Health Care Administrators

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1 Health Care Administrators January 21, 2005 Depend on HCA to be your resource for news and information. Page 1 of 2 1 Important Clarifications Related to Health Savings Accounts You ve asked for more information about preventive care benefits with the health savings account rider CMM-HSA-PCB and combined medical/drug deductibles attached to health savings accounts. We know your customers are asking, too, so here is some information you can share with them. Combined medical/drug deductible Originally it was unclear whether or not customers would be allowed to move to a qualified, combined medical/drug deductible plan at renewal if their renewal date was after Jan. 1, According to a clarification from the U.S. Treasury Department, all HSA-qualified high-deductible health plans that have prescription drug coverage must include a combined medical/drug deductible or eliminate their drug coverage, effective Jan. 1, This clarification affects: All customers enrolled in our Blue HSA high-deductible health plans that have separate prescription drug coverage All customers who are considering enrolling in our Blue HSA high-deductible health plans with separate prescription drug coverage BCBSM Blue HSA products for 2005 do not have a combined medical/drug deductible option available. The 2005 HSA requirements allow groups to have a separate prescription drug plan outside the medical deductible. BCBSM is currently developing a new high-deductible product, which will be made available Jan. 1, 2006, that will include a combined medical and prescription drug deductible. As a result of the clarification, BCBSM sales staff and agents should make sure that customers are aware of this requirement and the impact it may have on their members, union contracts, etc., if they elect a Blue HSA option in In order for their employees to remain eligible for a health savings account in 2006, groups will need to move to one of our newly designed high deductible plans that will include a combined medical/drug deductible or eliminate prescription drug coverage. They will be required to submit a group-wide change in either case before Jan. 1, Some groups may want to delay moving to a Blue HSA plan until 2006 to avoid having to move to another plan before their renewal date. Additional information on the new HSA products in development and transitioning groups will be made available in the late third quarter Please note that customers enrolled in our Blue HSA high-deductible health plans with no prescription drug coverage are NOT affected by the clarification. HEALTH CARE ADMINISTRATORS, INC High Pointe Blvd., Suite 400 Novi, MI (800) Fax: HCA is an Authorized Independent Managing Agent for Blue Cross Blue Shield of Michigan and Blue Care Network. Blue Cross Blue Shield of Michigan and Blue Care Network are Non-profit Corporations and Independent Licensees of the Blue Cross Blue Shield Association.

2 Health Care Administrators Depend on HCA to be your resource for news and information. Page 2 of 2 2 Preventive care benefits rider Sales staff, agents, members and customers have asked whether preventive care benefits with rider CMM-HSA-PCB are subject to the deductible. Benefits under the preventive care rider (CMM-HSA-PCB) are not subject to the Blue HSA deductible or copays with the exception of mammography. Covered preventive services are payable at 100 percent of the approved amount, up to an annual combined benefit maximum of $500 per member, except for mammograms. Routine mammograms are subject to member cost-sharing requirements. Services (except mammograms) must be provided by a participating physician or a panel physician if the member is enrolled under rider CMM-PPO. Sales staff, agents, members and customers are also asking if the coverage for preventive services is the same for CMM-HSA-PCB and Community Blue. In our field alert dated, Sept. 1, 2004, we communicated that the preventive care benefits under CMM-HSA-PCB were similar to the preventive care benefits under Community Blue. However, there are some differences. The benefits under rider CMM-HSA-PCB have some age restrictions, while Community Blue preventive care benefits do not in most cases. Please see the Benefits-at-a-Glance charts for Community Blue and for Blue HSA with CMM-HSA-PCB plans available on the agent Web site at A copy of rider CMM-HSA-PCB rider is also attached. More information More information about BCBSM s Blue HSA products, please contact your Managing Agent or Regional Sales Office Agent Coordinator. HEALTH CARE ADMINISTRATORS, INC High Pointe Blvd., Suite 400 Novi, MI (800) Fax: HCA is an Authorized Independent Managing Agent for Blue Cross Blue Shield of Michigan and Blue Care Network. Blue Cross Blue Shield of Michigan and Blue Care Network are Non-profit Corporations and Independent Licensees of the Blue Cross Blue Shield Association.

3 IMPORTANT KEEP THIS RIDER WITH YOUR CERTIFICATE RIDER CMM-HSA-PCB HEALTH SAVINGS ACCOUNT PREVENTIVE CARE BENEFITS AMENDS COMPREHENSIVE HEALTH CARE COPAYMENT CERTIFICATES SERIES CMM SERIES CMM SERIES CMM Rider CMM-HSA-PCB amends the certificates named above to add coverage for certain preventive care benefits. This rider is effective when you, your employer or remitting agent is notified. [logo] A nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association

4 Your certificate is amended as follows: The Coverage for Physician and Other Professional Provider Services section of your certificate is amended to add the following subsection: Preventive Care Services We will pay 100 percent of our approved amount, up to an annual combined benefit maximum of $500 per member, for the preventive care services listed below, except mammograms. Services must be provided by a participating physician (or a panel physician if the member is enrolled under Rider CMM- PPO). Preventive services billed by a hospital or a facility are not covered. Health Maintenance Examination A comprehensive history and physical examination including blood pressure measurement, ocular tonometry (measurement of pressure in the eye), skin examination for malignancy, breast examination, testicular examination, rectal examination and health counseling regarding potential risk factors. We pay for health maintenance examinations as follows: Flexible Sigmoidoscopy Examination One routine flexible sigmoidoscopy examination for members age 50 and older once every five years. Gynecological Examination and Pap Smear For members age 18 and older, one gynecological examination and one Pap smear once every 12 months. Routine Mammogram Routine mammograms are subject to member cost-sharing requirements. They are covered whether obtained from a participating or non-participating physician, or a panel or non-panel physician. Mammograms are paid as follows: - Members age 35 to 40: one baseline mammogram - Members age 40 and older: one routine mammogram per calendar year Fecal Occult Blood Screening A laboratory test to detect blood in feces or stool, fecal occult blood screenings are paid as follows: Prostate Specific Antigen Screening One PSA screening for members age 40 and older, once per year.

5 Coverage for Physician and Other Professional Provider Services (continued) Preventive Care Services (continued) Chemical Profile This routine blood test is paid as follows: Cholesterol Screening We pay for one cholesterol screening once per member, per year. Complete Blood Count We pay for this routine laboratory test as follows: Urinalysis We pay for urine tests as follows: Routine Radiology Services We pay for the following services once per member, per year: - Chest X-ray - EKG Well-Baby and Child Care Visits and Immunizations We pay for well-baby and child care visits through age 15 as follows: - Six visits for children from birth through 12 months - Six visits for children 13 months through 23 months - Two visits for children 24 months through 35 months - Two visits for children 36 months through 47 months - One visit per birth year for children 48 months through age 15 We pay for childhood immunizations as recommended by the Advisory Committee on Immunization Practices and the American Academy of Pediatrics.

6 GENERAL Until further notice, all the terms, definitions, limitations, exclusions and conditions of your certificates and related riders remain unchanged and in full force and effect, except as otherwise provided in Rider CMM-HSA-PCB. BLUE CROSS BLUE SHIELD OF MICHIGAN Richard E. Whitmer President and Chief Executive Officer Form No. 2320

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