Indandfam Med Dent Life

Individual & Family Medical, Dental & Life Plans

March 2009

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PPO Plans

SmartSense

Lumenos CDHPs

PPO Share

RightPlan PPO 40

3500 Deductible PPO

PPO 3500 HSA-Compatible

Basic PPO (2500/1000)

Benefits shown on slides that follow are in-network

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PPO Plans

Reliable protection with some of our lowest rates

Choice of deductible

Choice of generic or comprehensive drug coverage

“Embedded” family deductible and out-of-pocket maximum

3 office visits before deductible

4th quarter deductible carryover

$7 million lifetime benefits

No maternity coverage

Member-level-rated

2-year anniversary date rate guarantee on 5000 deductible plans

SmartSense

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Annual Out-of-Pocket Maximum Single/Family (in addition to deductible)

$2,500/$5,000 (family out of pocket can be satisfied by 2 or more members)

Annual Deductible$500, $1,500, $2,500 or $5,000 (single)

$1,000, $3,000, $5,000 or $10,000 (family deductible can be satisfied by 2 or more members)

Office Visits 3 before deductible w/ $30 copay, then 30% after deductible

Preventive Care30% after deductible

HealthyCheck Centers: $25/$75 copay for basic/ premium screenings, with deductible waived

Hospital In/Outpatient 30% after deductible

Drug Benefits Generic plan

Comprehensive plan

Generic: $15 copay or 40%, whichever is greater

Generic: $15 copay or 40%, whichever is greater

Brand name: $500 annual brand deductible (2-member maximum), then $15 copay or 40%, whichever is greater (up to $500 maximum per prescription) — $4,500 maximum annual out-of-pocket in addition to brand deductible

4th Quarter Deductible CarryoverFor last 3 months of calendar year for expenses incurred in the 4 th quarter

that are less than the deductible

Maternity Not covered

SmartSense

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PPO Plans

Consumer-Driven Health Plans (CDHPs) HSA-compatible, HIA and HIA Plus plans Deductible waived in-network (no cost to member) for

nationally recommended preventive care services Choice of no maternity plans or one maternity plan After deductible, member pays 0% or 30% co-insurance

(depending on plan) for most covered services Generic and brand drugs – member pays 0% or 30% after

annual deductible (depending on plan) $7 million lifetime maximum (no maternity plans),

$5 million lifetime maximum (maternity plan)

Member-level-rated Powerful online health management tools

Lumenos®

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HSA Account Funded by subscriber, up to maximum limit set by U.S. Treasury Unused dollars rollover year-to-year Subscriber “owns” HSA

Annual Out-of-Pocket Maximum (in addition to deductible)

Single: $3,500/$2,000/$0

Family: $7,000/$4,000/$0 (aggregate)

Annual Deductible$1,500/$3,000/$5,000 (single)

$3,000/$6,000/$10,000 (family maximum)

Coinsurance after deductible

30%/30%/0%

Office Visits 30%/30%/0% after deductible

Preventive Care (nationally recommended services)

$0 (deductible waived)

Hospital In/ Outpatient 30%/30%/0% after deductible


Drug Benefits 30%/30%/0% after deductible

Lumenos Health Savings Account (HSA)-Compatible

Without Maternity

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HSA Account

Funded by subscriber, up to maximum limit set by U.S. Treasury Unused dollars rollover year-to-year Subscriber “owns” HSA

Annual Out-of-Pocket Maximum/Member (in addition to deductible)

$0

Annual Deductible$5,000 (single)

$10,000 (family maximum)


0%

Office Visits $0 after deductible



Hospital In/ Outpatient $0 after deductible

Maternity $0 after deductible

Drug Benefits $0 after deductible

Lumenos Health Savings Account (HSA)-Compatible With Maternity

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HIA Account Funded through financial incentives earned through Healthy Rewards Must be actively enrolled in HIA plan to access HIA account funds

Annual Out-of-Pocket Maximum/member (in addition to deductible)

Single: $3,500/$2,000/$0



$3,000/$6,000/$10,000 (family maximum)


30%/30%/0%







Lumenos Health Incentive Account (HIA) Without Maternity

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HIA Account Funded through financial incentives earned through Healthy Rewards Must be actively enrolled in HIA plan to access HIA account funds


$0




0%







Lumenos Health Incentive Account (HIA)With Maternity

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HIA+ Account

Funded through health plan allocation of $500/$1000 per year single/family and financial incentives earned through Healthy Rewards Must be actively enrolled in HIA plan to access HIA account funds


Single: $3,500/$2,000/$0



$3,000/$6,000/$10,000 (family maximum)


30%/30%/0%







Lumenos Health Incentive Account Plus (HIA+) Without Maternity

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HIA+ Account

Funded through health plan allocation of $500/$1000 per year single/family and financial incentives earned through Healthy Rewards Must be actively enrolled in HIA+ plan to access HIA+ account funds


$0




0%







Lumenos Health Incentive Account Plus (HIA+) With Maternity

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PPO Plans

Comprehensive PPO plans

Once deductible is met, member pays 30% co-insurance for most covered services

Deductible waived for office visits, annual physical exam and preventive care

Maternity coverage

$5 million lifetime maximum

PPO Share (5000/2500/1500)

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5000 2500 1500Annual Out-of-Pocket Maximum (in addition to deductible)(2-member maximum, par/non-par)

$2,500 per member

$5,000 per member

$4,500 per member

Annual Deductible(2-member maximum)

$5,000 per member

$2,500 per member

$1,500per member

Office Visits$40 copay

deductible waived

$35 copay

deductible waived

30% of negotiated fee,

deductible waived

Preventive Care(deductible waived)

Annual physical exam: 30% of negotiated fee, or HealthyCheck Centers: $25/$75 copay for basic/premium screenings

Routine mammogram, Pap, PSA ordered by physician: 30% of negotiated fee

Well Child: 40% of negotiated fee

Hospital In/ Outpatient 30% of negotiated fee

Maternity 30% of negotiated fee

Drug Benefits (Anthem Blue Cross Formulary) (2-member maximum for brand deductible)

$15 generic;

$35 brand copay after $750 brand deductible

$10 generic;


$10 generic;


PPO Share (5000/2500/1500)

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PPO Plans

Our no-deductible PPO plan No deductible

$40 office visit copay, 40% share of costs

3 prescription drug options: None Generic only Comprehensive (generic and brand)

Single policy coverage (each family member gets their own policy)

No maternity


RightPlan PPO 40

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Annual Out-of-Pocket Maximum (par/non-par)

$7500/subscriber

Annual Deductible No deductible

Office Visits $40 copay

Preventive CareHealthyCheck Centers: $25/$75 copay for basic/ premium screenings

Routine mammogram, Pap, PSA ordered by a physician: $40 office visit plus 40% of negotiated fee

Well Child: $40 office visit plus 40% of negotiated fee

Hospital In/Outpatient

Inpatient: 40% of negotiated fee plus $500 copay/day; 4-day maximum copay per admission

Outpatient: 40% of negotiated fee plus $500 copay per outpatient surgery admission


Drug Benefits (Anthem Blue Cross Formulary)

No coverage (P958), orGeneric coverage (PE48) - $15 generic, orComprehensive coverage (PE49) - $15 generic, $35 brand copay

after $500 brand deductible

RightPlan PPO 40

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PPO Plans

HSA-Compatible plan HSA-compatible

Most services covered at 100% after deductible is met ($100 copay for emergency services after deductible; waived if admitted)

Deductible waived for HealthyCheck screenings

No maternity

Generic and brand drug coverage after annual deductible is met

Member-level-rated


2-year anniversary date rate guarantee

PPO 3500 (HSA-Compatible)

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(Medical/Pharmacy combined, par/non-par)

$1500/member, $3,000/family (aggregate)

Annual Deductible (Medical/Pharmacy combined, par/non-par)

$3500/member, $7,000/family (aggregate)


Preventive Care

HealthyCheck Centers: $25/$75 copay for basic/ premium screenings, deductible waived

Routine mammogram, Pap, PSA ordered by physician: $0 after deductible

Well Child: $0 after deductible

Hospital In/Outpatient $0 after deductible



$15 generic; $35 brand copay

after Medical/Pharmacy deductible met

PPO 3500 (HSA-Compatible)

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PPO Plans

Another affordable plan for individuals and families Most services covered at 100% after deductible is met

($100 copay for emergency services after deductible; waived if admitted)

Out-of-pocket maximum met in-network when deductible is met

Deductible waived for HealthyCheck screenings

No maternity

Member-level-rated

Generic and brand drug coverage


2-year anniversary date rate guarantee

3500 Deductible PPO

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Annual Out-of- Pocket Maximum(in addition to deductible)

(2-member maximum, par/non-par)Satisfied in-network once annual deductible is met


$3500/member


Preventive Care

HealthyCheck Centers: $25/$75 copay for basic/premium screenings, deductible waived

Routine mammogram, Pap, PSA ordered by physician: $0 after deductible

Well Child: $0 after deductible

Hospital In/Outpatient $0 after deductible



$15 generic; $35 brand copay after $500 brand deductible (2-member maximum)

3500 Deductible PPO

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PPO Plans

Our most basic and affordable plan

In-hospital coverage in the event of catastrophic illness or injury

Office visit only after out-of-pocket maximum is met

Prescription drugs in the hospital only

Available with or without $1,000 Term Life

No maternity


Basic PPO (2500/1000)

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(2-member maximum, par/non-par)

$2500 $2500


$2500/member $1000/member

Office VisitsNo office visit benefits until out-of-pocket maximum is met, then

plan pays 100% of negotiated fee

Preventive Care(deductible waived)

HealthyCheck Centers: $25/$75 copay for basic/ premium screenings

Routine mammogram, Pap, PSA ordered by physician: 20% of negotiated fee

Hospital In/Outpatient 20% of negotiated fee


Drug Benefits Not covered

Basic PPO (2500/1000)

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HMO Plans

HMO Saver

Individual HMO

Select HMO

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HMO Plans

First dollar coverage on: Office visits Generic drugs Preventive care

Unlimited office visits with set copays

Coverage for services from doctors and hospitals in HMO network

Comprehensive drug plan

Maternity coverage

Lifetime maximum - unlimited

HMO Saver, Individual HMO, Select HMO

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HMO Plans

HMO Saver Individual HMO Select HMOAnnual Out-of-Pocket Maximum(in addition to deductible)

(2-member maximum)

$1500/member $3,000

Annual Deductible $1,500/member for Inpatient, Outpatient and

ASCs onlyNo deductible

Office Visits (unlimited) $10 copay/visit $25 copay/visit

Preventive Care(specific services)

$10 copay $25 copay

Hospital In/Outpatient $1,500 deductible, then:

Inpatient: 20% of negotiated fee

Outpatient: 20% of negotiated fee (emergency & non-emergency services subject to deductible)

Inpatient: 20% of negotiated fee

Outpatient: 20% of negotiated fee

Inpatient: $250 copay/day first 4 days; then covered at 100%

Outpatient: 20% of negotiated fee,$250/surgery

Maternity See Office visits and In/Outpatient

(subject to deductible)

Office visits: $10 copay

Inpatient: no charge

Outpatient: 20% of negotiated fee

See Office visits and In/Outpatient

Drug Benefits (Anthem Blue Cross formulary)

$10 generic; $30 brand copay after $250 brand deductible (2-member maximum)

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Plan Options Based on Prospect’s Needs

If Main Need Is: Recommended Plans:

Budget Basic PPO, SmartSense

Immediate coverage for office visits before deductible

PPO Share and HMO (unlimited) SmartSense (up to three)

No deductibleRightPlan PPO 40

Individual HMO or Select HMO

100% coverage of most services after deductible

Lumenos HSA/HIA/HIA+ (0% coinsurance plans)3500 Deductible PPO or PPO 3500 (HSA-Compatible)

Control over finances, including health care expenses

LumenosPPO 3500 (HSA-Compatible)

Maternity coverageLumenos with maternityPPO ShareHMO

2-year anniversary date rate lock SmartSense 5000, 3500 HSA, 3500 PPO

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Rating Methodology Summary

PlanAnniversary-

Rated?

Member-Level or Contract Rated?

Gender-Rated?

SmartSense YES MEMBER YES

Lumenos YES MEMBER YES

3500 HSA, 3500 PPO YES MEMBER YES

RightPlan YES MEMBER YES

PPO Share YES CONTRACT NO

HMO YES CONTRACT NO

Basic PPO NO CONTRACT NO

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Short-Term Plans

Coverage from 30 to 180 days

Choice of deductible level


Easy application process

Streamlined underwriting

No maternity

Member-level-rated

Short-Term Plans

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Out-of-Pocket Maximum $1,000 per member plus deductible

Deductible $250, $500, $1,000, $2,000

Hospital In/Outpatient 20% of negotiated fee

Ambulatory Surgical Center and ER

20% of negotiated fee

(Accidental injuries not subject to deductible)



$10 generic; $30 brand name

Brand name maximum $500

Short-Term Plans

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Dental Coverage Options

Our New Dental Blue® PPO Plans

Dental SelectHMO Plans

SmileNet Dental Discount Program

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Dental Blue PPO Plans Power to choose from:

Two networks (Dental Blue 100 or 200)Can even go to a dentist in DB 300 network and still be “in-network”

Best to choose 200 Essential or 200 Plus plan if dentist is in DB 300 network

Four plans

Key benefits:Negotiated discounts during waiting periods

One of the largest PPO dental network in CA

Negotiated discounts after exceeding the plan maximum

Discounts on non-covered dental work such as teeth whitening, implants and orthodontics

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Individual Dental – Dental Blue

100 Basic 200 Essential 100 Plus 200 Plus

Deductible$25/person

(no family maximum)$50 single/$150 family

The deductible is waived for covered in-network Diagnostic & Preventive services

Maximum Benefit $500/person/yr $1000/person/yr

Waiting Periods(months)

0Basic services: 3 Major services: 12

Basic services: 0 Major services: 6

Basic services: 3 Major services: 12

Diagnostic Care (cleanings, exams, X-rays)

100% in-network (fee schedule out-of-network)

100% in-network (80% out-of-network)

Basic Services

80% fillings; 50% stainless steel

crowns(fee schedule OON)

Fee schedule (e.g., $42 for filling)

80% (60% OON)

Major Services Not coveredFee schedule

(e.g., $57 for stainless steel crown)

50% (in-network and OON)

Orthodontia Not covered

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Individual Dental – DHMO, SmileNet

(3) DHMO Plans SmileNet Dental Discount Program

Deductible None Not an insurance plan; a very simple, low-priced discount dental program

Maximum Benefit Unlimited

Waiting Periods None for most services

Office Visits $5

Routine Cleanings $0

Diagnostic Care (oral exams, X-rays)

$0

Orthodontia Coverage Yes

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What About Our Other (Previous) Dental PPO Plan?

Sell Dental Blue 200 Essential Plan, which offers:

Identical benefits to previous Dental PPO plan

Access to much larger network

Discounts during waiting periods and after exceed plan maximum

Discounts on non-covered dental work such asteeth whitening, implants and orthodontics

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Individual Life Insurance

Anyone who qualifies for one of our Level 1 or Level 1 + 25 medical plans can purchase: $15,000, $30,000, $50,000, $75,000 or $100,000 (if over age 19) $15,000 or $30,000 (ages 1-19)

Basic PPO and PPO Saver plans include $1,000 of Term Life insurance for: An additional $1 per month through age 49, or

An additional $2 per month for ages 50-64

Term Life Insurance

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Health • Dental • Life

Thank You for Selling Anthem Blue Cross!

Indandfam Med Dent Life

Economy & Finance

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