This presentation is a high-level summary and for general informational purposes only. The information in this presentation is not comprehensive and does not constitute legal, tax, compliance or other advice or guidance. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association On Exchange Product Training for 2014

To promote the health and wellness of our members and communities through accessible, cost-effective, quality health care. We are a customer-owned organization and our accountability is clear. Our Mission

Our promise to our members is to make insurance Simple. Affordable. Accessible.

PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION. Plan Design Components Plan Designs Components Essential Health Benefits Deductible and Out-of- Pocket Maximum (OPX) Per-Occurrence Deductible Out-of-Network Benefits Copays Rx Tiers *Excluded from both: Premiums, Claims for Uncovered Services, and Preauthorization Penalties 2

How do Claims Pay Towards OPX and Deductible in the New ACA World? Copays and Per-Occurrence Deductibles do not feed into the deductible – These costs go directly to the Out of Pocket Maximums (OPX) All other eligible expenses go towards the annual deductible Cost sharing feeds into the OPX – Includes Rx Copays – Includes Office and Hospital Copays – Includes Per-Occurrence Deductibles In 2014, the OPX could be more critical to the average consumer than their deductible. In 2014, the OPX could be more critical to the average consumer than their deductible. 4

How Do Per-Occurrence Deductibles Work? Per-Occurrence Deductible Includes: – Emergency Room – Inpatient Hospital Admission – Outpatient Surgery When a Per-Occurrence Deductible Is Paid: – The amount is subtracted from the claim – The balance of the claim is subject to the annual deductible and coinsurance – The Per-Occurrence Deductible is credited towards the OPX *Example Only – Based on In-Network Level of Benefits 5

Family Deductible and OPX Summary If one person meets the individual deductible, the remaining deductible can be met by the rest of the family members. The one person that meets the individual deductible will start to receive benefits and the coinsurance will begin to be applied towards that person’s OPX. If the one person that meets the individual deductible meets the individual OPX, he will receive 100% coverage even if the family deductible and OPX has not been met. The remaining family members can contribute to the balance of the family OPX. Once the family OPX is met, then all family members will receive 100% coverage. One person cannot meet the entire family deductible and OPX. Once the deductible is met, coinsurance will be applied. 6

PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION. Copays Office Visit copay will cover everything billed as part of office visit (if performed in the same office on the same day) Exceptions: Surgery Physical, Occupational and Speech therapy Chiropractic and Osteopathic manipulation If services are performed in a separate office or facility and billed separately, then coinsurance and deductible apply Mental Health and Substance Abuse will be covered the same as any medical service Inpatient covered at the in-patient per admission rate Outpatient covered at primary care provider (PCP) rate 8

PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION. Rx Benefits Structure Benefit Structures Drug Card Coinsurance after Medical Deductible Formulary Standard Formulary on PPO Network Generics Plus formulary on narrow networks Generics Plus is a leaner version of the standard formulary and includes non- specialty and specialty drugs for all major therapeutic categories 5-Tier Drug Copays (2-tier Generics) 9

PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION. Out-of-Network Benefits for PPO and HMO 7 Out of Network Benefits for PPO plans Out-of-network office visits (primary and specialist) are subject to deductible and coinsurance, no copays are applied Inpatient Admission Copay and Outpatient Surgery Copays: $100 increase over In Network copay, per occurrence copay in addition to deductible and coinsurance All other Out-of-Network services are subject to deductible and coinsurance Deductible: 2x In-Network up to $25,400 Out of Pocket: 2x In-Network up to $25,400 Coinsurance: 20% differential from In-Network level with a floor of 50% Emergency room services will be the same as In-Network HMO plans do not include Out of Network benefits HMO plans do not include ‘Away From Home’ benefits, only BlueCard Worldwide ® for emergency and urgent care

PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION. 13 Provider Networks and Plan Designs

PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION Retail Provider Networks 14

PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION. New Mexico Provider Network Service Areas PPO Provider Network Blue Advantage HMO Blue Community HMO New or Modified Network 15

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Why Choose Blue Brand Recognition Network Strength Claims Paying Capability Website Strength – Direct Enrollment Choices of Plans – PPO – HMO – Catastrophic New Mexico PPO Provider Network – 12,000 Providers Blue Community HMO Network SM – 5,000 Providers Blue Advantage HMO Network SM – 2,800 Providers Value Added Benefits BlueCard Worldwide ® We are part of the community! CareVan Program Blue Bear Outreach Healthy Kids, Healthy Families ® Blue Corps Team

This presentation is a high-level summary and for general informational purposes only. The information in this presentation is not comprehensive and does not constitute legal, tax, compliance or other advice or guidance. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 20