1. National Sales and Account Management May 2013 End to End SBC process Summary of Benefits and Coverage

2. 2 Fundamentals by Role EAMAAM/ATSNational Contract Administration NA RAMNA RAAMRegional SBC Team Capture the group Benefit Election and SBC needs Capture SBC Group Personalization needs in SBC Track, Report and Audit Support NA RAAM in validation and in meeting group deadlines Validate benefits displayed in the SBC Create compliant (Federal / State) documents  Obtain confirmation of groups’ benefit selection  Communicate and escalate SBC issues with group/ consultant as requested  Capture and document SBC personalization requests  Report SBC Progression status  Complete approved SBC formatting and personalization changes  Process approved edit requests (from group)  Finalize SBC with group  Storage of finalized SBC in SalesConnect  Tracking of SBC progression  Manage SBC translation requests  Transition support  Auditing of SBCs  Storage of SBCs in Sharepoint  Communicate SBC related updates to National Accounts, Regional SBC Teams  Review and confirm all SBC cost share, including maximums/ limitations, discovered by NA RAAM  Lead to resolution on any discrepancies as needed  Escalate as needed  Validate the SBC is displaying the correct cost sharing, including maximums/limitati ons  Report SBC Progression status  Advise of cost share discrepancies  Compose compliant SBCs, reflecting documented personalization  Report SBC Progression status  Process SBC corrections on cost sharing values  Process SBC edit requests (from group) that require compliance or regulatory review  Storage of finalized SBCs in regional storage solutions (for reprints)

3. 3 StepProcessAccountable Individual/Role Others InvolvedActionsHow 1  Group/consultant informs EAM team of final benefit selection  EAM  AAM, ATS  Obtain confirmation of final benefits from group/consultant  Inform AAM, ATS, and NA UWC of benefit selection  Engage with group/ consultant to finalize benefit selection 2  Discuss SBC personalization requests with group/consultant, document in National Universal Request Form (NURF)  AAM  ATS, EAM,  Complete NURF with personalization detail  Engage with group/ consultant; reference previous years SBC as needed/appropriate 3  Distribute NURF to Regional SBC partners  AAM  ATS, Regional SBC Teams, NA RAAM, NCA  Save completed NURF in SC WHQ using required naming convention  Email NURF, NPS packets and Benefit Summaries to Regional SBC Teams, cc NA RAAM,ATS, and SBC- NA-Intake (NCA) using the subject line: National SBC Request [Group Name]  Regional SBC team emails can be found in the NURF  For CA – Request CRTS from NA RAAM for any sold alternate plan designs. This can be a 2-3 day process  For CO and GA – Request from NA RAAM or pull from RFP folders/files the blue and white Benefit Summaries for all sold plans 4  Create SBC(s) and any applicable state supplemental documents are created.  Regional SBC Team  NCA, NA RAAM, NA RAM, AAM  Email completed Regional SBC to NA RAAM, cc NA RAM, SBC-NA-Intake; and AAM  As defined by the Regional process  SBC created in editable Word 2010 format, with personalization components added) 5  Benefit cost shares are validated against group confirmed sold benefits  NA RAAM  NA RAM  RAAM will validate all cost shares, including maximums/limitations, on Regional SBC  Reference NPS packets and regionally specific documents End-to-end Process Design SBC Process

4. 4 StepProcessAccountable Individual/Role Others InvolvedActionsHow If discrepancies are found during validation (follow steps 6-7): 6  Document benefit inconsistencies on the Regional SBC using track changes on the function in Word 2010  RAAM  Regional SBC Teams, NA RAM, AAM, NCA  Save and /or print marked Regional SBC for your teams records  Email saved document to Regional SBC teams using subject line of: National SBC Edit Request [Group Name] for editing, cc SBC- NA-Intake, AAM and RAM  Communicate with AAM or ATS on recommended changes  Engage NA RAM, as needed  NA RAM to escalate as needed 7  Correct the SBC to match the selected plan design, updating coverage calculator results if applicable  Regional SBC Team  NA RAAM, NA RAM, NCA  Email revised Regional SBC, in Word 2010 format, to NA RAAM, cc: NA RAM and SBC-NA-Intake  As defined by the Regional process 8  Distribute validated and approved Regional SBC to EAM Team  NA RAAM  AAM, ATS Regional SBC Team, NA RAM, and NCA  Save approved Regional SBC on SC in Regional Record in Notes / Attachments section using applicable naming convention (found in NURF instructions)  Email validated/accurate Regional SBC, in Word 2010 format, to AAM with cc to ATS, NA RAM, Regional SBC email box and, SBC-NA-Intake End-to-end Process Design SBC Process

5. 5 StepProcessAccountable Individual/Role Others InvolvedActionsHow 9  Review all Regional SBC’s requested in Step 3  AAM  EAM, ATS, Peer AAM  Validate benefits, including maximums and limitations, formatting and requested personalization fields  Update editable fields for consistency/accuracy  Request peer review of SBC from ATS or peer AAM  Reference NPS packets and regionally specific documents along  Communicate/confirm with group as needed 10  Complete peer review and validation of SBC in Word 2010 format  ATS  Group EAM or AAM  SuperUser  NCA, NA RAAM and NA RAM  If accurate, email all SBC’s to AAM with a cc: to EAM  If errors are found, use track changes to record found errors and email to AAM with a cc: to EAM, SBC-NA-Intake, NA RAM, NA RAAM  Reference NPS packets and regionally specific documents along with any additional information provided by AAM  Save peer review checklist in SC 11  Convert all SBC’s from Word format to PDF Format  AAM  ATS  Save all Regionally approved and accurate SBC’s in PDF Format  See PDF job aid on SC Content for assistance as needed. 12  Deliver all reviewed and validated Regional SBC’s. in PDF format, to group/consultant for their review and approval  AAM  EAM, ATS, NCA  Email to Group/Consultant with a cc :to EAM, ATS and bcc: to SBC-NA-Intake  Save on local drive in group folder (assuming we already have this functionality) End-to-end Process Design SBC Process

6. 6 StepProcessAccountable Individual/Role Others InvolvedActionsHow If edits to SBC requested (by group/consultant) 12a  Review all group requested SBC changes and determine next steps; use previously converted Word 2010 Regional SBC’s to track group requested SBC requested changes  Confirm with group/consultant the expected group delivery dates for revised SBC’s  AAM  EAM, ATS, NCA, NA RAAM, NA RAM, SME’s, SuperUsers  In scope, repeat steps 9 - 11  Out of scope, email back to Regional SBC team with cc: to SBC-NA-Intake, NA RAM and NA RAAM using subject line of: National SBC Edit Request [Group Name]  Save on local until group approval / confirmation of SBC is received  If escalation is needed; communicate with Super User and escalate further as needed 12b  Review group requested out of scope changes, make edits as appropriate or provide rationale as to why edit cannot be made  Regional SBC Team  NA RAAM, NA RAM and NCA  Email revised Regional SBC, in Word 2010 format, to NA RAAM, cc:SBC-NA- Intake and NA RAM  If escalation is required notify NCA of possible delay in delivery of SBC 12c  Convert all SBC’s from Word format to PDF Format  AAM  ATS  Save all Regionally approved and accurate SBC’s in PDF Format  See PDF job aid on SC Content for assistance as needed. 13  Email all Regional SBC’s, in PDF format, and all state required documents to group/consultant  AAM  EAM, ATS, NCA, NA RAAM and NA RAM  Email group/consultant cc: to EAM, ATS and bcc: to NA RAAM, NA RAM and SBC-NA-Intake 14  Confirm agreement and approval of all Regional SBC’s with group/consultant  AAM  EAM. ATS  Confirm with group/consultant by email/phone/in-person  Record approval as a task in SC WHQ record End-to-end Process Design SBC Process

7. 7 StepProcessAccountable Individual/Role Others Involved Communication RequirementsHow 15  Store SBC in SalesConnect  AAM  ATS, Regional SBC team, Regional AAM, NCA  Save final SBC, in PDF format, in SalesConnect (under WHQ) using required naming convention  Email reviewed and approved SBC’s, in PDF format, to all Regional SBC teams with a cc: to NA RAAM, NA RAM and SBC-NA-Intake  See PDF job aid on SC Content for assistance as needed 16  Final SBCs are loaded in regional storage solution  Regional SBC Team  NCA  Receive email from AAM with all regional SBC’s in PDF format  Regional SBC teams will store final and approved SBC’s in regional storage solution  NCA stores in Sharepoint If Translation is Requested 16a  Once final English version is approved - initiate SBC Translation Request (may require further approval)  AAM  NCA, ATS  Threshold languages: Email final SBCs (in Word 2010 format) to SBC-NA-Intake  Non-threshold languages, request approval from NA Director and, if approved, Email final SBC’s (in Word 2010 format) to SBC-NA-Intake  NCA will drive, manage and provide oversight on the translation request with a single source NA vendor  Thresholds are established based on HHS requirements. and noted on the Renewal Confirmation Form and on SC Content 16b  Deliver all final translated SBC’s  NCA  AAM, ATS and EAM  Email translated SBCs to AAM, with a cc: to ATS and EAM, in PDF format  Using translation process, obtain alternate language SBCs and deliver to AAM 16c  Deliver SBC to group/consultant  AAM  EAM, NCA  Repeat Steps 14-16  AAM sends translated SBCs to group by email, notifies NCA at SBC-NA- INTAKE, then stores them on SC End-to-end Process Design SBC Process