A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Today We Will Cover: Your BCBSNM plan features Customer Service Health and wellness programs Online tools and resources 2

3 Standard (LoboCare) Network In-network (HMO-type benefits) There is no need to: Obtain referrals for specialist care You receive the highest level of benefits: Use providers in specified networks Prior authorization required for certain services Provider files claims BlueCard & Away from Home Care Programs Always verify provider network status Out of Network: You pay more of the cost of out-of-network benefits - Higher deductibles, coinsurance You may need to file your own claim You could be balance billed for amounts over allowed amount

4 Standard (LoboCare) Network Uses UNMH and First Choice providers UNM Hospitals and facilities PLUS additional providers and facilities including: Urgent Care Centers Laboratories Durable Medical Equipment Suppliers Pharmacies Home Health Care Facilities

5 Your Standard (LoboCare) Network Benefits Benefit HighlightsIn-NetworkOut-of-Network Individual Deductible$300$1,800 Family Deductible$600$3,600 Individual Out-of-Pocket Max (Medical)$5,000$10,000 Preventive Care ServicesNo ChargeNot Covered Primary Care Physician$3040%* Specialist Physician$4040%* Inpatient Admission$500 (per admission after deductible) 40%* Emergency Room$250 (per visit after deductible) Urgent Care$75 (per visit after deductible) N/A Other Urgent Care$100 (per visit after deductible) 40%* *After deductible you may be responsible for charges over the allowable fee.

6 Services covered only when received from Standard Network providers Preventive care (physicals, routine immunizations, well- child exams, etc.) Infertility services (through UNMH only) Allergy testing and injections Acupuncture and chiropractic care Prescription drugs

Prescription Drugs

Prescription Drug Benefit Retail Pharmacy Copays Preferred Generic$8 Non-Preferred Generic$20 Preferred* Brand $45 Non-Preferred $75 Preferred Specialty $150 Non-Preferred Specialty $300 Home Delivery (Mail Order) Copays (Up to a 90-day supply) Preferred Generic $16 Non-Preferred Generic$40 Preferred* Brand$90 Non-Preferred Brand$150 *Preferred also known as “Formulary” 8 Out-of-Pocket Limit (Retail & Mail Order) $1,500/Individual or $3,000/Family

9 Urgent Care Sudden onset of an illness or injury, not life-threatening Unable to see a PCP Urgent medical conditions such as sprains, high fever, minor cuts requiring stitches Walk In Care Nextcare New Mexico LLC Concentra Urgent Care UNM Hospital Urgent Care Contact PCP for follow-up care

10 BlueCard ® Travels With You Urgent care when you’re away from home less than 90 consecutive days Call BLUE to locate a provider or visit bcbsnm.combcbsnm.com Call your PCP to obtain a prior authorization (within 48 hours) Simply present your member ID card to a participating provider and pay the applicable copayment

11 Emergency Care Definition: A sudden and unexpected medical condition that a reasonable person feels could result in death or serious disability if no medical attention is received Call 911 Go to the nearest emergency room

12 Away From Home Care ® Privileges Reside outside New Mexico longer than 90 consecutive days college student divorce, dependent children work part of year outside of New Mexico Call customer service to enroll at Choose a PCP and pay applicable copayments for services

How to Find a UNM Hospitals Provider 13 Call Customer Service at the number on the back of your ID card From your computer OR mobile phone, log on to bcbsnm.com and click on Provider Finder Talk with your physician’s office

14 Bcbsnm.com

15 bcbsnm.com/unmh You will find: Standard (LoboCare) Benefits Provider Finder or Find a Doctor at UNM Forms / Formulary Link to UNMH website

Online Tools and Resources

Blue Access for Members SM 17 Go to bcbsnm.com and log in to Blue Access for Members via web or mobile. Click Register Now for New Users To register you will need your ID number (1) on the back your ID card, OR (2) call Customer Service

Blue Access for Members SM 18 My Claim Activity displays recent claims, or go to the Claims Center for all your claim details Form Finder easier to view and find specific forms for members Quick Links for easy access to Health Assessment, Fitness Program, Member Discounts, or to get an ID card My Coverage includes benefit highlights, spending accounts, as well as deductibles and out- of-pocket and copay summaries My Health tab links you to health and wellness content, articles, videos, and My Care Profile Access the Provider Finder ® to locate doctors & hospitals and view cost estimates for a variety of procedures

BCBSNM App 19 Find a doctor, hospital or urgent care facility Search for doctors that speak Spanish Log in to Blue Access for Members SM View claims and coverage details Create / view messages from customer service Access or request ID cards Access health and wellness information Link to map and directions To download the app, go to Google Play, the App Store or text BCBSNMAPP to 33633

Blue365 ® Member Discount Program 20 Member discounts simply for being a BCBS member Exclusive health and wellness deals from national and local retailers Save money on gym memberships, vision exams and services, hearing aids and diet-related services Share deals with friends and family and receive cash rewards on future offers Log on to Blue Access for Members SM for updates and to register for weekly s Under the My Coverage tab

Special Beginnings ® Expectant mothers and babies get off to a healthy start with prenatal and postnatal education and support 21 WEBTEXT Enroll in the Special Beginnings program to receive guidance from pregnancy to six weeks after delivery Pregnancy risk assessment Frequent, personal contact based on risk Educational materials Coordinated care with your physician Screening for depression

Blue Care Advisors SM – Condition Support 22 If you have a chronic condition, we offer help. Completely confidential and voluntary If you choose to participate in the BCBSNM Condition Management Program, you will become eligible to receive a co-pay waiver of $10 per generic prescription per month. Blue Care Advisors – clinical professionals – can help you manage chronic health conditions, understand and follow physician’s orders, review medications, side effects, compliance, refills and current services, establish goals and schedule follow-ups as appropriate: Asthma, COPD, diabetes, heart disease, low back pain, metabolic syndrome, and high blood pressure.

Available in English and Spanish Advice anytime. Advice isn’t just needed from 9 to 5. Round-the-clock health and the wellness advice from licensed professionals More than 1,200 AudioHealth Library topics 24/7 Nurseline 23

Call your BCBS customer service team for: Claim questions or status Medical benefit coverage questions Help with finding network providers Membership and eligibility Help with navigating online tools ID card requests Health education and transfer to other health programs Transition of care Enter your ID Number Monday – Friday 6AM – 8PM Saturdays & most Holidays Service that Takes You Out of the Middle 24

25 Rates 2016/2017 Standard (LoboCare) Network COVERAGE TYPEEE COST Full TimeEE COST Part Time Employee$ 0.00$60.00 Employee + Spouse/DP$299.00$ Employee + Child(ren)$142.00$ Employee + Family$328.00$388.00

Thank you!