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Individual & Family Medical, Dental & Life Plans March 2009 PPO Plans SmartSense Lumenos CDHPs PPO Share RightPlan PPO 40 3500 Deductible PPO PPO 3500 HSA-Compatible Basic PPO (2500/1000) Benefits shown on slides that follow are in-network 2 PPO Plans SmartSense Reliable protection with some of our lowest rates Choice of deductible Choice of generic or comprehensive drug coverage “Embedded” family deductible and out-of-pocket maximum 3 office visits before deductible 4th quarter deductible carryover $7 million lifetime benefits No maternity coverage Member-level-rated 2-year anniversary date rate guarantee on 5000 deductible plans 3 SmartSense Annual Out-of-Pocket Maximum Single/Family $2,500/$5,000 (family out of pocket can be satisfied by 2 or more members) (in addition to deductible) $500, $1,500, $2,500 or $5,000 (single) $1,000, $3,000, $5,000 or $10,000 (family deductible can be satisfied by 2 or more members) Annual Deductible Office Visits 3 before deductible w/ $30 copay, then 30% after deductible 30% after deductible HealthyCheck Centers: $25/$75 copay for basic/ premium screenings, with deductible waived Preventive Care Hospital In/Outpatient 30% after deductible Drug Benefits Generic plan Comprehensive plan 4th Quarter Deductible Carryover Maternity Generic: $15 copay or 40%, whichever is greater Generic: Brand name: $15 copay or 40%, whichever is greater $500 annual brand deductible (2-member maximum), then $15 copay or 40%, whichever is greater (up to $500 maximum per prescription) — $4,500 maximum annual out-of-pocket in addition to brand deductible For last 3 months of calendar year for expenses incurred in the 4 th quarter that are less than the deductible Not covered 4 PPO Plans Lumenos® Consumer-Driven Health Plans (CDHPs) HSA-compatible, HIA and HIA Plus plans Deductible waived in-network (no cost to member) for nationally recommended preventive care services Choice of no maternity plans or one maternity plan After deductible, member pays 0% or 30% co-insurance (depending on plan) for most covered services Generic and brand drugs – member pays 0% or 30% after annual deductible (depending on plan) $7 million lifetime maximum (no maternity plans), $5 million lifetime maximum (maternity plan) Member-level-rated Powerful online health management tools 5 Lumenos Health Savings Account (HSA)-Compatible Without Maternity HSA Account Annual Out-of-Pocket Maximum (in addition to deductible) Funded by subscriber, up to maximum limit set by U.S. Treasury Unused dollars rollover year-to-year Subscriber “owns” HSA Single: $3,500/$2,000/$0 Family: $7,000/$4,000/$0 (aggregate) Annual Deductible $1,500/$3,000/$5,000 (single) $3,000/$6,000/$10,000 (family maximum) Coinsurance after deductible 30%/30%/0% Office Visits 30%/30%/0% after deductible Preventive Care (nationally recommended services) $0 (deductible waived) Hospital In/ Outpatient 30%/30%/0% after deductible Maternity Drug Benefits Not covered 30%/30%/0% after deductible 6 Lumenos Health Savings Account (HSA)-Compatible With Maternity HSA Account Annual Out-of-Pocket Maximum/Member Funded by subscriber, up to maximum limit set by U.S. Treasury Unused dollars rollover year-to-year Subscriber “owns” HSA $0 (in addition to deductible) Annual Deductible $5,000 (single) $10,000 (family maximum) Coinsurance after deductible 0% Office Visits $0 after deductible Preventive Care (nationally recommended services) $0 (deductible waived) Hospital In/ Outpatient $0 after deductible Maternity $0 after deductible Drug Benefits $0 after deductible 7 Lumenos Health Incentive Account (HIA) Without Maternity HIA Account Annual Out-of-Pocket Maximum/member (in addition to deductible) Funded through financial incentives earned through Healthy Rewards Must be actively enrolled in HIA plan to access HIA account funds Single: $3,500/$2,000/$0 Family: $7,000/$4,000/$0 (aggregate) Annual Deductible $1,500/$3,000/$5,000 (single) $3,000/$6,000/$10,000 (family maximum) Coinsurance after deductible 30%/30%/0% Office Visits 30%/30%/0% after deductible Preventive Care (nationally recommended services) $0 (deductible waived) Hospital In/ Outpatient 30%/30%/0% after deductible Maternity Drug Benefits Not covered 30%/30%/0% after deductible 8 Lumenos Health Incentive Account (HIA) With Maternity HIA Account Annual Out-of-Pocket Maximum Funded through financial incentives earned through Healthy Rewards Must be actively enrolled in HIA plan to access HIA account funds $0 (in addition to deductible) Annual Deductible $5,000 (single) $10,000 (family maximum) Coinsurance after deductible 0% Office Visits $0 after deductible Preventive Care (nationally recommended services) $0 (deductible waived) Hospital In/ Outpatient $0 after deductible Maternity $0 after deductible Drug Benefits $0 after deductible 9 Lumenos Health Incentive Account Plus (HIA+) Without Maternity HIA+ Account Annual Out-of-Pocket Maximum/Member (in addition to deductible) Funded through health plan allocation of $500/$1000 per year single/family and financial incentives earned through Healthy Rewards Must be actively enrolled in HIA plan to access HIA account funds Single: $3,500/$2,000/$0 Family: $7,000/$4,000/$0 (aggregate) Annual Deductible $1,500/$3,000/$5,000 (single) $3,000/$6,000/$10,000 (family maximum) Coinsurance after deductible 30%/30%/0% Office Visits 30%/30%/0% after deductible Preventive Care (nationally recommended services) $0 (deductible waived) Hospital In/ Outpatient 30%/30%/0% after deductible Maternity Drug Benefits Not covered 30%/30%/0% after deductible 10 Lumenos Health Incentive Account Plus (HIA+) With Maternity HIA+ Account Annual Out-of-Pocket Maximum/Member Funded through health plan allocation of $500/$1000 per year single/family and financial incentives earned through Healthy Rewards Must be actively enrolled in HIA+ plan to access HIA+ account funds $0 (in addition to deductible) Annual Deductible $5,000 (single) $10,000 (family maximum) Coinsurance after deductible 0% Office Visits $0 after deductible Preventive Care (nationally recommended services) $0 (deductible waived) Hospital In/ Outpatient $0 after deductible Maternity $0 after deductible Drug Benefits $0 after deductible 11 PPO Plans PPO Share (5000/2500/1500) Comprehensive PPO plans Once deductible is met, member pays 30% co-insurance for most covered services Deductible waived for office visits, annual physical exam and preventive care Maternity coverage $5 million lifetime maximum 12 PPO Share (5000/2500/1500) Annual Out-of-Pocket Maximum (in addition to deductible) (2-member maximum, par/non-par) Annual Deductible (2-member maximum) Office Visits Preventive Care (deductible waived) 5000 2500 $2,500 per member $5,000 per member $5,000 per member $2,500 per member $1,500 per member $40 copay deductible waived $35 copay deductible waived 30% of negotiated fee, deductible waived Annual physical exam: HealthyCheck Centers: Routine mammogram, Pap, PSA ordered by physician: Well Child: 30% of negotiated fee 40% of negotiated fee 30% of negotiated fee Maternity 30% of negotiated fee (Anthem Blue Cross Formulary) (2-member maximum for brand deductible) $15 generic; $35 brand copay after $750 brand deductible $4,500 per member 30% of negotiated fee, or $25/$75 copay for basic/premium screenings Hospital In/ Outpatient Drug Benefits 1500 $10 generic; $30 brand copay after $500 brand deductible $10 generic; $30 brand copay after $250 brand deductible 13 PPO Plans RightPlan PPO 40 Our no-deductible PPO plan No deductible $40 office visit copay, 40% share of costs 3 prescription drug options: None Generic only Comprehensive (generic and brand) Single policy coverage (each family member gets their own policy) No maternity $5 million lifetime maximum 14 RightPlan PPO 40 Annual Out-of-Pocket Maximum (par/non-par) $7500/subscriber Annual Deductible No deductible Office Visits Preventive Care Hospital In/Outpatient Maternity Drug Benefits (Anthem Blue Cross Formulary) $40 copay HealthyCheck Centers: $25/$75 copay for basic/ premium screenings Routine mammogram, Pap, PSA ordered by a physician: $40 office visit plus 40% of negotiated fee Well Child: $40 office visit plus 40% of negotiated fee Inpatient: 40% of negotiated fee plus $500 copay/day; 4-day maximum copay per admission Outpatient: 40% of negotiated fee plus $500 copay per outpatient surgery admission Not covered No coverage (P958), or Generic coverage (PE48) - $15 generic, or Comprehensive coverage (PE49) - $15 generic, $35 brand copay after $500 brand deductible 15 PPO Plans PPO 3500 (HSA-Compatible) HSA-Compatible plan HSA-compatible Most services covered at 100% after deductible is met ($100 copay for emergency services after deductible; waived if admitted) Deductible waived for HealthyCheck screenings No maternity Generic and brand drug coverage after annual deductible is met Member-level-rated $5 million lifetime maximum 2-year anniversary date rate guarantee 16 PPO 3500 (HSA-Compatible) Annual Out-of-Pocket Maximum (in addition to deductible) $1500/member, $3,000/family (aggregate) (Medical/Pharmacy combined, par/non-par) Annual Deductible (Medical/Pharmacy combined, par/non-par) Office Visits $3500/member, $7,000/family (aggregate) $0 after deductible HealthyCheck Centers: Preventive Care Hospital In/Outpatient Maternity Drug Benefits (Anthem Blue Cross Formulary) $25/$75 copay for basic/ premium screenings, deductible waived Routine mammogram, Pap, PSA ordered by physician: Well Child: $0 after deductible $0 after deductible $0 after deductible Not covered $15 generic; $35 brand copay after Medical/Pharmacy deductible met 17 PPO Plans 3500 Deductible PPO Another affordable plan for individuals and families Most services covered at 100% after deductible is met ($100 copay for emergency services after deductible; waived if admitted) Out-of-pocket maximum met in-network when deductible is met Deductible waived for HealthyCheck screenings No maternity Member-level-rated Generic and brand drug coverage $5 million lifetime maximum 2-year anniversary date rate guarantee 18 3500 Deductible PPO Annual Out-of- Pocket Maximum (in addition to deductible) (2-member maximum, par/non-par) Annual Deductible (2-member maximum) Office Visits Satisfied in-network once annual deductible is met $3500/member $0 after deductible HealthyCheck Centers: Preventive Care Hospital In/Outpatient Maternity Drug Benefits (Anthem Blue Cross Formulary) $25/$75 copay for basic/premium screenings, deductible waived Routine mammogram, Pap, PSA ordered by physician: $0 after deductible Well Child: $0 after deductible $0 after deductible Not covered $15 generic; $35 brand copay after $500 brand deductible (2-member maximum) 19 PPO Plans Basic PPO (2500/1000) Our most basic and affordable plan In-hospital coverage in the event of catastrophic illness or injury Office visit only after out-of-pocket maximum is met Prescription drugs in the hospital only Available with or without $1,000 Term Life No maternity $5 million lifetime maximum 20 Basic PPO (2500/1000) Annual Out-of-Pocket Maximum (in addition to deductible) (2-member maximum, par/non-par) Annual Deductible (2-member maximum) Office Visits $2500 $2500 $2500/member $1000/member No office visit benefits until out-of-pocket maximum is met, then plan pays 100% of negotiated fee HealthyCheck Centers: $25/$75 copay for basic/ premium screenings Preventive Care (deductible waived) Hospital In/Outpatient Routine mammogram, Pap, PSA ordered by physician: 20% of negotiated fee 20% of negotiated fee Maternity Not covered Drug Benefits Not covered 21 HMO Plans HMO Saver Individual HMO Select HMO 22 HMO Plans HMO Saver, Individual HMO, Select HMO First dollar coverage on: Office visits Generic drugs Preventive care Unlimited office visits with set copays Coverage for services from doctors and hospitals in HMO network Comprehensive drug plan Maternity coverage Lifetime maximum - unlimited 23 HMO Plans HMO Saver Annual Out-of-Pocket Maximum (in addition to deductible) (2-member maximum) Annual Deductible $3,000 $1,500/member for Inpatient, Outpatient and ASCs only No deductible $10 copay/visit $25 copay/visit $10 copay $25 copay Preventive Care (specific services) $1,500 deductible, then: Inpatient: 20% of negotiated fee Outpatient: 20% of negotiated fee (emergency & non-emergency services subject to deductible) Maternity See Office visits and In/Outpatient (subject to deductible) Drug Benefits (Anthem Blue Cross formulary) Select HMO $1500/member Office Visits (unlimited) Hospital In/Outpatient Individual HMO Inpatient: 20% of negotiated fee Outpatient: 20% of negotiated fee Office visits: $10 copay Inpatient: no charge Outpatient: 20% of negotiated fee Inpatient: $250 copay/day first 4 days; then covered at 100% Outpatient: 20% of negotiated fee, $250/surgery See Office visits and In/Outpatient $10 generic; $30 brand copay after $250 brand deductible (2-member maximum) 24 Plan Options Based on Prospect’s Needs If Main Need Is: Recommended Plans: Budget Basic PPO, SmartSense Immediate coverage for office visits before deductible PPO Share and HMO (unlimited) SmartSense (up to three) No deductible RightPlan PPO 40 Individual HMO or Select HMO 100% coverage of most services after deductible Lumenos HSA/HIA/HIA+ (0% coinsurance plans) 3500 Deductible PPO or PPO 3500 (HSA-Compatible) Control over finances, including health care expenses Lumenos PPO 3500 (HSA-Compatible) Maternity coverage Lumenos with maternity PPO Share HMO 2-year anniversary date rate lock SmartSense 5000, 3500 HSA, 3500 PPO 25 Rating Methodology Summary AnniversaryRated? MemberLevel or Contract Rated? Gender-Rated? SmartSense YES MEMBER YES Lumenos YES MEMBER YES 3500 HSA, 3500 PPO YES MEMBER YES RightPlan YES MEMBER YES PPO Share YES CONTRACT NO HMO YES CONTRACT NO Basic PPO NO CONTRACT NO Plan 26 Short-Term Plans Short-Term Plans Coverage from 30 to 180 days Choice of deductible level $3 million lifetime maximum Easy application process Streamlined underwriting No maternity Member-level-rated 27 Short-Term Plans Out-of-Pocket Maximum Deductible Hospital In/Outpatient Ambulatory Surgical Center and ER Maternity Drug Benefits (Anthem Blue Cross Formulary) $1,000 per member plus deductible $250, $500, $1,000, $2,000 20% of negotiated fee 20% of negotiated fee (Accidental injuries not subject to deductible) Not covered $10 generic; $30 brand name Brand name maximum $500 28 Dental Coverage Options Our New Dental Blue® PPO Plans Dental SelectHMO Plans SmileNet Dental Discount Program 29 Dental Coverage Options Dental Blue PPO Plans Power to choose from: Two networks (Dental Blue 100 or 200) Can even go to a dentist in DB 300 network and still be “in-network” Best to choose 200 Essential or 200 Plus plan if dentist is in DB 300 network Four plans Key benefits: Negotiated discounts during waiting periods One of the largest PPO dental network in CA Negotiated discounts after exceeding the plan maximum Discounts on non-covered dental work such as teeth whitening, implants and orthodontics 30 Individual Dental – Dental Blue 100 Basic Deductible 200 Essential 100 Plus 200 Plus $50 single/$150 family $25/person (no family maximum) The deductible is waived for covered in-network Diagnostic & Preventive services Maximum Benefit Waiting Periods (months) Diagnostic Care (cleanings, exams, X-rays) $500/person/yr $1000/person/yr 0 Basic services: 3 Basic services: 0 Basic services: 3 Major services: 12 Major services: 6 Major services: 12 100% in-network (fee schedule out-of-network) Basic Services 80% fillings; 50% stainless steel crowns (fee schedule OON) Major Services Not covered Fee schedule (e.g., $42 for filling) 100% in-network (80% out-of-network) 80% (60% OON) Fee schedule Orthodontia (e.g., $57 for stainless steel crown) 50% (in-network and OON) Not covered 31 Individual Dental – DHMO, SmileNet (3) DHMO Plans Deductible Maximum Benefit Waiting Periods None Unlimited $5 Routine Cleanings $0 (oral exams, X-rays) Orthodontia Coverage Not an insurance plan; a very simple, low-priced discount dental program None for most services Office Visits Diagnostic Care SmileNet Dental Discount Program $0 Yes 32 Dental Coverage Options What About Our Other (Previous) Dental PPO Plan? Sell Dental Blue 200 Essential Plan, which offers: Identical benefits to previous Dental PPO plan Access to much larger network Discounts during waiting periods and after exceed plan maximum Discounts on non-covered dental work such as teeth whitening, implants and orthodontics 33 Individual Life Insurance Term Life Insurance Anyone who qualifies for one of our Level 1 or Level 1 + 25 medical plans can purchase: $15,000, $30,000, $50,000, $75,000 or $100,000 (if over age 19) $15,000 or $30,000 (ages 1-19) Basic PPO and PPO Saver plans include $1,000 of Term Life insurance for: An additional $1 per month through age 49, or An additional $2 per month for ages 50-64 34 Health • Dental • Life Thank You for Selling Anthem Blue Cross! 35