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

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3 Today We Will Cover: Two Network Options Standard & Extended Same services available in both networks Differences between the two networks  Provider network  Copayments  Bi-monthly premium NOTE TO USER: Edit as needed

4 Standard & Extended Network Similarities 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

5 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

6 Benefit Highlights In-NetworkOut-of-Network Individual Deductible$250$1,500 Family Deductible$500$3,000 Individual Out-of-Pocket Max$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. Your Standard (LoboCare) Network Benefits

7 Extended Network Entire BCBSNM HMO network of over 22,000 providers including University and First Choice providers and UNM Hospitals, PLUS Lovelace Hospitals & Facilities Independent physicians Women’s Hospital West Mesa Medical Center Lovelace Medical Center Kindred Hospital Urgent Care Centers Heart Hospital of New Mexico

8 Benefit Highlights In-NetworkOut-of-Network Individual Deductible$250$1,500 Family Deductible$500$3,000 Individual Out-of-Pocket Max$5,000$10,000 Preventive Care ServicesNo ChargeNot Covered Primary Care Physician$4540%* Specialist Physician$6040%* Inpatient Admission $500 (per admission after deductible) 40%* Emergency Room $300 (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. Your Extended Network Benefits

9 Services covered only when received from Standard & Extended 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

10 RxRxRxRx Pharmacy Benefits

11 Prescription Drug Benefit *Retail Pharmacy: Maximum Generic$10 Brand-Name on Drug List$40 Brand-Name Not on Drug List$70 Specialty Medication 20% up to maximum copayment of $250 *Mail Order: Two copayments for Tiers 1,2 & 3 only (90 day supply) Maximum Generic$20 Brand-Name on Drug List$80 Brand-Name Not on Drug List$140

12 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 ABQ Health Partners Urgent Care Centers Concentra Urgent Care UNM Hospital Urgent Care Contact PCP for follow-up care

13 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.com bcbsnm.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

14 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

15 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

16 OR Contact your physicians and ask How to Find a PPO Provider

17 minute A new member subscribes to Blue Access for Members every Blue Access for Members SM Secure member site

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 Blue Access for MEMBERS SM

19 Blue Access Mobile SM Blue Access for Members SM Public Site Find a Doctor / Hospital Health Care 101 Shop for Insurance Log in or register for Blue Access for Members Contact Us Text Messaging Static – One-Way Alerts Rx Reminders, Diabetes, CAD, Diet Tips, Claim Status, Exercise & Fitness Tips Dynamic – Two-Way ID Card Management, Coverage Management Digital ID Card Benefits / eligibility Claims Status User Profile Pay My Bill Health and Wellness Articles – Diabetes, Maternity Care, Nutrition, Obesity, Fitness, My Care Profile, Metabolic Syndrome 20,000 mobile page views per day More than Five text messages sent per minute More than

20 Health Services and Programs

21 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 Blue365 ® Member Discount Program Member discounts simply for being a BCBS member Log on to Blue Access for Members SM for updates and to register for weekly s Under the My Coverage tab

22 Expectant mothers and babies 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 WEBTEXT get off to a healthy start with prenatal and postnatal education and support

23 Your Blue Care Connection ® Condition Management If you are identified as being at-risk or having one of the managed chronic conditions, such as asthma, high blood pressure, or diabetes, a Blue Care Advisor will contact you. Call Back! This is a completely confidential service offered at no cost to you. Your participation is voluntary, but Blue Care Connection will help you better manage your condition and stay healthier. Personalized Outreach and integrated support by certified clinical professionals

24 Available in English and Spanish Nurseline 24/ 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

25 Claim questions or status Medical benefit coverage questions Help with finding network providers Membership and eligibility Help with navigating online tools ID card requests Transition of care What if I Have Questions? Call your BCBSNM customer service team for: Toll-free Enter your ID Number Monday-Friday 6 AM – 8 PM Saturday & most holidays 8 AM – 5 PM Toll-free Enter your ID Number Monday-Friday 6 AM – 8 PM Saturday & most holidays 8 AM – 5 PM

26 Select a Network: Standard or Extended You must note your selection of either the Standard (LoboCare) Network or Extended Network when enrolling You cannot change your Network selection except during Open Enrollment, regardless of any qualifying event during the plan year (August 1 through July 31)

27 Rates 2014/2015 Standard & Extended Networks Standard (LoboCare) Network COVERAGE TYPE EE COST Full Time EE COST Part Time Employee$ 0.00$ Employee + Spouse/DP$ $ Employee + Child(ren)$ $ Employee + Family$ $ Extended Network COVERAGE TYPE EE COST Full Time EE COST Part Time Employee $ $ Employee + Spouse/DP $1, $1, Employee + Child(ren) $ $ Employee + Family $ l, $ 1, UNMH pays $ per month for health plan coverage for each enrolled full time employee. ($ for part time)

28 Questions?