#8 Plans offered in 2016 Colorado Provider reference guide



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#8 s offered in 2016 Colorado Provider reference guide Individual plans on the exchange Affordable Care Act (ACA) compliant s Page 1 of 9 Revised: September 27, 2015 Anthem Bronze HMO 0% for HSA HMO VAB IND Y N Anthem Bronze HMO 25% for HSA HMO VAB IND Y N Anthem Bronze HMO 4500/25% AI HMO VAB IND Y N Anthem Bronze HMO 5000/40% HMO VAB IND Y N Anthem Bronze HMO 5000/40% AI HMO VAB IND Y N Anthem Bronze HMO 5400/50% HMO VAB IND Y N Anthem Bronze HMO 5400/50% AI HMO VAB IND Y N Anthem Bronze HMO 5800/30% HMO VAB IND Y N Anthem Bronze HMO 5800/30% AI HMO VAB IND Y N Anthem Bronze HMO 6250/20% HMO VAB IND Y N Anthem Bronze HMO 6250/20% AI HMO VAB IND Y N Anthem Bronze HMO 6300/0% AI HMO VAB IND Y N Anthem Silver HMO 0/0% AI HMO VAB IND Y N Anthem Silver HMO 150/35% S06 HMO VAB IND Y N Anthem Silver HMO 150/50% S06 HMO VAB IND Y N Anthem Silver HMO 200/10% S06 HMO VAB IND Y N Anthem Silver HMO 200/15% S06 HMO VAB IND Y N Anthem Silver HMO 200/25% S06 HMO VAB IND Y N Anthem Silver HMO 450/50% S05 HMO VAB IND Y N Anthem Silver HMO 700/25% S05 HMO VAB IND Y N Anthem Silver HMO 700/35% S05 HMO VAB IND Y N Anthem Silver HMO 750/10% S05 HMO VAB IND Y N Anthem Silver HMO 800/15% S05 HMO VAB IND Y N

Page 2 of 9 Revised: September 27, 2015 Anthem Silver HMO 1250/35% S04 HMO VAB IND Y N Anthem Silver HMO 1250/35% AI HMO VAB IND Y N Anthem Silver HMO 1300/35% HMO VAB IND Y N Anthem Silver HMO 2000/25% HMO VAB IND Y N Anthem Silver HMO 2000/25% S04 HMO VAB IND Y N Anthem Silver HMO 2000/25% AI HMO VAB IND Y N Anthem Silver HMO 2250/10% S04 HMO VAB IND Y N Anthem Silver HMO 2350/50% S04 HMO VAB IND Y N Anthem Silver HMO 2400/10% HMO VAB IND Y N Anthem Silver HMO 2500/10% AI HMO VAB IND Y N Anthem Silver HMO 2500/15% HMO VAB IND Y N Anthem Silver HMO 2500/15% S04 HMO VAB IND Y N Anthem Silver HMO 3200/50% HMO VAB IND Y N Anthem Silver HMO 3200/50% AI HMO VAB IND Y N State State S04 State S05 State S06 State AI Anthem Gold HMO 0/30% HMO VAB IND Y N Anthem Gold HMO 0/30% AI HMO VAB IND Y N Anthem Gold HMO 1500/20% HMO VAB IND Y N Anthem Gold HMO 1500/20% AI HMO VAB IND Y N Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi- State HMO XFV IND Y N

Page 3 of 9 Revised: September 27, 2015 Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi- HMO XFV IND Y N State AI Anthem Catastrophic HMO 6850/0% HMO VAB IND Y N Anthem Silver HMO 200/25% S06* HMO VAB IND Y N Anthem Silver HMO 850/25% S05* HMO VAB IND Y N Anthem Silver HMO 2250/25% S04* HMO VAB IND Y N Anthem Silver HMO 3250/25%* HMO VAB IND Y N Anthem Silver HMO 3250/25% AI* HMO VAB IND Y N Mountain Enhanced X Anthem Bronze Mountain Enhanced X HMO 5000/40% HMO VAG IND Y N Mountain Enhanced X Anthem Bronze Mountain Enhanced X HMO 5000/40% AI HMO VAG IND Y N Mountain Enhanced X Anthem Silver Mountain Enhanced X HMO 200/25% S06 HMO VAG IND Y N Mountain Enhanced X Anthem Silver Mountain Enhanced X HMO 700/25% S05 HMO VAG IND Y N Mountain Enhanced X Anthem Silver Mountain Enhanced X HMO 2000/25% HMO VAG IND Y N Mountain Enhanced X Anthem Silver Mountain Enhanced X HMO 2000/25% S04 HMO VAG IND Y N Mountain Enhanced X Anthem Silver Mountain Enhanced X HMO 2000/25% AI HMO VAG IND Y N Mountain Enhanced X Anthem Gold Mountain Enhanced X HMO 1100/10% HMO VAG IND Y N Mountain Enhanced X Anthem Gold Mountain Enhanced X HMO 1100/10% AI HMO VAG IND Y N Anthem PPO Anthem Bronze X PPO 0% for HSA PPO HWT IND Y N Anthem PPO Anthem Bronze X PPO 0% AI PPO HWT IND Y N Anthem PPO Anthem Bronze X PPO 20% for HSA PPO HWT IND Y N Anthem PPO Anthem Bronze X PPO 20% AI PPO HWT IND Y N Anthem PPO Anthem Bronze X PPO 5200/20% PPO HWT IND Y N Anthem PPO Anthem Bronze X PPO 5200/20% AI PPO HWT IND Y N Anthem PPO Anthem Bronze X PPO 6200/30% PPO HWT IND Y N Anthem PPO Anthem Bronze X PPO 6200/30% AI PPO HWT IND Y N Anthem PPO Anthem Bronze X PPO 6300/20% PPO HWT IND Y N Anthem PPO Anthem Bronze X PPO 6300/20% AI PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 200/15% S06 PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 200/20% S06 PPO HWT IND Y N

Anthem PPO Anthem Silver X PPO 350/25% S06 PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 550/0% S06 PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 800/20% S05 PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 950/25% S05 PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 1000/15% S05 PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 1300/0% S05 PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 2100/20% S04 PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 2350/20% PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 2350/20% AI PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 2700/25% S04 PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 3200/25% PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 3200/25% AI PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 3300/0% S04 PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 3500/15% S04 PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 4000/0% PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 4000/0% AI PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 4000/15% PPO HWT IND Y N Anthem PPO Anthem Silver X PPO 4000/15% AI PPO HWT IND Y N Anthem PPO Anthem Gold X PPO 25% PPO HWT IND Y N Anthem PPO Anthem Gold X PPO 25% AI PPO HWT IND Y N Anthem PPO Anthem Gold X PPO 1250/10% PPO HWT IND Y N Anthem PPO Anthem Gold X PPO 1250/10% AI PPO HWT IND Y N Anthem PPO Anthem Catastrophic X PPO 6850/0% PPO HWT IND Y N *Current ACA compliant plan, but not actively sold in 2016 Page 4 of 9 Revised: September 27, 2015

Small Group plans on the exchange Page 5 of 9 Revised: September 27, 2015 Anthem Bronze HMO 6350/50%/6850 HMO VAC SG Yes No Anthem Silver HMO 2000/30%/5000 Plus HMO VAC SG Yes No Anthem Gold HMO 500/20%/5000 Plus HMO VAC SG Yes No Individual plans off the exchange Pathway Anthem Bronze Pathway HMO 0% for HSA HMO VAA IND Y N Pathway Anthem Bronze Pathway HMO 25% for HSA HMO VAA IND Y N Pathway Anthem Bronze Pathway HMO 5000/40% HMO VAA IND Y N Pathway Anthem Bronze Pathway HMO 5400/50% HMO VAA IND Y N Pathway Anthem Bronze Pathway HMO 5800/30% HMO VAA IND Y N Pathway Anthem Bronze Pathway HMO 6250/20% HMO VAA IND Y N Pathway Anthem Silver Pathway HMO 1300/35% HMO VAA IND Y N Pathway Anthem Silver Pathway HMO 2000/20% HMO VAA IND Y N Pathway Anthem Silver Pathway HMO 2000/25% HMO VAA IND Y N Pathway Anthem Silver Pathway HMO 2400/10% HMO VAA IND Y N Pathway Anthem Silver Pathway HMO 2500/15% HMO VAA IND Y N Pathway Anthem Silver Pathway HMO 3000/10% HMO VAA IND Y N Pathway Anthem Silver Pathway HMO 3200/50% HMO VAA IND Y N Pathway Anthem Gold Pathway HMO 0/30% HMO VAA IND Y N Pathway Anthem Gold Pathway HMO 1100/10% HMO VAA IND Y N Pathway Anthem Gold Pathway HMO 1500/20% HMO VAA IND Y N Pathway Anthem Catastrophic Pathway HMO 6850/0% HMO VAA IND Y N Pathway Anthem Silver Pathway HMO 3250/25%* HMO VAA IND Y N Mountain Enhanced Anthem Bronze Mountain Enhanced HMO 5000/40% HMO VAF IND Y N

Mountain Enhanced Anthem Silver Mountain Enhanced HMO 2000/25% HMO VAF IND Y N Mountain Enhanced Anthem Gold Mountain Enhanced HMO 1100/10% HMO VAF IND Y N Anthem PPO Anthem Bronze PPO 0% for HSA PPO VAI IND Y N Anthem PPO Anthem Bronze PPO 20% for HSA PPO VAI IND Y N Anthem PPO Anthem Bronze PPO 5200/20% PPO VAI IND Y N Anthem PPO Anthem Bronze PPO 6200/30% PPO VAI IND Y N Anthem PPO Anthem Bronze PPO 6300/20% PPO VAI IND Y N Anthem PPO Anthem Silver PPO 2350/20% PPO VAI IND Y N Anthem PPO Anthem Silver PPO 3200/25% PPO VAI IND Y N Anthem PPO Anthem Silver PPO 4000/0% PPO VAI IND Y N Anthem PPO Anthem Silver PPO 4000/15% PPO VAI IND Y N Anthem PPO Anthem Gold PPO 25% PPO VAI IND Y N Anthem PPO Anthem Gold PPO 1250/10% PPO VAI IND Y N Anthem PPO Anthem Catastrophic PPO 6850/0% PPO VAI IND Y N *Current ACA compliant plan, but not actively sold in 2016 Small Group plans off the exchange Page 6 of 9 Revised: September 27, 2015 Pathway Anthem Bronze Pathway HMO 4500/50%/6350 Plus w/hsa HMO XFX SG Y N Pathway Anthem Silver Pathway HMO 2500/20%/6850 HMO XFX SG Y N Pathway Anthem Silver Pathway HMO 2600/20%/4500 Plus w/hsa HMO XFX SG Y N Pathway Anthem Silver Pathway HMO 3000/20%/6000 Plus HMO XFX SG Y N Pathway Anthem Silver Pathway HMO 3500/0%/4500 Plus* HMO XFX SG Y N Pathway Anthem Silver Pathway HMO 4000/20%/6350* HMO XFX SG Y N Pathway Anthem Gold Pathway HMO 50/0%/6350 Plus HMO XFX SG Y N Pathway Anthem Gold Pathway HMO 1500/20%/4000 Plus HMO XFX SG Y N Mountain Enhanced Anthem Bronze Mountain Enhanced HMO 6000/30%/6850 Plus HMO VAK SG Y N Mountain Enhanced Anthem Silver Mountain Enhanced HMO 2500/20%/6000 Plus HMO VAK SG Y N Mountain Enhanced Anthem Silver Mountain Enhanced HMO 2600/20%/4500 Plus HMO VAK SG Y N

w/hsa Page 7 of 9 Revised: September 27, 2015 Mountain Enhanced Anthem Gold Mountain Enhanced HMO 50/0%/6350 Plus HMO VAK SG Y N Mountain Enhanced Anthem Gold Mountain Enhanced HMO 500/20%/5000 Plus HMO VAK SG Y N Mountain Enhanced Anthem Gold Mountain Enhanced HMO 1500/20%/4000 Plus HMO VAK SG Y N Blue Priority HMO Anthem Bronze Blue Priority HMO 6000/30%/6850 Plus HMO XFI SG Y Y Blue Priority HMO Anthem Bronze Blue Priority HMO 6000/30%/6850 Plus HMO XFI SG Y Y w/dental* Blue Priority HMO Anthem Silver Blue Priority HMO 1750/40%/6350* HMO XFI SG Y Y Blue Priority HMO Anthem Silver Blue Priority HMO 2500/20%/6000 Plus HMO XFI SG Y Y Blue Priority HMO Anthem Gold Blue Priority HMO 1000/20%/4000 Plus HMO XFI SG Y Y Blue Priority PPO Anthem Silver Blue Priority PPO 2500/20%/6000 Plus* PPO XFS SG Y N Anthem PPO Anthem Silver PPO 2000/30%/4500 Plus w/dental* PPO VAD SG Y N Anthem PPO Anthem Bronze PPO 3250/50%/6550 Plus w/hsa PPO VAD SG Y N Anthem PPO Anthem Bronze PPO 4750/30%/6550 Plus w/hsa PPO VAD SG Y N Anthem PPO Anthem Bronze PPO 6350/30%/6850 Plus PPO VAD SG Y N Anthem PPO Anthem Bronze PPO 5900/0%/6850 Plus* PPO VAD SG Y N Anthem PPO Anthem Bronze PPO 6000/0%/6000 w/hsa PPO VAD SG Y N Anthem PPO Anthem Silver PPO 1500/30%/5000 Plus PPO VAD SG Y N Anthem PPO Anthem Silver PPO 2000/30%/4500 Plus PPO VAD SG Y N Anthem PPO Anthem Silver PPO 2000/30%/4500 Plus w/dental* PPO VAD SG Y N Anthem PPO Anthem Silver PPO 2000/50%/6350 PPO VAD SG Y N Anthem PPO Anthem Silver PPO 2600/20%/4500 w/hsa PPO VAD SG Y N Anthem PPO Anthem Silver PPO 3000/30%/4000 Plus PPO VAD SG Y N Anthem PPO Anthem Silver PPO 3400/0%/3400 w/hsa PPO VAD SG Y N Anthem PPO Anthem Silver PPO 4500/30%/6850 Plus PPO VAD SG Y N Anthem PPO Anthem Gold PPO 50/0%/6350 Plus PPO VAD SG Y N Anthem PPO Anthem Gold PPO 500/20%/4500 PPO VAD SG Y N Anthem PPO Anthem Gold PPO 500/20%/4000 Plus PPO VAD SG Y N Anthem PPO Anthem Gold PPO 500/20%/4000 Plus w/dental* PPO VAD SG Y N

Anthem PPO Anthem Gold PPO 750/20%/4500* PPO VAD SG Y N Anthem PPO Anthem Gold PPO 1000/20%/3500 PPO VAD SG Y N Anthem PPO Anthem Gold PPO 1500/20%/4000 PPO VAD SG Y N Anthem PPO Anthem Gold PPO 2000/20%/5000 Plus w/hra PPO VAD SG Y N Anthem PPO Anthem Gold PPO 2000/40%/3500 PPO VAD SG Y N Anthem PPO Anthem Gold PPO 2250/0%/2250 HSA PPO VAD SG Y N Anthem PPO Anthem Gold PPO 3000/20%/4500 Plus w/hra PPO VAD SG Y N Anthem PPO Anthem Platinum PPO 20/0%/5000 Plus PPO VAD SG Y N Page 8 of 9 Revised: September 27, 2015

Category Product Name Product Classic Traditional s Large Group plans offered (ACA does not apply) BlueAdvantage HMO HMO HMO XFY LG Yes No Pathway Network VAE BlueAdvantage HMO Deductible Mountain Enhanced Network VAH HMO HMO XFY LG Yes No Pathway Network Mountain Enhanced Network BlueClassic PPO PPO PPO XFW LG No No BluePreferred PPO PPO PPO XFW LG No No PPO 750G PPO PPO XFW LG No No Narrow Networks Blue Priority HMO Blue Priority (HMO) XFD LG Yes Yes Consumer Driven Health s Anthem Healthy Support Blue Priority PPO PPO Blue Priority PPO XFM LG Yes No Lumenos HRA 1 PPO PPO XFW LG No No Lumenos HSA 2 PPO PPO XFW LG No No Lumenos HSA prescription PPO PPO XFW LG No No drug copay Lumenos HSA embedded deductible PPO PPO XFW LG No No Healthy Support PPO PPO PPO XFW LG No No Healthy Support PPO w/hsa PPO PPO XFW LG No No Healthy Blue Priority HMO Blue Priority (HMO) XFD LG Yes Yes Healthy Blue Priority w/hsa HMO Blue Priority (HMO) XFD LG Yes Yes VAE VAH * Note: We have some group members that may have a customized alpha prefix. These members would still have a product listed above as referenced on their ID card. 1 HRA = Health Reimbursement Account 2 HSA = Health Saving Account Page 9 of 9 Revised: September 27, 2015

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