Dental, vision and life products for California

A complete benefits package for your business For groups with 2-50 employees Dental, vision and life products for California Complement your health coverage with other valued benefits. 21736CAEENABC Rev. 09/14 21736CAEENABC Rev. 09/14

A single solution that works smarter Dental Anthem 1 is a leader in the dental benefits business, with more than 40 years of experience. Together with our sister companies, we handle more than 70,000 groups and manage plans for more than 8 million people. For dental selections, see page 3. Life We are the #1 group life insurance carrier in the under-100 employee market. 2 We re rated A (Excellent) for financial strength by A.M. Best Company. And we have best in class life insurance claim payment turnaround time. Our claim turnaround time is among the fastest in the industry usually within two days. 3 To add some life to your benefits package, see page 12. Vision Blue View Vision SM membership has grown to more than 4 million people in just a few years. 1 This is because of our great plans and service. For a closer look at vision, see page 10. When you add dental, vision and life benefits to your health plan, you get a comprehensive benefits program that works smarter. Our enhanced dental, vision and life benefits deliver more to improve the overall health of your business and employees. 1

Dental coverage From Anthem Blue Cross Life and Health Insurance Company and Anthem Blue Cross We have the right dental plans for your unique needs Choosing a dental plan for your employees is all about balance. Cost matters. But so does your employees health. That s why you have choices with Anthem dental. We ll help you find the right mix of benefits that can have the best impact on your employees health. And no matter which dental plans you choose, you can count on: Solid coverage at a good price. Benefits that make sense for dental health and total health. Service you can trust. Strong network access. Preventive dental services When employees take care of their teeth and go to the dentist for regular checkups, they can protect their overall health. These services can help find dental and other health problems early on. In fact, more than 90% of all diseases show signs and symptoms in people s mouths. 4 That s why most of our Dental Prime, Dental Complete, Dental Blue and Dental Net plans cover routine cleanings, exams and X-rays at 100% at network dentists. Other preventive services include: Special treatments for kids. We cover sealants for children up to age 15 and fluoride treatments up to age 18 to protect teeth from decay and promote better dental health. Brush biopsy benefits. A brush biopsy may help diagnose oral cancer when combined with a lab analysis and a surgical biopsy with lab analysis. Extra services for members who are pregnant or living with diabetes. We offer an extra cleaning or periodontal maintenance procedure each year for members who are pregnant or living with diabetes. 2

Great dental plans to choose from With a wide variety of dental PPO and DHMO plans to choose from, it s easy to find a dental plan to fit your company s and your employees needs. All of our dental plans include value-added member support services, including: Easy-to-access information: We give your employees 24/7 online access to their claim and benefit information. International Emergency Dental Program: 5 Members who travel outside of the U.S. have access to emergency dental services. With one call, we ll help them find a credentialed, English-speaking dentist for urgent dental care. We can even help them with translation services when they call the dentist s office. Services received through this program do not count toward the member s annual maximum, if their plan has one. Dental health materials: These helpful pieces focus on teaching members the importance of dental health. Dental Prime and Dental Complete plans designed for better health When we created the new Dental Prime and Dental Complete plans, we made sure they could be custom fit to your needs. That means lots of choices in coverage, including options for: Coverage for dental implants and composite (tooth-colored) fillings on any tooth. Optional orthodontic benefits for kids and adults. Optional annual maximum carryover feature. Dental Prime members have access to the GRID network, a deep-discount network (for the best savings) with more than 17,600 unique dentists (more than 30,000 access points) in California. This network has nearly 64,000 unique providers nationwide. Dental Complete members have access to the GRID+ network, a broad network (for the most access) with more than 16,200 unique dentists (more than 36,000 access points) in California. This network has more than 85,700 unique providers nationwide. What are unique dentists and access points? Some carriers count access points. This means they count each dentist at each location he or she practices at even if they go to a location once or twice a year. For example, if one dentist works at two different offices, that dentist has two access points. We recommend comparing unique dentists because each dentist is counted only once. That gives you a more accurate picture of how many dentists are available to see your employees. Affordability is key, too Our flexible dental plan designs fit into our Value, Classic and Enhanced categories. That way you can choose the level of benefits that fit your needs and budget. Plus, we also offer voluntary dental plans so you can offer dental coverage to your employees without adding to your expenses. And, our voluntary dental plans are available when you keep at least five enrolled employees. Dental networks that work hard for you Dental Prime and Dental Complete members have access to one of the nation s largest dental networks through the national Dental GRID. 6 The national Dental GRID links dental networks, including the dental network of many of the nation s Blue plans, and includes dentists in all 50 states so your employees can find a dentist wherever they live or visit. 3

4 Dental Prime and Dental Complete This chart is an overview of coverage. A comprehensive description of coverage, benefits, exclusions and limitations can be found in the Combined Evidence of Coverage and Disclosure Form. Value Plan Coinsurance for diagnostic and Endodontic, Calendar-year Deductible preventive/basic/major Posterior Out-of-network periodontic and oral Orthodontia maximum composites reimbursement level In-network Out-of-network surgery services Value Complete CA-1A $1,000 $50/$150 100/80/0 100/80/0 Basic Yes No 80th Classic Plan Calendar-year maximum Deductible Coinsurance for diagnostic and preventive/basic/major In-network Out-of-network * Carryover is included with the Classic Complete CA-2R option only. All above dental plans include brush biopsy and an additional cleaning for pregnant and diabetic members. Endodontic, periodontic and oral surgery services Dental implants posterior composites Orthodontia Out-of-network reimbursement level Classic Complete CA-2A $1,000 Major Yes Classic Complete CA-2S 80th $1,500 $50/$150 100/80/50 80/60/50 No Classic Complete CA-2G Basic No Classic Complete CA-2K $2,000 90th Classic Complete CA-2L $1,000 90th No Classic Complete CA-2N Yes 80th Classic Complete CA-2Q Child and adult Classic Complete CA-2E 80th No Classic Complete CA-2F $1,500 $50/$150 100/80/50 100/80/50 Basic No Classic Complete CA-2R * 90th Classic Complete CA-2M Yes Classic Complete CA-2P Child only Classic Complete CA-2J 80th $2,000 No No Classic Complete CA-2H 90th Enhanced Plan Calendar-year maximum Deductible Coinsurance for diagnostic and preventive/basic/major In-network Out-of-network Endodontic, periodontic and oral surgery services Dental implants posterior composites Orthodontia Out-of-network reimbursement level Enhanced Complete CA-3A No 80th $2,000 Enhanced Complete CA-3B 100/80/50 Child and adult 90th Enhanced Complete CA-3E $2,500 $50/$150 100/90/60 Basic Yes No 80th Enhanced Complete CA-3C $2,000 Enhanced Complete CA-3D $2,500 100/90/60 Voluntary No 90th Plan Calendar-year maximum Deductible Coinsurance for diagnostic and preventive/basic/major In-network Out-of-network 80/60/50 Voluntary Prime CA-4A $1,500 $50/$150 100/80/50 Voluntary Prime CA-4B 100/80/50 Endodontic, periodontic and oral surgery services Dental implants posterior composites Orthodontia Out-of-network reimbursement level Major Yes No 80th

Our menu of dental plan options offers more flexibility On many of our dental plans you can choose the annual deductible and benefit maximum. And you can pick whether to include orthodontic coverage or our annual maximum carryover feature. Plus, you can choose your plan s level of out-of-network reimbursement: 1. 80th percentile of FAIR Health. This means the amount we pay for a service is equal to or greater than 80% of the charges for that service in a given ZIP code, based on data collected by FAIR Health, a third-party vendor. 2. 90th percentile of FAIR Health. This means the amount we pay for a service is equal to or greater than 90% of the charges for that service in a given ZIP code, based on data collected by FAIR Health, a third-party vendor. 3. MAC fee schedule. This is an affordable option when your employees see out-of-network dentists. How the annual maximum carryover feature works When you include the annual maximum carryover feature in one of our Dental Prime or Dental Complete plans, your employees can carry over unused benefit dollars to the next plan year. Here are the guidelines to qualify: Members must be enrolled in the dental plan for the full benefit (calendar) year. They must submit at least one claim for a covered service during that year. The total benefit amount that we pay out for covered services in that same year can t be more than $500. When these guidelines are met, members can carry over $250 each year until they reach $1,000. They can then use the money in a future year, giving them a higher maximum for all covered services. 5

This chart is an overview of coverage. A comprehensive description of coverage, benefits, exclusions and limitations can be found in the Combined Evidence of Coverage and Disclosure Form. Dental PPO plans Dental Blue PPO plans Dental Blue Silver 100-80 Dental Blue Silver Plus 100-80 Dental Blue Gold 100-80 Dental Blue Gold Plus 100-80 Dental Blue Platinum 100-80 Dental Blue Platinum Plus 100-80 In-network Out-of-network In-network Out-of-network In-network Out-of-network In-network Out-of-network In-network Out-of-network In-network Out-of-network Our Dental Blue PPO plans offer: More than 12,700 dentists with more than 30,000 access points in California and more than 94,200 access points nationwide. One bill and one premium check for all of your benefits. Cleanings, exams and X-rays at no cost when using in-network dentists. Fillings at 80% (or even 90%) when using in-network dentists. More extensive services like oral surgery, crowns and root canals. Orthodontic services covered on most plans. No waiting periods. An extra cleaning or periodontal maintenance procedure each year for members who are pregnant or living with diabetes. Out-of-network reimbursement Annual deductible Waived in-network for diagnostic and preventive services (single/family) 80th percentile $50/$150 $50/$150 $50/$150 $50/$150 $50/$150 $50/$150 Annual maximum $1,000 $1,500 $1,500 $1,500 $2,000 $2,000 Diagnostic and preventive (cleanings, exams, X-rays) Minor restorative (fillings) Major restorative Oral surgery (tooth extraction) Endodontics (root canal therapy) Periodontics (scaling/root planing) Prosthodontics (crowns, bridges and dentures) Orthodontics Adult and child Waiting periods 100% 80% 100% 80% 100% 80% 100% 80% 100% 100% 100% 100% 80% 60% 80% 60% 80% 60% 80% 60% 90% 80% 90% 80% 50% 50% 80% 60% 50% 50% 80% 60% 60% 50% 90% 80% 50% 50% 80% 60% 50% 50% 80% 60% 60% 50% 90% 80% 50% 50% 80% 60% 50% 50% 80% 60% 60% 50% 90% 80% 50% 50% 50% 50% 50% 50% 50% 50% 60% 50% 60% 50% 50% up to $1,000 Not covered 50% up to $1,000 50% up to $1,000 50% up to $1,500 50% up to $1,500 No waiting periods 6

Dental DHMO plans Dental Net DHMO plans This chart is an overview of coverage. A comprehensive description of coverage, benefits, exclusions and limitations can be found in the Combined Evidence of Coverage and Disclosure Form. Our Dental Net DHMO plans offer: Nearly 8,800 general dentist and specialist access points in California. (Services must be received from Dental Net providers. Members choose a primary care dentist who coordinates any specialty care or orthodontic services that are needed.) No annual maximums,* no deductibles and no waiting periods. That s unlike many dental plans that limit the amount of services members can get in a year. Set copays for nearly 300 different procedures, including fillings and crowns. This gives members a good idea of their costs ahead of time. Composite (tooth-colored) fillings on any tooth and general anesthesia for oral surgery. Orthodontic coverage with lower costs than you might expect: $1,695 for children up to age 18 $1,895 for adults $200 for retention for children and adults * There is no maximum or age limit for pediatric dentistry performed by your participating dentist. If your participating dentist believes he or she is unable to give care to a child, or your dental plan makes that determination, then your child may be referred to a pediatric dentist. This would be a benefit for children under the age of five with a $750 maximum. Exceptions are made on a pre-approval basis only. Plan Designs You ve got three great plans to choose from. All are available on an employer-paid or voluntary basis. The following chart includes a sampling of the nearly 300 different services and procedures covered by our three new Dental Net plans. For a complete list of copays for each of the covered Current Dental Terminology (CDT) codes, please see the Dental Net fee schedule brochure. CDT code Benefit Member s copay Plan 2000A Plan 2000B Plan 2000C Diagnostic services D0120 Periodic oral exams $0 $0 $0 D0210 Intraoral X-rays complete series (including bitewings) $0 $0 $0 Preventive services D1110 or D1120 Teeth cleaning (prophylaxis) adult or child two per year $0 $0 $0 D1208 Topical fluoride, covered to age 18 $0 $0 $0 D1351 Sealants, per tooth, through age 15 $7 $5 $0 Restorative services, fillings (permanent) D2140 Amalgam (silver colored) one-surface fillings $0 $0 $0 D2330 Resin-based composite (tooth-colored) fillings on anterior (front) tooth, one surface $0 $0 $0 D2391 Resin-based composite (tooth-colored) fillings on posterior (back) tooth, one surface $30 $20 $10 D2393 Resin-based composite (tooth-colored) fillings on posterior (back) tooth, three surfaces $55 $45 $30 Oral surgery services D7140 Simple extraction of erupted tooth or exposed root $15 $5 $5 D7210 Surgical extraction of erupted tooth $30 $25 $20 D7220 Removal of impacted tooth soft tissue $50 $45 $40 D7230 Removal of impacted tooth partial bony $70 $60 $50 D7240 Removal of impacted tooth completely bony $100 $70 $60 Endodontic services D3220 Therapeutic pulpotomy (excluding final restoration) $20 $15 $10 D3310 Root canal: anterior (front tooth) (excluding final $90 $70 $65 restoration) D3320 Root canal: bicuspid (excluding final restoration) $125 $80 $75 D3330 Root canal: molar (excluding final restoration) $160 $140 $130 7

Dental Net is available in the following counties: Alameda, Contra Costa, Fresno, Los Angeles, Marin, Orange, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Luis Obispo, Santa Barbara, Santa Clara, Solano and Sonoma. Dental Net has limited availability in El Dorado, Kern, Kings, Monterey, Placer, Riverside, San Mateo, Santa Cruz, Tulare and Ventura counties. Dental Net can be offered on a dual-option basis with a Dental Prime or Dental Complete plan. We will administer each product separately. Talk to your Anthem rep about participation rules. In addition to Dental Prime, Dental Complete, Dental Blue and Dental Net, other dental plans may be available in your area. Visit anthem.com/specialty, or contact your broker or Anthem Sales representative for more information or a quote. Member s copay CDT code Benefit Plan 2000A Plan 2000B Plan 2000C Periodontic services D4210 Gingivectomy: four or more contiguous teeth, per quadrant $95 $70 $55 D4211 Gingivectomy: one to three teeth touching each other (contiguous), per quadrant $48 $20 $15 D4261 Osseous surgery, one to three contiguous teeth, per quadrant $150 $115 $90 D4342 Periodontal scaling and root planing, per quadrant, one to three teeth $23 $15 $10 D4910 Periodontal maintenance $25 $13 $13 Prosthodontic services D2750 Crown: porcelain fused to high noble metal (i.e., gold) $175* $170* $90* D5110 or D5120 Complete upper or lower denture $175 $150 $125 D5211 or D5212 Partial upper or lower denture, resin base (including conventional clasps, rests and teeth) $150 $125 $100 D5730, D5731, Denture reline: chair side D5740 or D5741 $40 $20 $0 D6240 Pontic (bridge), porcelain fused to high noble metal (i.e., gold) $175* $150* $125* Orthodontic services 24 months of standard orthodontic coverage, exclusive of records/retention fees D8080 Child (through age 17) $1,695 $1,695 $1,695 D8090 Adult $1,895 $1,895 $1,895 D8680 Retention (placement of retainers) $200 $200 $200 Other services Out-of-area emergency care maximum payment $100 All charges over $100 All charges over $100 All charges over $100 D9215 Local anesthesia $0 $0 $0 D9220 General anesthesia first 30 minutes $160 $145 $130 D9440 Office visit: after hours $25 $25 $25 D9940 Occlusal guards (mouth guards) $100 $75 $50 8 * Plus costs for noble or high noble metal, not to exceed $125, and/or costs for porcelain, not to exceed $100.

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Vision coverage From Anthem Blue Cross Life and Health Insurance Company 10 Get vision coverage and see increased productivity Comprehensive, low-cost vision plans can help manage the overall health and well-being of your employees. It s been shown that regular eye exams and wearing corrective eyewear when needed can greatly decrease the risk of more serious, long-term eye diseases, and could even lead to the early detection of other chronic health conditions. 7 Healthy employees who are able to see at their best are more productive. You get the picture, and so do we. That s why you should consider a Blue View Vision SM plan. Blue View Vision and Blue View Vision Plus feature: One of the nation s largest vision networks: Blue View Vision members can visit a private practice doctor, call or click online at 1-800 CONTACTS or choose from national optical stores like: LensCrafters, Sears Optical SM, Target Optical and JCPenney Optical. Convenience: Our network includes popular retail stores with evening and weekend hours. This makes accessing vision care even more convenient. Plus, with Blue View Vision, members can get an eye exam at one location and purchase eyewear from another. Value-added savings: Employees can enjoy additional savings of 15% to 40% on extra pairs of eyewear, conventional contact lenses, lens treatments, specialized lenses and various accessories even after they ve exhausted their covered benefits. They ll also enjoy: Factory scratch coating on standard eyeglass lenses included at no extra cost. Transitions and polycarbonate lenses for kids under 19 years old at no extra cost. Transitions lenses for adults at a fixed price of $75. Tiered pricing for premium progressive lenses and premium anti-reflective coatings, which can help to limit out-of-pocket costs. Easy-to-use benefits: In-network providers verify eligibility and handle all of the paperwork. All a member has to do is: Make an appointment with a network provider. Show the member ID card at the visit. Pay any applicable copay amounts or balances in excess of covered benefits. A commitment to care: Members who have our vision coverage and our health and wellness program included in their health plan may be enrolled in our ConditionCare: Diabetes program if their vision claims include a diabetic-related diagnosis. We are the first vision plan to enable two-way communication between eye doctors and primary care doctors. We help them work together, share information and coordinate care all through one company. Employees benefit from an approach that makes the eye exam far less routine. There s more to offer with Anthem vision and health plans: Two-way communication between network eye care and health care providers. Care alerts to help employees manage ongoing health problems like diabetes and heart disease. Nurse coaches to help employees stay on top of their conditions. We help connect the information and all of our network providers so they can all see eye-to-eye on our members care. Blue View Vision plans are available on an employer-paid or voluntary basis. With voluntary benefits, if you feel like your budget is too tight and you can t afford to spend more on benefits, you can give your employees access to the additional coverage they need and at no extra cost to you.

Vision plans This is an overview of coverage. A comprehensive description of coverage, benefits, exclusions and limitations can be found in the Combined Evidence of Coverage and Disclosure Form. Employer-paid Vision rates Blue View Blue View Plus Rate structure 4-tier Monthly premium Monthly premium Employee only $7.19 $14.38 Employee + spouse $12.32 $23.62 Employee + child(ren) $12.02 $23.11 Employee + family $18.54 $36.10 Voluntary Vision rates Blue View Blue View Plus Rate structure 4-tier Monthly premium Monthly premium Employee only $9.24 $17.46 Employee + spouse $15.41 $29.78 Employee + child(ren) $14.79 $28.65 Employee + family $23.42 $45.86 Take a closer look at the value of adding vision coverage to your employee benefits package. It s value you can see. 11

Life coverage From Anthem Blue Cross Life and Health Insurance Company Get life and share the benefits of your employees security Your employees depend on you, and their families depend on them. Life insurance is an easy, low-cost way to help your employees improve their families financial security. Your employees will appreciate that you took the time to include their families future in your company s benefits package. Save with composite life rates Enroll 10 or more employees and you ll automatically receive our composite life rates. Composite rates mean your group will receive a single rate per $1,000 of life coverage no matter what the age or gender of the employees enrolling. What s in it for you? Easier administration and yet another way to possibly get lower rates. Life is easy with Guaranteed Issue amounts All of our Anthem Blue Cross health benefits groups with two or more enrolled employees can get some life coverage without going through health underwriting. And there are no health questionnaires to fill out. Improve employee productivity and well-being with our member assistance programs Resource Advisor Life demands a lot, and asking for help can be difficult. That s why we automatically include Resource Advisor in our plans. The program gives employees and their families access to confidential support and resources that they may need to deal with any problems they re facing before they become an emotional or financial burden. Services include face-to-face counseling, telephone counseling, online support and identity theft victim recovery services. And when an employee dies, Beneficiary Companion is there to help. With one phone call, beneficiaries (executors of the estate) can get help to settle the estate. This gives them more time to focus on healing. Grief counseling and legal and financial counseling are also available. Travel assistance Our group term life and Accidental Death and Dismemberment (AD&D) insurance plans include travel assistance benefits. These services are available 24/7 through the multilingual Europ Assistance USA Coordination Center. When employees are traveling more than 100 miles from home, they can get help with emergency medical assistance, travel services and pre-departure information. All active employees with life and AD&D coverage, as well as their dependents, can use travel assistance. Enjoy the ease of one application, one bill You need to fill out only one application for both health coverage and life insurance. And you ll get just one monthly bill that includes both health and life. Strength, stability and service When you choose Anthem Blue Cross Life and Health Insurance Company, you ll feel confident knowing: We re the #1 group life insurance carrier in the under-100 employee market. 8 We re rated A (Excellent) for financial strength by A.M. Best Company. We have the best in class life insurance claim payment turnaround time. That s because our claim turnaround time is among the fastest in the industry usually within two days. 9 All of this means you can give your employees the valuable benefit of life insurance, knowing it s backed by the strength and stability of one of the most respected names in the industry. 12 The availability of group life insurance is subject to underwriting, and the rates are subject to change. See your Certificate for Exclusions and Limitations. For a copy of the Certificate, call 1-800-627-8797.

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Basic term life coverage When you offer basic term life, your employees and their families will gain extra peace of mind and financial support in the event of untimely death or great physical loss (i.e., the loss of a limb). AD&D benefits are included automatically. The life benefit is payable if a member dies at any time. And the automatic AD&D feature gives employees an additional benefit equal to the amount of the life benefit in case of an accidental death or a serious qualifying accident. With the Living Benefit, members who have 12 months or less to live can ask for up to 75% of their death benefit. Extras included with AD&D coverage: If your employee should pass away while their kids are still in school, AD&D pays an additional benefit to cover college expenses, up to $40,000 total. A seat belt provision that adds the lesser of 10% of the coverage amount or $15,000 and airbag benefit pays an additional 10% up to $10,000 to the AD&D benefit. A $5,000 maximum repatriation benefit for preparation and transportation services should death occur more than 75 miles from home. A coma benefit of 1% of the AD&D benefit for each month of coma. Common carrier benefit. 14

Dependent and optional supplemental life coverage You can choose to offer dependent life plans. Dependent life is a benefit to employees if their insured dependent dies. You can also offer optional supplemental life insurance, which lets employees who are enrolled in their group s basic term life coverage buy extra life coverage. This is a great way to give your employees the chance to protect themselves with more coverage at no extra cost to you. This is an overview of coverage. A comprehensive description of coverage, benefits, exclusions and limitations is contained in the Life Insurance contract (policy and Certificate). Life plan options This chart gives you details about basic term life. And to give you the full picture, it shows you what coverage can look like when you add dependent and/or supplemental life benefits. Benefit amounts available Employer contributions and participation requirements Guaranteed issue guidelines Basic Term Life choose one of three options: }} Schedule A: Flat dollar amounts for all employees You select one flat dollar amount for all employees. }} Schedule B: Life benefits graded by job title* You select one amount in $1,000 increments for Class I employees (officers, managers, supervisors) and another amount for Class II employees (all others). * Job title descriptions shown are examples. You may use them as a guideline or provide your own. There must be at least one person in each class (job description). Only one benefit schedule may be offered. The benefit amount for Class I can t be more than 2.5 times the benefit amount for Class II. Groups of 2-9, one class only. }} 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. Salary-based benefits have a minimum benefit of $25,000 and maximum benefits of: Groups of 2-9: up to $100,000 Groups of 10-19: up to $250,000 Groups of 20-50: up to $300,000 * Groups of 2-9, one times salary only. Flat benefit amounts: Groups of 2-9: $25,000, $30,000 or $50,000 Groups of 10-19: $25,000, $30,000, $50,000 or $100,000 Groups of 20-50: $25,000 to $300,000 If employer pays between 25% and 99%, then 75% employee participation is required. Minimum employer contribution is 25%. If employer pays 100%, then 100% employee participation is required. Groups of 2-9: $30,000 Groups of 10-50: Varies by group, see Anthem proposal for each group. Dependent Life dependent life coverage is available: }} Groups of 2-19: $10,000 for spouse, $5,000 for children. Available only if employee life benefit is $20,000 or more. $5,000 for spouse, $2,500 for children. }} In addition, groups of 20-50 can also choose: $20,000 for spouse, $10,000 for children. $15,000 for spouse, $7,500 for children. $2,000 for spouse, $1,000 for children. Children are eligible from coverage from 15 days to 26 years of age. AD&D benefits are not available with dependent life coverage. Optional Supplemental Life Employer is not required to contribute toward the cost of dependent life coverage. If employees are paying part of the premium, at least 50% of all eligible employees with dependents must participate in dependent life coverage. All amounts are Guaranteed issue. }} Available for groups with 20 or more employees. }} 100% employee paid. }} Available in four flat benefit amounts: $15,000, $25,000, $50,000 or $100,000. Premiums are 100% employee paid. Required participation is 25%. $50,000 15

Discover the Anthem advantage You know us for our health plans, but did you know we re also among the leading dental, vision and life companies in the country? It s easy to add these products to your health plan. And you can feel good knowing that they re backed by the same reputation and levels of service that you already expect from us. Visit anthem.com/specialty, or contact your broker for more information or a quote. 16

1 Anthem and affiliated companies. 2 2010 JHA Life Survey of Inforce Cases. 3 LIMRA Marketscan 2011. 4 Academy of General Dentistry website: Importance of Oral Health to Overall Health (October 2008): knowyourteeth.com/infobites/abc/article/?abc=o&iid=320&aid=1289. 5 The International Emergency Dental Program is managed by DeCare Dental. DeCare Dental is an independent company offering dental management services to Anthem Blue Cross. 6 The national Dental GRID is managed by the GRID Dental Corporation (GDC), a separate company that provides access to dental networks and services on behalf of Anthem Blue Cross Life and Health Insurance Company. 7 American Optometric Association, aoanet.org. 8 2010 JHA Life Survey of Inforce Cases. 9 LIMRA Marketscan 2011. Life products underwritten by Anthem Blue Cross Life and Health Insurance Company. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. anthem.com/specialty