Anthem’s Lumenos® with HSA Plan Another popular Consumer Directed Health Plan is Anthem’s Lumenos® with HSA Plan. Let’s look at how this plan works. 1

Who can open an HSA? The IRS and the U.S. Department of the Treasury have specific rules on who can open an HSA. You can open an HSA if you: Are enrolled in the Lumenos HSA plan, because it includes an HSA-compatible health plan Are a U.S. resident and not a resident of American Samoa Are not enrolled in Medicare Are not claimed as a dependent on another individual’s tax return Are not active military Others – refer to online health site To be eligible to establish a health savings account, an individual (according to I R S published rules) must meet four requirements: One – You must be enrolled in an HSA compatible that satisfies certain requirements with respect to deductibles and out-of-pocket-expenses. Our Lumenos H S A plan is HSA compatible. Two – if you are covered by any other health plan, it too must be a qualifying High Deductible Helath Plan – with the exception of certain limited health insurance coverage such as dental or vision insurance. Three – You may not be enrolled in Medicare or TriCare (which is the benefit plan for military personnel). Four – You may not be claimed as a dependent on someone else’s tax return. Dependent children are not eligible for a health savings account for example, although they may be included in a parent's plan. These four requirements apply to the individual who is the H S A account holder. For example, the requirement for no other medical coverage applies only to the account holder, not to a spouse or children. An account holder’s spouse may be on Medicare The last point is that your eligibility can change. For example, if an eligible individual opened an H S A at age 63 and then at age 65 enrolls in Medicare, that person’s eligibility has changed. By the way, that person may keep the H S A but may not make any further contributions – nor open any other H S A. They may, however, continue to spend their H S A funds on qualified medical expenses. IMPORTANT TO EMPHASIZE: The eligibility requirements apply to the employee (the account holder). The eligibility requirements do not apply to the dependents. Note: You cannot open an HSA if you have coverage under any other health plan that is not an HSA-compatible health plan.

Lumenos Plan Overview Now let’s look at how this type of plan works, using real-life situations. 3

Traditional Health Coverage Anthem’s Lumenos Plan Stay healthy with Preventive Care coverage You and the Plainville BOE make contributions to your account to use toward your deductible and/or co-insurance to pay for medical care and prescription drugs Once you have satisfied your annual deductible, Traditional Health Coverage then covers additional expenses (similar to a PPO) An annual out-of-pocket maximum protects you from large medical expenses Plus earn Healthy Rewards dollars Preventive Care 100% In-Network HSA Funded by you and employer to help satisfy annual deductible and save for future medical expenses Annual Deductible HSA stands for Health Savings Account. It combines a special savings account, which is used specifically to pay for medical costs, with traditional insurance. Here's how it works: 100% of your preventive care from network providers—including routine physical exams, immunizations and preventive screenings—is covered. You and <Company name> can make annual allocations to your HSA. When you need medical care or prescription drugs, you use the money from this account to pay your out-of-pocket costs. After the deductible is satisfied, traditional insurance kicks in, which is similar to a PPO. If you have money left over in your HSA account at the end of the year, it rolls over to the next year to help offset future out-of-pocket costs. An annual out-of-pocket maximum protects you from large medical expenses. Your contribution to your HSA is generally tax deductible, but be sure to check with your tax advisor. <One of the great things about Anthem’s Lumenos® with HSA is that you can earn more dollars in your account as a reward for healthy behavior.> Traditional Health Coverage Healthy Rewards

Your Lumenos Plan Details At-a-Glance Anthem’s Lumenos® with HSA Plan Single Coverage Family Coverage Preventive Nationally recommended services No cost, no deduction from HSA <with in-network providers> HSA Annual HSA contribution maximum for 2015 $3,350 $6,650 Traditional Health Coverage Annual Deductible You can use the funds from your Health Savings Account to help satisfy your annual deductible $2000 $4000 Then, you pay coinsurance for covered services 100% for In-Network Services 80% for Non-Network Services Anthem’s Lumenos® Plan pays 100% after annual out-of-pocket maximum (includes annual deductible and coinsurance) In-Network $2000 Non-Network $4,000 In-Network $4000 Non-Network $8,000 Let's look at the details of the Anthem’s Lumenos with HSA plan benefits for <Company Name> employees. (Review, customized per employer.)

How Your Plan Works When you visit an in-network doctor: Show your ID card at the time of service Typically you pay nothing at the time of service. Your provider will file a claim You will receive a Claim Recap showing the total cost and the “allowed” cost. Your provider will then bill you for the “allowed” cost of the service(s) If you have funds in your HSA you can pay your provider using your HSA checkbook or debit card When you visit a doctor that is not in the network: You may be asked to pay at the time of services. Use your HSA checkbook or debit card to pay your provider for services (provided you have the funds available) If your provider does not file a claim on your behalf, you will need to file a claim with Anthem BCBS to ensure expenses get applied towards your out-of-pocket. You can download a claim form at anthem.com The Anthem’s Lumenos with HSA plan is easy to use. Once you're enrolled, you will receive an Anthem member ID card. Carry it with you always and show your ID card whenever you need care. When you visit an in-network doctor, you will usually pay nothing at the time of service and your provider will file a claim. You will receive a Claim Recap, which shows the total cost and the cost that is allowed by the plan. If you have funds in your HSA, and if you choose to use them to pay your costs, you can use your HSA checkbook or debit card to pay your provider. If you visit a doctor who is not in the network, you may be asked to pay at the time of services. If funds are available in your account, you may use your HSA checkbook or debit card. Your out-of-network provider may or may not file a claim on your behalf. If not, you will need to file a claim with Anthem Blue Cross and Blue Shield in order for your payment to be applied to your deductible. You can download a claim form at anthem.com.

Using Your HSA Plan to Get Care When you visit a pharmacy: Show your ID card at the pharmacy Until you have satisfied your annual deductible you will pay the full discounted cost of your prescription drug You can pay for your prescription at the pharmacy using your HSA debit card or checkbook as long as there are funds available in your HSA account. Once you satisfy your deductible and the Traditional Health Coverage begins To get the lowest cost, visit our online health site to learn about generics or other low-cost alternatives Or order your prescriptions by mail: Order a 90-day prescription drug supply Take advantage of our ability to buy in volume and potentially save money Download a mail order form from anthem.com and obtain refills by phone It’s easy to use your plan to get prescription medicines at your pharmacy—just show your ID card. If you haven’t yet satisfied your annual deductible, you will pay the full discounted cost of your prescription drug. You can use your HSA debit card or checkbook if you have funds available in your HSA account. Once your deductible is satisfied and the traditional health coverage begins, you pay the low <co-pay or coinsurance> amount. You may be able to lower your cost even more by choosing generic drugs. Visit our online health site to learn about your low-cost alternatives. One way to save money is by using our home delivery prescription service. You can download a Home Delivery form at our web site.

Using your HSA for Qualified Medical Expenses (QMEs) Now let’s look at how this type of plan works, using real-life situations. 8

HSA’s and Non-Qualified Medical Expenses Any amount you spend will be considered taxable income (you will have to pay taxes on the amount used), and you will have to pay a 20% penalty on the amount Non-qualified expenses will not count toward your out-of-pocket responsibility under the Traditional Health Coverage Once you are 65, you can withdraw the money without penalty, but it will be considered taxable income The government allows tax advantages for Health Savings Accounts. So if the HSA is used for non-qualified medical expenses, the amount used is subject to normal income taxes and a 20% penalty tax. Non-qualified expenses will not count toward your out of pocket responsibility under the traditional health coverage. The 20% penalty tax is waived if the individual is over the age of 65—however, normal income taxes always apply on non-qualified medical expenses.

Covered and Qualified Medical Expenses Covered Medical Expenses Qualified Medical Expenses Medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease. Expenses covered by the medical plan described in the Summary Plan Description. Some examples are: Dr. Office/Specialist/Chiropractic Visits Hospital Stays, Radiology, Lab Work Speech/Occupational/Physical therapies Prescription Drugs Qualified medical expenses are those expenses that would generally qualify for the medical and dental expenses deduction under tax advantaged accounts (FSA’s & HSA’s). These are defined by the IRS under Publication 502. Some of these medical expenses are not covered by your Medical Plan and don’t count towards your deductible, but you may still use HSA funds for payment. Copays, coinsurance Vision checkups, glasses Dental care, etc.    Remember, there are two parts to your plan: the Health Savings Account, and the Traditional Health Coverage. Each of these consider your medical expenses in a different way. Some medical expenses will be considered “covered,” and some will be considered “qualified.” Covered medical expenses are those covered by the medical plan. They include things like office visits with your doctor, specialist or chiropractor; hospital stays, radiology and lab work, prescription drugs; and various types of therapies. These expenses are described in your Summary Plan Description. Qualified medical expenses are not covered by your Medical Plan and do not count towards your deductible. However, you can use your HSA funds to pay for these expenses which include co-pays and coinsurance, vision checkups and glasses, over-the-counter drugs with a physician’s prescription and dental care. A complete list of eligible Qualified Medical Expenses can be found on the IRS website. For a complete listing of qualified medical expenses, visit www.irs.gov and search “Publication 502”.

Funding Your HSA Now let’s look at how this type of plan works, using real-life situations. 11

Making Contributions to Your HSA There are several ways you can contribute to your account: Tax-free through payroll deductions Post-tax by personal check When you file your taxes, you can make an adjustment to your gross income to receive the tax benefit You’ll receive deposit slips for your HSA in the mail Anyone may contribute to your HSA, provided the total contributions to your HSA do not exceed your maximum allowable annual limit $3,250 for individual coverage $6,450 for family coverage You can make catch-up contributions if you are 55 years of age or older ($1,000 for 2012) You can contribute tax-free through payroll deductions. You can contribute after taxes, using a personal check. Make an adjustment to your gross income when you file your taxes to receive the tax benefit. If you have parents, a spouse or others who want to contribute to your HSA, they may do so. Just make sure that the total contributions don't exceed the maximum allowable limit each year. The maximum $3,050 for individual coverage and $6,150 for family coverage. If you are age 55 or older, you can make catch-up contributions. For 2011, the maximum catch-up contribution is $1,000, for a maximum annual contribution of $4,050 for individual or $7,150 for family coverage.

Our Health Approach in Action Now let’s look at how this type of plan works, using real-life situations. 13

360° Health Programs 360° Health is our approach to surrounding you with the resources, tools, guidance and support to help you manage your health MyHealth Coach Future Moms Healthy Lifestyles ConditionCare Programs ComplexCare 24/7 NurseLine MyHealth Coach nurses: Help you manage conditions such as high blood pressure, high cholesterol, lower back pain and other common concerns Pregnancy is a very exciting time! We know your goal is to have a safe delivery and healthy baby. We want that for you, too. That’s why we offer Future Moms, a program to help you take care of your baby before you deliver. Tobacco-Free Program Covers 100% of the cost of telephone counseling services and educational materials Also covers nicotine replacement therapy Healthy Weight Program Covers 100% of the cost of counseling calls with a registered dietitian and health educator Includes online tools and educational materials Condition Care Asthma (Pediatric and Adult) Diabetes (Pediatric and Adult) Chronic Obstructive Pulmonary Disease Heart Failure Coronary Artery Disease 24/7 NurseLine is there for you and your family 24 hours a day, seven days a week ComplexCare reaches out to members with multiple health care issues to offer support and assistance

Anthem.com – Engaging, intuitive, and easy Easy, more secure access to personalized member services Quick access to the most common member tasks Seamless transition from public to private site for secure content Tone is friendly, helpful, simple language without insurance jargon We’ve redesigned anthem.com/ca to engage members and enable them to get right to work. Your employees can now log on to the secure site right from the home page They can even initiate some of the most common tasks and seamlessly transition to the secure site when needed And throughout the site, they’ll be guided by simple, friendly language – without insurance jargon.

Appendix – Post Enrollment Communications

Quarterly Health Statement Each quarter, you will receive a Health Statement that summarizes your benefits and current status. It’s very easy to read and understand, and we think you’ll find it helpful to see how your health care dollars are spent.

Claim Recap When you have a claim, you will receive a Claim Recap. This provides a summary of your claim, your account balance, payment details, and more.

Legal Disclaimer Anthem Blue Cross and Blue Shield is the trade name for the following: In Colorado, Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky. In Maine: Anthem Health Plans of Maine, Inc. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. In Missouri: RightCHOICE® Managed Care, Inc. (RIT) and Healthy Alliance® Life Insurance Company (HALIC). RIT and certain affiliates administer non-HMO benefits underwritten by HALIC. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi") underwrites or administers the PPO and indemnity policies; Compcare and BCBSWi collectively underwrite or administer the POS policies. Serving residents and business in Indiana, Kentucky, Ohio, Colorado, Nevada, Connecticut, Main, New Hampshire, Virginia (excluding the city of Fairfax, the town of Vienna and the area east of State Route 123), Missouri (exclluding 30 counties in the Kansas City area) and Wisconsin. Independent licensees of the Blue Cross and Blue Shield Association. ® Anthem, Lumenos and 360°Health are registered trademarks. ® Blue Cross and Blue Shield names and symbols are registered trademarks of the Blue Cross and Blue Shield Association.