EmployeeElect designed for businesses with employees. The value you need. The coverage your employees deserve.

Transcription

1 EmployeeElect designed for businesses with employees The value you need. The coverage your employees deserve.

2

3 Table of Contents Protect your employees with coverage from Anthem Blue Cross... 1 EmployeeElect for groups of Medical plan options PPO plans (Basic PPO, Saver PPO, PPO $40/$30 Copay, Advantage PPO $25 Copay, Premier PPO $20/$10 plans) PPO $35/$45 Copay GenRx plans... 4 PPO Power HealthFund 500/750 plans... 5 Lumenos HIA Plus 3000 plan... 6 PPO 2400/3500 (HSA-Compatible) plans... 7 Lumenos HSA 3000/2000/1500 plans... 9 Solution 2500/3500/5000 PPO plans HMO plan highlights (HMO 100%, HMO $25 100%, Classic HMO, Classic $30 HMO, Saver HMO, Saver $30 HMO) Power SelectHMO plan Wellness programs Dental coverage Life coverage Information for the employer Convenient services to assist you Enrollment guidelines General provisions Employer application checklist... 24

4

5 Protect your employees with coverage from Anthem Blue Cross Why purchase health coverage? Offering health coverage to your employees can help you recruit and retain the quality workers who can help make your business a success. In a recent survey, employers gave these reasons for offering health benefits to their workers: 80 percent report that it helps with recruitment and retention. 70 percent report that it increases productivity by keeping employees healthy. 68 percent report that it reduces absenteeism by keeping workers healthy. And because health insurance premiums are treated as a general business expense, they may be 100 percent tax-deductible. 1 It s a win-win for you and your employees. You win by maximizing employee choice while creating a tax advantage for your business. And, you win because you can attract employees by offering the health coverage they deserve. Your employees win because they have more plan options from which to choose. Anthem Blue Cross advantages Wide array of plans for every budget Maximum plan choice for your employees Financing options to control your business health care budget One-stop-shopping for medical, dental and life One of the largest provider networks in California Wellness programs to help develop healthy lifestyles The security of over 65 years of health coverage industry leadership National Committee for Quality Assurance (NCQA) Accreditation for HMO and PPO 1 Consult your tax advisor. The following are offered by Anthem Blue Cross: PPO $40/$30 Copay plans and Premier PPO $20/$10 Copay plans; Saver HMO, Saver $30 HMO, Classic HMO, Classic $30 HMO, HMO 100%, HMO $25 100%, Power SelectHMO and Power $35 SelectHMO plans. The following are offered by Anthem Blue Cross Life and Health Insurance Company: Basic PPO, Saver PPO, Advantage PPO $25 Copay, Power HealthFund 500, Power HealthFund 750, PPO 2400 (HSA-Compatible), PPO 3500 (HSA Compatible), PPO $35 Copay GenRx, PPO $45 Copay GenRx, Lumenos HSA 1500, Lumenos HSA 2000, Lumenos HSA 3000, Lumenos HIA Plus 3000, Solution 2500 PPO, Solution 3500 PPO, Solution 5000 PPO; Dental Blue; Term Life and accidental death and dismemberment products. 1

6 EmployeeElect for groups of EmployeeElect key features EmployeeElect With EmployeeElect, you can offer your employees any or all of our medical and/or dental plans. Employees then have the flexibility to choose the type of coverage that works best for themselves and their families, according to their unique needs and budgets. Important: Employers that offer HMO coverage must choose either the Power SelectHMO/Power $35 SelectHMO plans (Select Network) or one of the other three HMO plans (Anthem Blue Cross HMO), but cannot combine the SelectHMO plans with non-selecthmo plans. Medical contribution options Traditional contribution: You choose the percentage (50 to 100 percent) to contribute to your employees monthly premiums. Percentage applies to all plans offered to employees. Defined contributions: You have the flexibility to set a fixed and predictable contribution level. You also decide how many total plans to offer your employees. Dependent contribution is optional. Percentage & plan option: You choose one percentage (50 to 100 percent) to contribute to your employees monthly premiums, and tie that contribution to any plan you offer your employees, excluding the Basic PPO plan. Your employees have the option to select any other plan and use that contribution toward the purchase of their chosen plan. The employee is responsible for any premium amount over the percentage dollar amount for the plan to which you have chosen to contribute. Fixed dollar option: You choose to pay any fixed dollar amount, $100 or greater in $5 increments, to contribute to your employees monthly premiums. Amount applies to all plans offered to employees. Dental contribution options Traditional contribution: You pay a minimum of 50 percent per employee per month. Fixed dollar option: You pay $15 or more (in $5 increments) per employee per month. 2

7 Medical plan options Anthem Blue Cross PPO plans PPO Plan Highlights for: Basic PPO, Saver PPO, PPO $40 Copay and PPO $30 Copay, Advantage PPO $25 Copay, and Premier PPO $20 Copay and $10 Copay Access to over 53,000 California PPO network doctors and specialists and nearly 400 hospitals - so chances are your employees doctors are in our network. Money stays in your employees pockets - because we ve negotiated lower fees with the doctors and hospitals in our network, your employees save. Out-of-state coverage - our health coverage goes with your employees when they travel. Immediate (no deductible) benefits for generic drugs and office visits on most plans Payment at 100 percent for most in-network covered services once you ve met your out-of-pocket maximum Coverage of up to $5 million in benefits over member s lifetime The following example illustrates how our PPO plan discounts work when used with in-network providers (participating providers). What you pay for professional services Assumptions: Based on the Premier PPO $20 Copay plan Total charges: $1,000 Anthem Blue Cross negotiated fee: $600 Customary and reasonable fee: $700 In-Network Negotiated Fees Out-of-Network Customary and Reasonable Fees Total charges $1,000 $1,000 Anthem Blue Cross negotiated savings $400 No discount Adjusted charges $600 $700 Annual wellness screenings through our HealthyCheck SM centers Access to participating doctors and health care facilities nationwide through the BlueCard program Anthem Blue Cross pays: 80% of negotiated fee 60% of customary/ reasonable fee $480 $420 Our PPO plan gives the freedom to choose between an Anthem Blue Cross PPO in-network provider and an out-of-network PPO provider (a provider who does not belong to the Anthem Blue Cross PPO network). The main advantage, however, is that employees can receive significant cost savings when visiting Anthem Blue Cross PPO network health care providers for covered services. And, Anthem Blue Cross PPO in-network providers have agreed to submit any claims to Anthem Blue Cross. You pay $120 $580 * Assuming any deductible has been met and you have not yet reached your annual out-of-pocket maximum and your coinsurance amount is 20 percent for participating and 40 percent for non-participating doctors. 3

8 Medical plan options Additional PPO plans PPO $35 Copay GenRx and PPO $45 Copay GenRx plans GenRx Plan Highlights Affordable premiums Comprehensive PPO coverage Low office visit copay Safe and effective generic-only drug coverage: $15 generic copay Access to Anthem Blue Cross negotiated savings on brand name drugs To help control premium costs and soaring prescription drug costs, we have come up with a simple, yet revolutionary approach that offers pharmacy coverage for generic drugs only. This is the innovative foundation for the PPO $35 Copay GenRx and PPO $45 Copay GenRx plans. With a generic-only pharmacy benefit, the GenRx plans can provide sizeable cost savings and still offer comprehensive PPO health benefit features. Members should always inform their doctor that the GenRx plan covers only generic medications from the GenRx Formulary. However, if a suitable generic equivalent is not available, or if the doctor believes a brand-name drug is necessary, the plan offers the members access to Anthem Blue Cross negotiated savings on brand-name medications from an in-network pharmacy. This alternative helps support medications that are prescribed in the best interest of the member. Get a copy of the GenRx Formulary The GenRx Formulary is a broad listing of generic drugs covered by the PPO $35 Copay GenRx and PPO $45 Copay GenRx Plans. Any drugs not included in the formulary will not be covered by the plan. The GenRx Formulary can be viewed and downloaded by logging on to anthem.com/ ca, and clicking on Visitors, Groups of 51 or more, Products, Pharmacy, then GenericRx Formulary. Members can also contact Customer Service at (800) and request a copy of the GenRx Formulary. Useful definitions Coinsurance: the percentage of allowable costs you pay for covered health care services after you satisfy your annual deductible; amounts vary by plan Deductible: the amount you pay each year for covered services before your plan begins paying part of the cost In-network provider/participating provider: a doctor, hospital, or other provider who has a contract with Anthem Blue Cross to provide health care at a negotiated fee Negotiated fees: discounted fees for medical services that have already been agreed upon by Anthem Blue Cross and in-network participating providers Out-of-network provider/non-participating provider: a doctor, hospital, or other provider that is not part of the network. You pay substantially more for health care services received from these providers Out-of-network providers within a participating hospital or outpatient facility: a doctor or other health care provider or service that is not part of the network, but may be providing services within a participating hospital or outpatient facility. You pay substantially more for health care services received from these providers. It is the member s responsibility to determine the status of a provider before acceptance of services. Out-of-pocket costs: your share of costs for ongoing health care services, including certain deductibles and coinsurance payments Out-of-pocket maximum: the maximum amount for qualifying covered services you would have to spend in any one year, including certain deductibles, before your plan pays 100 percent of your covered costs for most services. 4

9 Power HealthFund 500 and Power HealthFund 750 plans Power HealthFund PPO plans highlights First-dollar coverage before deductible is met Office visit copay after deductible Unused first-dollar coverage rolls over to the next year Simple plan design - no complicated tiers or restrictions Employees gain more control over their health care spending Power HealthFund PPO (PHF) 500 and 750 plans are simple for your employees to use and easy for you to administer. These plans feature a unique benefit design of a first dollar coverage before members have to satisfy an annual medical deductible giving your employees immediate coverage and more control over their health care costs. There are no complicated employee accounts to manage and no confusing benefit tiers to explain. Our Power HealthFund PPO plans will change the way you and your employees think about health care coverage. Comfort through predictability Employees will take comfort in the easy predictability of the PHF plans. It works in three simple steps we call it the PHF Step 1 use first dollar coverage: It pays for whatever the plans cover except prescription drug copays and the annual brand-name drug deductible. Step 2 satisfy the medical deductible: Once members exhaust their first-dollar benefits, they must satisfy a medical deductible. Step 3 coinsurance/office visit copays take over: After the medical deductible is met, the plan immediately begins paying a specific percentage (coinsurance) for covered services except office visits, which are covered by a flat copay. First-dollar roll-over: Any first-dollar funds left over at the end of the year are automatically added to the first dollar coverage for the following year.* Balances can be rolled over to a maximum of two times the first-dollar coverage amount. This provides your employees with even more first-dollar coverage. Better yet, for families, there are no restrictions on how much of the first-dollar coverage each member can use. If one person needs it all, he can use it all including the roll-over from the previous year. *If employees enroll in the last quarter of the year, they will receive first-dollar coverage for that quarter, but any unused funds will not carry over to the next year. Benefit payment example: Single Member on PHF 750 Plan Step 1: First-Dollar Coverage (First $750) Step 2: Medical Deductible (Next $500) Member Pays $0* 100% Step 3: Coinsurance/Office Visit Copays Take Over 25% coinsurance $35 office visit copay Plan Pays $750 $0 75% coinsurance * First-dollar coverage cannot be used to pay for prescription drugs. Drug coverage under the plans requires that members pay for generic prescription drug copays and satisfy an annual brandname prescription drug deductible first before they are eligible for brand-name copays. 5

10 Medical plan options Lumenos HIA Plus 3000 plan This consumer-driven plan includes an account, called a Health Incentive Account (HIA), in which the health plan makes an annual allocation to the member s HIA to help the member pay for medical care and prescriptions while still having the protection of a typical health plan, plus much more. Among the advantages: Health care dollars to offset out-of-pocket costs. The health plan makes an annual allocation to an HIA and the member controls how the funds are spent on covered medical services and prescriptions. Preventive coverage. 100 percent coverage for nationally recommended preventive care services when members see an in-network provider. Earn additional dollars. Members can earn extra dollars in their account for doing good things for their health through the Healthy Rewards Program. Earn dollars for completing the Health Assessment online to identify health risks, enrolling in and completing our Personal Health Coach Program and completing our Smoking Cessation and Weight Management programs, if eligible. Save dollars not used. Unused funds roll over to the next year to help reduce out-of-pocket expenses in the future. Here s How The Lumenos HIA Plus Plan Works FIRST: Members can use HIA to pay for medical care and prescriptions. Plus stay healthy with Preventive care THEN: Use the Traditional Health Coverage if needed. Health Incentive Account (HIA) Funded by an annual allocation from the health plan*. $1,000 individual coverage $2,000 family coverage Members can earn more money for their HIA through the Healthy Rewards Program. Use to pay for covered health expenses when funds are available. Unused dollars roll over from year to year. Preventive Care Pays 100% of nationally recommended preventive services. No deduction from the employee s HIA, and no out-of-pocket cost when the member s care is received from an in-network provider. Traditional Health Coverage After members have used all of their HIA funds, members will pay a limited amount out-of-pocket (called the Bridge ) which is needed to satisfy the deductible. Then the plan pays the majority of the cost for additional covered services. Plan s annual deductible $3,000 individual coverage $6,000 family coverage * Note: the allocation is prorated based on any effective date other than January 1. 6

11 PPO 2400 and PPO 3500 (HSA-compatible) plans Our PPO 2400 and PPO 3500 (HSA-compatible) plans feature a builtin option for setting up a Health Savings Account (HSA). Through our arrangement with JPMorgan Bank, National Association (Chase), PPO 2400 and PPO 3500 plan members can apply for the health plan and savings account at the same time. What is a Health Savings Account (HSA)? HSAs are designed to help eligible individuals save for qualified medical and retiree health expenses on a tax favored basis. The HSA is an individually owned and optional account that must be paired with an HSA-compatible high-deductible health plan (HDHP). To establish an HSA and begin making tax favored contributions, an individual must first enroll in an HSA-compatible, HDHP. Contributions to HSAs can be made by both individuals and their employers. Interest earnings and withdrawals are tax advantaged, provided they are only used to pay for current and future qualified medical expenses. Seamless Combination Because this combination offers savings and tax benefits for employers and employees, the demand for HSA-compatible, HDHPs is rapidly growing. Anthem Blue Cross two high-deductible health plans, PPO 2400 and PPO 3500, are designed to work seamlessly with HSAs. Group members have the option of enrolling in an HSA on their own or taking advantage of this opportunity to enroll in a Chase HSA as part of their Anthem Blue Cross enrollment process. Enrollment in an HSA qualified plan, such as the PPO 2400 or PPO 3500, is required before individual plan members can establish an HSA. Package benefit highlights Our PPO 2400 and PPO 3500 (HSA-compatible) plans offer: Lower premiums because of the high-deductible benefit designs Comprehensive PPO coverage after the deductible is met Low, negotiated provider fees that reduce out of pocket costs The tax-advantaged 1 Chase HSA provides: Tax benefits for both employers and employees Help for employees to pay for deductibles and certain medical expenses not covered by the plan Contributions that may be 100 percent tax deductible Withdrawals and interest that are tax-free, if used to pay for qualified medical expenses Balances that roll over from year to year, so employees don t have to worry about using it or losing it Portability, employees own their HSA; it moves with them Helping employers control spending Defined contribution and other employer contribution options help firms predict and control their monthly premium costs. Premium Only Plans (P.O.Ps), made possible by Section 125 of the Internal Revenue Service (IRS) tax code, allow employers to use pre-tax salary dollars to pay their employees share of benefit premiums. 1 HSAs are tax advantaged for the purposes of federal income tax. Treatment under state income tax laws may vary. Consult a qualified tax advisor. 7

12 Medical plan options Integrated enrollment process Employers and employees work together to complete all the necessary enrollment paperwork. Employers must check to ensure that all the necessary paperwork is submitted accurately and completely to Anthem Blue Cross. The following forms are required for the employer and employee to submit for enrollment in an HSA. HSA questions/answers For employers that choose to make HSA contributions, must they contribute the same amount to each employee s HSA? Yes. If an employer chooses to make contributions to employees HSA accounts, the guideline is comparable contributions on behalf of all comparable participating employees (i.e., eligible employees with comparable coverage) during the same period. Contributions are considered comparable if they are either the same amount or same percentage of the deductible under the HDHP. Who applies for the HSA - the employer or the employee? The employee applies for the HSA. For employees that wish to take advantage of this Chase HSA option however, the employer must first submit a Chase Group Initiation Form. The employer is also responsible for setting up automatic payroll deductions with the bank. If an employer is deducting from the payroll, the employee gives permission to have a certain amount taken out of his or her paycheck and sent to the HSA account. Can employees open an HSA with any bank? Yes. Employees can open an HSA with any HSA qualified bank or financial institution, provided they are enrolled in a highdeductible health plan first. Please Note: Anthem Blue Cross does not administer the HSA or provide tax advice and this document should not be used for tax consultation purposes. Please encourage your clients to seek the advice of a tax professional about the benefits of setting up an HSA. Required Forms Employer Submissions Employee Submissions Anthem Blue Cross submits the HSA forms to Chase on the employer s behalf, as part of the integrated application process. Anthem Blue Cross processes the health plan applications Anthem Blue Cross Employer Application (and other documents as applicable) Chase HSA Group Initiation Form Anthem Blue Cross Employee Application Chase HSA Enrollment Form Chase processes the HSA applications 8

13 Lumenos HSA 3000, Lumenos HSA 2000 and Lumenos HSA 1500 (HSA-compatible) plans Our Lumenos HSA plans feature a built-in-option for setting up an HSA. You have the option of selecting Bank of New York Mellon for administration of your Lumenos HSA. This consumer-driven plan provides the ability to save tax-free dollars in an account while still having the protection of a typical health plan, plus much more. Among the advantages: Tax savings. Set aside pre- or post-tax dollars. Lower your taxes while paying for covered health expenses. Save dollars not used. Unused funds roll over to the next year to help reduce out-of-pocket expenses in the future. Take it with you. The money is yours take your unused balances when you retire or leave the company. Investment growth. Grow your available health care dollars by investing your HSA funds. Convenience. Use your HSA debit card or checkbook to access your account. Here s How The Lumenos HSA Plans Work FIRST: Members can use HSA to pay for medical Health Savings Account (HSA) For 2008*, contributions can be made to an HSA up to the following limits. $2,850 individual coverage $5,650 family coverage Unused dollars are saved and are yours to keep if you retire or leave the company. HSA dollars earn interest and can be invested. * The contribution limits set by the U.S. Treasury and the IRS may be increased for inflation annually. These limits include contributions from any source Plus stay healthy with Preventive care Preventive Care Pays 100% of nationally recommended preventive services. No deduction from the employee s HSA, and no out-of-pocket cost when the member s care is received from an in-network provider. THEN: Use the Traditional Health Coverage if needed. Traditional Health Coverage If the member does not have enough HSA funds available to pay for covered services, or the member chooses not to use the HSA, they will pay for the covered health expenses out-of-pocket until the deductible is satisfied. Then the plan pays the majority of the cost for additional covered services. 9

14 Medical plan options Solution 2500, 3500 and 5000 plans We ve learned a thing or two about your employees health coverage needs. And what we ve found is that the average, healthy small business employee needs: To see a doctor a few times a year, including physical exams To save on prescriptions To have enough coverage for any unexpected hospital stays We don t think that s too much to ask for. And we don t think you should have to pay more for health coverage your employees don t want and may never use. So we decided to come up with a Solution: High-deductible Solution PPO health plans The Solution-at-a-glance Three high-deductible PPO plan options. Plans are available with deductibles of $2500, $3500 or $5000. Offer one, two or all three plans or any combination of plans within EmployeeElect. With Solution PPO plans deductibles are higher, savings are greater. Simple! Three contribution levels. Just choose the option you can afford and your employees pay the rest through payroll deductions: - Fixed dollar amount - you pay $100 (or more in $5 increments) - Traditional - you pay 50 percent or more - Percentage and plan - you pay 50 percent or more for a specific plan* Peace of mind from guaranteed rates and benefits during your first year of coverage. Easy online tools to help you manage your benefits quickly - right from your desktop. *Excludes Basic PPO plan The Solution to your employees needs Solution PPO health plans are different than most other health plans because they focus on providing the coverage your employees want, need and will use the most, including: Predictable copays for doctor visits and prescriptions. In- and outofnetwork doctor visits are unlimited. Preventive care benefits to keep your employees at peak performance. Just in case coverage for hospitalizations and other major medical expenses. It probably won t happen, but if unexpected illness or injury comes up, your employees will know that their plan s out-of-pocket max is the most they ll have to pay. This means you can actually pay less and still get the comprehensive coverage your employees will use the most. The Solution to your business needs Offering health coverage through EmployeeElect has a lot of advantages or a small business like yours, including: Tax breaks Ability to attract and keep qualified employees A healthier, more productive workforce Fewer employee absences and sick days Ability to offer a wide range of plans designs to meet your needs Discounts on bundled dental, life and workers compensation coverage Solution PPO health plans offer you even more advantages because the combine the coverage your employees want at a budget your small business can live with. 10

15 Health care decision tools All PPO plans, PPO 2400 and 3500 (HSA-compatible) plans and Power HealthFund plans and GenRX plans HealthyCheck The HealthyCheck SM program offers members an annual preventive care screening that evaluates a variety of health risks. Members can choose either a basic or premium screening and pay a flat copay. Each screening includes a detailed health status report, educational materials and a summary of results sent to the member s personal physician and available for the member to take home immediately. HealthyCheck Centers are available in communities throughout California with new locations being added regularly. Members can locate a HealthyCheck Center online at anthem.com/ca/healthycheck or by calling (800) 274-WELL. Healthcare Advisor* PPO members can link to an interactive website providing one-of-a-kind, decision making resources and information. The Healthcare Advisor by Subimo offers an array of information that members can access if they are preparing for a medical procedure or managing a medical condition. The Healthcare Advisor can be accessed by logging on to the Anthem Blue Cross website, anthem.com/ca, and going to the confidential MemberAccess Login. With Subimo, members can: Research hospital information about complication rates, which hospital is most suited for a given procedure, how many times a hospital has performed a given procedure, etc. Find details about how common a given procedure is, the risks involved, possible non surgical alternatives, etc. Search for details via an online medical encyclopedia and links to related informational sites. Go to page 14 for information about additional wellness programs for all plans! * The Subimo Web site is owned and operated by Subimo LLC, P.O. Box 5335, River Forest, IL Subimo LLC is solely responsible for its Web site and is not affiliated with Anthem Blue Cross or any affiliate of Anthem Blue Cross. 11

16 Medical plan options Anthem Blue Cross HMO plans HMO plan highlights for: HMO 100%, HMO $25 100%, Classic HMO, Classic $30 HMO, Saver HMO and Saver $30 HMO plans Comprehensive health care coverage Unlimited lifetime benefits for covered services Low out-of-pocket costs Immediate (no deductible) benefits for generic drugs and office visits Self-referral for OB/GYN care DirectAccess and SpeedyReferral SM programs to make seeing a specialist easier Our Health Maintenance Organization (HMO) plans cover more of your employees health care costs than any other plan type, so members get the lowest out of-pocket expenses. With HMO coverage, you must choose a participating medical group (PMG) or independent practice association (IPA) from the Anthem Blue Cross HMO network, through which you ll receive your medical care. You also choose a specific doctor within that group to be your primary care physician (PCP). Whenever you need medical care, your first step is to contact your PCP, who will coordinate any specialist consultations, laboratory tests, or other medical services you need. Only medical services that are coordinated through your PCP or your PMG/IPA will be covered by your HMO plan, except in case of emergency. * Important: Employers cannot combine the Power SelectHMO and/or Power $35 SelectHMO plans with other Anthem Blue Cross HMO plans. Power SelectHMO and Power $35 SelectHMO plan Power SelectHMO plan highlights Unique SelectHMO network Plan design featuring variable copays for primary care physicians and specialists Solution for affordable, high-quality HMO coverage Standard HMO coverage procedures Brand-name prescription drug deductible per member Low copay for generic drugs Offered as part of EmployeeElect* There is a growing need for California businesses to offer health care access close to where employees live and work. Anthem Blue Cross SelectHMO Network and Power SelectHMO/Power $35 SelectHMO plans are designed to provide employees with convenient health care facilities that are close to home. And, we recognize that this need exists in certain California communities, especially those businesses that employ lower income workers. With Power SelectHMO/Power $35 SelectHMO, employers and employees do not have to compromise quality for affordability. Along with its network of over 6,000 providers in select counties state-wide, these plans offer variable copays depending on the type of office visit. When they visit a specialist, employees will pay a slightly higher copay than when they see their primary care physician or medical group. This benefit design helps maintain robust, comprehensive HMO benefits at a remarkably affordable price. Useful definitions Copay: a set amount you pay for a specific medical service, such as a $10 fee for an office visit Independent practice association (IPA): physicians in the Anthem Blue Cross HMO network who practice in their own independent offices, and may refer you to a specialist or laboratory facility at another location Out-of-pocket costs: your share of costs for ongoing health care services, including certain deductibles and copays 12 Participating medical group (PMG): a group of physicians and specialists in the Anthem Blue Cross HMO network who practice together in one location and provide most medical services, including X-ray and laboratory tests, at the same location Primary care physician (PCP): the physician you select within your medical group to coordinate all your health care needs

17 Anthem Blue Cross DirectAccess SM Anthem Blue Cross DirectAccess provides HMO members the option of self-referral to participating specialty service providers affiliated with their PMG/IPA for some services, without prior authorization from their PCPs. Specialty services include allergy, dermatology, and ear, nose and throat. This program is available to HMO members who choose medical groups in the Provider Directory that participate in the DirectAccess program. Anthem Blue Cross SpeedyReferral SM With SpeedyReferral, HMO members benefit from immediate referrals from their PCPs for certain specialtyfirst consultations without prior authorization from their medical group s management committee. These specialty services include cardiology, dermatology, ear, nose and throat, endocrinology, gastroenterology, general surgery, hematology, neurology, obstetrics, gynecology, oncology, ophthalmology, orthopedic surgery, podiatry, routine laboratory tests, routine X-ray, and urology. This program is available to HMO members who choose medical groups in the Provider Directory that participate in the SpeedyReferral program. What s best for your employees? Now that you have had a chance to review our PPO, HMO and HSA options, you may want to talk to your employees about their health care needs and expectations in order to choose plans that work for them. Consider these questions in choosing which plans to offer: Do my employees Want more control over their health care and access to any doctor or specialist they choose? Want lower monthly premiums, so they re willing to pay more for their health care services as they occur throughout the year? Want an account where funds can be set aside and they have control over their health care dollars? Want to pay as little as possible when they see a doctor, so they re willing to select a specific medical group and physician to coordinate all of their health care needs? Want to pay a higher premium each month so their costs for health care services will be lower as they occur throughout the year? PPO Plan PPO Plan Lumenos Consumer-Driven Health Plans HMO Plan HMO Plan If you chose statements 1 and 2, you prefer PPO plan coverage. Selecting 3 indicates that consumer-driven plans are an option. With statements 4 and 5, your preference is HMO plan coverage. You also have the option of offering all plans. 13

18 Wellness programs for all plans Building healthy lifestyles There s more to wellness than just visits to the doctor. That s why we ve created a variety of programs to help your employees take an active role in shaping healthy lifestyles. 360 Health a valuable part of every plan, all year round. Quite simply, 360 Health gives you a way to help your employees be as healthy as they can be. A comprehensive suite of programs and services that work together to help achieve optimal health outcomes, 360 Health offers access to: Online resources, including helpful decision-making tools Interactive health programs Discounts on health-related products Your employees also will appreciate the personalized programs that help manage and coordinate care for over 40 chronic conditions. 360 Health can help your employees at all stages of their lives, and wherever they are along the health spectrum. Note: For Lumenos plans, 360 Health programs may vary. MyHealth@Anthem Personal Health Manager provides you with a wealth of health information tools and resources including : Health Assessment - Complete the Health Assessment to determine your score and identify ways to lower personal health risks and track your progress over time with a personalized health improvement program. Symptom and Drug Interaction Checker - Enter medical symptoms or drugs you are taking and immediate access to relevant information. Personal Health Record - You and your family can store, manage and maintain your health information in a secure, centralized location. Fitness - LEAP, the Lifetime Exercise Adherence Program, lets you manage your fitness, or to be guided by fitness and health experts. Condition Centers - Access education information for more than 35 different conditions ranging from allergies to diabetes to women s health. SpecialOffers* With SpecialOffers, you can receive discounts on products and services that help promote better health and well-being. And, there s no extra cost to you. SpecialOffers is just one of the perks of being a member. To take advantage of these discounts, simply show your ID card when purchasing items or inform the product or service provider that you are a member. Discounted products and services Save on family and home items including discounts for everything needed for mother and baby; nursery items; baby safety gear; elder care advisory services or selected health and wellness books. Take advantage of discounts for medicine and treatments from providers such as drugstore.com National Allergy Supply and medical ID bracelets from Lauren s Hope. Enjoy better fitness and health with discounts on health club memberships, weight loss programs and alternative health and wellness paths including massage therapists, acupuncturists and more. Take advantage of vision and hearing discounts for: Eyewear Lasik surgery Hearing tests and aids * This program is provided by Anthem Blue Cross as a service to our members. This service does not constitute benefits under Anthem Blue Cross plans and is subject to change or cancellation without notice. Goods and services available through discount programs are not benefits of coverage. Anthem Blue Cross does not endorse or recommend any goods or services provided at a discount by these vendors or practitioners. These programs may be changed or withdrawn at any time without notice by the offering vendor or practitioner. 14

19 Wellness Programs for all plans Condition Management Anthem Blue Cross provides programs and activities for managing chronic conditions that affect a large number of our members. We currently offer programs such as asthma, diabetes and congestive heart failure. Anthem Blue Cross works with members, health care providers and employers to provide education, home or telephone coaching, and tools to help members who have chronic conditions enjoy fuller, more active lives. EmployerAccess An easy way to manage your company s health benefits all year long. With our online benefit administration tool EmployerAccess, you can quickly and conveniently perform simple benefit functions in real time. Here s what you can do: View your employees coverage Enroll employees and add dependents Change or cancel coverage for employees and dependents Request ID cards View open invoices Pay bills online Schedule payments Manage your bank account used for payments View 12 months of past invoices Gain more control and enjoy the benefits of managing your medical, dental, vision and life coverage in one seamless online experience. Visit anthem.com/ca or ask your Anthem Blue Cross agent for more details. Anthem Blue Cross Web resources Our website, anthem.com/ca, offers members a wealth of resources on health and wellness including: An Education Programs Directory to help members locate health and wellness classes Our Provider Finder online directory to help locate a physician in your community. Preventive health care guidelines for children, adolescents, adults and seniors Health articles on a broad array of topics A wealth of Web and organizational resources addressing issues such as cancer and women s health. Future Moms information for pregnant members and new parents Condition Management programs, offering education and lifestyle management for those dealing with chronic conditions Access to Healthy Living powered by MyHealth@Anthem Offers health information tools and assessment resources with a link to SpecialOffers 15

20 Dental coverage Special savings offer Save one percent on your medical premium when you enroll in medical coverage and dental coverage. Dental plans to make you smile We offer a variety of affordable, easy-to-administer Dental PPO and Dental HMO plans that fit your employees needs and your budget. You and your employees will benefit from: Selection: You get to decide how much you want to contribute and which of our many affordable plans you want to offer. Ease: You ll enjoy simple administration, with one bill and one premium check. Also, your employees will receive one ID card. Access: Your employees will have access to a network of more than 20,000 Dental PPO and more than 5,000 Dental HMO dentist locations in California alone. Experience: We are the seventh largest Dental company in the nation, serving more than 5.2 million customers. Maximizing Your Choice Our dental plans blend reliability with flexibility. You choose the number of insured Dental plans you want to offer your employees (one plan, a mix of dental HMO and/or Dental PPO plans, or all of our plans) giving your employees affordable choices that best fit their lifestyle and your budget. It is truly your choice. Dental Blue PPO Hightlights Dental Blue provides comprehensive diagnostic, preventive, basic and major coverage for your employees with no waiting periods. In addition, Dental Blue gives you: Access to one of the largest networks in the state Out-of-network reimbursement at the 80th percentile Access to our negotiated discounts on non-covered services such as implants, veneers, orthodontics and treatment for TMJ when visiting an in-network provider Access to our negotiated discounts after the calendar year maximum has been met when visiting an in-network provider Dental Net (DHMO) plan highlights Choosing our Dental HMO plan offers your employees affordable, easy-to-use coverage. Highlights include: More than 5,000 California dentists to choose from No deductibles No annual maximums Low out-of-pocket costs No waiting periods Orthodontic services for children and adults SpecialOffers SM provides information about discounts on health and wellness products and services from independent vendors* Our Dental Net plan offers comprehensive benefits at low cost to you and your employees. Your initial step in enrolling is choosing a dentist from our Dental Net network. Whenever you need specialty dental care, your first step is to contact your dentist, who will then coordinate any necessary specialty referrals. Only the services received from a Dental Net participating dental office are covered. * This program is provided by Anthem Blue Cross as a service to our members. This service does not constitute benefits under Anthem Blue Cross plans and is subject to change or cancellation without notice. Goods and services available through discount programs are not benefits of coverage. Anthem Blue Cross does not endorse or recommend any goods or services provided at a discount by these vendors or practitioners. These programs may be changed or withdrawn at any time without notice by the offering vendor or practitioner. 16

21 Life insurance coverage Life coverage Anthem Blue Cross Life and Health Insurance Company also offers Term Life and accidental death and dismemberment (AD&D) insurance for your employees. This valuable coverage offers your employees a way of protecting their families financial future. Basic Term Life and AD&D benefits You may choose one of the following Basic Term Life employee benefit options: Schedule A: Flat dollar amounts for all employees - You select one flat dollar amount from $15,000 to $250,000 in $1,000 increments for all employees. Schedule B: Life benefits graded by job title - You select one amount in $1,000 increments for Class 1** employees (officers, managers, supervisors) and another amount for Class II** employees (all other employees). Coverage amounts may be selected from $15,000 to $250, The benefit of each class can not be more than two-and-a half times the next lower class - There can be no more than two classes of employees Schedule C: Salary Based Life Insurance - You select either one or two times the employee s annual salary. All employees must have the same salary schedule. - Minimum benefit available - $15,000 - Maximum benefit available - $250,000 We will Guarantee Issue Non-contributory Group Life Coverage up to $100,000 for full time active employees* Guaranteed Issue Amounts There s no underwriting and no medical questionnaires with Guaranteed Issue amounts up to $100,000 for full-time active employees*. With all coverage amounts, AD&D and Living Benefit are included automatically Extras included with AD&D: An annual $3,000 college education benefit for eligible dependents A seat belt provision that adds the lesser of 10 percent of the coverage amount, up to $25,000, to the AD&D benefit * 100 percent of eligible employees must participate. Coverage is not available to retirees. COBRA individuals are not eligible.** The job title descriptions shown are examples. You may use them as a guideline, or prepare your own. There must be at least one person in eachclass (job description). Only one benefit schedule may be offered. The benefit amount for Class I cannot exceed $250,000 per employee andcannot exceed two-and-a half times the benefit amount for Class II. A repatriation benefit for preparation and transportation expenses should death occur more than 75 miles from home, to a maximum of $5,000 The Living Benefit Employees diagnosed with a 12-month life expectancy due to a terminal condition may request an advanced payment of up to 50 percent of their death benefit Two Dependent Life coverage options: $10,000 spouse, $10,000 children six months to 19 years (age 24 if full-time student), $1,000 for children under six months of age. (This option only available if employee life benefit is $20,000 or more). $5,000 spouse, $5,000 children six months to 19 years (age 24 if full-time student), $500 for children under sixmonths of age. The AD&D and Living Benefit are not available on either of the Dependent Life insurance options. Composite rates make life a breeze Automatic when enrolling 11 or more employees in Anthem Blue Cross Life and Health Life insurance Group receives a single rate per $1,000 of life coverage, which means all employees pay the same rate, regardless of age or sex Composite rates mean easier administration Employers must contribute a minimum of 25 percent of the employee s Basic Term Life premiums. The group must also enroll at least 75 percent of the eligible employees. The employer is not required to contribute toward the cost of dependent coverage. 17 Special savings offer Save one percent on your medical premium when you enroll in medical coverage and $25,000 or more in life insurance coverage.* In some cases, this savings may cover the entire life premium. The medical savings can be applied to cover a large amount of life insurance costs making life insurance more affordable than ever for your business. * Based on lowest available RAF of 0.90 Extras your employees want LifeConnections member assistance program is included at no additional cost if you purchase at least $25,000 of Group Life coverage. This valuable program gives employees and their families free and confidential access to work/life support resources, 24/7 telephone counseling and referral services, and website resources.

22 Information for the employer Convenient services to assist you At Anthem Blue Cross, we value customer service and are committed to providing you with the information you need, when you need it. Our convenient Internet and telephone resources can help save you time, answer your questions and give you access to some of our most commonly requested information. Internet resource options You can access information that is important to you and your employees by visiting our website at anthem.com/ca. Group administrators can: Print employee applications, change of coverage applications and group employee information change forms Review frequently asked questions View and print the Group Administrator Manual Find important telephone numbers and addresses Members can: View contract information Review address information Access information on medical plan coverage, programs for healthy lifestyles and pharmacy benefits Check claim status Find available providers, including specialists, and their locations Information available through the member portion of the site is in a secured format with confidential information accessible only through the use of a personal identification number (PIN). Telephone resource options Anthem Blue Cross Interactive Voice Response (IVR) System guides callers to a Customer Service representative or self service automated information via a series of instructions and prompts. Group administrators and members can access a number of helpful resources simply by calling: (800) Group administrators can: Obtain information about the most recent premium payment Obtain important addresses and phone numbers Request a variety of frequently used forms to be faxed to you Request a replacement ID card for an existing member Most importantly speak to a Customer Service representative Members can: Request a replacement ID card Access important addresses including Internet addresses for premium and billing, applications and claims, and dental claims Access phone numbers for assistance with coverage while traveling, dental claims, mail order pharmacy and retail pharmacy Access information about a doctor or hospital bill, and find out what s covered Change their address, or add or remove a family member 18

23 Enrollment guidelines Eligible employees Full-time: Employees must be employed on a permanent, full-time basis and have a normal work schedule of at least 30 hours per week. In addition, they must be compensated for that work by the employer (subject to withholding appearing on a W-2 form). Part-time: Employees must be employed on a permanent, part-time basis and have a normal work schedule of 15 to 29 hours. Note: The employer must choose one of two part-time options, either 15 to 29 or 20 to 29 hours. All part-time employees must be compensated for that work by the employer (subject to withholding appearing on a W-2 form). Note: It is the employer s option to offer health coverage to part time employees. If that option is exercised, all similarly situated individuals must be offered coverage under the employer s benefit plan. Sole proprietors/partners/corporate officers: Sole proprietors, partners and corporate officers must work at least 20 hours per week to be eligible for coverage. Ineligible employees Temporary, seasonal, leased or substitute workers and persons compensated on a 1099 basis are not eligible to enroll in an Anthem Blue Cross group plan. COBRA- and FMLA-Eligible Groups Employers who are qualified for coverage under COBRA (the Federal Consolidated Omnibus Budget Reconciliation Act) or FMLA (Family and Medical Leave Act) must complete a questionnaire, indicating the qualifying event and the date continuation coverage began. Effective date The date coverage takes effect for a group must be the first of the month. Employer waiting periods After employees are hired, there may be a specific period they must be employed, known as an employer waiting period, before they and their dependents become eligible for group coverage. The employee s eligibility date is the first of the month after the waiting period ends. Employers may choose a waiting period of the first of the month following an employee s date of hire, or one, two, three, four, five or six months of employment before an employee becomes eligible for benefits. Spouses A husband and wife employed at the same company may both be covered as employees. Children may be considered the dependents of either one or both of the employees. Adding employees and dependents New employees and dependents must submit completed applications to Anthem Blue Cross within 30 days of becoming eligible for coverage. Applications must be received no later than the last day of the month prior to the requested effective date. Eligible dependents An eligible dependent has one of the following relationships with an eligible employee: Lawful spouse Domestic partner (restrictions may apply) Unmarried child under age 19 (natural or legally adopted) of the employee, employee s enrolled spouse or the domestic partner s Unmarried child (between 19 and 24) who is a full time student and qualifies as a dependent for federal income tax purposes Ward (child) of a permanent legal guardian 19