Anthem Lumenos Plans— A Health Plan that is Part of the Solution

Anthem Lumenos Plans— A Health Plan that is Part of the Solution

Good Employee Health is Good for Business.
The health of your business depends on the health of your employees. It’s an investment you make every day. Anthem's suite of Lumenos® consumer-driven health plan (CDHP) products provides a completely new approach to better health care management – one that promotes healthier behaviors and encourages and supports consumer decision making. Makes doing the right thing to do the easy thing to do by giving consumers the control and information they want while rewarding them for being more informed and involved in their health care.

Why Employers Consider CDHPs

Why Are Employers Considering CDHPs?
Introduce consumerism Want employees to have a better understanding of the cost of care Offer employees more choice Improve the quality of care Improve employee health Improve employee satisfaction Offer employees opportunity to lower tax burden Increased employee contribution levels Long-term and retirement savings Manage medical costs through better employee health

To Reduce Costs We Need to Understand What Drives the Increase
Health Behaviors Ineffective Care Inefficient Care

Employee Behaviors: 50-70% of Health Care Costs
Health Behavior Costs: $6,691 50% of total medical spending Source: Milliman Medical Index 2006

The Medical Cost of the “Big 3”
Average 10% of total claims costs attributable to obesity 60% of Americans exceed ideal BMI Soon to become the leading cause of death Average 10% of total claims costs attributable to tobacco 25% of Americans smoke Leading cause of death...Still 60% perform no substantial activity or exercise 62% of the rise in private insurance costs from was due to population risk factors and their treatment Source: Thorpe, et al, Health Affairs, June 2005

What Does This Mean For The Average Company?
Focus on behavior change, not just benefits Decreases costs within 18 months Reduces total employee costs (total fringe) Target $50M per year (avg company of 10,000 employees) Return to bottom line rapidly by impacting absenteeism, disability, turnover, etc.

Strategically Addressing Challenges

Reduce Risk Factors & Improve Effective Care
The 3-Step approach to better health care management

Reduce Risk Factors & Improve Effective Care
Start with a sound clinical strategy A consumer-focused health improvement strategy to make it easier for employees to take proactive steps toward healthier behaviors and better care Support with helpful tools to create educated consumers Back it up with account-based CDHPs Giving consumers more control and rewards for improved health behaviors and health care decisions Support through a bold, ongoing communications approach/ marketing program Provide a sequence of communications to educate and build enthusiasm

Start with Sound Clinical Strategy
Incentive-based Health Improvement

Incentive-based Strategy
Identify, improve risk and care Provide rewards for updating or completing health risk assessment 80% completion goal Maintain low risk group to a minimum of 70% Take optimal care of the sick Engage population to understand & reduce risks Provide incentives to complete risk reduction programs

Risk Factors Reduction
Source: D.W. Edington Research GM-UAW LifeSteps Health Promotion Program Risk factors include: Smoking Physical inactivity BMI Alcohol drug use Job/personal dissatisfaction

Health Risks Predict Medical Costs
Annual medical costs by health risk level and age High Risk Medium Risk Low Risk Source: StayWell data analyzed by University of Michigan

Identify, improve risk and care
Incentive-based Strategy Identify, improve risk and care Identify MyHealth Assessment $50 reward* for online completion (limited to one reward per family each year) $100 reward* for enrollment for each eligible family member Participation in health coaching programs Engaging with health coach to identify goals; and understand and manage their health condition Engage Health Coaching Participation $200 reward* for graduating from a health coaching program (limited to one reward per eligible family member each year) Goals achieved with knowledge, skills and functional provider-patient relationship Engage Health Coaching Completion *Rewards may be allocations to account or, for fully-insured HSA plans, credit dollars to redeem for gift cards to select health-focused retailers.

Where to Begin – Healthy Lifestyles Programs
Tobacco- Free Program $50 reward* for successful completion (available for employee and spouse; limited to one/lifetime) Counseling calls with tobacco treatment specialist Individualized plan, decision support for pharmacotherapy and nicotine replacement fulfillment Individualized coaching and support via phone, and ongoing access to online resources *Rewards may be allocations to account or, for fully-insured HSA plans, credit dollars to redeem for gift cards to select health-focused retailers.

Where to Begin – Healthy Lifestyles Programs
Healthy Weight Program $50 reward* for successful completion (available for employee and spouse; limited to one/lifetime) Telephone course sessions address diet and healthy eating, physical activity and exercise, stress management, maintenance and relapse prevention Phone counseling facilitated by a registered dietitian or health educator Includes educational materials appropriate for consumer’s specific needs *Rewards may be allocations to account or, for fully-insured HSA plans, credit dollars to redeem for gift cards to select health-focused retailers.

Engagement & Graduation – Health Coaching
Six- to nine-month partnership Assess medical history, medications, review of systems, lifestyle behaviors, depression screen Educate about disease/condition Compare treatment plan with current guidelines Clarify patient’s belief and value system Assess self-management motivation and capability Specify principal care physician and next appointment Create support and adoption of self-management plan

Health Coaching Enrollment Results
Incentive Status Participation Average (Range) Health Coaching Enrollment Book of Business Full Replacement Incentive 3% % No Incentive 1% % Increased Health Coaching Enrollment 3X (up to 6X) Results are from historical Lumenos client data. Data is not yet available to show participation averages for the current Anthem program.

Health Coaching Enrollment
Self & Health Assessment Referral = Early Behavior Change “engaged consumers” Lumenos 2005 = 47% (with incentives) Health Assessment 2002 No Incentives 2003 HRA Incentive Only 2004 Integrated Incentives 2005 Integrated Incentives Self Customer Service Provider Risk Screen Hospital Percentage of HC Enrollees Referral Source Source: Results from Lumenos book of business

Health Coaching Programs
Examples of conditions supported: Asthma Cancer Congestive Obstructive Pulmonary Disease (COPD) Coronary Artery Disease Diabetes (Type I, II) Heart Failure Hypertension Hyperlipidemia Low Back Pain Maternity

Back It Up With Account-based CDHPs

Clinically Appropriate Plan Design
Sample Plan Design Preventive Care Preventive care Coverage for nationally recommended preventive care services Health account Health account should be sufficient for many people Out-of-pocket responsibility The amount consumer pays to satisfy their remaining deductible after health account funds are exhausted Traditional health plan coverage Coinsurance and annual out-of-pocket protection Health Account and/or Rewards Out-of-Pocket deductible to Traditional Health Coverage Traditional Health Coverage

Types of Lumenos Plans Health Reimbursement Account (HRA)
Health Incentive Account Plus (HIA Plus) Health Savings Account (HSA) Health Incentive Account (HIA)

Anthem's Lumenos HRA, HIA and HIA Plus Plans

Anthem's Lumenos HRA Plan
Out-of-Pocket deductible to Traditional Health Coverage HRA Funded by annual employer allocation Plus Additional reward dollars Preventive Care 100% In-Network Traditional Health Coverage Consumers use employer-funded HRA dollars to pay for covered expenses Earn more dollars for their HRA through rewards for healthy behaviors Preventive services are covered at 100% Unused HRA dollars roll over from year to year and can be used for future health care expenses Traditional Health Coverage covers expenses after the deductible

Anthem's Lumenos HIA Plus Plan
Works like an HRA, except the account allocations are provided by Anthem as a part of the health plan Consumers earn more dollars for their HIA through rewards for healthy behaviors Preventive services are covered at 100% Unused account dollars roll over from year to year Traditional Health Coverage covers expenses after the deductible HIA Plus Funded by annual plan allocation Plus Additional reward dollars Preventive Care 100% In-Network Traditional Health Coverage Out-of-Pocket deductible to Traditional Health Coverage

Anthem's Lumenos HIA Plan
Traditional Health Coverage HIA Funded by reward dollars Preventive Care 100% In-Network Out-of-Pocket deductible to Traditional Health Coverage Companion product to introduce elements of consumerism Can replace an existing PPO offering with a similar PPO plan design Has the added benefit of financial rewards for healthy behaviors Includes Traditional Health Coverage to cover expenses after deductible Also includes all of the tools, services and programs to encourage and reward positive consumer behavior

Sample HRA/HIA Plus Consumer Experience Pharmacy Service
Rx 1) Consumer visits pharmacy to fill a prescription 2) Pharmacy connects to Anthem to determine consumer’s benefit and funds available 3) Anthem determines consumer’s benefits and HRA funds available “real-time” Rx $ 5) Pharmacy provides consumer with prescription Consumer pays nothing out of pocket. 4) Anthem debits consumer’s HRA and pays pharmacy for the prescription

Sample HRA/HIA Plus Consumer Experience Physician Service
1) Consumer visits physician 2) Physician submits claim to Anthem $ 3) Anthem determines consumer’s benefits and HRA funds available 4) Anthem applies benefit and debits consumer’s HRA then pays physician for the services $ 5) Anthem sends consumer Claims Recap record of benefit applied and account funds used

Integrated Plans Employer product set-up: One combined health plan and HRA employer application (no additional paperwork) Consumer enrollment: One combined health plan and member application (no additional paperwork) Direct payment from plan to providers and pharmacy Customer service: Customer Service Advocate can assist with all benefit information as well as health account service Consumer portal: Consumers go to anthem.com for both their benefit and plan details

Anthem's Lumenos HSA Plan

What is Drawing Employers to HSA Plans?
Most requested features include: Preventive benefits covered before the deductible is satisfied Condition management services (asthma, diabetes, CAD/CHF, etc.) Online access to health education tools Online access to account information/personal health records Access to health care cost information Access to hospital/physician quality information Anthem’s Lumenos HSA Plans include all of these highly requested features!

Anthem's Lumenos HSA Plan
Preventive Care 100% In-Network Consumers can fund their HSA with pre-tax dollars and can use funds for health care expenses Employers can also contribute to employees’ HSAs Additional dollars earned with rewards for healthy behaviors* Preventive services are covered at 100% Includes Traditional Health Coverage to cover expenses after the deductible HSA Funded by annual employee and/or employer contributions Plus Additional funds available through rewards (optional) Out-of-Pocket deductible to Traditional Health Coverage Traditional Health Coverage *Rewards may be allocations to account or, for fully-insured HSA plans, credit dollars to redeem for gift cards to select health-focused retailers.

Rewards Allocations to HSA
Reward dollars earned are deposited directly into the consumer’s HSA Reward allocations are tax-free to the employee, so amounts count toward the annual HSA contribution limit Use like any HSA funds – tax-free if used for qualified medical expenses Credit dollars to redeem for gift cards Provided through IncentOne When reward is earned, consumer receives notification by mail Consumer redeems reward dollars for a gift card, online or by phone, choosing from a select list of fitness and wellness-focused retailers like Foot Locker, Dick’s Sporting Goods and the Sports Authority Rewards are taxable, and consumer will receive a 1099 form if they redeem rewards over $600 in a single year Rewards may be allocations to account or, for fully-insured HSA plans, credit dollars to redeem for gift cards to select health-focused retailers.

HSA Integration with Partner Bank
Employer product set-up One combined health plan and HSA employer application Consumer enrollment One combined health plan and HSA consumer application Employer funding implementation Plan-based resources and partner bank resources that will support employers’ efforts to facilitate payroll-based funding Customer service Customer Service Advocate can assist with all benefit information, level 1 HSA account service, and warm-transfers to partner bank for level 2 support Consumer portal Consumers will come to anthem.com for both their benefit and HSA details HSA consumer communications Consumers will receive all of their benefit and banking enrollment materials from Anthem

Sample HSA Consumer Experience Pharmacy Service
1) Consumer visits pharmacy to fill a prescription Rx 2) Pharmacy connects to Anthem to determine consumer’s benefit 5) Consumer uses HSA checkbook or debit card to access HSA funds and pay pharmacy $ Rx 4) Pharmacy provides consumer with prescription and charges the appropriate amount 3) Anthem determines consumer’s benefits “real-time” and passes back to pharmacy the amount the consumer is responsible for paying

Sample HSA Consumer Experience Physician Service
1) Consumer visits physician 2) Physician submits claim to Anthem $ 3) Anthem applies benefits and notifies physician of the amount the consumer is responsible for paying $ 5) Physician sends bill to consumer 4) Anthem sends consumer Claims Recap record of benefit applied 6) Consumer uses HSA checkbook or debit card to access HSA funds to pay physician

Offerings and Product Approaches
Full suite of CDHP options allows for personalized strategies for employers Single Lumenos CDHP offering Multiple CDHP pairings – for example, HRA or HSA paired with HIA to replace (transition from) existing PPO Lumenos CDHP offered alongside a non-CDHP

Consumer Support Online Health Site

Online Health Tools View your coverage, doctors and prescriptions – without a single click Get a side-by-side view of your claims and benefits Quickly find doctors and facilities in-network – and see which ones are best View complex information through simple charts, graphs and illustrations Provide access to your health information for loved ones Easily access health services to help improve your life – and those around you So we all have questions. If you’ve spent time on an insurance site, chances are many weren’t answered right away. But what if you could… View your coverage, doctors and prescriptions – right when you log in Get a side-by-side view of your claims and benefits – so you can easily make sense of who pays for what and how much you’ve spent to date Look at which doctors and facilities are in-network – and instantly use transparency tools (alt: cost and quality tools) to compare and choose the one that’s best for you View complex information through simple charts, graphs and illustrations – such as your medicine cabinet at home Provide access to the site for caregivers – so that loved ones and those who assist in your care can view claims, order prescriptions and more Easily access health and wellness services that can help improve your life – and the lives of those around you

Convenient combined view of benefits & claims
Integrated view of benefits and claims for subscriber and their dependents for each plan Single click for additional eligibility and benefits information Immediate access to claims with ability to filter by family member The new site provides a convenient side-by-side view of benefit information and claims. Now if you have a question about a claim, you can answer it without leaving the page. The page includes an integrated view of benefits and claims for the subscriber and each dependent on the plan. With a single click, you view additional eligibility and benefits information. Claims can be filtered by family member and they can be sorted by date of service, provider, total charges, member responsibility and more. [Optional: And you may notice that we bolded the member responsibility since that’s what’s members care about most.] Ability to sort claims by date of service, provider, total charges, member responsibility and more 43

A simple way to find the best doctor or facility
Side-by-side comparison of credentials – education, awards and more Single click for maps and directions Link to doctor’s website if available Finding the right doctor is quick and easy. Members can view a side by side comparison of doctors including their education, awards and more. The site features single clicks for maps and directions, and a link to each doctor’s website is included, if available. Each doctor’s profile contains (as available) detailed cost and quality information, including NCQA Designation, Bridges to Excellence, Zagat Health Survey ratings, cost of office visits, exams and more. Detailed cost & quality information in the doctor’s profile, including Zagat Health Survey where available 44

Convenient tools that improve member health
360° HEALTH® TOOLS Symptom Checker MyHealth Assessment MyHealth Record Health Trackers Healthy Lifestyles Condition Centers WebMD Articles Health & Wellness provides all the 360° Health services you’ve come to trust from us, now in an integrated page that makes it easy to find everything. This includes the symptom checker, my health assessment, my health record, health trackers, healthy lifestyles, condition centers, and articles from WebMD and other premier online sources.

Online MyHealth Assessment

Consumer Advocacy: High-touch Service

Enhanced Consumer Experience
Customer Service Advocates provide high touch service - Every touch point is an opportunity to educate Dedicated service centers for consumers Customer Service Advocates with in-depth Lumenos plan knowledge Single point of contact for consumer Plan and account information Monthly Status/Claim Recap – combining benefits and account status information Web experience

Sample Monthly Status and Claim Recap

Enhanced Consumer Experience
Integration with PBM Point of sale processing for integrated medical/Rx deductible helps ensure accuracy Integration with providers Direct pay model for HIA, HRA and HIA Plus products Integration with preferred partner bank Simplified service and account administration for HSA

Support with Bold, Ongoing Marketing and Communication Campaign
More than just an enrollment event!

The Cultural Imperative
Current health plans focus on employees when they are “sick”… little to no focus is placed on the true “health” of the employee Programs should support and protect long-term investment in employees Employees spend a majority of their day with the Company… we can potentially impact their health behaviors quicker than other avenues The impact of employee health is far-reaching to include: Total benefit costs (medical, disability, workers’ comp) Productivity Employee morale Corporate results True, long-lasting change in our employees’ personal beliefs and actions occurs only when a consistent support system is provided.

Open Enrollment Communications Strategy
The following strategies will help consumers understand our Lumenos plans and their appeal: Preparation – presentations to senior leadership and HR, building the case for change and delivering the solution Announcement/Awareness – announce the change, show the importance of the change and the value to the employee Education – inform and build comprehension through repetitive communications, utilizing easy-to-understand examples Employee Buy-In – face-to-face interaction to drive the message throughout the organization and deal with concerns Enrollment – provide enrollment support via phone and online

Consumer Driven Plan Pre-Enrollment Communication Timeline
Week 2 Pre-Enrollment Announcement/ Awareness Phase Week 1 Pre-Enrollment Preparation Phase Week 3 Pre-Enrollment Awareness/ Education Phase Week 4 Train-the-Trainer: Presentations to HR and Sr. Leadership Presentations to key management Communication from leadership to all employees on new benefits strategy “Did You Know” poster series begins

Sample Consumer Driven Plan Pre-Enrollment Communication Timeline
Week 5 & 6 Pre-Enrollment Educate/ Buy-In Phase Week 7 & 8 Open Enrollment 2 Weeks Prior to Go Live Employee Seminars Webcasts ID Card Distribution of OE Packet Consumer brochure Plan Summary FAQs Case Studies Preventive Care flyer or guidelines New Customer Getting Started Guide OE Meetings Welcome Kit (HSA Only)

Lumenos Communication Lessons Learned
Initiate communication with employees early and often. Timeline will vary based on size of employer group and/or clients goals for CDH enrollment. /Direct Mail Internet Seminars/Cafeteria Fairs/Webinars Organizational commitment from management HR and senior managers must be viewed by employees as committed to plan Education/training for benefits staff Support to answer questions Finalize benefit design early CDHP is a new concept with a new language Engage and commit to education and communication with employees

Why Anthem Lumenos Plans?

Why Anthem? Proven results Consumer centric health improvement model
Best in class products Network breadth and discounts give consumers more for their health care dollars Comprehensive communication and engagement Consumer advocacy Total integration for seamless consumer experience

Positive Results When coupled with the right clinical strategy
Reduction in overall pharmacy costs by 15% 92% generic drug substitution Reduced outpatient visits by 18% Increase in preventive care spent (CDHP = 5% of total medical expenses v. 2-3% for rest of market) 53% report increased knowledge in managing health care 36% report that they are more actively involved in health-related behaviors 20% of consumers said their health has actually improved since enrolling in a Lumenos plan Source: Results from Lumenos book of business 2005

Good Employee Health is Good for Business.
We can help lead your business and employees to better health. We deliver measurable results and real value – right now and long term. Let’s get started. (Tie this slide to your opening) OPEN DISCUSSION QUESTIONS CLOSE

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, Inc. 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 Ohio. In Virginia: Anthem Health Plans of Virginia, Inc. (serving Virginia excluding the city of Fairfax, the town of Vienna and the area east of State Route 123.) In Missouri: RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), 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 Health Services Insurance Corporation (“Compcare”) underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. 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 marks of the Blue Cross and Blue Shield Association.

Anthem Lumenos Plans— A Health Plan that is Part of the Solution

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Anthem Lumenos Plans— A Health Plan that is Part of the Solution

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