Welcome to Your Blue Cross and Blue Shield of Illinois (BCBSIL) Coverage Guide for 2014

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1 A Guide to Your Sprint Basic Plan with Health Savings Account January 1, 2014

2 Welcome to Your Blue Cross and Blue Shield of Illinois (BCBSIL) Coverage Guide for 2014 Look inside to learn about: How your plan works For additional information, you can review the Summary Plan Description and Summary of Benefits and Coverage (SBC) on Sprint s intranet at i-connect>life & Career. How to find a network provider Sprint members utilize the Find a Doctor tool at bcbsil.com/sprint to search for in-network hospitals and providers. Tools and Resources Use the custom website for all Sprint members at bcbsil.com/sprint to find out more details about your benefits and to use the online resources available to you. As part of Sprint s continuous green efforts, Explanation of Benefits (EOB) statements are set up for electronic distribution. You can view, download and/or print your EOBs by logging in to Blue Access for Members SM (BAM) at bcbsil.com/sprint. If you prefer to have them mailed, you have the option to turn on a print and mail function by logging in to BAM and clicking on Settings and then Preferences in the drop-down menu. Please join Sprint in the efforts to stay paperless. You can even set your Preferences to send a text or whenever a claim is processed. Find a doctor or hospital Sprint members utilize the Provider Finder at bcbsil.com/sprint to search for in-network hospitals and providers. Get the most from your benefits Use the custom website for all Sprint members at bcbsil.com/sprint to find out more details about your benefits and to use the online resources available to you. Use these phone numbers for the best service Customer Service Sprint Alive!* or *545 from your Sprint phone CVS Caremark Rx* Phone numbers for the best service BCBSIL Customer Service Sprint Alive!* or *545 from your Sprint phone CVS Caremark Rx* BenefitWallet And much more! POD

3 Sprint Basic with Health Savings Account (HSA) Plan Why Choose Sprint Basic Plan with a Health Savings Account (HSA) *? Sprint Basic Plan with HSA is a consumer-directed health care plan that helps you achieve your health and financial goals. It is a high-deductible health plan qualified to be compatible with a health savings account (HSA). You and Sprint make deposits to your personal HSA, which you decide to either pay for qualified health care expenses with tax-free dollars or save with tax-free earnings for later. Features of the Basic Plan Include: Preventive care and wellness visits Adults and children are covered at 100% when you use network providers. You don t have to meet the Plan deductible to enjoy these benefits. Freedom and Choice Choose any doctor whenever you need care; but choosing a network doctor means getting care at the highest level of benefits. Online decision tools Personalize how you manage your health care and your health care spending. Log in to Blue Access for Members SM (BAM), a safe, secure website at bcbsil.com/sprint to: o Manage your benefits o Search for a network provider o Estimate the cost of a procedure or treatment o Find health and wellness information and resources When you seek care from network providers, your costs may be paid automatically from your HSA. Features of the HSA include: Sprint funding up to $500 over the year ($1000 for family coverage tiers), if you open an account and contribute a minimum of $24 per year through payroll deductions.** See details on HSA rules and services offered by our vendor, BenefitWallet, in the Additional Information section. Tax Savings contributions, potential account earnings and distributions for qualifying health care expenses are exempt from federal, most state, income taxes, and payroll deduction contributions are exempt from FICA taxes. Control you decide when, where and how your HSA dollars are spent.*** The savvier a consumer you are, the more you extend how far your HSA will take you. Portability your HSA belongs to you; unused funds remain in your account if you change health plans, or your job, or if you retire. *Because of strict federal rules on HSA, if you are enrolled in the Basic Plan, Sprint: does not allow you to enroll in the Sprint HC FSA for the same coverage period; will charge fair market value at the On-Site Health Clinics, which will be a covered health expense under the Basic Plan; and ends your ability to contribute to the HSA through payroll deductions after your Basic Plan coverage ends. **If you haven t set up your BenefitWallet account by the 31st day after your Basic Plan coverage begins, any potential Sprint HSA funding for that period will be forfeited and your HSA payroll deduction contribution withheld during that time will be paid out to you on your next available paycheck. ***Withdrawals from your HSA are tax-free only if used for qualifying health care expenses. Note that since your adult child who is still allowed to be covered under the Basic Plan (up to age 26), or your covered Domestic Partner, may not be your tax dependent, their expenses may not be qualifying health care expenses under the HSA rules

4 Sprint Basic Plan Specifications This Plan gives you freedom to choose providers and protects you from significant medical and prescription drug expenses. Here are the specifications: There are no co-pays with this Plan. The Basic Plan pays 100% for preventive prescription drugs and Network (and limited Non-Network) medical care. For other covered care and prescription drugs, the Basic Plan pays Co-insurance after you meet your deductible. The amount of Co-insurance depends on whether you use network providers or not. After you meet your Out-of-Pocket Limit with your part of the Co-Insurance, the Basic Plan pays all covered expenses. Remember, if you contribute to an HSA, Sprint will, too, so if you use your HSA funds to pay your Co-insurance, not all of those costs will be out of your pocket. Type of Cost Your Costs Network Non-Network Deductible Individual Family Tiers Co-Insurance (after Deductible) Doctor visits Specialist visits Ambulance and E.R. if Emergency Ambulance and E.R. if non-emergency Surgery Bariatric Surgery Infertility Services ($7,500 lifetime max) Gender Identity Disorder Services Prescription Drugs (administered by CVS Caremark) $1,750 $3,500 20% 20% 20% 40% 20% 50% 20% 50% 20% $3,500 $7,000 40% 40% 20% 40% 40% 100% 100% 100% 20% Out-of-Pocket Limit Individual Family Tiers $4,000 $8,000 $8,000 $16,000 For complete benefit coverage information, please see the Summary Plan Description. Network Information Use Provider Finder at bcbsil.com/sprint to see if your doctor is in the network or to search for another network provider. You may also call BlueCard Access toll-free at BLUE ( ) for provider information. Once you become a member, you can call the toll-free customer service telephone number on the back of your ID card for assistance.

5 How It Works Sprint Basic Plan with your HSA Examples Year One Aileen, Ben and their two children are covered under Sprint Basic Plan. Aileen elected an annual contribution of $3,000, or $125 per paycheck (24 pay periods), to the BenefitWallet HSA that includes a debit card. Sprint contributes $41.66 per paycheck during the year as well, making a total savings to their HSA of $ per paycheck, or $4,000 for the year. Both children had annual physicals and routine immunizations in March. $320 was paid by the Basic Plan for this Network preventive care. Then, in early September, Ben tore a ligament in his knee that required surgery. By this time, with eight months of both Aileen s and Sprint s HSA contributions, there was a total of $2, in the account, so Ben paid charges of $675 for the emergency room visit with the HSA debit card, counting toward the family Network Deductible of $3,500. Ben s Network surgery charges were $6,000. He cleared out the HSA of the remaining $1,991.56, and paid $ from his regular checkbook to satisfy the remaining $2,825 of his Deductible. For the balance of the surgery charges ($3,175), the Basic Plan paid its Co-insurance of 80% ($2,540), and he paid his 20% Co-insurance ($635) also from his regular checkbook. The rest of Year One was healthy for the family, and the last four months of Aileen s and Sprint s contributions to the HSA totaled $1, While Aileen considered withdrawing those funds to reimburse Ben s out-ofpocket charges in September (he had kept his receipts), she decided to just leave them in the HSA to start out the next year. Year Two Aileen continued her enrollment in the Sprint Basic Plan, she continued the same level of her HSA contributions, and Sprint continued its contributions to the HSA. Ben and Aileen had physicals and preventive care lab tests in March, and the children had annual physicals (neither required immunizations this year) as well. The Basic Plan paid $525 for Ben and Aileen and $275 for the children for this Network preventive care. In April, Aileen saw her dermatologist for a follow-up visit and Ben picked up his prescriptions at a local Network pharmacy. Aileen paid for the $175 office visit with the HSA debit card Ben paid $450 for his prescriptions using the HSA debit card. Again, the rest of the year for the family was free of medical events. So, the HSA balance from the end of Year One ($1,333.28), plus the Year Two contributions by Aileen and Sprint ($4,000), less the year s qualifying health care expenses of $625 paid from the HSA, left a total of $4, in the HSA to begin Year Three!

6 Sam Sam enrolled in Sprint Basic Plan and began contributing to the BenefitWallet HSA through payroll deductions of $41.66 per paycheck (24 pay periods, or $1,000 for the year). Sprint contributes $20.83 per paycheck throughout the year as well, for a total savings to his HSA of $62.49 per paycheck, or $1,500 for the year. Sam got a debit card from BenefitWallet for his account. Year One Sam injured his back and saw a Network specialist the last weekend in June. Charges totaled $315. Since his and Sprint s contributions for the 12 pay periods to date totaled $749.88, Sam used his BenefitWallet debit card to pay the charges, which applied to his Network deductible of $1,750 and left a balance of $ in his HSA. He had six physical therapy visits for his back with a Network therapist. Each therapy session cost $175, for a total of $1,050; he decided to not use his HSA and instead paid for those sessions from his regular checking account, also counting toward his Deductible. In September, Sam had a physical and preventive care lab tests. The Basic Plan covered the entire $225 for these Network preventive care costs. Sam broke his leg in late November, needing Network provider services costing $3,000. His and Sprint s eight additional per paycheck contributions in July through November ($624.90) added to his prior HSA balance for a total of $1, available. So he used his HSA debit card to pay the $385 remaining on his Deductible; for the balance of the charges ($2,615), the Basic Plan paid its Co-insurance of 80% ($2,092) and he paid his 20% Co-insurance ($523) with his HSA debit card. He then had $ remaining in his HSA; adding the last two paycheck contributions of the year, he had a year-end balance of $ in his HSA. Sam had saved his receipts from his PT sessions, so he decided to withdraw the entire HSA balance tax-free to partially reimburse himself using BenefitWallet s on-line banking service. This left no funds in his HSA to start the next year. Year Two Sam continued his employee-only enrollment in the Sprint Basic Plan, he increased his HSA contributions to $50 per paycheck, and Sprint continued its $20.83 contributions to the HSA, for a total of $70.83 per paycheck, or $1, for the year. In August, Sam had an annual physical and several preventive care lab tests. $280 was paid by the Basic Plan for this Network preventive care. Sam then picked up prescriptions from a local Network pharmacy. Total charges were $50, which Sam paid with his HSA debit card. He had no other medical events during Year Two, so his HSA balance at the end of the year was the total of his and Sprint s annual contribution less the $50 he paid for his prescriptions. Even though Sam changed employers the next year, since his HSA is completely portable, he kept the $1, to be used tax free for qualified medical expenses, such as out-of-pocket costs under his new plan, whether it s a high-deductible health plan or not.

7 Find a Doctor Tool Quick and Easy Ways to Find Providers and Treatment Costs The Find a Doctor tool, from Blue Cross and Blue Shield of Illinois (BCBSIL), is an innovative way to help you estimate and manage health care costs. Plus, you can select providers using independent, third-party quality ratings and meaningful patient reviews. The Find a Doctor tool shares information that puts you in charge. Do you want to know more about the providers who take care of you or your family? Do you need to know the estimated cost of a medical service and your estimated out-of-pocket share of the cost? How do you choose where to go for medical services? You can use the Find a Doctor tool to: Find a network primary care physician, specialist or hospital. Filter search results by doctor, specialty, ZIP code, language and gender even get directions from Google Maps. Make an appointment to consult with a provider in select geographic areas*. Estimate the cost of a provider s procedures, treatments and tests and help estimate your out-of-pocket expenses*. Determine if a Blue Distinction Center for Specialty Care is an option for treatment. View patient feedback or add your review for a provider*. View quality, certifications and recognitions for doctors. It s easy, immediate, secure and available at bcbsil.com/sprint. * To have access to this function, you will need to go through Blue Access for Members SM (BAM). After logging in to BAM, click on the Doctors and Hospitals tab. You will then see the Find a Doctor tool

8 Integrated Provider Finder helps you make important health care decisions Screen shots are for illustrative purpose only. It s easy to get started with the Integrated Provider Finder by registering for Blue Access for Members SM (BAM): 1. Go to bcbsil.com. 2. Click the Log In tab, and then click the Register Now link. 3. Use the information on your BCBSIL ID card to complete the registration process. 4. Once you are registered, log in to BAM. The Integrated Provider Finder tool is located under the Doctors & Hospitals tab. Get assistance while you re away from home. Go to bcbsil.com and register or log in to BAM. You can stay connected to your claims activity, ID card information, coverage information, prescription reminders, and health tips via text messages. You can also call a BCBSIL Customer Service Advocate at the toll-free telephone number on the back of your member ID card for help in locating a provider

9 Log in to Blue Access for Members SM (BAM) Your Online Resource Would you like to know when your medical claims are paid and the payment amounts? Do you need to confirm who in your family is included under your coverage? BAM, the secure member portal from Blue Cross and Blue Shield of Illinois (BCBSIL), can help. Get immediate online access to health and wellness information, and: Check the status of a claim and your claims history Confirm the family members who are covered under your plan View and print an Explanation of Benefits (EOB) statement for a claim Select an option to stop receiving EOBs by mail Set your preferences to receive notifications for claims status and wellness updates through s or text alerts. Locate a doctor or hospital in the network Request a new or replacement member ID card or print a temporary member ID card Join My Blue Community, a social network for BAM members Use BAM while you re on the go. Register or log in by going to bcbsil.com/sprint from your mobile device Web browser for secure and convenient access. It s easy to get started 1. Go to bcbsil.com /sprint. 2. Click the Already a Member? Then click the Register Now button in the BAM section. 3. Use the information on your BCBSIL ID card to complete the registration process

10 Find what you need at Blue Access for Members SM (BAM) 8 9 J My Coverage: Review benefit details for you and the family members covered under your plan. 2. Claims Center: View and organize details such as payments, dates of service, provider names, claims status and more. 3. My Health: Make more informed health care decisions by reading about health and wellness topics and researching specific conditions. 4. Doctors & Hospitals: Use the Find a Doctor tool to locate a network doctor, hospital or other health care provider, and get driving directions. 5. Forms & Documents: Use the form finder to get claim and other forms quickly and easily. 6. Message Center: Learn about updates to your benefit plan, and receive notification of pending and finalized claims via secure messaging. 7. Quick Links: Go directly to some of the most popular pages for information, such as medical coverage, replacement ID cards, manage preferences and more. 8. Settings: Set up notifications and alerts to receive updates via text messaging and , review your member information, and change your secure password at anytime. 9. Help: Look up definitions of health insurance terms, get answers to frequently asked questions and find Health Care School articles and videos. 10. Contact Us: Submit a question and a Customer Service Advocate will respond by phone or through the message center

11 Blue Access Mobile SM Blue Access Mobile brings convenient, secure access to your mobile phone. From your mobile phone Web browser, you can: Register or log in to your secure member site Blue Access for Members SM to view coverage details, access or request identification (ID) cards, check claims status, manage your user profile, use the Message Center and view health and wellness information Download the Find Doctor app to find an in-network doctor, hospital or urgent care facility. Sign up for text or notifications, tips and reminders Access Health Care Reform and Health Care 101 to view general health insurance information and terminology Shop for insurance and get a quote before applying Locate Blue Cross and Blue Shield of Illinois (BCBSIL) contact information It is easy to experience Blue Access Mobile. Simply go to bcbsil.com /sprint from your mobile phone Web browser. There is no registration required to access the mobile site. However, BCBSIL members must enter their user name and password to log in to Blue Access for Members. bcbsil.com/mobile

12 The Affordable Care Act: Preventive Services at 100% 1 of 4 Preventive Care Services Covered Without Cost-sharing Without Copay, Coinsurance or Deductible The Affordable Care Act requires non-grandfathered health plans and policies to provide coverage for preventive care services 1 without cost-sharing (such as coinsurance, deductible or copayment), when the member uses a network provider. Services may include screenings, immunizations, and other types of care, as recommended by the federal government. Blue Cross and Blue Shield of Illinois (BCBSIL) is committed to implementing coverage changes to meet ACA requirements as well as the needs and expectations of our members. General Highlights of New Regulations Applies to group health plans including insured and self-insured plans, as well as individual and family policies. Preventive services are to be covered without any cost-sharing when using a network provider. Cost-sharing can still be required when using a provider that is not in the BCBSIL provider network. New requirements can be issued at any time. As new or updated preventive care recommendations or guidelines are issued, employers and insurers have one year to implement the new guidelines unless otherwise specified by the government. 2 Plans that cover preventive services in addition to those required may apply cost-sharing requirements for the additional services. The regulation references preventive care services with an A or B rating as outlined by the United States Preventive Services Task Force (USPSTF). 1 They are listed in this fact sheet and can be found at: factsheets/2010/07/preventive-services-list.html BCBSIL will use reasonable medical management techniques to determine any coverage limitations on the service, including the frequency, method, treatment or setting for the service, and the use of an out-of-network provider. Plans that are grandfathered, meaning plans that had at least one individual enrolled on March 23, 2010, and have not made certain changes since that date to cause a loss of grandfathered status, are not required to implement some of the new requirements of the Affordable Care Act, including the requirement to cover preventive services with no cost-sharing. For more information about grandfathered health plans visit this BCBSIL web site: htt p://bcbsil.com/affordable_care_act/pdf/ bcbsil_fact_sheet_aca_gr_plans.pdf Preventive Care Services to Be Offered Without Copay, Coinsurance or Deductible Evidence-based preventive services: The list of ACA required preventive services includes those that are recommended and rated A or B by the USPSTF. Routine vaccinations: A list of immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention are included in the rule. They are considered routine for use with children, adolescents and adults, and range from childhood immunizations to periodic tetanus shots for adults. Publication Date: 12/11/

13 The Affordable Care Act: Preventive Services at 100% 2 of 4 Prevention for children: The rule includes preventive care guidelines for children from birth to age 21 developed by the Health Resources and Services Administration with the American Academy of Pediatrics. Services include regular pediatrician visits, developmental assessments, immunizations, and screening and counseling to address obesity. Prevention for women: The regulation mandates certain preventive care measures for women. These recommendations will be in place until new requirements for prevention for women are issued by the USPSTF or appear in comprehensive guidelines supported by the Health Resources and Services Administration. 2 BCBSIL s Focus on Prevention Laying the groundwork for a healthy tomorrow means disease prevention and early detection. Many chronic diseases and conditions can be prevented and/or managed through early detection. Preventive screenings are an important way to track your health and avoid chronic conditions before they become more serious. BCBSIL encourages you to take full advantage of your preventive care benefits and other available wellness resources. After completing a health screening, take appropriate steps to improve your health. Talk with your physician about ways to improve your health. There is no better time than now to get started and head off potential health problems before they begin. Billing and Office Visits If a recommended preventive service or item is billed separately from an office visit, then cost-sharing may be applied to the office visit. If a recommended preventive item or service is not billed separately from an office visit and the primary purpose is preventive care, then cost-sharing requirements may not be imposed with respect to the office visit. If a recommended preventive item or service is not billed separately from an office visit and the primary purpose of the office visit is not preventive care, then cost-sharing may be applied to the office visit. Covered Preventive Care Services 1 Depending on the particular health plan, coverage may be provided for the following preventive services without cost-sharing. 1 This list may not include all of a particular plan s covered services. BCBSIL members can call Customer Service at the number on their member ID card for details on how these benefits apply to their coverage and the most up-to-date list of covered preventive services, including those paid without any cost-sharing. Children and Adolescents Well-child exam Examples of services included as part of a wellchild exam include history and physical exam, measurements of height, weight and body mass index (BMI), hearing screening 4, vision acuity test 5, developmental and behavioral assessments, prescription of fluoride if water source is deficient in fluoride, evaluation of need for a dentist visit, counseling about health risks such as sexually transmitted infections, and obesity counseling. Immunizations Diphtheria, Tetanus, Pertussis Haemophilus influenzae type B Hepatitis A Hepatitis B Human Papillomavirus (HPV) Influenza (Flu) Measles, Mumps, Rubella Meningococcal Pneumococcal Inactivated Poliovirus Publication Date: 12/11/

14 The Affordable Care Act: Preventive Services at 100% 3 of 4 Rotavirus Varicella (Chickenpox) Screening tests Screening for hearing loss, hypothyroidism, sickle cell disease and phenylketonuria (PKU) in newborns Hematocrit or hemoglobin screening Obesity screening Lead screening Dyslipidemia screening for children at higher risk of lipid disorder Tuberculin testing Depression screening Screening for sexually transmitted infections (STIs) HIV screening Cervical dysplasia screening Preventive treatments Gonorrhea preventive medication for eyes of all newborns Adults Preventive exam Examples of services included as part of a preventive exam include history and physical exam, measurements of height, weight and body mass index (BMI). Immunizations Hepatitis A Hepatitis B Human Papillomavirus (HPV) Influenza (Flu) Measles, Mumps, Ruebella Meningococcal Pneumococcal Tetanus, Diphtheria, Pertussis Varicella (chickenpox) Zoster Screening tests Blood pressure screening Cholesterol screening Colorectal cancer screenings using fecal occult blood testing, sigmoidoscopy or colonoscopy 3 Depression screening Diabetes screening for adults with high blood pressure HIV screening Obesity screening Sexually transmitted infection (STI) screenings (chlamydia, gonorrhea, syphilis) Health Counseling Alcohol misuse Healthy diet Obesity Prevention of sexually transmitted infections (STIs) Tobacco use and cessation Use of aspirin to prevent cardiovascular disease Use of folic acid Men Only Abdominal Aortic Aneurysm screening Women Only Annual well woman visit Breast cancer screening/ Screening mammography Cervical cancer screening including Pap smear Osteoporosis screening Genetic counseling and evaluation for BRCA testing where family history is associated with an increased risk Human Papillomavirus (HPV) DNA test Counseling related to chemoprevention of breast cancer Breastfeeding 9 Domestic violence counseling Contraception 6 Publication Date: 12/11/

15 The Affordable Care Act: Preventive Services at 100% 4 of 4 Contraception 6 Depending on your particular health plan, coverage without cost-sharing may expand to include the following contraceptive services when provided by a health care provider in the BCBSIL network. Prescription 7 One or more products within the categories approved by the FDA for use as a method of contraception Over-the-counter Contraceptives available approved by the FDA for women (foam, sponge, female condoms) when prescribed by a physician The morning after pill Medical devices such as IUD, diaphragm, cervical cap and contraceptive implants Female sterilization 8 For more information about Women s Preventive Services download this BCBSIL Fact Sheet at htt p://bcbsil.com/affordable_care_act/pdf/ preventative_health_services_women_il.pdf Specifically for Pregnant Women Alcohol misuse screening and counseling Anemia screening Bacteriuria screening Rh Incompatibility screening Gestational diabetes screening Hepatitis B screening Screenings for Sexually Transmitted Infections (STIs) including chlamydia, gonorrhea, and syphilis Tobacco use and cessation counseling Footnotes 1 ACA requires non-grandfathered health plans and policies to provide coverage for preventive care services without cost-sharing only when the member uses a network provider. This includes preventive care services with an A or B rating as outlined by the United States Preventive Services Task Force as follows: Evidence-based items/services rated A or B in the current recommendations of the U.S. Preventive Services Task Force Routine immunizations for children, adolescents and adults recommended by the Advisory Committee on Immunization Practices of the Centers for Disease control and prevention Evidence-informed preventive care and screenings for infants, children, and adolescents in the comprehensive guidelines of the Health Resources and Services Administrations Evidence-based preventive care and screenings for women described in the comprehensive guidelines of the Health Resources and Services Administration For a listing of these services visit htt p://ww w.healthcare.gov/news/factsheets/2010/07/ preventive-services-list.html 2 New requirements can be issued at any time. Plans/policies have one year from issuance to add the new benefit. New requirements on women s preventive services were released by the U.S. Department of Health and Human Services on Aug. 1, Non-grandfathered plans/policies are required to cover these services beginning with plan/policy years starting on or after Aug. 1, Anesthesia also covered as preventive 4 Further evaluation recommended as a result of a hearing screening test is not considered preventive and may not be covered at 100%. 5 Vision acuity test to detect amblyopia (lazy eye), strabismus (cross eye), and defects in visual acuity in children younger than age 5 years. Normal vision screening and further evaluation recommended as a result of an acuity test are not considered preventive and may not be covered as preventive. 6 Under federal guidelines, certain religious employers may not be required to cover contraceptive services. Also, religious-affiliated employers meeting certain criteria may qualify for a temporary enforcement safe harbor period which doesn t require them to cover the recommended contraceptive services for one year. 7 Prescription coverage for contraception may vary according to the terms and conditions of your health plan s pharmacy benefit. Please call the customer service number on the member ID card for coverage details. 8 Certain restrictions may apply; there might be copay, coinsurance or deductible in some cases call the number on your member ID card for more information. Hysterectomies are not considered part of the women s preventive care benefit. 9 Breastfeeding Breastfeeding specialist/nurse practitioner with staterecognized certification who is in your provider network Breastfeeding support and counseling by a trained in-network provider while you are pregnant and/or after you ve given birth Manual breast pump Electronic and hospital-grade pumps will not be covered with no cost-sharing. This information is a high-level summary and for general informational purposes only. The information is not comprehensive and does not constitute legal, tax, compliance or other advice or guidance. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Publication Date: 12/11/

16 HSAs: A healthy investment Are you ready to take a few minutes to learn about Health Savings Accounts (HSAs)? These accounts are an important part of a revolution in health care a revolution offering you savings, control and ownership. With BenefitWallet TM, you can quickly build a health care piggy bank for current and future health care expenses with tremendous tax advantages while you enjoy the security of health care coverage that protects you and your family. How does it work? To help pay and save for health care expenses, the government allows individuals covered by high-deductible plans to open HSAs. Both the HSA owner and their employer are allowed to contribute to the account, but the owner gets to control and keep any funds left over after each year. The HSA offers valuable savings on federal and state taxes*: Contributions are tax free; Account interest accumulates tax free; and Dollars spent on qualified medical expenses are tax free. *Free from state tax in most states Any balance left over at the end of the year stays with the individual, available regardless of job changes or retirement. Balances earn interest and may be invested, offering HSA owners the ability to set aside thousands of dollars for later health care needs. Learn more about HSAs: Visit for complete information on BenefitWallet and tools. Visit the U.S. Treasury s HSA website at treas.gov (Click on Health Savings Accounts ), or call the BenefitWallet Service Center at Example: Federal tax savings available with an HSA HSA owner contribution: $1,000 Tax Rate: Potential Savings: 35% $350 33% $330 28% $280 25% $250 15% $150 In addition to the federal tax advantages, most states provide additional state tax deductions or rebates. HSA savings over time If an individual contributed $1,500 into an HSA each year starting at age 35 and spent $500 of that $1,500 each year on health care expenses after 30 years the account could grow to over $185,000. And at age 65 or after, account funds are available for non-medical expenses, without tax penalties! (This example assumes the owner takes advantage of available HSA investment options and receives an average 8% annual return.)

17 HSAs: how they work The idea is simple: you choose to set up an HSA as you enroll in an HSA-compatible health plan. As you build up a balance in your account, you can use your tax-free HSA dollars to pay for your eligible health care costs, such as doctor and hospital visits ( qualified medical expenses ). Even better, most qualified medical expenses paid from your HSA are credited toward meeting the deductible of your new health plan. If your total expenses reach your health plan deductible, an out-of-pocket maximum kicks in, capping your cost and activating insurance coverage for all additional covered expenses for the plan year. Even if you don t meet your deductible, you can use your tax-advantaged HSA dollars to pay for qualified medical expenses covered under your health plan, such as for chiropractic care, eyeglasses or other vision expenses, or alternative medical expenses. Growing your HSA Each year you may make HSA contributions up to an annual limit specified by the IRS: For 2013, that annual contribution limit is $3,250 for individual coverage and $6,450 for family coverage. For 2014, that annual contribution limit is $3,300 for individual coverage and $6,550 for family coverage. Signing up: Easy as 1, 2, 3! 1. After you enroll in the High Deductible Health Plan (HDHP) coverage, you ll receive a Welcome Kit in the mail that will provide you with more information and ask you to name an account beneficiary. 2. Return the paperwork to receive an HSA checkbook and health care payment card (in separate mailings, for your protection) to use to pay for your health care expenses. 3. You ll have access to all of your account activity online. If you have questions, you can call the BenefitWallet Service Center toll free. More opportunities to save Have you ever compared prices as you shopped for a car or planned a trip? With your HSA, you decide where to spend your health care dollars, and you keep the savings as you make smart health care decisions. Simple steps to keep more money in your account include: Using the discounted health care provider network, Asking for generic prescriptions when they are available, and Asking your physician questions about treatments and tests. If you are age 55 or older, you may make additional catch-up contributions of up to $1,000 for 2013 and (Some additional rules apply if you enroll after January 1. Visit our website at for more information.) If your employer puts money in your account, those contributions count toward your contribution maximum for the year. The good news, though: you own that money, regardless of whether you leave your current job or retire. You can choose to fund your HSA to meet your expected health care costs for the next year, or fund up to the contribution limit to build up taxadvantaged savings for the future. At the end of the year, any funds you have not used remain in your account, rolling over for future expenses. As your account grows, you can elect to transfer funds into an investment account. BenefitWallet offers an integrated investment platform with 22 investment options from a variety of fund families. You can open investments online once your HSA checking balance reaches $1,000. If or when you need those investment dollars for health care expenses, they can be returned to your original account without penalty Xerox HR Solutions, LLC. All rights reserved

18 My HSA HSA overview A Health Savings Account (HSA) enables you to save, invest, and spend funds for qualified medical expenses on a tax-advantaged basis. Unused HSA dollars roll over from year to year, making HSAs a convenient and easy way to save for future medical expenses. You won t pay taxes* on deposits, earnings, or payments for qualified medical expenses. It s your choice to save for future health expenses or pay for current health care expenses. Your HSA funds are yours even if you change health plans, change employers, or retire. *In most states 1. Opening an HSA 1. Enroll in an HSA qualified plan 2. Open your HSA online or by Master Signature Card 3. Elect an HSA contribution through your employer or make a deposit directly 4. Receive a health care payment card* after opening your HSA 5. Receive a checkbook* after completing a Master Signature Card 6. Start using your HSA *For security purposes, your health care payment card and checkbook are mailed separately in generic envelopes 2. Depositing and investing Contribute to your HSA by: Payroll contribution Online account-to-account transfer Mailing a check with a deposit slip Invest your accumulated funds Funds over $1,000 can be invested 22 mutual funds to choose from TM Investment selections can be made on BenefitWallet 's website 3. Paying for qualified medical expenses Pay for your expenses using your: Health care payment card Online bill pay Checkbook Reimburse yourself for out-of-pocket expenses by: Online account-to-account transfer Writing an HSA check to yourself There aren t any claim forms to submit, but be sure to keep your receipts in case the IRS asks for proof of your expenses. Ongoing resources Available resources on include: Modeling tools Frequently asked questions Educational video library Educational materials Call the BenefitWallet Service Center: Website: Account Statements available online or by mail 2013 Xerox HR Solutions, LLC. All rights reserved

19 Frequently Asked Questions What is a Health Savings Account or HSA? A Health Savings Account or HSA is a tax-advantaged savings account, similar to a traditional Individual Retirement Account (IRA), but designated for qualified medical expenses. An HSA allows you to pay for current qualified medical expenses and save for future qualified medical expenses on a tax-favored basis. HSAs provide triple-tax advantages: contributions, investment earnings, and qualified distributions all are exempt from federal income tax, FICA (Social Security and Medicare) tax and state income tax (for most states). Unused HSA dollars roll over from year to year, making HSAs an easy way to save and invest for future qualified medical expenses. You own your HSA and can take it with you when you change medical plans, change jobs or retire. This means the funds in your account, contributed by you and your employer, are non-forfeitable and portable. Funds in your account not needed for short-term expenses may be invested, providing the opportunity for funds to grow. Investment options include money market accounts and mutual funds. To be eligible to set up an HSA and contribute, you must be covered by a qualified High Deductible Health Plan (HDHP) and not have other coverage (e.g., Medicare). How does an HSA work? If you enroll in a qualified HDHP and meet other IRS criteria, you may open and contribute to an HSA. All of the money deposited into your HSA, up to the maximum annual contribution limit determined by the IRS each year, is 100% tax deductible for federal income tax, FICA (Social Security and Medicare) tax, and state income tax (for most states). If you choose, you may use your HSA funds to pay for expenses under your HDHP that you incur before you have met your deductible, for coinsurance or copayments you owe after meeting your deductible or for any other qualified medical expenses. The funds in your account can be used for other, non-medical expenses, but distributions used for non-medical expenses are subject to ordinary income taxes, plus a 20% penalty if you are under age 65. The 20% penalty does not apply if the distribution occurs after you reach age 65, become disabled or die; however, ordinary income tax may still apply. Funds remaining in your account at the end of the year roll over and accumulate for your future qualified medical expenses. You may choose not to spend your HSA dollars, use after-tax dollars for your qualified medical expenses and leave your HSA dollars to grow for the future. Choosing which expenses to pay with out-of-pocket after-tax dollars and which to pay with your HSA dollars is entirely up to you. What happens to my HSA if I quit my job or otherwise leave my employer? Your HSA is portable. This means that you can take your HSA with you when you leave and continue to use the funds you have accumulated. Funds left in your account continue to grow tax-free. If you are covered by a qualified HDHP you can even continue to make tax-free contributions to your HSA. Distributions from your HSA that are used exclusively to pay for qualified medical expenses for you, your spouse, or dependents are excludable from your gross income. Your HSA funds can be used for qualified expenses even if you are not currently eligible to contribute to your HSA

20 What does it mean to have my HSA checking account FDIC insured? TM BenefitWallet 's HSA custodian is The Bank of New York Mellon (BNY Mellon). Deposits to the HSA checking account are FDICinsured up to the FDIC coverage limit. The Federal Deposit Insurance Corporation, or FDIC, is an independent agency of the United States government. The FDIC insures your deposits up to a specified limit in the unlikely event of the failure of the insured bank or savings institution. Please visit the FDIC website at for more details. The FDIC does not insure the money in your HSA investment account. What health care expenses does my HSA cover? Your HSA funds can be used tax free to pay for out-of-pocket qualified medical expenses, even if the expenses are not covered by your HDHP. This includes expenses incurred by your spouse or dependents. There are hundreds of qualified medical expenses, including: Over-the-counter medications for which you have a prescription from your doctor; Dental visits; Orthodontics; Glasses All of these expenses may be paid for with distributions from your HSA, free from federal income tax or state income tax (for most states). Refer to IRS Publication 502 for a more complete list of qualified medical expenses. What happens to the money in my HSA if I become disabled? Building an account balance in preparation for expenses associated with disability or increasing medical usage in retirement is one of the great benefits of an HSA. If you become disabled and enroll in Medicare, contributions to your HSA must stop as of the first of the month in which you become enrolled. However, you can continue to use your funds to pay for qualified medical expenses, including payments for Medicare Parts A and B. If you use your funds for qualified medical expenses, the distributions from your account remain tax free (i.e., free from federal income taxes or state income tax (for most states). If you use the monies for non-qualified expenses, the distribution becomes taxable, but due to your disability, is exempt from the 20% penalty. What happens to the money in my HSA after I reach age 65? At age 65 and older, you may continue to use your HSA funds to pay for qualified medical expenses; for instance, you may use your HSA to pay certain insurance premiums, such as Medicare Parts A and B, Medicare HMO, or your share of retiree medical coverage offered by a former employer. Funds cannot be used tax-free to purchase Medigap or Medicare supplemental policies. If you use your funds for qualified medical expenses, the distributions from your account remain tax free (i.e., free from federal income taxes or state income tax (for most states)). If you use your funds for non-qualified expenses, the distribution becomes taxable, but due to your age, is exempt from the 20% penalty. Once you are enrolled in Medicare, you are no longer eligible to contribute to your HSA. If you reach age 65 or become disabled, you may still contribute to your HSA if you have not enrolled in Medicare Xerox HR Solutions, LLC. All rights reserved.

21 HSA Advantage Direct HSA Advantage Direct allows members who are enrolling in an HDHP to open their HSA online without having to wait for a Welcome Kit. HSA Advantage Direct allows the member to activate their account using a health plan specific URL in three easy steps. Click on or type the following URL to begin enrollment using HSA Advantage Direct: BenefitWallet Advantage Direct Enrollment System Step 1 Enter your information: Name Last 4 digits of SSN Date of birth ZIP code If you have a PO box as your mailing address, check the box. An address collection page will be displayed address and click Submit

22 Step 2 Review and click Next The BenefitWallet HSA Advantage Web site! BenefitWallet HSA. a BenefitWallet HSA, you must meet all of the criteria listed below. The Medicare Act of 2003, which established HSAs, defines eligible individuals as Step 3 Before you can OPEN your account, you must review the terms and conditions and select Agree and click Finish

23 Confirmation Screen Thank you for your online enrollment BenefitWallet BenefitWallet BenefitWallet Service Center at WHAT S NEXT? You will receive a confirmation if an was provided on the login screen. A personalized health care payment card will be mailed 5-10 days after BenefitWallet TM receives an enrollment file and the data match is successful. An abbreviated Welcome Kit will be issued by BenefitWallet containing a personalized Master Signature Card. You must complete and return the Master Signature to designate beneficiaries. If you would like to receive a checkbook, also complete the checkbook indicator on the Master Signature Card. If the indicator is checked, an HSA checkbook will be mailed to you once BenefitWallet processes the Master Signature Card. Once BenefitWallet processes the Master Signature Card, an HSA checkbook will be mailed

24 Sprint Alive! makes it easier for you and your family to improve and maintain health and well-being. Sprint Alive! Offers expert resources and services to help take small steps toward a healthier you. Sprint Alive! is part of your Sprint benefit plan, and it s always confidential. Sprint Alive! provides you the services you need to get and stay healthy, from helping you navigate the health care maze, to helping achieve individual health goals, to providing online health resources. Sprint Alive! is always confidential, and it s offered at no additional cost* as part of your Sprint benefit plan. When it comes to your health and well-being, Sprint Alive! offers you and your family the resources and service options to fit every need. In the maze of health care options, Health Advocates help navigate a clear path to the right care. Make them your first call for health! SprintAlive.com provides online resources to inform and motivate you. Plus, there are telephonic and online specialty health coaching programs to help you achieve your individual goals. Sprint Alive! Is confidential, and offered at no additional cost to you. Many Sprint Alive! health and wellness coaching programs offer additional motivation for completion like Sprint e-points incentives. Now that s win-win! win! Ask your Sprint Alive! Health Advocate about the incentives that are available with some of the health and wellness coaching programs. SPRINT ALIVE! HEALTH ADVOCATE Sprint Alive! Health Advocates help make it easier for you and your family to navigate the health care system. Your Sprint Alive! Health Advocate will help you and your family become and stay healthy. From connecting you with the right doctors to scheduling your appointments, they can help make navigating the health care system easier. It s much easier to be successful with your health when you have someone in your corner. Whether you re looking to lose weight, save money, or need help navigating the confusing health care system, Sprint Alive! Health Advocates are there to help. Sprint Alive! Health Advocates will help make it easier for you and your family to navigate the health care system. It s simple and convenient you ll have access to professionally trained individuals who team up with specialist nurses, physicians and health coaches. There s no one-size-fits-all solution to health care, so our team provides the individual help you deserve with no additional cost. They can help you save time by doing the legwork for you, from finding the best doctor to researching treatment options to scheduling appointments. This program is for your family members too. It s always confidential and offered at no additional cost* to you! What can a Health Advocate do? They can help you: Find local doctors rated for quality Schedule appointments for your entire family Research health questions or concerns Obtain a second opinion Help you understand your health benefits Create reasonable health goals based on your needs And so much more! How do you contact your Health Advocate? You can contact your Health Advocate at any time by calling ALIVE (25483) or dialing *545 from your Sprint phone or by ing an individual Health Advocate or DISCLAIMER *For all employees of Sprint who are not covered under a Sprint health benefit plan, the Sprint Alive! Program is available to you at no additional cost as part of your Sprint employee benefits. If you are an employee of Sprint who is covered under a Sprint health benefit plan, the Sprint Alive! Program is offered to you, and your eligible dependents, at no additional cost under your Sprint health benefit plan. The information provided herein is for informational purposes and is not a substitute for your doctor s care. Please discuss with your doctor how the information provided herein is right for you. The Sprint Alive! Program will use or disclose the information you provide in furtherance of our services under the Sprint Alive! Program or, for employees of Sprint who are covered under a Sprint health benefit plan, other services in furtherance of your health benefit plan.

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