Welcome! 2010 Excellus BlueCross BlueShield Fall Member Meeting A nonprofit independent licensee of the Blue Cross Blue Shield Association Excellus BlueCross BlueShield contracts with the FederalGovernment and is a Medicare Advantage Organization with aMedicare contract.

2 Our Vision “…to be a best in class Medicare Program, providing Medicare beneficiaries with a range of products and services that meet their needs for health coverage at an affordable price.”

3  As the health care landscape evolves, Excellus BlueCross BlueShield continues to provide low cost, benefit-rich Medicare health plans  No Change To Most Benefits  Valuable Extras 2010 Highlights

4 Why Excellus BlueCross BlueShield?  Power of Blue – One of the most recognized health care insurers  More than 3,000 participating providers  In business for over 70 years  Commitment to serving our local communities

5 Agenda  Plan Changes  What’s New?  Valuable Extras  What Do You Need to Do?  Questions

6 HMO vs. PPO HMO Health Maintenance Organization PPO Preferred Provider Organization Primary Care Physician (PCP) is required.Primary Care Physician (PCP) not required Referrals required to see specialistsNo referrals required to see specialists Must use In-Network providers (You must receive all routine care from plan providers) Can use In-Network & Out-of-Network providers* (Out-of-pocket costs may be higher when you use an Out-of- Network provider, except in cases such as emergency care, urgently needed care, or out-of-area renal dialysis) *Excellus BlueCross BlueShield provides reimbursement for all covered benefits regardless of whether they are received In-Network, as long as they are medically necessary. You are eligible to join a Medicare Advantage Plan if you have Medicare Part A and B, live in our service area, and don’t have end stage renal disease.

7 Medicare Advantage Plan Options  HMO Plans  Medicare Blue Choice Value SM (HMO)  Medicare Blue Choice Value Plus SM (HMO)  Medicare Blue Choice Optimum SM (HMO)  Medicare Blue Choice Platinum SM (HMO)  PPO Plan  Medicare Blue PPO SM Plan 201 (PPO) For full information on Medicare Blue Choice and/or Medicare Blue PPO benefits, call our Customer Service Department at for Medicare Blue Choice or for Medicare Blue PPO, TTY/TDD Monday – Friday, 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are available weekends from 8:00 a.m. – 8:00 p.m. Our contract with CMS is renewed annually and the availability of coverage beyond the current contract year is not guaranteed. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, Please contact Excellus BlueCross BlueShield for details.

8 Medicare Blue Choice Value SM (HMO) PCP Office Visit Specialist Office Visit Ambulance Services Emergency Room Inpatient Hospital Outpatient Hospital Physical Therapy Skilled Nursing Facility (SNF) Chiropractic $650 GoGetters ® Fitness Benefit …and more! No changes to the following benefits or cost-sharing in 2010:

9 Medicare Blue Choice Value SM (HMO) $0*$5.50* Monthly Premium * You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

10 Medicare Blue Choice Value SM (HMO) Benefit Outpatient Mental Health Care (per visit) 50% coinsurance45% coinsurance Durable Medical Equipment30% coinsurance20% coinsurance Prosthetic Devices30% coinsurance20% coinsurance Diabetic Supplies30% coinsurance20% coinsurance Part D Deductible$175$150

11 Medicare Blue Choice Value Plus SM (HMO) No changes to the following benefits or cost-sharing in 2010: PCP Office Visit Specialist Office Visit Ambulance Services Emergency Room Inpatient Hospital Outpatient Hospital Physical Therapy Skilled Nursing Facility (SNF) Chiropractic $650 GoGetters ® Fitness Benefit …and more!

12 Medicare Blue Choice Value Plus SM (HMO) Monthly Premium $35*$41* * You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

13 Medicare Blue Choice Value Plus SM (HMO) Benefit Outpatient Mental Health Care (per visit) 50% coinsurance45% coinsurance Durable Medical Equipment30% coinsurance20% coinsurance Prosthetic Devices30% coinsurance20% coinsurance Diabetic Supplies30% coinsurance20% coinsurance Part D Deductible$175$150

14 Medicare Blue Choice Optimum SM (HMO) No changes to the following benefits or cost-sharing in 2010: PCP Office Visit Specialist Office Visit Ambulance Services Emergency Room Inpatient Hospital Outpatient Hospital Physical Therapy Skilled Nursing Facility (SNF) Chiropractic $650 GoGetters ® Fitness Benefit …and more!

15 Medicare Blue Choice Optimum SM (HMO) Monthly Premium $90*$101* * You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

16 Medicare Blue Choice Optimum SM (HMO) Benefit Durable Medical Equipment25% coinsurance20% coinsurance Prosthetic Devices25% coinsurance20% coinsurance Diabetic Supplies30% coinsurance20% coinsurance

17 No changes to the following benefits or cost-sharing in 2010: PCP Office Visit Specialist Office Visit Ambulance Services Emergency Room Inpatient Hospital Outpatient Hospital Physical Therapy Skilled Nursing Facility (SNF) Durable Medical Equipment (DME) Chiropractic $650 GoGetters ® Fitness Benefit …and more! Medicare Blue Choice Platinum SM (HMO)

18 Monthly Premium $45*$61* Medicare Blue Choice Platinum SM (HMO) * You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

19 Benefit Diabetic Supplies30% coinsurance20% coinsurance Medicare Blue Choice Platinum SM (HMO)

20 PCP Office Visit Specialist Office Visit Ambulance Services Emergency Room Inpatient Hospital Outpatient Hospital Physical Therapy Skilled Nursing Facility (SNF) Chiropractic $650 GoGetters ® Fitness Benefit …and more! Medicare Blue PPO SM Plan 201 (PPO) No changes to the following benefits or cost-sharing in 2010:

21 Monthly Premium $25*$36* Medicare Blue PPO SM Plan 201 (PPO) * You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

22 Benefit Radiology Services (per visit)10% coinsurance In-Network 20% coinsurance In-Network Outpatient Mental Health Care (per visit) 50% coinsurance In-Network 45% coinsurance In-Network Durable Medical Equipment 30% In-Network 40% Out-of-Network coinsurance 20% In-Network 30% Out-of-Network coinsurance Prosthetic Devices 30% In-Network 40% Out-of-Network coinsurance 20% In-Network 30% Out-of-Network coinsurance Seasonal flu/pneumonia vaccines30% Out-of-Network Covered in full Out-of-Network Diabetic Supplies30% coinsurance In-Network 20% coinsurance In-Network Part D Deductible$175$150 Medicare Blue PPO SM Plan 201 (PPO)

23 Medicare Prescription Drug Plan (Part D) You pay $2.50 for generics and $6.30 for brand name drugs, or 5% of the price (whichever is greater) Catastrophic Coverage Excellus BlueCross BlueShield pays the balance Coverage Gap All costs are out-of-pocket You Pay Your copays/coinsurance Initial Coverage Period Excellus BlueCross BlueShield pays the balance Deductible is out-of-pocket $0 or $150 2 Medicare Drug BenefitOut Of Pocket 4 Coverage Phases Catastrophic Coverage begins when you or others on your behalf have spent $4, No coverage when total drug spend exceeds $2,830 1 until your true out of pocket spending reaches $4, You must pay your deductible (if applicable) before you start getting your prescription coverage. 1 Coverage limits for all phases of the Part D benefit change annually. 2 Benefits, formulary, pharmacy network, premium, copayment/coinsurance may change on January 1, Contact Excellus BlueCross BlueShield for details. Initial Coverage starts after you have met your deductible, if applicable, and continues until your total drug costs reach $2,830. 1

24 Medicare Prescription Drug Plan (Part D) Formulary Changes Review the drugs you are taking Consult with your doctor if your drug will no longer be covered. Network About 60,000 pharmacies nationwide Retail, mail order, long-term care, home infusion, Indian/Tribal/Urban pharmacies included For additional information regarding our pharmacy network, quantity limits, and mail order prescription drug service, call: TTY/TDD Monday-Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1 representatives are also available weekends from 8:00 a.m. – 8:00 p.m. You may write us at: Excellus BlueCross BlueShield, PO Box 546, Buffalo, NY You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use network pharmacies.

25 Medicare Prescription Drug Plan (Part D) You may be able to get Extra Help to pay for your prescription drug premiums and costs.  To see if you qualify for getting Extra Help, call: MEDICARE ( ), TTY/TDD users should call , 24 hours a day/7 days a week; The Social Security Administration at between 7:00 a.m. – 7:00 p.m., Monday through Friday, TTY/TDD users should call ; or Your State Medicaid office.

26 People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for:  seventy-five percent of drug costs including monthly prescription drug premiums,  annual deductibles, and  coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty.  Many people are eligible for these savings and don’t even know it.  For more information about this Extra Help, contact your local Social Security office or call MEDICARE ( ), 24 hours per day, 7 days per week. TTY users should call Medicare Prescription Drug Plan (Part D)

27 Summary of 2010 Benefit Changes  No Change To Most Benefits  Valuable Extras

28  GoGetters ® Fitness Benefit Up to $650 per calendar year* Qualified fitness facility membership fees Qualified weight management program membership fees Can be used in conjunction with Blue365 * This benefit does not cover any ancillary services or items that are not part of a membership fee. Health and Wellness

29 Blue365 offers access to savings and discounts on items that members may purchase directly from independent vendors. Blue365 may also be used in conjunction with the GoGetters ® Benefit.  Fitness- save on membership, monthly fees and other services at Gold’s Gym ®, Curves ®, Snap Fitness TM and Global Fit TM  Nutrition- Save on programs, products and consultations at eDiets ®, Kronos Optimal Health ® and Jenny Craig ®  Elective procedures- Save on vision products and services at Davis Vision ®, QualSight LASIK ®, LasikPlus ® and TruVision TM  Hearing aids- Save on products from Beltone TM and TruHearing The products and services described above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Excellus BlueCross BlueShield grievance process. Note: Not all vendors that have provided discounts for Blue365 are qualified fitness facilities or weight management programs for purposes of our GoGetters benefit. What’s New

30 What’s New  Side by side comparisons of:  Your plan options &  Estimated out-of-pocket costs.  2010 plan changes  Learn more about cost-cutting options  Research health topics  Change your doctor  Request ID cards  Access health coaching information Enhanced Web Tools

31 Valuable Extras  Medicare Dedicated Customer Service Unit  Knowledgeable and friendly staff dedicated to answering any questions you may have timely, accurately, and professionally.  24-hour Personal Health Coaching Line  Provides education and programs on nutrition, weight management and much more.  Disease & Case Management  Clinical staff work with you to make informed choices on your health care and prescriptions

32 What To Expect  Whether changing your coverage or not, you will receive new:  ID cards  GoGetters ® card (if you already have a card that you’re using for this benefit)

33 What Do You Need To Do?  If you want to stay in your current plan, there is nothing you need to do.  If the plan you are in no longer suits your needs, we have many other plan options.  Complete an option transfer form if switching from an HMO plan to another HMO plan within our organization.  Complete an application if switching between HMO, PPO or Medicare Supplement Plans.

34 Medicare Advantage Plan Enrollment Periods Annual Enrollment Period (AEP) Runs from November 15 – December 31, each year Can change Medicare Advantage plan or stand-alone Prescription Drug Plan Can add or drop prescription drug coverage Can return to Original Medicare Enrollment changes take effect on January 1 Open Enrollment Period (OEP) Runs from January 1 – March 31, each year Can change Medicare Advantage plans Cannot add or drop prescription drug coverage One opportunity to change to a similar plan (No-drug plan to no-drug plan – OR – drug plan to drug plan) Enrollment or disenrollment becomes effective the month after the application is received There are only certain times during the year when you may change or voluntarily end your membership in a Medicare Advantage Plan.

35 Special Enrollment Period (SEP) Change of residence into or out of the service area Loss of employer coverage Qualify for Low Income Subsidy Medicare Advantage Plan Enrollment Periods To obtain more information regarding Medicare Advantage Plan enrollment periods you can call our Customer Service Department at for Medicare Blue Choice or for Medicare Blue PPO TTY/TDD Monday – Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are also available weekends 8:00 a.m. – 8:00 p.m.

36 How to Contact us Call us: Medicare Blue Choice ® (HMO) Medicare Blue PPO SM TTY/TDD Monday – Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are also available weekends from 8:00 a.m. – 8:00 p.m. Write us: Excellus BlueCross BlueShield P.O. Box 546 Buffalo, NY Visit us on the Web at

37 Interested in Receiving s? Fill out our simple form provided by your sales representative or call us to receive some information such as health and wellness from Excellus BlueCross BlueShield in your ! Call: (TTY/TDD ), Monday – Friday, 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are also available weekends from 8:00 a.m. – 8:00 p.m. Interested in Becoming an Ambassador? Ask your Medicare representative about our exciting Ambassador program.

38 We Value Your Opinion Tell Us How We Are Doing! Call Our Confidential Voice Message System Hours a day, 7 days a week

39 Questions ?

Thank You! H3351, H _0 (10/2009)