§ 773/296-7157 · (audiologia, lenguaje e ingestion) ...

57-5927

NO POSTAGE NECESSARY IF MAILED

IN THE UNITED STATES

BUSINESS REPLY MAIL FIRST CLASS MAIL PERMIT NO. 57377 CHICAGO, ILLINOIS

POSTAGE WILL BE PAID BY ADDRESSEE

ADVOCATE ILLINOIS MASONIC MEDICAL CENTER ATTN: HISPANOCARE836 W. WELLINGTON AVENUECHICAGO IL 60657-5193

(6065751938)

(773) 296-7157

Proveedores 1. Advocate Illinois Masonic Medical Center 836 W

. Wellington

Chicago, Illinois 60657

773-975-1600 2. Gottlieb Mem

orial Hospital 701W

.North Avenue

Melrose Park, Illinois 60160

708-681-3200 Otros Servicios

§ Advocate Illinois M

asonic Medical C

enter (audiologia, lenguaje e ingestion)

§ C

entro del Ojo (Advocate Illinois M

asonic Medical

Center)

§ Program

a de Descuento (R

ecetas Medicas)

§ C

entro del Ojo (G

ottlieb Mem

orial Hospital)

§ C

entro de Cancer C

reticos (Advocate Illinois Masonic

Medical C

enter) §

Laboratorio Ortésico y Protésico M

D

§ Im

ágenes por Resonancia M

agnética §

Pearle Vision

Los B

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¡APLIQUE AHORA!Los Beneficios de Membresía...

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(773) 296-7157

Proveedores 1. Advocate Illinois Masonic Medical Center 836 W. Wellington Chicago, Illinois 60657 773-975-1600

2. Gottlieb Memorial Hospital 701W.North Avenue Melrose Park, Illinois 60160 708-681-3200 Otros Servicios § Advocate Illinois Masonic Medical Center

(audiologia, lenguaje e ingestion) § Centro del Ojo (Advocate Illinois Masonic Medical

Center) § Programa de Descuento (Recetas Medicas) § Centro del Ojo (Gottlieb Memorial Hospital) § Centro de Cancer Creticos (Advocate Illinois Masonic

Medical Center) § Laboratorio Ortésico y Protésico MD § Imágenes por Resonancia Magnética §

Pearle

Vision

Los Beneficios de Membresia…

¡APLIQUE HOY! ¡APL

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eficios de Mem

bresía...

La Edad de O

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iendo mayor tiene sus ventajas

A program of

Advocate Illinois M

asonic Medical C

enteraffiliated w

ith Gottlieb M

emorial H

ospital

773/296-7157

La Edad de O

ro

The Golden AgeGetting older has its advantages

A program ofAdvocate Illinois Masonic Medical Center

The Golden Age

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The Benefits of Membership…

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836 W. Wellington Chicago, Illinois 60657 773-975-1600

2. Gottlieb Memorial Hospital Otros Servicios

asonic

Los Beneficios de Membres

¡APLIQUE HOY!

57-5927NO POSTAGE NECESSARY IF MAILED





(6065751938)

(773) 296-7157


. Wellington


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orial Hospital 701W

.North Avenue




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La Edad de OroSiendo mayor tiene sus ventajas

Advocate Illinois Masonic Medical Center

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57-5927






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A program of

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773/296-7157

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773-975-1600 2. Gottlieb Mem

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.North Avenue




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773/296-7157

La Edad de Oro

57-5927






(6065751938)

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orial Hospital 701W

.North Avenue




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La Edad de O

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773/296-7157

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Pearle

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¡APLIQUE HOY! ¡APLIQ

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A program of

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773/296-7157

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The Golden Age

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(773) 296-7157


. Wellington


773-975-1600 2. Gottlieb Mem

orial Hospital 701W

.North Avenue




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TheBenefitsofM

embership...

APPLYTODAY!

12/13 57-5928-EN

Hospital Provider:

STE 159

(773) 296-7157

Other Services:• AdvocateIllinoisMasonicEyeCenter• AdvocateIllinoisMasonicMedicalCenter (Audiology,SpeechandSwallowing)• AdvocateIllinoisMasonicMedicalCenter (CreticosCancerCenter)• AdvocateIllinoisMasonicMedicalCenter (NeuroscienceInstitute)• AdvocateIllinoisMasonicMedicalCenter (HeartandVascularInstitute)• PrescriptionDiscountProgram• MDOrthotic&ProstheticLaboratory• OpenMRIofChicago(MRIImaging)• PearleVision(Eyecare,LensesandFrames)

Benefits of Membership

WELCOME The Golden Age, a Medical Discount Program, was started nearly

Hispanocare®, a program of Illinois Masonic Medical Center. This program offers a full range of contacts, providers and services in both English and Spanish. Community education programs and services are offered in both languages to ensure our commitment that all members will be comfortable with their care and obtain the maximum possible benefit from their membership. The Golden Age, a program of Advocate Illinois Masonic Medical Center is not a discount program for people 65 years old and over with Medicare.

An annual membership fee of $

drugs, podiatry and more depending on services and medicare

Audiology – Membership entitles you to enjoy a 20 percent discount at the audiology department of Advocate Illinois Masonic Medical Center in room 3809, 3rd floor. Please remember that a physician referral is required. To schedule an appointment, or if you require additional information, call 773-296-7136.

Dental Care – You are invited to visit the Advocate Illinois Masonic Dental Center and receive a 25 percent discount on usual and customary out-of-pocket dental services. Visit any of the Golden Age private providers and receive a 20 percent discount on those services typically not covered by Medicare.

Eye Care – You will also receive a 20 percent discount on eye glasses, frames, prescription lenses and eye exams at selected Pearle Vision locations and hospital provider sites.

Financial Counseling – Advocate financial counselors are available to provide assistance with Medicare paperwork from 8:30 a.m. to 4:30 p.m. Monday through Friday. Counselors are also available to answer your questions about hospital bills and insurance benefits.

Hospital Services – As an active member of The Golden Age, you will receive 20 percent discount on all hospital services not covered by Medicare at Advocate Illinois Masonic Medical Center.

Co-payments, coinsurance and excluded from these discounts.

Parking – Valet Parking is available for a fee at the main door of the hospitals until 6:00 p.m. This parking service is available for handicapped and special needs patients as well as for individuals who have difficulty walking. For other visitors, parking is available in the main parking lot for a discounted rate.

Prescriptions – Membership in The Golden Age program entitles you to discounts on your prescriptions at over 60,000 pharmacies throughout the United States including Walgreens, Osco and CVS. Just show your NeedyMeds prescription card when filling your prescriptions and start saving. Discounts may vary by drug and are based on availability.

Transportation – Based on availability, transportation to and from Advocate Illinois Masonic Medical Center for medical appointments can be arranged 48 hours in advance for a small fee. Availability is on a first-come first-served basis, so werecommend you call early in the day. Service is not available on Saturday and Sundays, boundary restrictions may apply.

Educational Programs – You are invited and encouraged to attend the Free seminars on a variety of topics related to your health and personal safety.

Health Screenings – We will help to keep your health on track. As a member, you will receive notices about discounted or Free screenings such as, blood pressure checks, flu shots, diabetes screenings and other valuable tests offered regularly.

Golden Age Breakfast Club– Free quarterly breakfast seminars on a variety of topics related to your health and personal safety. Please call 773-296-7157 for a list of current dates.

Questions? – If you have any questions, please call The Golden Age at 773-296-7157 or visit us at: www.hispanocare.org.

The Golden Age® A program of Advocate Illinois Masonic Medical Center

affiliated with Gottlieb Memorial Hospital

SENIOR MEMBER APPLICATION YES! For $15 Annual Fee, I want to join The Golden Age Program

Please complete this application and mail it with your payment in the attached self-addressed stamped envelope to Hispanocare/The Golden Age (no postage is required).

PLEASE PRINT: __________________________________________________ Name

______________________________________________________ Address

______________________________________________________ City State Zip Code

______________________________________________________ Daytime Telephone

________________________/_________________/____________ Date of Birth (required) Gender: � Male � Female I have the following medical coverage: � Medicare

� Medicare HMO

� Medicare and supplemental insurance

� Other: ___________________________________________

I understand that this program offered by Hispanocare

(a program of Advocate Illinois Masonic Medical Center

and affiliated

with Gottlieb Memorial Hospital) is not an insurance plan and that

the benefits may change without notice. Signature

Date

OFFICE USE ONLY Date: _____________ID#__________________Exp:

____________

Code: _________________________ Rep Initials:_____________

Because we are not an insurance, all providers accept any and all pre-existing conditions, have no limitations and have no claim forms to complete. Medicare participants under The Golden Age program will only benefit from services not typically covered by Medicare.

twenty years ago as a part of

20 entitles you to discounts of 20 to 80 percent on medical services, dental care, eye care, prescription

coverage. For your convenience, the following details the program benefits.


WELCOME The Golden Age, a Medical Discount Program, was started nearly nineteen years ago as a part of Hispanocare®, a program of Illinois Masonic Medical Center. This program offers a full range of contacts, providers and services in both English and Spanish. Community education programs and services are offered in both languages to ensure our commitment that all members will be comfortable with their care and obtain the maximum possible benefit from their membership.

Center not a

people 65 and over with Medicare.

An annual membership fee of $15 entitles you to discounts of 20 to

details the program benefits.





Hospital Services – As an active member of The Golden Age, you will receive 20 percent discount on all hospital services not covered by Medicare at Medical Center and Gottlieb Memorial Hospital. Co-payments, coinsurance and deductible amounts (if any) are excluded from these discounts.



Transportation – Based on availability, transportation to and

hours in advanc Availability is on a first-come first-served basis, so we recommend you call early in the day. Service is

apply.

Educational Programs – You are invited and encouraged to attend the Free seminars on a variety of topics related to your health and personal safety.


Golden Age Breakfast Club– Free quarterly breakfast seminars on a variety of topics related to your health and personal safety. Please call 773-296-7157 for a list of current dates.

Questions? –

Age at 773-296-7157 or visit us at: www.hispanocare.org.


SENIOR MEMBER APPLICATION

to join The Golden Age Program Please complete this application and mail it with your payment in the attached self-addressed stamped envelope to Hispanocare/The Golden Age (no postage is required).


______________________________________________________ Address



________________________/_________________/____________ Date of Birth (required) Gender: � Male � Female I have the following medical coverage: � Medicare

� Medicare HMO


� Other: ___________________________________________

I understand that this program offered by Hispanocare (a program of Advocate Illinois Masonic Medical Center)

is not an insurance plan and that

Signature Date

OFFICE USE ONLY

Date: _____________ID#__________________Exp:____________

Code:

_________________________

Rep Initials:_____________



WELCOME The Golden Age, a Medical Discount Program, was started nearly

Masonic Medical Center. This program offers a full range of contacts, providers and services in both English and Spanish. Community education programs and services are offered in both languages to ensure our commitment that all members will be comfortable with their care and obtain the maximum possible benefit from their membership. The Golden Age, a program of Advocate Illinois Masonic Medical Center, affiliated w

An annual membership fee of $15





Hospital Services – As an active member of The Golden Age, you will receive 20 percent discount on all hospital services not covered by Medicare at Advocate Illinois Masonic Medical Center

deductible amounts (if any) are excluded from these discounts.



Transportation – Based on availability, transportation to and from Advocate Illinois Masonic Medical Center and Gottlieb

hours in advty is on a first-come first-

not available on Saturday and Sundays, boundary restrictions may

Educational Programs – You are invited and encouraged to

attend the Free seminars on a variety of topics related to your health

and personal safety.


Golden Age Breakfast Club– Free quarterly breakfast seminars on a variety of topics related to your health and personal

safety. Please call 773-296-7157 for a list of current dates.

Questions? – If you have any questions, please call The Golden


affiliated with Gottlieb Memorial Hospital

SE NIOR MEMBER APPLICATION YES! For $15 Annual Fee, I want

Please complete this application and mail it with your payment in the attached self-addressed stamped envelope to Hispanocare/The Golden Age (no postage is required).


______________________________________________________ Address



________________________/_________________/____________ Date of Birth

(required) Gender

: � Male � Female I have the following medical

coverage: � Medicare

� Medicare HMO


� Other

: ___________________________________________

I understand that this program offered by Hispanocare (a

program of Advocate Illinois Masonic Medical Center and affiliated with Gottlieb Memorial Hospital) is not an insurance plan a

Signature

Date

OFFICE USE ONLY Date: _ ____________

ID#__________________Exp:____________ Code: _________________________ Rep Initials:_____________


the benefits may change without notice.

supplemental insurance plan, but a medical

deductible amounts (if any) are

___________� Medicare Part A � Part B

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