Health Insurance Guide. for individuals and families

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1 Health Insurance Guide for individuals and families

2 We have the coverage you need. About Farm Bureau Michigan Farm Bureau is the state s largest general farm organization, with almost 200,000 family members in 67 county Farm Bureaus. You don t have to be a farmer to join Farm Bureau and take advantage of our many member benefits. Becoming a part of the Farm Bureau family means joining with other people who share the goal of a prosperous economy and a safe society for today and for the future. For more information, visit our web site at michfb.com. Farm Bureau s exclusive member health insurance plans are underwritten by 4Ever Life Insurance Company and administered by Blue Cross Blue Shield of Michigan. Blue Cross Blue Shield of Michigan does not underwrite or assume any financial risk with respect to claims liability associated with 4 Ever Life underwritten health care products. 4 Ever Life Insuarnce Company, an independent licensee of the Blue Cross and Blue Shield Association, is a wholly owned subsidiary of BCS Financial Corporation. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. You must be a Farm Bureau member and Michigan resident to apply for coverage. Nothing is more important than your health. And that s why health insurance is essential. Farm Bureau wants to provide you the health care you need. At Farm Bureau, we offer a variety of quality health insurance plans underwritten by 4Ever Life Insurance Company and administered by Blue Cross Blue Shield of Michigan... the state s most trusted name in health care. Count on us to guide you through the process and choose the health plan that best suits your needs and your budget. Why Farm Bureau? When you choose Farm Bureau and Blue Cross Blue Shield of Michigan as your health insurance provider, you have a lot of advantages, like: Easy to find an agent you trust. With more than 400 agents across Michigan, you ll find one of our agents in almost every town. If you don t already have an agent, check out our website at fbinsurance-mi.com for list of agents in your area. Easy to understand. We believe in telling it like it is. We ll tell you about our plans and benefits in easy to understand language. Easy to choose. We ll help you select from plans designed to fit your needs. And the Blues nationwide provider network gives you a vast selection of physicians, hospitals and pharmacies to choose from. Easy to afford. Since we offer so many plans in a range of premium prices, you can choose how much to spend in premium versus out-of-pocket expenses. Easy to get the service you need. We believe personal service is essential to a quality health care plan. We ll meet with you face-to-face to help you make adjustments to your policy as your needs change, or to help you with any questions you have about your plan. You ll also have toll-free telephone access to our Personalized Service Unit at Blue Cross Blue Shield of Michigan for claim and benefit questions. It s easy to apply Once you ve narrowed down your choices to a few plans, simply contact your local Farm Bureau Insurance agent to discuss your options and find the plan that best suits your unique situation. Your agent will help you fill out the application for coverage and explain the application process. If you don t currently have an agent, call for a referral or go to our website at mfbhealth.com. Have questions? Visit your local Farm Bureau Insurance agent Check out our website at mfbhealth.com Call us at mfbhealth.com

3 Need help selecting a plan? IF YOU... Are looking for an affordable policy with low premium payments... Are a single adult under age 30 and you want the lowest possible premium payments... Use only basic health care services and want to keep your premium payments low... Don t want to pay a lot for frequent doctor visits for you and the kids... Want a balance of low premium payments and quality coverage... Want a plan that works with a tax-advantaged Health Savings Account Think that robust coverage is more important than the lowest possible cost... Don t want maternity coverage... CONSIDER... Member Value Blue PPO SM Blue Value Options SM PPO CMM-PPO Simply Blue SM PPO HSA Young Member Blue PPO SM Member Value Blue PPO Blue Value Options PPO Community Blue SM PPO Simply Blue SM PPO CMM-PPO Member Value Blue PPO CMM-PPO Blue Value Options PPO Simply Blue PPO HSA Community Blue PPO Simply Blue PPO Young Member Blue PPO Perhaps you ve just left an employer group plan, graduated from college, are looking for a lower cost option, or maybe you re currently uninsured. Whatever your situation, at Farm Bureau we re here to help. Let us give you a few tips to help you choose the right plan for your unique situation and priorities. This chart may be a good starting point for you... Value Plan - Lower premiums, higher out-of-pocket costs, fewer benefits Comprehensive Plan - Higher premiums, more benefits HSA Compatible Plan - Works with a tax-advantaged Health Savings Account A few things to keep in mind Generally speaking, the lower your premiums (or payments), the higher your deductible, which is the amount you pay out-of-pocket before the plan begins paying for expenses. Lower premiums may also mean a higher copay, which is the amount you pay out-of-pocket at doctor visits, hospital stays, etc. after your deductible has been met. The lower your deductible, the higher your premiums will be. Some plans have no deductible at all, which means they begin paying immediately. You ll pay less by using in-network doctors, hospitals, pharmacies and other health care providers who participate in the nationwide Blue Cross Blue Shield network than by using out-of-network doctors mfbhealth.com 3

4 What is an HSA? Myths & Facts about HSAs Myth: HSAs are only for the healthy and wealthy. Fact: Statistics show: No significant difference exists between having an HSA-compatible health plan or a non-compatible plan and reporting average to excellent health % of respondents had an annual household income of less than $85, Myth: HSAs are for the young. Fact: 46% of HSA account holders are age 40 or older. 2 Myth: You must fully fund your HSA account at the beginning of each year. Fact: You decide when and how much to deposit into your HSA account each year (as long as you don t exceed the annual maximum contribution amount). In a lean year, you can just deposit money into your account as medical expenses occur. By putting the money into your account first and then withdrawing it to pay medical expenses, you re eligible for tax savings on the money you put into the account. A Health Savings Account (HSA) is made up of two parts: a qualifying highdeductible health plan and a Health Savings Account. H SA [ Part 1 High Deductible Health Plan Part 2 Health Savings Account A Health Savings Account is a special tax-free savings or investment account that can be used for specific qualified medical expenses by individuals, spouses or dependents. HSAs must be used in conjunction with a qualified high-deductible health plan. You re eligible to open an HSA account if: Intended to cover serious illness or injury once the deductible has been met. Used to cover qualified medical expenses until the deductible has been met. You re enrolled in an HSA-qualified high deductible health plan. You are not enrolled in Medicare or Medicaid. You are not on TRICARE. You have not received any Veterans Administration health benefits in the last three months. You are not covered by another health insurance plan that is not an HSAqualified high-deductible health plan. You are not claimed as a dependent on someone else s tax return. Health Savings Account annual contribution limits IRS requirements for 2012 Single Plan Family Plan Contribution limit $3,100 $6,250 Catch-up contribution (age 55+) $1,000 $1,000 IRS requirements for 2013 Single Plan Family Plan Contribution limit $3,250 $6,450 Catch-up contribution (age 55+) $1,000 $1,000 1 HSA Benchmark Survey. April AHIP Center for Policy and Research. April mfbhealth.com

5 Advantages of an HSA 1. Lower health insurance premiums With a Health Savings Account, you are in control of your health care dollars. Instead of purchasing a traditional high-cost health plan, you purchase a low-cost, high-deductible health plan and put the savings in premium into an HSA account. You control the funds in your HSA and decide how to spend or save the money. Traditional Insurance Premium $ 2. Triple tax advantages The money you deposit into your account is 100% tax-deductible. The interest and gains on the money in your account is tax-exempt. The money you withdraw for qualified medical expenses is tax-free. 3. Future savings High Deductible Insurance Premium $ Premium Savings $ put into HSA Think of an HSA as a medical IRA. Whatever money you don t use in your HSA rolls over from year to year. Any money left in your HSA when you turn 65 is yours to use for any purpose. You ll just pay normal income tax on the money you withdraw for non-medical expenses. Withdrawals for qualified medical expenses are never taxed. Below are examples of how much you could save for the future. These examples are for illustration purposes only. Savings amounts and future values will vary based on actual contribution amounts, medical expenses, number of years the account is in use, Federal and state tax brackets, interest rates and investment options. For illustration purposes, we ve used a federal tax rate of 25%, a state tax rate of 4% and a bank interest rate of 3%. Is an HSA right for you? A high deductible health plan and HSA account may be right for you if: You re interested in more control over how your health care dollars are spent. You want only one deductible per family. You re interested in trading low deductible health insurance for a higher deductible plan to save money on monthly premiums and income taxes. You want to save tax-free money for retirement. You re willing to take responsibility for routine health care expenses in exchange for lower premiums. You d like to use tax-free dollars to pay for qualified medical expenses including prescription drugs, overthe-counter medications, dental work, eyeglasses, acupuncture and much, much more. (For a complete list of qualified medical expenses, visit p502.pdf.) Average contribution per year $2, $3, $5, $3, $5, Average medical expenses per year $ $ $1, $ $1, Net contributions per year $1, $2, $4, $2, $4, Number of years your account will accumulate Net contributions $15, $22, $40, $45, $80, Tax savings on contributions $4, $6, $11, $13, $23, Tax savings on tax-deferred growth $ $ $1, $4, $7, FUTURE VALUE $17, $25, $45, $60, $107,

6 Compare benefits Benefits Deductible (annual) COMPREHENSIVE PLANS Comm. Blue PPO 4&11 Simply Blue PPO 1000 IN-NETWORK Plan 4: $500 per person Plan 11: $1,000 per person (maximum 2 deductibles per family) IN-NETWORK $1,000 per person (maximum 2 deductibles per family) VALUE Young Member Blue PPO IN-NETWORK $1,000 Coinsurance (member s responsibility) Coinsurance maximum (annual) Lifetime benefit maximum Preventive care Office visits Urgent care visits Emergency room Physician inpatient services Hospital services Pre-natal and post-natal care Maternity delivery and nursery care Lab, X-ray and diagnostic services Chiropractic spinal manipulation Physical/Occupational therapy Skilled nursing care Home health care Hospice Durable medical equipment Prescription drug coverage Underwriting required Preexisting condition waiting period Physician choice 20% Plan 4: $1,500 person/$3,000 family Plan 11: 1,000 person/$2,000 family Unlimited $10 copay per visit, unlimited visits $10 copay per visit $50 copay (waived if admitted to hospital or accidental injury). Unlimited days., up to 24 visits, up to 60 visits, up to 120 days, unlimited visits Optional rider. 20% copayment with $20 minimum charge per prescription or refill. Medical underwriting 365 days for members age 19 and older* Use Blue Preferred PPO providers for in-network benefits. Out-ofnetwork you ll have higher out-of-pocket costs and some services may not be covered. 20% $2,500 for one person contracts $5,000 for family contracts Unlimited $30 exam copay* per visit, unlimited visits. $30 exam copay* per visit. $150 copay per visit (copay waived if admitted). Unlimited days. $30 exam copay* per visit, up to 12 visits, up to 30 visits, up to 120 days Optional rider. Copay of $20 for generics; $60 for formulary brand name drugs; $80 or 50% (whichever is greater) with $100 maximum for nonformulary brand name drugs Medical underwriting 365 days for members age 19 and older* Use Blue Preferred PPO providers for in-network benefits. Out-ofnetwork you ll have higher out-of-pocket costs and some services may not be covered. 30% $2,500 per contract Unlimited, up to 120 days (60 day renewal) up to 60 consecutive days/condition. Drug discount available. Medical underwriting 365 days for members age 19 and older* Use Blue Preferred PPO providers for in-network benefits. Out-ofnetwork you ll have higher out-of-pocket costs and some services may not be covered. *Deductible and coinsurance apply to office services provided during the visit including diagnostic, therapeutic and surgery. 6 mfbhealth.com

7 PLANS Member Value Blue PPO IN-NETWORK None 30% HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLE PLANS Simply Blue PPO HSA CMM-PPO Blue Value Options PPO IN-NETWORK $1,250 for one-person $2,500 for a family (one deductible per family) 20% IN-NETWORK Low Option $1,250 for oneperson or $2,500 for family High Option $2,500 for oneperson or $5,000 for family (one deductible per family) 20% IN-NETWORK $2,000 for one-person $4,000 for family (one deductible per family) 30% $2,500 per contract Unlimited Covered 70% $1,000 for a one-person contract $2,000 for a family contract Unlimited, unlimited visits Covered 80% after deductilbe $1,000 per contract Unlimited, unlimited visits $3,000 for a one-person contract $6,000 for a family contract Unlimited Covered 70% Covered 70%, up to 120 days (60 day renewal) Covered 70%, unlimited days, unlimited days, up to 365 days (60 day renewal) Covered 70% Covered 70% up to 60 consecutive days per condition Covered 70%, up to 12 visits, up to 30 visits, up to 90 days, unlimited visits, up to 60 visits Covered 50% with a minimum copay of $10 and a maximum of $100 per prescription. Medical underwriting 365 days for members age 19 and older* Use Blue Preferred PPO providers for in-network benefits. Out-ofnetwork you ll have higher out-of-pocket costs and some services may not be covered. Covered after deductible with copay of $20 for generics; $60 for formulary brand names; $80 or 50% (whichever is greater) with $100 maximum for nonformulary brand name drugs Medical underwriting 365 days for members age 19 and older* Use Blue Preferred PPO providers for in-network benefits. Out-ofnetwork you ll have higher out-of-pocket costs and some services may not be covered.. Drug discount available.. Drug discount available. Medical underwriting Medical underwriting 365 days for members age 19 and 365 days for members age 19 and older* older* 7 Use Blue Preferred PPO providers Use Blue Preferred PPO providers for in-network benefits. Out-ofnetwork for in-network benefits. Out-of- you ll have higher network you ll have higher out-of-pocket costs and some out-of-pocket costs and some services may not be covered. services 7 may not be covered mfbhealth.com 7

8 Here s what else you get! Farm Bureau Member-Only Wellness Benefits Pharmacy discounts Save up to 60% off brand and generic drugs at participating pharmacies nationwide when you show your Farm Bureau membership ID card. (The Clarity program is not an insurance benefit and cannot be combined with any other discount or insurance programs.) The Clarity program also offers discount prescription drugs through the mail. Lasik eye surgery discount Save up to 50% on LASIK eye surgery with Farm Bureau s discount through QualSight. Hearing aids discount Save up to 15% off the purchase price on hearing aids with Farm Bureau s discount through Beltone. Eyeglasses discounts Save on eyeglass frames and lenses with Farm Bureau s discount program through PearleVision. Save on exams, eyeglasses and contact lenses with Farm Bureau s discount program through RxOptical Vision Advantage program. Member Secured Services Once you re enrolled in one of our health plans, you can log into the Blues web site at bcbsm.com and take advantage of a host of Member Secured Services. View details on who s covered on your plan, what your plan covers, track your deductible and coinsurance totals, inquire about a claim, pay your premium bill, sign up for electronic explanation of benefits statements, request ID cards and much, much more. With your Blues plan, you ll have also access to free tools and resources that will help you stay healthy, like: BlueHealthConnection online tools Gives you access to a variety of health and wellness information, available 24 hours a day, every day, through Member Secured Services. You ll have the latest information on health and wellness as well as digital health coaching and a tailored health assessment. Get Connected to Your Health This 24/7 nurse line provides you access to a registered nurses, supported by board-certified physicians, for general medical questions and to help you determine whether to seek medical care. Quit the Nic! Quit smoking for good with this smoking cessation program. Healthy Blue Xtras SM Healthy Blue Xtras is a local program that offers big savings and special discounts to Blue Cross Blue Shield of Michigan members. Enjoy exclusive savings on healthy products and services from groceries to fitness gear and travel from companies across the great state of Michigan. Blue365 Blue365 is a nationwide program that Blue Cross Blue Shield of Michigan members can take of advantage of to save on products and services for a well balanced lifestyle. Blue365 provides members with access to a wide range of savings from top health and wellness brands around the country, weekly Featured Deals and long term Ongoing Deals on healthy products, along with discounts on health and fitness clubs, weight-loss programs, healthy travel experiences, and so much more. Summary of Benefits & Coverage A Summary of Benefits and Coverage (SBC) related to the coverage outlined in this brochure is available on the Web at michfb.com. The SBC is not a contract and only provides a general overview of coverage information. If there is any difference or discrepancy between the SBC and any applicable plan document (including certificates and riders), the plan document will take precedence. A paper copy of the SBC is also available, free of charge, by calling For more Farm Bureau member-only benefits and discounts, visit michfb.com/benefits. 8 mfbhealth.com

9 What you need to know Eligibility requirements To qualify for coverage, you must meet all of the following criteria: You are a Farm Bureau member. You are a Michigan resident and live in the state for a minimum of six months each year. You are not eligible for Blues group coverage through an employer. Your employer does not pay for or reimburse any part of your health insurance premiums. You do not have Medicare, Medicaid, group or any other health insurance coverage. Family members must be written on the same contract. You must not have had prior Farm Bureau sponsored member-only health coverage that canceled within the past year. How to apply for health or dental coverage To apply for coverage or for more information about any of Farm Bureau s member health or dental insurance plans, call or visit your local Farm Bureau Insurance agent or county Farm Bureau office. For the phone number and location of the office nearest you, call or visit our web site at mfbhealth.com. Application process for a Farm Bureau member health plan The application process generally takes days, depending on whether or not the medical underwriter requests medical records from your doctors and how quickly you return those records to her. If you re approved, your effective date will be determined by the medical underwriter based on the date all your necessary health information is received. Our effective dates for coverage are future dates and are always on the 20th of the month. Your coverage will become effective on the date assigned by the medical underwriter once you have paid your first premium payment. This is a prepaid health coverage plan. Claims will not be paid and acknowledgement of coverage will not be given until the first premium payment is made. About medical underwriting Farm Bureau s exclusive member-only plans are underwritten by 4Ever Life Insurance Company and administered by Blue Cross Blue Shield of Michigan. Medical underwriting is required. You will be asked to complete a health questionnaire and additional information may be requested from your health care providers. If you have serious or chronic health conditions, you may be denied coverage, or if accepted, assigned a higher premium rate. What is a pre-existing condition waiting period? A health condition for which you have had medical advice, diagnosis, care or treatment recommended or received within six months prior to enrollment is considered a pre-existing condition. If you have a pre-existing condition, there will be an initial waiting period from the start date of your coverage for which related claims may not be reimbursable. This period is 365 days. You cannot waive this waiting period. Effective January 1, 2011, the preexisting condition waiting period does not apply to children under age 19. Automatic Payment Plan The Blues Automatic Payment Plan offers the convenience of paying your health care bill on time, every time. No need to write checks, mail payments or worry about late payments resulting in rejected services. There is no charge for this service. To participate, simply register for ebilling online in the Member Secured Area of bcbsm.com. If you don t have Interent access, you can fill out and mail in the automatic payment plan form. If you re mailing in the form, please include a voided check from your designated account for verification. Please allow three to four weeks for processing your application. If you need to change your banking information in the future, just submit a new automatic payment plan enrollment form and allow three to four weeks for processing. To cancel this service, fax your cancellation notice to VALUED MEMBER

10 Member dental insurance Farm Bureau s member dental plan offers quality coverage from Blue Cross Blue Shield of Michigan... the state s most trusted name in health care. We guarantee your acceptance Farm Bureau members who apply for our member dental plan are guaranteed acceptance into the plan. The member dental plan is a separate, stand-alone policy. You do not have to purchase member health insurance to purchase a member dental insurance policy. Use any dentist you choose With Farm Bureau s Traditional Plus dental plan, you have the freedom to choose any licensed dentist. Network dentist or not you re covered. You have three options when selecting a dentist: Blue Par Select SM dentist Blue Par Select dentists agree to participate on a per claim basis. So before each procedure, ask whether your dentist participates. Almost all dentists participate with the Blues under this arrangement. Dental Network of America dentist DNoA Preferred Network dentists always participate and give you discounts of 20 to 40 percent off usual charges and lower out-of-pocket costs than non-network dentists. Finding a DNoA network dentist is easy. Our network has more than 4,300 dentist access points* in Michigan and more than 185,300 dentist access points nationwide. Visit bcbsm.com to learn more and locate a DNoA dentist in your area. Blue Par Select and DNoA Preferred Network dentists will file all claims for you and receive payment directly from the Blues. You ll only be responsible for paying the dentist your deductible, coinsurance and any fees for non-covered services. Nonparticipating dentist You may visit nonparticipating dentists, but you may be charged for the difference between the Blues approved amount and the dentist s charge. This amount is in addition to your deductible and coinsurance. You usually have the highest out-of-pocket costs with this option. Nonparticipating dentists will often file claims for you, but the claim is submitted as pay subscriber, which means you receive reimbursement directly from the Blues. You are then responsible for paying the dentist. Effective dates of coverage and waiting periods Applications for dental coverage submitted to Michigan Farm Bureau by the 10th of a month will have an effective date of the 20th of the same month for Class 1 (preventive) services. There is a six-month waiting period from your effective date of coverage for Class 2 (restorative) and Class 3 (constructive) services. Eligibility requirements To qualify for dental coverage, you must meet all of the following criteria: You are a Farm Bureau member. You are a Michigan resident and live in the state for a minimum of six months each year. You have not had prior Farm Bureau-sponsored Blues dental coverage that canceled within the past year. Family members must be on the same dental care contract. *A dentist access point is any place a member can see a dentist to receive high-quality dental care. Example: One dentist practicing in two locations would be two access points. 10 mfbhealth.com

11 Dental benefits-at-a-glance Member s responsibility Annual deductible (2 deductibles per family)...$50 per person Class 1 coinsurance...25% Class 2 & 3 coinsurance...50% Annual benefit maximum...$1,200 per person Class 1 services (preventive) Oral exams... 75%, twice per calendar year Bitewing x-rays... 75%, twice per calendar year Full-mouth and panoramic x-rays... 75%, once every 60 months Teeth cleaning... 75%, twice per calendar year Fluoride treatment... 75%, twice per calendar year Space maintainers...75%, one per quadrant per lifetime, up to age 19 Palliative emergency treatment...75% Sealants (for members age 19 or under)... 75%, once per tooth every 36 months Class 2 services (restorative) Fillings - permanent teeth...50%, once every 24 months per tooth Fillings - primary teeth...50%, once every 12 months per tooth Inlays, onlays, crowns and gold fillings (perm. teeth)... 50%, once every 60 months Recementing of inlays, onlays, crowns and bridges... 50%, three per calendar year Root canal therapy... 50%, once every 12 months Periodontal scaling and planing... 50%, once every 24 months Occlusal adjustment...50%, up to 5 times per 60 month period Periodontic appliances or biteguards... 50%, once every 12 months General anesthesia or IV sedation (oral or dental surgery)...50% Extractions - simple and surgical...50% Relining or rebasing of partials or dentures... 50%, once every 36 months per arch Tissue conditioning...50%, once every 36 months per arch Repairs to existing partials or dentures...50%, every 12 months Did you know? Proper dental care is essential to your overall well-being. The lack of dental care can lead to major complications including infections, tooth decay, tooth loss, gum disease and more. Increasing evidence also links gum diseases to heart disease and diabetes. Regular dental checkups and professional cleanings can prevent most dental problems from developing. And a good dental insurance policy can help you pay for regular dental care. Farm Bureau wants to provide you the dental care you need at a price you can afford. Class 3 services (constructive) Removable dentures and partials... 50%, once every 60 months Fixed bridges... 50%, once every 60 months Endosteal implants - for members age 16 or older...50%, once per tooth Class 4 services (orthodontics) Orthodontics (braces)... This is intended as an easy-to-read summary and provides only a general overview of your benefits. It is not a contract. Additional limitations and restrictions may apply. Payment amounts are based on BCBSM s approved amount, less any applicable deductibles and coinsurances.

12 Glossary of terms To help you understand your health care options, here are a few definitions of terms you may see in this brochure. The Blues Blue Cross Blue Shield of Michigan. Coinsurance A designated percentage of the BCBSM-approved amount you pay for certain medical services. For example, you may pay 20% of the approved amount for a medical service and your health insurance plan would pay the remaining 80%. Coinsurance maximum The maximum amount of coinsurance you would be required to pay in a calendar year before your health insurance plan would start to pay 100% of your covered benefits. Copayment (copay) A designated dollar amount you pay for certain covered medical services. Covered services Services, treatments or supplies identified as payable in your certificate and riders. Covered services must be medically necessary to be payable, unless otherwise specified. Deductible A deductible is a fixed amount you must pay toward covered medical services each year before benefits are payable by the health plan. On a Value or Comprehensive plan, two or more members must meet the family deductible. If the individual deductible has been met, but not the family deductible, the health plan will pay covered services only for that member. Covered services for the remaining family members will be paid when the full family deductible has been met. On an HSA-compatible health plan, you have one deductible per family. All covered services for all family members will be credited toward that one family deductible. One or more family members may satisfy the family deductible. The entire deductible must be met before covered services are paid. Exclusions Medical services that are not covered by your insurance policy. In-network Providers or health care facilities that are part of a health plan s network of providers with which it has negotiated a discount. You will usually pay less when using an in-network provider, because those networks provide services at lower cost to the insurance companies with which they have contracts. Lifetime benefit maximum The maximum dollar amount your insurance plan will pay out in benefits for each individual on your policy over the course of his or her lifetime. Pre-existing condition waiting period If you have a pre-existing health condition at the time you apply for health insurance, there may be an initial waiting period from the start date of your coverage for which related claims may not be reimbursable. Premium The amount charged, often in installments, for an insurance policy. Provider A person (such as a physician) or facility (such as a hospital) that provides services or supplies related to medical care. Out-of-network Providers or health care facilities that are not part of a health plan s network of providers. Rider A legal document that amends a certificate by adding, limiting or clarifying benefits. Services Care, procedures and supplies from a health care provider to diagnose or treat medical conditions. The fine print This brochure is intended as an easyto-read guide. It is not a contract. Additional limitations and exclusions may apply to covered services. Not all health services are covered. An official description of benefits is contained in applicable 4Ever Life Insurance Company certificates and riders. Plan features are subject to change. Payment amounts are based on the Blue Cross Blue Shield-approved amount, less any applicable deductible, coinsurance or copay amounts required by the plan. A 365-day waiting period is applied on all Farm Bureau exclusive member plans for pre-existing medical conditions, removal of tonsils and/or adenoids, voluntary sterilization and maternity coverage. If you are pregnant on the date the Blues receives your application for coverage, the pregnancy will not be covered. If your date of conception is after the date the Blues receives your application, and you re approved for coverage, the maternity will be covered from your paid effective date of coverage forward. Note: Maternity coverage is not available on the Young Member Blue PPO plan. Effective January 1, 2011, children under age 19 are not subject to the pre-existing condition waiting period. If you receive care from a nonparticipating provider, even if referred, you may be billed for the difference between the Blues-approved amount and the provider s charge. This coverage is provided pursuant to a contract entered into in the state of Michigan and shall be construed under the jurisdiction and according to the laws of the state of Michigan. 12 mfbhealth.com MFB# 110 NOV2012

13 Member Individual and Family Health Insurance Premium Rates Preferred Premium Rates (monthly) for non-smokers with no chronic or severe health conditions Number Age Plan Deductible of People Young Member $1,000 One Person $47.76 Young Member Blue PPO is not available Blue PPO to members over age 30. WITHOUT drugs Number Under Plan Deductible of People Age 35 Age Age Age Age Member Value None One Person $ $ $ $ $ Blue PPO Two Persons $ $ $ $ $ WITH drug coverage Family $ $ $ $ $1, HSA CMM-PPO $1,200/$1,250* single One Person $ $ $ $ $ low option $2,400/$2,500* family Two Persons $ $ $ $ $1, WITHOUT drugs (1 deductible/family) Family $ $ $ $1, $1, HSA CMM-PPO $2,500 single One Person $ $ $ $ $ high option $5,000 family Two Persons $ $ $ $ $1, WITHOUT drugs (1 deductible/family) Family $ $ $ $1, $1, HSA Blue Value $2,000 single One Person $ $ $ $ $ Option PPO $4,000 family Two Persons $ $ $ $ $ WITHOUT drugs (1 deductible/family) Family $ $ $ $ $ HSA Simply Blue $1,250 single One Person $ $ $ $ $ PPO 1250 $2,500 family Two Persons $ $ $1, $1, $1, WITH drug coverage (1 deductible/family) Family $ $1, $1, $1, $2, Simply Blue PPO $1,000 per person One Person $ $ $ $ $ (max. 2 deductibles Two Persons $ $ $ $1, $1, WITHOUT drugs per family) Family $ $ $1, $1, $1, Simply Blue PPO $1,000 per person One Person $ $ $ $ $ (max. 2 deductibles Two Persons $ $ $ $1, $1, WITH drug coverage per family) Family $ $ $1, $1, $1, Community Blue $500 per person One Person $ $ $ $ $ PPO Plan #4 (max. 2 deductibles Two Persons $ $ $1, $1, $1, WITHOUT drugs per family) Family $1, $1, $1, $1, $2, Community Blue $500 per person One Person $ $ $ $ $ PPO Plan #4 (max. 2 deductibles Two Persons $1, $1, $1, $1, $2, WITH drug coverage per family) Family $1, $1, $1, $2, $2, Community Blue $1,000 per person One Person $ $ $ $ $ PPO Plan #11 (max. 2 deductibles Two Persons $ $ $ $1, $1, WITHOUT drugs per family) Family $ $ $1, $1, $1, Community Blue $1,000 per person One Person $ $ $ $ $ PPO Plan #11 (max. 2 deductibles Two Persons $ $1, $1, $1, $1, WITH drug coverage per family) Family $1, $1, $1, $1, $2, *HSA CMM-PPO Low Option deductible amounts will change in 2013 due to IRS guidelines deductible amounts are listed first, followed by 2013 deductible amounts. Premium rates effective: September 20, August 19, 2013 Premium rates represent the cost of one month of coverage. Members are billed monthly. These rates are good through August 19, The age categories are based on the age of the named subscriber, the person whose name appears at the top of the application for coverage. Preferred rates are for healthy, non-smokers. If you smoke or have preexisting chronic or severe health conditions, you may be denied coverage, or, if accepted, assigned a standard rate which is higher than the preferred rate. 4Ever Life Insurance Company medical underwriters will determine which rate you are assigned based on your medical history. Farm Bureau s exclusive member health insurance plans are underwritten by 4Ever Life Insurance Company and administered by Blue Cross Blue Shield of Michigan mfbhealth.com

14 Member Individual and Family Health Insurance Premium Rates Standard Premium Rates (monthly) for smokers and those with chronic or severe health conditions Number Age Plan Deductible of People Young Member $1,000 One Person $59.70 Young Member Blue PPO is not available Blue PPO to members over age 30. WITHOUT drugs Number Under Plan Deductible of People Age 35 Age Age Age Age Member Value None One Person $ $ $ $ $ Blue PPO Two Persons $ $ $ $ $1, WITH drug coverage Family $ $ $ $ $1, HSA CMM-PPO $1,200/$1,250* single One Person $ $ $ $ $ low option $2,400/$2,500* family Two Persons $ $ $ $1, $1, WITHOUT drugs (1 deductible/family) Family $ $ $1, $1, $1, HSA CMM-PPO $2,500 single One Person $ $ $ $ $ high option $5,000 family Two Persons $ $ $ $1, $1, WITHOUT drugs (1 deductible/family) Family $ $ $1, $1, $1, HSA Blue Value $2,000 single One Person $ $ $ $ $ Option PPO $4,000 family Two Persons $ $ $ $ $ WITHOUT drugs (1 deductible/family) Family $ $ $ $ $1, HSA Simply Blue $1,250 single One Person $ $ $ $ $ PPO 1250 $2,500 family Two Person $ $1, $1, $1, $2, WITH drug coverage (1 deductible/family) Family $1, $1, $1, $2, $2, Simply Blue PPO $1,000 per person One Person $ $ $ $ $ (max. 2 deductibles Two Person $ $ $1, $1, $1, WITHOUT drugs per family) Family $ $1, $1, $1, $2, Simply Blue PPO $1,000 per person One Person $ $ $ $ $ (max. 2 deductibles Two Person $ $ $1, $1, $1, WITH drug coverage per family) Family $1, $1, $1, $1, $2, Community Blue $500 per person One Person $ $ $ $ $ PPO Plan #4 (max. 2 deductibles Two Persons $1, $1, $1, $1, $2, WITHOUT drugs per family) Family $1, $1, $1, $2, $2, Community Blue $500 per person One Person $ $ $ $ $1, PPO Plan #4 (max. 2 deductibles Two Persons $1, $1, $1, $2, $2, WITH drug coverage per family) Family $1, $1, $2, $2, $3, Community Blue $1,000 per person One Person $ $ $ $ $ PPO Plan #11 (max. 2 deductibles Two Persons $ $ $1, $1, $1, WITHOUT drugs per family) Family $1, $1, $1, $1, $2, Community Blue $1,000 per person One Person $ $ $ $ $ PPO Plan #11 (max. 2 deductibles Two Persons $1, $1, $1, $1, $2, WITH drug coverage per family) Family $1, $1, $1, $2, $2, *HSA CMM-PPO Low Option deductible amounts will change in 2013 due to IRS guidelines deductible amounts are listed first, followed by 2013 deductible amounts. Premium rates effective: September 20, August 19, 2013 Premium rates represent the cost of one month of coverage. Members are billed monthly. These rates are good through August 19, The age categories are based on the age of the named subscriber, the person whose name appears at the top of the application for coverage. Preferred rates are for healthy, non-smokers. If you smoke or have preexisting chronic or severe health conditions, you may be denied coverage, or, if accepted, assigned a standard rate which is higher than the preferred rate. 4Ever Life Insurance Company medical underwriters will determine which rate you are assigned based on your medical history. Farm Bureau s exclusive member health insurance plans are underwritten by 4Ever Life Insurance Company and administered by Blue Cross Blue Shield of Michigan mfbhealth.com

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