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

Two Network Options Today We Will Cover Standard & Extended Same services available in both networks Differences between the two networks Provider network Copayments Bi-monthly premium 2

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

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

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

Extended Network Entire BCBSNM HMO network of over 26,000 providers including University and First Choice providers and UNM Hospitals, PLUS Lovelace Hospitals & Facilities Independent physicians Women’s Hospital Lovelace Medical Center Kindred Hospital Urgent Care Centers Lovelace Medical Center Downtown (formerly The Heart Hospital of New Mexico)

Benefit Highlights In-NetworkOut-of-Network Individual Deductible$250$1,500 Family Deductible$500$3,000 Individual Out-of-Pocket Max (Medical)$5,000$10,000 Preventive Care ServicesNo ChargeNot Covered Primary Care Physician$4540%* Specialist Physician$6040%* Inpatient Admission $600 (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

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

Prescription Drugs

Prescription Drug Benefit Retail Pharmacy Copays Generic $10 Preferred* Brand $40 Non-Preferred $70 Specialty Drugs (20% up to maximum copayments of $250) Home Delivery (Mail Order) Copays (Up to a 90-day supply. Tiers 1,2 & 3 only) Generic$20 Preferred* Brand$80 Non-Preferred $140 *Preferred also known as “Formulary” Out-of-Pocket Limit (Retail & Mail Order) $1,500/Individual or $3,000/ Family 10

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

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

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

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 HMO Provider 15 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’ OR talk with your physician’s office

bcbsnm.com/unmh 16 You will find: Standard or Extended Benefits Provider Finder or Find a Doctor at UNM Forms Link to UNMH website

Online Tools and Resources

Log on to Blue Access for Members SM 18 To register you will need your ID number (1) on the back your ID card, OR (2) call Customer Service Or click Register Now for New Users Go to bcbsnm.com via web or mobile

Blue Access for Members SM 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 19

Blue Access Mobile SM 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 20 To download the app, go to Google Play, the App Store or text “BCBSNMAPP” to 33633

Health and Wellness

Blue365 ® Member Discount Program 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 22

Special Beginnings ®΄ WEBTEXT 23 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 Expectant mothers and babies get off to a healthy start with prenatal and postnatal education and support

Blue Care ® Advisors Condition Management 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, diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), coronary artery disease (CAD), and high blood pressure. 24

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 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 Health education and transfer to other health programs Transition of care Call your BCBS customer service team for: Enter your ID Number Monday-Friday 6AM – 8PM Saturday & most Holidays 8 AM – 5 PM What If You Have Questions? 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)

Rates 2015/2016 Standard & Extended Networks Standard (LoboCare) Network COVERAGE TYPE EE COST Full Time EE COST Part Time Employee$ 0.00$ Employee + Spouse/DP$299.00$ Employee + Child(ren)$142.00$ Employee + Family$328.00$ Extended Network COVERAGE TYPE EE COST Full Time EE COST Part Time Employee $ $ Employee + Spouse/DP $1, $1, Employee + Child(ren) $ $ Employee + Family $1, $1, UNMH pays $ per month for health plan coverage for each enrolled full time employee ($ for part time).

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