employers who want to...

save money with the lowest possible premiums

reduce long-term costs by maximizing employee engagement in health care decisions

provide tax-advantaged savings for employees to help offset the burden of increased cost-sharing

Develop a long-term strategy for affordable retiree coverage

who it’s for

A high-deductible PPO plan with a tax-advantaged health savings account

Group Health Plan

Your plan for better health. bcbsnc.comSM1

Blue Options HSA pairs a high-deductible plan with a tax-advantaged savings account employees use to pay for all of their – or their dependents’ – covered medical expenses, up to the deductible.2,4

employer objectives the Blue options hsa solution

Save money with the lowest possible premiums.

Premiums are lowest for high-deductible plans like this one. Employers can expect premium savings of up to 30% when compared to our most popular PPO plan.1

Reduce long-term costs by maximizing employee engagement in health care decisions.

The dramatic shift in plan design delivered by Blue Options HSA (no copays or coinsurance before deductible) exposes employees to the real cost of health care and causes them to think more carefully before making purchasing decisions, especially when they have options.

Provide tax-advantaged savings for employees to help offset the burden of increased cost-sharing.

With Blue Options HSA, employees pay a greater portion of the total cost of their health care, but this cost-sharing can be offset by tax savings. Employees save tax-free, earn interest tax-free and spend tax-free.

Develop a long-term strategy for affordable retiree coverage.

Blue Options HSA is similar to a 401k for medical expenses. Employees can save tax-free for medical expenses for when they retire, and employers can contribute tax-free, too. Developing a retiree strategy based on HSA savings can be significantly cheaper than fully funding retiree medical coverage.2,3

a cost-saving plan with maximum employee engagement and tax-advantaged savings

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How it works

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Why Blue?+ The #1 health insurance brand in North Carolina9

+ No fees for small group employers

+ Flexible large group fee packaging

+ Deep network discounts mean savings before deductible

+ Committed to making the transition to CDH a success – before, during and after enrollment with our dedicated account specialists there to help

+ Integrated fund and plan – managed in a single online location

Benefit design options

plan feature Cost/coverage options

Single deductible5 $1,250; $1,500; $2,000; $2,500; $2,700; $3,000; $3,500; $5,000

Family deductible5 $2,500; $3,000; $4,000; $5,000; $5,450; $6,000; $7,000; $10,000

Coinsurance (in-network/out-of-network)6 100%/70%, 90%/60%, 80%/50%, 50%/50%, 60%/40%

Single out-of-pocket maximum (in-network) $1,250-$5,000, depending on selected combination of deductible/coinsurance

Family out-of-pocket maximum (in-network) $2,500-$10,000, depending on selected combination of deductible/coinsurance

Prescription drugs integrated with medical deductible, coinsurance and out-of-pocket maximum

Preventive care7

you will receive 100% coverage for a broad range of preventive services, including:

+ Coverage in a wider variety of in-network settings

+ no limits on number of visits

for a list of covered preventive care services go to bcbsnc.com/preventive. please contact your agent or BCBsnC representative with questions.

a cost-saving plan with maximum employee engagement and tax-advantaged savings

+ More than 70% of large employers contribute to their employees’ HSA fund with $500 – $1,000 being the most popular levels.8

+ For smaller employers, the market is quickly moving toward higher deductibles, like a $2,700 single deductible and 100% coinsurance.8

Popular plan design options

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Blue Options HSA is just one of the plans we’ve built to address the changing needs of today’s employers. From our flagship PPO design to the most aggressive consumer-driven health (CDH) plans available, we can help you create a health care strategy that delivers the results you need.

Like most health plans, Blue Options HSA has some limitations and exclusions. Once you are enrolled, you will receive a member guide. It will contain detailed information about plan benefits, exclusions and limita-tions. Coverage for dependent children ends at age 26. Consult your employer regarding dependent eligibility requirements. Members will be notified 30 days in advance of any change in coverage.

This brochure contains a summary of benefits only. It is not your insurance policy. Your policy is your insurance contract. If there is any dif-ference between this brochure and the policy, the provisions of the policy will control.

This is a partial list of benefits that are not payable:• Services for or related to conception by artificial means or for

reversal of sterilization• Treatment of sexual dysfunction not related to organic disease• Treatment for transsexualism, sex changes or modifications

including surgery• Services that are investigational in nature• Services for complications or side effects arising from

excluded services, procedures or treatments• Services that are not medically necessary• Services or expenses that are covered by any governmental

unit except as required by federal law

• Services received from an employer-sponsored dental or medical department

• Services received or hospital stays before the effective date of coverage

• Custodial care, domiciliary care or rest cures• Eyeglasses or contact lenses or refractive eye surgery except

as covered by your health benefit plan• Services to correct nearsightedness or refractive errors• Services for cosmetic purposes• Services for routine foot care• Travel, except as specifically listed in the member guide• Services for weight control or reduction, except for surgical

treatment of morbid obesity• Inpatient admissions that are primarily for physical therapy,

diagnostic studies or environmental change• Services that are rendered by or on the direction of those

other than doctors, hospitals, facility and professional providers; services that are in excess of the customary charge for services usually provided by one doctor when done by multiple doctors

• Services that are the result of war or while in military service• Services for which a charge is not normally made in the

absence of insurance or services provided by an immediate relative

• Personal hygiene, comfort and/or convenience items• Telephone consultations; charges for failure to keep scheduled

visits, for completion of any form or for medical information required by the plan

• Services primarily for educational purposes• Maintenance therapy• Services not specifically listed as covered services

Limitations and Exclusions

1 Blue Cross and Blue Shield of North Carolina (BCBSNC) internal data 2011. Based on copayment plans that include a $2,000 coinsurance max and $10/$25/$40 copayment structure for prescription drugs. Based on data for Blue Options Underwritten Groups as of 10/1/2010 with 5 to 20 subscribers. Pricing is for a single male age 40-44, residing in Durham.

2 Withdrawals are tax-free only if used for qualified medical expenses. Visit www.irs.gov for specific tax information.

3 For more information on retirement savings regulations, visit www.irs.gov. 4. Blue Options HSA combines a high-deductible health plan and a health

savings account (HSA). BCBSNC does not administer your HSA and is not affiliated with your HSA custodian or administrator. Your HSA custodiam is The Bank of New York Mellon.

5. These amounts may be updated each year to align with IRS guidelines. For the most up-to-date information visit www.bcbsnc.com.

6. When using out-of-network providers, in addition to in-network deductible and coinsurance amounts, you may be responsible for the difference between the BCBSNC allowed amount and the provider’s actual charge.

7. New Preventive care benefits are a result of Health Care Reform require-ments for non-grandfathered plans. See benefit booklet for any restrictions or cost-sharing for out-of-network benefits.

8. BCBSNC internal data as of 10/1/2010.9. 2009 W5 Brand Study; December 2009.10. Blue Options HRA combines a preferred provider organization (PPO)

health plan design and a health reimbursement arrangement (HRA). BCBSNC is the administrator for your HRA funds.

An independent licensee of the Blue Cross and Blue Shield Association. ®, SM Marks of the Blue Cross and Blue Shield Association. SM1 Mark of Blue Cross and Blue Shield of North Carolina. U4556, 12/10. BOptions HSA, 2/10

employee engagement

network PPO PPO PPO PPO

Group size 1+ 1+ 100+ 1+

savings potential

fund — —

tax advantage(for employees)

— — —2

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Our flagship product, offering the highest standard of convenience

The only plan that offers CDH engagement with traditional plan design

Our most flexible CDH product

A CDH plan that drives maximum employee engagement

Options (PPO) OptionsHRA OptionsHSA

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Your plan for better health. bcbsnc.comSM1