CLAIMS MANAGEMENT. People Who Care... Benefit Solutions That Work. PLAN MANAGEMENT RISK MANAGEMENT.

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1 CLAIMS MANAGEMENT People Who Care... Benefit Solutions That Work.

2 Claims Management COMPREHENSIVE BENEFIT SERVICES ClaimSecure is committed to developing solutions for our clients to manage claim costs more effectively without sacrificing patient care. Anna Cvecich - Vice President, Human Resources - General Electric CLAIMS MANAGEMENT ClaimSecure delivered what they promised when they promised. Drug Claims National 24/7 On-line Drug Management System ClaimSecure s drug management system requires that every electronically transmitted prescription be subject to a number of plan design and cost containment checks and edits prior to the drug claim being accepted, adjusted or rejected. Dental Claims The plan participant simply presents their pay direct health card to the pharmacist, along with a written prescription. The transaction details are submitted electronically and are verified by our system. Confirmation of exact plan coverage is then communicated in real time to the pharmacist. National 24/7 On-line Dental Management System Cost Containment ClaimSecure s drug system optimizes savings by adjudicating ingredient cost and dispensing fee charges separately. The system compares the submitted amount for both categories against predefined maximums and pricing guides, and applies adjustments (if required). Ingredient costs and dispensing fees are managed on a provincial basis to recognize regional differences. When a plan participant presents their pay direct health card to a participating dentist, information regarding dental procedures, member eligibility and pricing details are verified by our system and adjudicated within seconds. Acknowledgment of claim receipt and confirmation that the claim is being paid or adjusted including information required to produce an Explanation of Benefit (EOB) is then communicated to the dentist. For clients who require a customized approach to management of their drug programs, ClaimSecure s experienced Clinical Services team of licensed pharmacists is available to provide assistance. Clinical Services Clinical Consulting ClaimSecure s clinical offering is specifically designed to maximize the drug benefit dollars spent and includes a number of unique services such as: All new drugs entering the Canadian marketplace are reviewed and compared with existing therapies available under the current drug plan. A number of clinical criteria are considered prior to finalizing a decision on coverage status. Special Authorization Special Authorization service is a drug evaluation process that manages patient access to certain medications to ensure individuals receive the most appropriate and cost effective drug therapy. The list of medications is updated and managed by licensed pharmacists to optimize results. Specialty Drug Program Individual s access to high-cost medications is subject to the Special Authorization process to assess appropriate use. This approach ensures that less expensive medications are used first to maximize our client s drug benefit dollars. 90 Days Maintenance Program When less than a 90 day supply is submitted for drugs classified as maintenance medications, our system will intervene and require that a 90 day supply be dispensed. Pharmacare Coordination Program Used solely or in conjunction with the Specialty Drug Program, this program provides clients with the opportunity to tailor their drug benefit program to coordinate with provincial government programs. Extended Health Care Claims ClaimSecure offers a full range of Extended Health Care (EHC) claims management services including hospital coverage, paramedical services, hearing aids and vision care programs. Eligibility guidelines for certain practitioners and provincial coverage related to these programs often differ by province. ClaimSecure s experienced health claim advisors add the clarity required to these often complicated coverage questions to ensure the benefit program is properly managed. ClaimSecure s anti-fraud department also provides a methodical review of claiming patterns to detect fraud, misuse and abuse of specific benefits. ClaimSecure s pharmacists take the time to understand your program and explain your options. Our clinical team will detail the cost drivers behind your specific plan and educate you on the medications that are required to help your employees better perform. Managed Formulary Claims submitted manually are reviewed and processed daily by ClaimSecure s team of dental claim examiners. ClaimSecure has partnered with the Canadian Dental Association (CDA) and the Quebec Dental Association (ACDQ) to access the country s pre-eminent dental network the Canadian Dental Association Network (CDAnet).

3 Plan Management With ClaimSecure, we have a dedicated service team to support us - one that OUR works to accommodate our needs with innovative solutions and recommendations we can trust. PROCESS Plan Setup & Maintenance ID Card Production & Issuance Member Support Services Member Payments Dedicated Client Service Associate Master Application Standard Customer Response Center (CRC) Pay Member/ Pay Provider Capabilities ClaimSecure matches the unique needs of every client to a dedicated and experienced Client Service Associate (CSA). Partnered with a Client Service Coordinator, these teams provide our clients with the knowledge, guidance and support necessary to produce optimum results. Our CSA s help our clients by: ClaimSecure s Master Application is designed to reflect the exact plan coverage requested by our clients. The information detailed in the Master Application is critical to the accurate implementation of the new program and the completion of plan amendments. It forms an integral part of the final contract between ClaimSecure and our clients. Member health identification cards, with the client s logo prominently displayed, are produced onsite, subject to strict quality control and service standards. etags Miniaturized Member health identification cards are produced in sets of three (3) that can be attached to a key chain for easy access and contain a lost key security feature. Customized Clients have the option to purchase health cards incorporating their unique logo, company information and corporate colors. ClaimSecure will work with each client to ensure cards are produced professionally and cost effectively. Service Philosophy ClaimSecure supports its clients by assisting in the design of health benefit plans that meet their unique needs and address their specific cost concerns. Working with the brokerage and consulting communities, ClaimSecure is committed to ensuring that every client receives premium claims management service delivered in a professional and consistent manner. Members wishing to obtain information, report a problem, or ask for assistance, may call ClaimSecure s bilingual staff of experienced representatives. Our team of skilled agents is ready to provide knowledgeable, prompt, and courteous service. On-line Services Secure, convenient and user friendly on-line services are only a click away. Plan participants can visit their eprofile (Member web portal) account to access the following: Direct Deposit electronic claim payments enews health plan news Pre-populated claim forms Health Library health advice Claims Query personal claims history Plan Booklet Submit coverage questions electronically And much more! ClaimSecure issues claim payments directly to members or service providers based on pre-established payment schedules. The payment processes differ depending on the method of payment selected (electronic or manual payment), where the claim originated and the payee (Member or Provider) to be reimbursed. For Members, claims are processed within five (5) business days of receipt. Payments are made daily either via direct deposit or cheque and include an Explanation of Benefits (EOB). For Providers, electronic claims are processed in real time while paper claims are processed within five (5) business days of receipt. Provider claims are aggregated with payments issued twice monthly according to ClaimSecure s published schedule. A statement detailing all transactions is available as required. Documented Service Standards There are two payment funding models available: Standard Invoicing Invoice cycle is twice monthly. Deposit requirements are dependant on payment terms. Minimum deposit requirements are equal to two (2) weeks of anticipated claims, fees, and taxes. Payments can be made electronically or via cheque. Budgeted Administration Services Only (BASO) Payment is due monthly in advance of the month in which benefits are to be paid. Payments are equalized and are subject to quarterly reconciliations. No claim deposit is required for this model. Note: Insured services (e.g. Travel Coverage) are invoiced monthly. ClaimSecure is dedicated to continuously improving the quality and delivery of its services. Service standards are published and regularly reviewed to ensure that our commitments are honored and consistently executed. Employees are recognized for generating ideas that improve any aspect of ClaimSecure s operation. Ultimately, ClaimSecure s successes are judged by clients through feedback from our annual Client Satisfaction Survey. This is our report card! Finalizing group structure and plan design requirements Establishing time line for initial test and production enrollment files Coordinating the production of customized, health identification cards Facilitating the set up of the suite of internet services Communicating billing/invoicing requirements Scheduling the training programs Reviewing and delivering the contract Providing on-going service based on a pre-established service program The success of any program originates with the initial plan set up. Our Client Service Associates are experts in asking the right questions and making plan adjustments to ensure that client expectations are fully understood and implemented. Invoicing Account Management Robert Underwood - President & CEO - Actra Fraternal Benefit Society

4 Plan Management We are impressed with ClaimSecure s ability to balance experienced Reporting Everyone has an eprofiletm waiting to be discovered. Monitor plan performance by viewing, exporting or printing Drug, Dental and Extended Health Care claim information via a user friendly, bilingual reporting system. Choose from a comprehensive report catalogue of standard, enhanced and customized reports. customer service support and web-based reporting capabilities, with low administration costs. ON-LINE SERVICES Joey Harris - Corporate Benefits Advisor - Manitoba Hydro Request Coverage Information questions regarding claim coverage, claim or eligibility status and payment details, all from your own desktop. Responses are provided within 48 hours. Forms Library Our extensive bilingual forms library is structured to facilitate claims submissions, program administration and special authorization drug access. S.O.F.T. Direct Deposit Enrolment & Maintenance This secure payment method provides faster, hassle free payments deposited directly into your bank account. The service also includes an electronic statement of each transaction. Our on-line eligibility system allows clients to easily view, add or modify individual eligibility records at the touch of a button. eprofiletm for Members Secure On-line File Transfer (S.O.F.T.) is ClaimSecure s web based file transfer system. A safe and convenient gateway to send or retrieve data. Claim Query eprofiletm for Administrators View your claims transaction history, access provider payment details and print results for coordination of benefits (COB), tax calculations, and more. Plan Booklet Access current plan coverage details via an electronic booklet. Information is password protected ensuring that participants can only view their specific benefits. Benefit Guide Communication Material ebulletintm enews Health Library Stay informed of new plan design details, employee wellness initiatives and relevant legislative changes by reading informative ClaimSecure publications. This electronic messaging system provides our clients with the opportunity to post important benefit notices in participant s eprofiletm accounts. Read important, timely notices regarding market trends, service or fee changes from various providers, provincial & federal legislative changes and industry news that impact your benefit coverage. Manage your health more effectively by recognizing the signs to commonly diagnosed health conditions and be more aware of your treatment options. Your road map for understanding coverage, and facilitating successful claim submissions as well as a manual for utilizing available web services.

5 Risk Management I am very impressed with ClaimSecure s Project Management capabilities. Not only did they deliver the product as promised, they made a major implementation seem easy. SOLID AND TRUSTWORTHY Andrew Cameron - Director, Global Benefits and Employee Wellness - Air Canada ClaimSecure Travel Medical Emergency Insurance provides protection and peace of mind while travelling PROTECTION Stop-Loss Coverage ClaimSecure has partnered with one of the Canada s leading insurance companies to offer Stop-loss protection that enables the client to combine the cost savings and flexibility of an Administrative Services Only contract with the security of an insured program. There are 3 comprehensive Stop-loss products available to meet the client s risk tolerance and preferred plan design and assist in balancing risk and reduced costs: SecurePak Specific PlusTM SecurePak UltraTM SecurePak AggregateTM The following Plan Highlights apply to both SecurePak Specific PlusTM and SecurePak UltraTM products: Plan Highlights National coverage Catastrophic claims protection Eliminate GST on covered benefits Individual coverage per family member up to $1,000,000 per lifetime Drug and EHC or Drug Only options available Attachment levels available range from $10,000 to $25,000 SecurePak ULTRATM SecurePak AGGREGATETM Claims experience is reviewed at the time of application and at the first renewal and specific attachment levels are adjusted for individuals with current annualized claims exceeding or trending beyond seventyfive percent (75%) of the group attachment level. This is the ultimate ClaimSecure Stop-loss product in terms of minimizing client risk. This stop-loss program is available on a stand-alone basis or in conjunction with other stop-loss programs. The cost of this product is significantly lower than that of the SecurePak Ultra program due to the fact that the underwriter has the ability to adjust coverage for high claimants at the first renewal. Specific attachment levels are set for individuals with claims exceeding or trending beyond seventy-five percent (75%) of the group attachment level at application only. From that point forward, any amount paid for eligible claims that exceeds the attachment levels set at application will qualify for reimbursement. Plan Highlights: Protection against catastrophic claims or higher than expected claiming frequency Group coverage up to $1,000,000 per annum Attachment levels available range from 110%, to 150% of projected claims Drug and EHC or Drug Only options available Vision PlusTM ClaimSecure has partnered with a leading travel coverage provider to offer our clients a comprehensive travel program. ClaimSecure has partnered with one of Canada s leading vision care networks to offer Vision PlusTM to our valued clients. Vision PlusTM is ClaimSecure s national Preferred Provider Network (PPN) offering enhanced benefits to plan members while providing effective costcontainment and reporting to clients. Plan Highlights:... A choice of coverage options available between 30 and 180 days... $5,000,000 aggregate limit per trip... No pre-existing condition clause for stable medical conditions for active employees under age seventy (70)... ClaimSecure branded call centre with toll-free North American / International customer support... Medical and claim assistance 24 hours per day, 7 days per week... Retiree travel program available... Detailed member enrollment kit Plan Highlights:... A $25 $40 enhanced benefit month repair guarantee ($1,000 maximum)... Laser vision correction benefit of $125 per eye... Complete reporting... The Vision PlusTM network consists of national eyewear chains including Sears Optical, The Bay Optical, Zellers Vision Centres, Lenscrafters and Pearle Vision. SecurePak SPECIFIC PLUSTM Out of Country Travel

6 About ClaimSecure People Who Care... Benefit Solutions That Work. Established in 1982, ClaimSecure is a leader in providing online, real-time claims management and plan administration services to Canadian corporations. Today, ClaimSecure provides bilingual services to 7,500 Canadian companies representing 1.3 million Canadians and $500 million in annual claims. We Protect Your Privacy Our diverse client base includes regional and national organizations consisting of insurers, plan sponsors, unions, associations, government agencies and educational institutions. ClaimSecure s vast experience in working with a multitude of industry stakeholders enables us to provide guidance and solutions to address these partners unique concerns and objectives. We support our clients by consistently delivering on our commitments and we invite you to participate in our quality programs. HEAD OFFICE - MISSISSAUGA PHONE FAX ADDRESS ClaimSecure is committed to protecting your privacy and the confidentiality of your personal information. We will always explain how we intend to use your personal information before we collect it. If we plan to release information about you to other persons, we will only do so where we have your consent or we are required to do so by law. We promise to always treat you fairly and with respect. info@claimsecure.com Contact Us OPERATIONS CENTRE - SUDBURY City Centre Drive, Suite 620 Mississauga, Ontario, CANADA L5B 1M2 PHONE FAX ADDRESS ClaimSecure PO Box 6500 Station A Sudbury ON P3A 5N5