6233, Rockville, MD 20849 www.kp.com Optimum Choice, Mid-Atlantic, HMO (plan 340) Member Services # 800-709-7604 or 800-331-2102 Mailing Address 800 Oak Street, Frederick, MD 21703 www.mamsiunitedhealthcare.com Florida Aetna, Florida, HMO (plan 273) Member Services # 800-323-9930 or 800-756-7039 Mailing Address P.O. Box 14089, Lexington, KY 40512-4089 Aetna, Florida, Senior HMO (plan 705) Blue Cross Blue Shield, Florida Panhandle, PPO (plan 236) Member Services # 800-628-3988 Mailing Address P.O. Box 9907, Columbus, GA 31908 www.bcbsga.com 8

United Healthcare, Florida, EPO (plan 255) Member Services # 888 363 7738 Mailing Address P.O. Box 30555, Salt Lake City, UT 84130-0555 www.myuhc.com Georgia Aetna, Georgia, HMO (plan 397) (Self Insured) Member Services # 800-455-5222 Web address Aetna, Georgia, Senior HMO (plan 708) Web address Aetna, Georgia, Golden Choice Senior PPO (plan 706) Web address Blue Cross Blue Shield (Blue Choice), Southern Georgia, PPO (plan 235) Member Services # 800-628-3988 Mailing Address P.O. Box 9907, Columbus, GA 31908 www.bcbsga.com Blue Cross Blue Shield, Georgia, HMO (plan 303) Member Services # 800-441-2273 Mailing Address P.O. Box 9907, Columbus, GA 31908 www.bcbsga.com CIGNA Healthcare, Georgia, HMO (plan 300) (Self Insured) Member Services # 800-244-6224 Mailing Address P.O. Box 182223, Chattanooga, TN 37422-7223 www.cigna.com Kaiser Foundation Health Plan of Georgia, Inc., HMO (plan 233) Member Services # 800-865-5813 or 404-261-2590 Mailing Address Kaiser Permanente Claims Administration, P.O. Box 190849, Atlanta, GA 31119-0849 9

Kaiser Senior Advantage, Georgia, Inc., HMO (plan 603) Member Services # 800-232-4404 or 404-233-3700 Mailing Address Kaiser Permanente Claims Administration, P.O. Box 190849, Atlanta, GA 31119-0849 www.kp.com Hawaii Hawaii Medical Services, PPO (plan 312) Member Services # 800-776-4672 or 808-948-6111 Mailing Address 818 Keeumoku Street, Honolulu, HI 96814 www.hmsa.com Kaiser Permanente, Hawaii, HMO (plan 253) Member Services # 808-432-7500 or 800-966-5955; 808-432-5955 (Oahu) Mailing Address 80 Mahalani St., Wailuku, HI 96793 Kaiser Permanente, Hawaii, Senior HMO (plan 653) Member Services # 808-432-5955 (Oahu) or 800-966-5955 (Neighbor Islands) Mailing Address 80 Mahalani St., Attn: Affiliate Care, Wailuku, HI 96793 Louisiana Humana, Louisiana, HMO (plan 350) Member Services # 800-448-6262 Mailing Address Humana Claims, P.O. Box 14610, Lexington, KY 40512-4610 www.humana.com Humana, Louisiana, Senior HMO (plan 750) Member Services # 800-457-4708 (claims) or 800-992-2551 (other) Mailing Address P.O. Box 14601, Lexington, KY 40512 www.humana.com Maine Harvard Pilgrim HealthCare, HMO (plan 311) Member Services # 888-333-4742 Mailing Address P.O. Box 699183, Quincy, MA 02269-9183 www.harvardpilgrim.org 10

Maryland Aetna, Maryland, Senior HMO (plan 716) Aetna, Mid-Atlantic, HMO (plan 309) (Self Insured) Member Services # 800-455-5222 Aetna Golden Choice, Maryland, Senior HMO (plan 644) Kaiser Permanente, Mid-Atlantic, HMO (plan 254) Member Services # 800-777-7902 or 301-468-6000 Mailing Address P.O. Box 6233, Rockville, MD 20849 Kaiser Permanente, Mid-Atlantic, Senior HMO (plan 654) Member Services # 800-777-7902 or 301-468-6000 Mailing Address P.O. Box 6233, Rockville, MD 20849 Optimum Choice, Mid-Atlantic, HMO (plan 340) Member Services # 800-709-7604 or 800-331-2102 Mailing Address 800 Oak Street, Frederick, MD 21703 www.mamsiunitedhealthcare.com Massachusetts Harvard Pilgrim HealthCare, HMO (plan 311) Member Services # 888-333-4742 Mailing Address P.O. Box 699183, Quincy, MA 02269-9183 www.harvardpilgrim.org Minnesota HealthPartners, Minnesota, HMO (plan 323) (Self Insured) Member Services # 888-735-9200 or 952-967-7080 Mailing Address P.O. Box 1309, Minneapolis, MN 55440-1309 www.healthpartners.com 11

HealthPartners Freedom Group, Minnesota, Senior HMO (plan 723) Member Services # 800-233-9645 or 952-883-7979 Mailing Address P.O. Box 9463, Minneapolis, MN 55440-9463 www.healthpartners.com Mississippi United Healthcare, Mississippi, HMO (plan 289) Member Services # 800-239-3215 Mailing Address P.O. Box 740800, Atlanta, GA 30374 www.myuhc.com Nevada Secure Horizons, Nevada, Senior HMO (plan 803) Member Services # 866-622-7981 Mailing Address P.O. Box 98319, Las Vegas, NV 89193 www.securehorizons.com New Hampshire Harvard Pilgrim HealthCare, HMO (plan 311) Member Services # 800-333-4742 Mailing Address P.O. Box 699183, Quincy, MA 02269-9183 www.harvardpilgrim.org New Jersey Aetna, New Jersey, HMO (plan 265) (Self Insured) Member Services # 800-455-5222 Aetna, Northern & Southern, New Jersey, Senior PPO (plan 694) Aetna Golden Choice, Northern & Southern, New Jersey, Senior PPO (plans 647 & 673) CIGNA, New Jersey, HMO (plan 337) (Self Insured) Member Services # 800-244-6224 Mailing Address P.O. Box 182223, Chattanooga, TN 37422-7223 www.cigna.com 12

New Mexico CIGNA, New Mexico, HMO (plan 280) (Self Insured) Member Services # 800-244-6224 Mailing Address P.O. Box 182223, Chattanooga, TN 37422-7223 www.cigna.com New York CDPHP (Capital District Physicians Health Plan, Inc.), New York, HMO (plan 293) (Self Insured) Member Services # 800-250-5319 or 518-641-3130 Mailing Address 500 Patroon Creek Blvd., Albany, NY 12206-1057 www.cdphp.com Empire HealthNet, Downstate New York, HMO (plans 328) Member Services # 800-453-0113 Mailing Address P.O. Box 1407, Church Street Station, New York, NY 10008-1434 www.empireblue.com Independent Health, New York, Encompass HMO (plan 308) Member Services # 800-501-3439 Mailing Address 511 Farber Lakes Drive, Buffalo, NY 14221 www.independenthealth.com MVP Health Plan, New York, HMO (plan 341) (Self Insured) Member Services # 800-229-5851 Mailing Address P.O. Box 1434, Schenectady, NY 12301-1434 www.mvpselectcare.com Ohio Anthem, Ohio Blue Preferred, HMO (plan 243) Member Services # 800-552-9159 Mailing Address P.O. Box 37180, Louisville, KY 40233-7180 www.anthem.com Kaiser Permanente, Ohio, HMO (plan 262) Member Services # 800-686-7100 Mailing Address Claims Dept., P.O. Box 5316, Cleveland, OH 44101 Kaiser Permanente, Ohio, Senior HMO (plan 662) Member Services # 800-686-7100 Mailing Address Claims Dept., P.O. Box 5316, Cleveland, OH 44101 13

Oregon Kaiser Permanente, Oregon, HMO (plan 263) Member Services # 800-813-2000 or 503-813-2000 Mailing Address 500 N.E. Multnomah, Suite 100, Portland, OR 97232-2099 Kaiser Permanente, Oregon, HMO (plan 663) Member Services # 800-813-2000 or 503-813-2000 Mailing Address 500 N.E. Multnomah, Suite 100, Portland, OR 97232-2099 Pennsylvania Aetna, Pennsylvania, HMO (plan 326) (Self Insured) Member Services # 800-455-5222 Aetna, Pittsburgh/Western & Southeast Pennsylvania, Senior HMO (plans 697 & 698) Aetna Golden Choice, Pittsburgh/Western & Southeast Pennsylvania, Senior PPO (plans 645 & 661) Geisinger Health Plan, Pennsylvania, HMO (plan 238) Member Services # 800-447-4000 Mailing Address 100 North Academy Ave, Danville, PA 17822-3020 www.thehealthplan.net Geisinger Gold Classic, Pennsylvania, Senior HMO (plan 798) Member Services # 800-498-9731 Mailing Address 100 North Academy Ave, Danville, PA 17822-3020 www.thehealthplan.net Keystone Health Plan, Pennsylvania, HMO (plan 378) Member Services # 800-227-3114 or 215-241-2273 Mailing Address 1901 Market Street, Philadelphia, PA 19103 www.ibx.com 14

Keystone Health Plan, Pennsylvania, Senior HMO (plan 707) Member Services # 800-645-3965 or 215-241-2365 Mailing Address Independence Blue Cross, P.O. Box 898815, Camp Hill, PA 17089-8815 www.site65.com UPMC, Pennsylvania, HMO (plan 248) Member Services # 888-876-2756 Mailing Address P.O. Box 2999, Pittsburg, PA 15230 www.upmchealthplan.com UPMC, Pennsylvania, Senior HMO (plan 681) Member Services # 877-539-3080 Mailing Address P.O. Box 2997, Pittsburg, PA 15230 www.upmchealthplan.com Puerto Rico Triple-S, Puerto Rico, PPO (plan 035) Member Services # 787-774-6060 Mailing Address P.O. Box 363628, San Juan, Perto Rico 00936-3628 www.ssspr.com South Carolina Blue Choice, South Carolina, HMO (plan 376) Member Services # 800-868-2528 Mailing Address P.O. Box 6170, Columbia, SC 29260-6170 www.bluechoicesc.com Texas Aetna, Austin, HMO (plan 370) Member Services # 800-323-9930 or 800-756-7039 Aetna, Dallas/Fort Worth, HMO (plan 274) (Self Insured) Member Services # 800-455-5222 Aetna, Harlingen, PPO (plan 269) (In Network) Member Services # 888-562-8111 Mailing Address P.O. Box 14586, Lexington, KY 40512-4586 15

Aetna, Houston, HMO (plan 296) (Self Insured) Member Services # 800-455-5222 Aetna, San Antonio, HMO (plan 385) Member Services # 800-323-9930 or 800-756-7039 Aetna, Texas, Senior HMO (plan 682) Aetna Golden Choice, Texas, Senior PPO (plan 713) CIGNA, Texas, HMO (plan 240) (Self Insured) Member Services # 800-244-6224 Mailing Address P.O. Box 182223, Chattanooga, TN 37422-7223 www.cigna.com PacifiCare, Texas, HMO (plan 310) Member Services # 800-825-9355 Mailing Address Claims Dept., P.O. Box 29217, San Antonio, TX 78229 www.pacificare.com Secure Horizons, Texas, Senior HMO (plan 807) Member Services # 800-950-9355 Mailing Address P.O. Box 29127, San Antonio, TX 78229 www.securehorizons.com Utah Select Health, Utah, HMO (plan 241) Member Services # 800-538-5038 Mailing Address P.O. Box 30192, Salt Lake City, UT 84130-0192 www.selecthealth.org 16

Virginia Aetna, Mid-Atlantic, HMO (plan 309) (Self Insured) Member Services # 800-455-5222 Aetna, Mid-Atlantic, Senior HMO (plan 683) Aetna Golden Choice, Virginia, Senior PPO (plan 714) Kaiser Permanente, Mid-Atlantic, HMO (plan 254) Member Services # 800-777-7902 or 301-468-6000 Mailing Address P.O. Box 6233, Rockville, MD 20849 Kaiser Permanente, Mid-Atlantic, Senior HMO (plan 654) Member Services # 800-777-7902 or 301-468-6000 Mailing Address P.O. Box 6233, Rockville, MD 20849 Optimum Choice, Mid-Atlantic, HMO (plan 340) Member Services # 800-709-7604 or 800-331-2102 Mailing Address P.O. Box 948, Frederick, MD 21705-0948 www.mamsiunitedhealthcare.com Washington Group Health Cooperative, Washington, HMO (plan 249) Member Services # 888-901-4636 or 206-901-4636 Mailing Address P.O. Box 34585, Seattle, WA 98124-1585 www.ghc.org Group Health Cooperative, Washington, Senior HMO (plan 664) Member Services # 888-901-4636 or 206-901-4636 Mailing Address P.O. Box 34585, Seattle, WA 98124-1585 www.ghc.org 17

DENTAL & VISION Regular Dental The dental plans below are Self Insured. Delta Comprehensive PPO Dental (435) Customer Services # 800-548-5468 Mailing Address P.O. Box 997330, Sacramento, CA 95899-7330 www.deltadentalca.org Vision The vision plans are Fully Insured. EyeMed Vision Care (plans 429 & 433) Customer Services # 866-353-4851 Mailing Address 4000 Luxottica Place, Mason, OH 45040 www.eyemedvisioncare.com LIFE AND OTHER INSURANCES & BENEFITS Life Insurance Life insurance is generally guaranteed under a contract or policy issued by the insurance carrier. Prudential Life Insurance Company of America Customer Services # 800-524-0542 Mailing Address Group Life Claims Division, P.O. Box 8517, Philadelphia, PA 19176 www.prudential.com Aetna Life Insurance Customer Services # 800-523-5065 Mailing Address Service Center, P.O. Box 14549, Lexington, KY 40512-4549 Dependent Optional Team Life Insurance Dependent Optional Term Life Insurance is generally guaranteed under a contract or policy issued by the insurance carrier. Prudential Life Insurance Company of America Customer Services # 800-524-0542 Mailing Address Group Life Claims Division, P.O. Box 8517, Philadelphia, PA 19176 www.prudential.com 18

COBRA Ceridian COBRA Continuation Services Customer Services # 800-272-9651 Mailing Address 3201 34 th Street South, St. Petersburg, FL 33711-3828 www.ceridian-benefits.com 19