The Boeing Company

This is a Member Boeing Well Being Partner Information Guide 2021

www.bcbsil.com/boeingBoeing Medicare Supplement Plan Contents

Welcome to Blue Cross and Blue Shield of Illinois...... 2 Frequently Asked Questions...... 5 Using Your Online Resources...... 7 Filing a Claim...... 9 Health Insurance Fraud...... 11 Blue Cross Blue Shield Global® Core...... 13 Blue Distinction® Specialty Care...... 15 24/7 Nurseline ...... 16 Understanding Your Explanation of Benefits Statement...... 17 Fitness Program...... 19 Prescription Drug Benefits: Prime Therapeutics®...... 20 Important Information...... 22 Contact Information At a Glance...... Back Cover

www.bcbsil.com/boeing 1 888-802-8776 Welcome to Blue Cross and Blue Shield of Illinois Preventive care may help you have a healthier life, and Blue Cross and Blue Shield of Illinois (BCBSIL) understands this. For more than 80 years, BCBSIL has provided health care benefits and services to the members and communities we serve. Through these covered services plans, BCBSIL provides members with access to programs and support to help them become knowledgeable health care consumers, make smart health care choices and manage their well-being.

www.bcbsil.com/boeing 2 888-802-8776 We Are Here to Help

BCBSIL knows that the choices you make If You Have Questions every day can affect your health now and in For details on your medical coverage, including the future. We have a wide variety of tools deductibles, copayments, coinsurance and covered and resources to help you plan and manage services, call Boeing Member Services. Health Advocates your health care. can answer questions about your medical benefits. You can also go to , which is If you have questions, call Boeing Member Services at www.bcbsil.com/boeing your source for benefits information and tools. There, 888-802-8776. A Health Advocate is available Monday you can register for Blue Access for MembersSM, a through Friday from 5 a.m. to 5 p.m. PT (8 a.m. to 8 p.m. secure member portal, where you can find answers to ET and 7 a.m. to 7 p.m. CT). Whether you are trying to your questions, send a secure email directly to Member improve your health or reach the next level of wellness, Services or chat live with them. BCBSIL is here to help.

How to Use This Guide Please note: This booklet is meant to be a summary of administrative services only. Benefits and coverage levels vary by plan option and are explained in more detail in the applicable summary plan descriptions, insurance contracts and Please take a few minutes to review this guide, which is other formal plan documents. In the event of a conflict between this booklet and intended to help you learn more about your benefits, such the formal plan documents, the plan documents will govern. as how to find a physician, contact dedicated clinicians, submit a claim and understand your explanation of benefits (EOB) statements.

www.bcbsil.com/boeing 3 888-802-8776 Watch for Your ID Cards. Member ID cards will arrive separately by mail. If you need a temporary or additional ID card, or need to request a replacement card, go online to www.bcbsil.com/boeing or call Boeing Member Services. You can access a digital ID card on Blue Access for Members. Remember to show your member ID card to each provider you see so he or she can update your records and help ensure that your claims are paid in a timely manner.

www.bcbsil.com/boeing 4 888-802-8776 Frequently Asked Questions

Who is BCBSIL? What type of information will Provider Finder BCBSIL provides health care coverage to more than give me? 8.1 million members. We started in the height of the Great Searching for a network doctor and pharmacy is now Depression in 1936 in Chicago and grew out of a shared easier than ever with the enhanced Provider Finder interest to protect individuals and families. tool. Members can compare providers on a single page, Today, we remain member-owned. We answer to view and sort providers by quality, cost and accessibility. our members. Members can also estimate costs for over 1,600 procedures and tests. How do I find a physician or hospital? Provider and facility profiles are also available, which Keep in mind that Medicare is primary and your Boeing include information about a provider’s specialty and areas plan provides secondary coverage to Medicare. Your plan of expertise as well as detailed member reviews and an does not include a network requirement, but you may overall quality rating. wish to confirm with your provider that he or she accepts Medicare reimbursement. Do I need to select a primary care physician or get a referral to see a specialist? The Provider Finder® tool can help you locate doctors and other health care providers that meet criteria you set. You are not required to select a primary care physician or You can view the most current list of providers online obtain a referral to see a specialist. However, an ongoing by visiting www.bcbsil.com/boeing. Click Menu, relationship with a primary care physician can help you select Find a Doctor or Hospital and then choose manage your health and address any concerns you have. Provider Finder. You can use Provider Finder from your computer or mobile phone web browser to search for primary care physicians for you and your covered family members in specialties such as internal medicine and family practice.

Will I receive a provider directory? Provider directories are not printed because they are updated frequently. You may view the current list of providers online by visiting www.bcbsil.com/boeing. Click Menu, select Find a Doctor or Hospital and then choose Provider Finder.

How can I get more information about my health care coverage through BCBSIL? Please visit www.bcbsil.com/boeing for more information about your health care coverage, or call Boeing Member Services. www.bcbsil.com/boeing 5 888-802-8776 Frequently Asked Questions

Where can I get a summary of my benefits? How do I submit a claim? You may view your plan benefits online by visiting If you use a Medicare provider, the provider will submit www.bcbsil.com/boeing. Click Menu, select claims directly to Medicare and then to BCBSIL. Be sure Coverage and Plans and then choose Medical to show your new ID card to each provider you see. If you Benefits. You can also call Member Services or view need to file a claim yourself, you must fill out and submit a your plan benefits via Boeing Worklife. claim following the instructions on page 9.

When will I receive ID cards? How and when can I call BCBSIL Member Services? If you have not already received a new member ID card, You can reach Member Services at 888-802-8776 from you should receive it soon. Please be sure to show 5 a.m. to 5 p.m. PT (8 a.m. to 8 p.m. ET and 7 a.m. to your new ID card to each provider you see so he or 7 p.m. CT). Health Advocates are available to explain she can update their billing systems with your new your benefits, answer questions about claims or information. Show your member ID card when seeking assist with many other matters. Call Boeing Member behavioral health services and at the pharmacy when Services or visit www.bcbsil.com/boeing and log filling prescriptions. in to Blue Access for Members to use Live Chat. You Digital ID cards are also available on Blue Access for can also find other helpful plan information online at Members. Text* BCBSILAPP to 33633 to use the any time. BCBSIL App. Can I email questions directly to BCBSIL? Why do the ID cards have only the subscriber’s name Yes. Once you register for Blue Access for Members, the and not all family members’ names? secure member portal at www.bcbsil.com/boeing, you The member ID cards display only the subscriber can send a secure email directly to Member Services. (employee or retiree) name. The cards are to be used for all eligible family members even though their names are not printed on the card. If you need an additional card, you can request one by contacting Member Services.

What’s new with my prescription drug benefits in 2021? Blue Cross Group MedicareRxSM (PDP), managed by Prime Therapeutics LLC** (Prime), has been selected by Boeing as your new pharmacy benefit administrator. Prime is collectively owned by several Blue Cross and Blue Shield plans, subsidiaries or affiliates of those plans, including the main administrator of Boeing-sponsored medical plans - Blue Cross and Blue Shield of Illinois (BCBSIL). To learn more about your pharmacy benefits, visitwww.myprime.com/boeing . All you need to register is your member ID card. Once you’ve registered, you can find network pharmacies, search medicines to see if they are covered, and set your communications preferences.

* Message and data rates apply. Terms, conditions and privacy policy are at bcbsil.com/mobile/text-messaging. ** Prime Therapeutics LLC is an independent company providing pharmacy benefit management services for Boeing health plan members. Prime Therapeutics has an ownership interest in AllianceRx Walgreens Prime, a central specialty pharmacy and mail service company. Myprime.com/boeing is an online resource offered by Prime Therapeutics LLC. www.bcbsil.com/boeing 6 888-802-8776 Using Your Online Resources

BCBSIL Provides Tools and Resources to BCBSIL App Help You Manage Your Health and Benefits You can access your health coverage and wellness Once you receive your new member ID card, you can information conveniently and securely via your mobile register for Blue Access for Members and use this device anytime, anywhere. You can even access your ID secure website to manage your benefits and health. Go card information. to www.bcbsil.com/boeing, click Member Log In and Text BCBSILAPP to 33633 to get the BCBSIL App that lets follow the steps to register. you use Blue Access for Members while you’re on the go.

Manage Your Benefits Provider Finder Once you register and log in, Blue Access for Members You can also use Provider Finder to locate in-network allows you to: doctors, hospitals and pharmacies. Filter the search • Review your coverage. results by provider type, specialty, ZIP code, language and gender. Plus, get door-to-door directions. • Review who is covered under your plan. With Provider Finder, it’s easy to: • Find and compare providers or facilities. • Compare providers on a single page • Check the status of a claim. • View and sort providers by quality, cost and accessibility • Sign up to receive email notifications when a claim is finalized. • Estimate costs for over 1,600 procedures and tests • View and print your explanation of benefits statements • Find pharmacies on the Prime Therapeutics network and opt out of receiving printed copies in the mail. • Request a replacement or additional ID card and print a temporary one.

*Message and data rates apply. Terms, conditions and privacy policy are at bcbsil.com/mobile/text-messaging. www.bcbsil.com/boeing 7 888-802-8776 Find What You Need with Blue Access for Members

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1 My Coverage: Review benefit details for you and the 6 Message Center: Receive notification of pending family members who are covered under your plan. and finalized claims and other updates via secure messaging. 2 Claims Center: View and organize details such as payments, dates of service, provider names, claims 7 Quick Links: Go directly to some of the most status and more. popular pages, such as replacement ID cards, manage preferences, stop receiving paper statements 3 My Health: Make more informed health care and more. decisions by reading about health and wellness topics and researching specific conditions. 8 Settings: Set up notifications and alerts to receive updates via text messaging and email, review your 4 Doctors & Hospitals: Use Provider Finder to locate member information and change your secure a network doctor, hospital, pharmacy or other health password at any time. care provider, and get driving directions. 9 Live Chat: Connect to a Health Advocate via 5 Forms & Documents: Use the form finder to get Live Chat. medical claim and other forms quickly and easily.

Please note: The information above is representative of the resources available through Blue Access for Members. However, the resources available to you may vary, based on the particular plan you have enrolled in. Contact Boeing Member Services with any questions. www.bcbsil.com/boeing 8 888-802-8776 Filing a Claim

Guidelines to Help Ensure Your Claims Are -- Place where service was received (hospital, Submitted Quickly office or clinic) -- Diagnosis of illness or injury; if an injury, give the date it Provider-Submitted Claims happened Most physicians, hospitals and other providers will file a -- Description of service received claim directly with Medicare. Show your member ID card to providers when checking in to confirm that they will file -- Date of each treatment or surgical procedure claims directly to BCBSIL after Medicare has paid. -- Charge for each treatment or surgical procedure

Member-Submitted Claims • Itemized bills for ambulance service should include: If you need to file a claim yourself, you will need to fill out -- Date(s) when service was used and submit a form to Medicare. You may call 888-802-8776 -- Base rate and mileage for assistance, or you may download a form online: -- Place where patient was picked up and driven to 1 Go to www.bcbsil.com/boeing and click Menu. -- If patient was transferred from one location to another, 2 Click Forms. a letter from the attending physician giving the reason for the transfer must be attached to the bill 3 Click Medical Claim Form and print the form and instructions. • Itemized bills for rental of durable medical equipment should include: Then, fill out the form completely, attach a copy of the original itemized bill and mail to the address shown on the -- A statement from the attending physician that’s claim form. attached to the bill and states why the equipment was necessary Tips for Submitting Claims -- An estimate of how long the equipment will be used Help us avoid unnecessary delays by answering all and the purchase price of the equipment; if for long- questions completely and accurately and including original term use, remember that rental is paid only up to the itemized bills that contain the information we need to purchase price of the equipment process claims. • Please remember to attach original bills to the claim • If your claim is submitted through Medicare first, BCBSIL form. We recommend that you make copies of each bill will process your benefits covered by Boeing. for your personal records. The original bills will not be • Show the instructions accompanying the claim form to returned. the persons providing your care and ask them to provide bills that follow the instructions. • Itemized bills for medical treatment or surgery should include: -- Provider’s name, address and phone number -- Provider’s tax identification number -- Full name of patient (not just name of person to whom bill is addressed) www.bcbsil.com/boeing 9 888-802-8776 Filing a Claim

Claim Form to Pay Insured/Subscriber P.O. Box 805107 • Chicago, Illinois 60680-4112

Each item on this form needs to be completed. Instructions for completion are listed on the reverse side. Please print or type. Insured/Subscriber Name (Last, First, Middle Initial) Group Number Insured/Subscriber Identification Number (from ID card)

Mailing Address Patient’s Full Name (Last, First, Middle)

1 City and State ZIP Code 2 Patient’s Sex Patient’s Date of Birth Month Day Year ______/______/______Insured Employed? Date of Retirement: Month Day Year Patient’s Relationship to Insured

£ Yes £ No £ Retired ______/______/______£ Self £ Spouse £ Child £ Other (explain) ______

Type of treatment received: Month Day Year Check only one type and attach itemized statements. Please use £ Injury — Date of accident: ______/______/______a separate claim form for each different type of treatment. 3 £ Illness — Date of first symptom: ______/______/______Please note: Preventive care includes immunizations, routine well baby care, routine physical examinations, vision and £ Pregnancy — Date of conception: ______/______/______hearing exams. £ Preventive — Date of service: ______/______/______

Describe: Diagnosis, symptoms of illness or injury or explain preventive or routine care received.

______4 ______

Was illness or injury work connected? £ Yes £ No Name and address of employer 5 ______6 If injury, was a motor vehicle involved? £ Yes £ No ______

Is patient covered under any other health benefits plan (besides Medicaid, Medicare or CHAMPUS)?£ Yes £ No

Insurance Co. ______Month Day Year Address ______Effective date of coverage ______/______/______7 Employer ______Sex of Insured £ Male £ Female Insured name ______Date of birth of insured ______/______/______Policy # ______Relationship to patient ______

If the other coverage is primary, attach the other insurance company’s Explanation of Benefits.

Medicare — Is the patient: Month Day Year a) Entitled to benefits under Medicare insurance (Part A)? £ Yes £ No Effective ______/______/______b) Entitled to benefits under Medicare insurance (Part B)? £ Yes £ No Effective ______/______/______8 c) Entitled to benefits under Medicare due to a disability? £ Yes £ No Effective ______/______/______

Patient’s Medicare Identification Number. (From Medicare ID card) ______

I certify the above is complete and correct and that I am claiming benefits only for charges incurred by the patient named above. Authorization is hereby given to any Hospital, Physician, Dentist, Provider, Insurance Carrier or other entity to give Blue Cross and Blue Shield of Illinois, upon request, any medical information which the Plans in their judgment deem necessary to the adjudication of this 9 claim. Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.

Signature of Insured Date Daytime telephone number

Total amount for ALL covered services and supplies received. $ 10 Itemized Bill(s) for covered services and supplies must be attached. (See Instructions on reverse side.)

228934.1015 www.bcbsil.com/boeing 10 888-802-8776 Health Insurance Fraud: What You Should Know

Don’t Be a Victim Identifying Fraud Commonly identified schemes involving providers include: • Misrepresenting services Intentionally billing procedures under different names or codes to obtain coverage for services that aren’t included in a member’s plan. • Upcoding Deliberately charging for more complex or more expensive services than those actually provided. • Non-rendered and/or “free” services Some providers intentionally bill for tests or services never provided. This can also mean that the provider offered “free” services to bill the insurance company for services not performed or needed. • Kickbacks, bribes or rebates Referring patients to a provider or facility where the referring provider has a financial interest. Commonly identified member schemes include: • Identity swapping Allowing an uninsured individual to use your insurance card. • Identity theft Using false identification to gain employment and the health insurance benefits that come with it. • Non-eligible members Adding someone to a policy who is not eligible Fraud Affects Everyone. or failing to remove someone when that person becomes ineligible. Fraud may cost the health care industry • Prescription medicine and abuse diversion (public and private payers) more than Controlled substances can be obtained through $200 billion each year. This fraud may deception or dishonesty for personal use or sale “on the street.” Prescription medications can be obtained cause you to face rising premiums, through doctor shopping, visiting several emergency increased copayments and deductibles rooms or stealing doctors’ prescription pads. and the elimination of certain benefits. www.bcbsil.com/boeing 11 888-802-8776 Health Insurance Fraud: What You Should Know

BCBSIL Offers Tips for Fighting Fraud The SID aggressively investigates allegations of fraud and • Know your own benefits and scope of coverage. refers appropriate cases for criminal prosecution. • Review all EOB statements. Make sure the exams, Fraud Isn’t Fair — Help Us Fight It procedures and tests billed were the ones you actually Reducing health care fraud is a collaborative effort had with the provider who treated you. between BCBSIL, its providers and its members. Additional • Understand your responsibility to pay deductibles information — including a “fighting fraud checklist” — is and copayments, and what you can and cannot be available through the SID website at www.bcbsil.com/sid. balance-billed (an amount your provider may bill you) for We also encourage you to report any suspected once your claim has been processed. incidence of fraud by calling our Health Care Fraud • Guard your health insurance card and personal Hotline, completing a form online or sending us a note in insurance information. Notify BCBSIL immediately if the mail. Suspicions of fraud can be reported to the SID your card or insurance information is lost or stolen. anonymously.

• Sign and date only one claim form per office visit. 3 Ways to Report Fraud to BCBSIL • Never lend your member ID card to another The SID is here to help you. You can contact the SID person. in any of the following ways: • Don’t give out insurance or personal information 1 800-543-0867 if services are offered as “free.” Be sure you understand The toll-free Health Care Fraud Hotline operates what is “free” and what you or your insurance company 24 hours a day, seven days a week. You can remain will be charged for. anonymous or provide information if you want to be • Ask your doctors exactly what tests or procedures contacted by a member of the SID. they want you to have and why they are necessary 2 www.bcbsil.com/sid/reporting before you have them.  This website address links to an online fraud-reporting • Be sure any referrals you receive from your form that you can complete and send to the SID network provider are to other network doctors or electronically. facilities. 3 U.S. Mail If you’re not sure, ask.  You can write the SID at: • Monitor your prescription use with Prime Blue Cross and Blue Shield of Illinois Therapeutics at www.myprime.com/boeing Special Investigations Department Make sure the medications billed to your insurance 300 E. Randolph Street are accurate. Chicago, Illinois 60601 Preventing Health Care Fraud BCBSIL created the Special Investigations Department (SID) to fight fraud and help lower health care costs. The staff includes individuals with medical, insurance and law enforcement backgrounds as well as data analysts experienced in detecting fraudulent billing schemes. www.bcbsil.com/boeing 12 888-802-8776 Blue Cross Blue Shield Global Core You’re Never Far from Health Care Services — Even When You’re Far from Home Like your passport, always carry your member ID card with you when you travel or live abroad. Through the Blue Cross Blue Shield Global Core program, you have access to doctors, hospitals and other health services in nearly 200 countries and territories around the world.

How Blue Cross Blue Shield Global Core Works To take advantage of the Blue Cross Blue Shield Global Core program, review this information: • Before you leave home, contact BCBSIL for coverage details. Your coverage outside the United States may be different. • Always carry your member ID card. • In an emergency, go directly to the nearest hospital. • The Blue Cross Blue Shield Global Core Service center is available 24 hours a day, seven days a week toll free at 800-810-BLUE (2583) or by calling collect at 804-673-1177.

Call the Service Center in these situations: • You need to locate a doctor or hospital or need medical services. An assistance coordinator, in conjunction with a medical professional, will arrange a physician appointment or hospital stay. • You need inpatient care. After calling the Service Center, you should also call BCBSIL Customer Service for precertification or pre-approval. You can find the telephone number on the back of your ID card. This number is different than the Blue Cross Blue Shield Global Core Service Center number shown here.

GeoBlue is the trade name of Worldwide Insurance Services, LLC (Worldwide Services Insurance Agency, LLC in California and New York), an independent licensee of the Blue Cross and Blue Shield Association. GeoBlue is the administrator of Blue Cross Blue Shield Global coverage provided under insurance policies issued by 4 Ever Life International Limited, Bermuda, an independent licensee Core is there if you need medical of the Blue Cross Blue Shield Association. care outside the U.S. www.bcbsil.com/boeing 13 888-802-8776 Blue Cross Blue Shield Global Core

Payment Information Claim Filing • For participating Blue Cross Blue Shield • The hospital will file your claimif the Blue Cross Global Core hospitals – Blue Shield Global Core Service Center arranged your In most cases, you should not need to pay up front for hospital stay. You will need to pay the hospital for the inpatient care at participating hospitals except for the usual out-of-pocket expenses. usual out-of-pocket expenses (non-covered services, • You must file the claim for outpatient and doctor care deductibles, copayments and/or coinsurance). The or inpatient care not arranged through the Blue Cross hospital should submit the claim on your behalf. Blue Shield Global Core Service Center. You will need to • For doctors and/or non-participating hospitals – pay the health care provider and submit an international You will need to pay up front for services. Then you claim form with the original bill(s). can complete a Blue Cross Blue Shield Global Core international claim form and send it with the bill(s) to the Claim Forms Blue Cross Blue Shield Global Core Service Center at the International claim forms are available from BCBSIL, the address on the form. You can also submit your claim Service Center or bcbsglobalcore.com. online or through the Blue Cross Blue Shield Global Core mobile app. The claim form is available from your Remember to take this information with Blue Cross Blue Shield company or online at bcbsglobalcore.com. you when you travel or live outside the U.S. Blue Cross Blue Shield Global Core Service Center Toll-free: 800-810-2583 Collect: 804-673-1177

www.bcbsil.com/boeing 14 888-802-8776 Blue Distinction Specialty Care

Choosing Quality Care for You and Your Family Nationwide Access With Blue Distinction® Centers, you have access to There are approximately 1,900 Blue Distinction Centers nationwide. Use Provider Finder to find designated specialty care facilities that have met national one near you: measures for quality and cost-efficient care. When you use a Blue Distinction Center, you will receive the most from 1 Go to www.bcbsil.com/boeing and click Menu. your benefits and know that the facility has a record of providing proven, effective specialty care. 2 Select Find a Doctor or Hospital in the menu, Blue Distinction Centers are available for the following click Blue Distinction Centers and then choose specialty health care services: Find a Blue Distinction® Specialty Care Facility. Blue Distinction® Centers for Bariatric Surgery 3 You may search for a specific area of specialty Postoperative, follow-up and patient education care or view a complete list of Blue Distinction Blue Distinction® Centers for Cardiac Care Centers by state. Cardiac care, cardiac rehabilitation, cardiac catheterization and cardiac surgery Note: Designation as Blue Distinction Centers means these facilities’ overall experience and aggregate data met objective criteria established Blue Distinction® Centers for Knee and in collaboration with expert clinicians’ and leading professional organizations’ recommendations. Individual outcomes may vary. To find out which services Hip Replacement are covered under your policy at any facilities, please call your local Blue Cross and Blue Shield Plan. Call your provider before making an appointment, Knee and hip replacement surgeries and services to verify the most current information on their Network participation status. ® Neither Blue Cross and Blue Shield Association nor any of its licensees are Blue Distinction Centers for Cellular Immunotherapy responsible for any damages, losses, or non-covered charges that may result from receiving care from a provider designated as a Blue Distinction Treatments for immune system diseases; chimeric antigen Center. receptor T (CAR-T) cell therapies Blue Distinction® Centers for Gene Therapy Gene therapies for inherited disorders, including ocular disorders Blue Distinction® Centers for Spine Surgery Spine surgery services, including discectomy, fusion and decompression procedures Blue Distinction® Centers for Substance Use Treatment and Recovery Treatment for substance use disorder, including opioid use disorder Blue Distinction® Centers for Transplants Transplant and support services

The goal of Blue Distinction Centers is to help you find consistent specialty care, while encouraging health care professionals to improve the overall quality and delivery of care nationwide. www.bcbsil.com/boeing 15 888-802-8776 24/7 Nurseline Around-the-Clock, Toll-Free Support

Health happens — good or bad, 24 hours a You can also call the 24/7 Nurseline whenever you or day, seven days a week. That is why we have your covered family members need answers to health registered nurses waiting to talk to you questions about: whenever you call our 24/7 Nurseline at • Asthma, back pain or a chronic health issue 800-765-7298. • Dizziness or severe headaches Our nurses can answer your health questions and try to • Cuts or burns help you decide whether you should go to the emergency • A grandchild’s high fever or nonstop crying room or urgent care center or make an appointment with • And much more your doctor. Plus, when you call, you can access an audio library of more than 1,000 health topics – with more than 500 topics available in Spanish.

Note: For medical emergencies, call 911 or your local emergency services first. 24/7 Nurseline is not a substitute for a doctor’s care. Talk to your doctor about any health questions or concerns.

www.bcbsil.com/boeing 16 888-802-8776 Understanding Your EOB

An explanation of benefits (EOB) statement What You Can Find is a notification form provided to members 1 Account name (member’s company or organization) when a health care benefits claim is 2 Date claim was finalized processed by BCBSIL. The EOB displays the 3 Toll-free number to call for additional information expenses submitted by the provider and shows how the claim was processed. 4  Member’s name and mailing address 5 The EOB has four sections: Messages 6 Member’s name • Claim Information includes the member and patient name, the member’s group and ID numbers and the 7 Employer and/or group identification number* claim number. 8 Identification number that appears on the ID card* • Summary highlights the financial information — the 9 Claim number* amount billed, the total benefits approved and the amount you may owe the provider. 10 Person who received the services* • Service Information identifies the health care 11 Provider name (top line) and description of provider, dates of service and charges. service (below)

• Coverage Information shows what was paid to whom, 12  Beginning and ending service dates what discounts and deductions apply and what part of 13 Amount billed by the provider for each service the total expense was not covered. 14 Portion of the billed amount not covered by the plan The EOB may include additional information: (a footnote will explain the reason) • Amounts Not Covered will show provider discounts, 15  Amount covered by the plan* or what benefit limitations or exclusions apply. 16 Total charges included on this claim • Out-of-Pocket Expenses will show an amount when a claim applies toward your deductible or counts toward 17 Plan reductions subtracted from billed amount, such your out-of-pocket expenses. as PPO allowances

• Appeals explains your rights regarding review of 18  Deductible and copayment or coinsurance amounts; claim denials. can also display applicable penalties • Fraud Hotline is a toll-free number to call if you think and/or reductions for failure to pre-authorize you are being charged for services you did not receive 19 Payment amounts approved for benefits or if you suspect any fraudulent activity. 20  Amount the member may be responsible for paying 21 Total benefits approved for provider 22 Summary box, including the total billed by the provider for the services, the benefits approved and paid by BCBSIL, and the remainder you may owe (see also 13, 19 and 20)

* Please provide this information when contacting us about a claim. www.bcbsil.com/boeing 17 888-802-8776 Understanding Your EOB

Your EOBs Are Available Online! 1 Go to www.bcbsil.com/boeing 2 and sign up for Blue Access for Members. You’ll get quick, convenient and confidential 4 ANTHONY DOE 3 100 BLUEBIRD LANE access to your claim information CHICAGO, IL 60601-7332 and history. 5 Check here for BCBSIL messages. To support our commitment to eco-friendly business practices,

6 you can choose to opt out of 7 receiving EOBs by mail. 8 9 10 This saves resources and offers you additional confidentiality. Just go to www.bcbsil.com/boeing, 11 12 13 14 15 log in to Blue Access for Members, click Settings at the top and select 16 Preferences.

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If you have questions about an EOB, call Boeing Member Services. www.bcbsil.com/boeing 18 888-802-8776 Fitness Program

Make Your Fitness Program Membership It’s Easy to Sign Up

Work for You!  1 Go to www.bcbsil.com/boeing and log in to Blue The Fitness Program* gives you flexible options to help Access for Members. you live a healthy lifestyle and gives you access to a  2 Under Quick Links, choose Fitness Program. On nationwide network of fitness locations. Choose one this page, browse packages, search for nearby fitness location close to home and one near work or visit locations facilities and learn more about the program.. while traveling. 3  Click Enroll Now. Then select the fitness package Flexible Gym Network that is best for you. Remember, you can visit any Options Base Core Power Elite participating gym in that network after you sign up. Monthly 4 Verify your personal information and method of $19 $29 $39 $99 Fee payment. Print or download your Fitness Program Gym membership ID card. You may also request to receive Facility the ID card in the mail. 3,000 7,500 12,000 12,400 Network Visit a fitness location today! Prefer to sign up by phone Size† or have questions about the Fitness Program? Just call $19 Initiation fee the number on your member ID card and speak to a

† Represents possible network locations. Check local listings for exact network Health Advocate. options as some locations may not participate. Network locations are subject to change without notice.

Studio Class Network: Boutique-style classes and specialty gyms with pay-as-you-go option and 30 percent off every 10th class. Family Friendly: Expands gym network access to your covered dependents at a bundled price discount. Convenient Payment: Monthly fees are paid via automatic credit card or bank account withdrawals.

Make new friends, take a class and try something new! Join the Fitness Program today.

* Individuals must be 18 years old to purchase a membership. Dependents, 16-17 years old, can join but must be accompanied to the location by a parent/ guardian who is also a Fitness Program member. Check your preferred location to see their membership age policy. Underage dependents can log in and join through the primary member’s account as an “additional member.” Taxes may apply. Individuals must be at least 18 years old to purchase a membership. The Fitness Program is provided by Tivity HealthTM, an independent contractor that administers the Prime Network of fitness centers. The Prime Network is made up of independently owned and operated fitness centers.

www.bcbsil.com/boeing 19 888-802-8776 Medicare Part D Prescription Drug Plan

Welcome to Blue Cross Group MedicareRxSM, managed by Set your preferences at www.myprime.com/boeing 1 Prime Therapeutics LLC (Prime) , your pharmacy benefit Help us keep in touch with you. Register at www. administrator. Prime pharmacy experts work hard to make myprime.com/boeing and set your communication your medicine more affordable and your experience easier. preferences so we can contact you in your preferred way. How your pharmacy benefits work Once you register, you can look up covered medicines, get an estimate of how much they’ll cost and do much more. Visit www.myprime.com/boeing to check the list of medicines covered under your pharmacy benefits (called You could save money a drug list or formulary). Doctors and pharmacists have AllianceRx Walgreens Prime can help you learn about carefully selected the generic and brand-name drugs on generic drugs that can cost you up to 85 percent less.1 the list. Drugs that aren’t on this list may cost you more. Generic drugs are lower-cost versions of a brand-name For covered medicines, the amount you pay is called your drug. They work the same as the brand-name drug in copay, or cost share. Your pharmacy benefit plan pays the safety, strength and effectiveness. Ask your doctor or rest. Your plan may also have a deductible, which is the pharmacist if a generic may be right for you. amount you must pay before your plan begins to pay. Save time (and possibly money) with home delivery Use a retail pharmacy • Get up to a 90-day supply of your long-term medicines • Prime offers a large national network of pharmacies from AllianceRx Walgreens Prime. where you can use your pharmacy benefits. If you • Standard shipping is free to anywhere in the United use a pharmacy that’s not in your network, you could States. pay more. • Learn more at www.alliancerxwp.com/home- • Find network pharmacies at www.myprime.com/ delivery or call 877-845-7710. boeing. www.bcbsil.com/boeing 20 888-802-8776 Medicare Part D Prescription Drug Plan

Trust an experienced specialty pharmacy Find pharmacies. One way we help make your medicines • AllianceRx Walgreens Prime offers a full-service specialty more affordable is by working with certain pharmacies pharmacy that’s part of your Pharmacy Select Network. to lower prices for you. These pharmacies make up your plan’s preferred pharmacy network. Search by pharmacy • AllianceRx Walgreens Prime’s experienced pharmacists name, your location and more. and dedicated staff focus on providing education and support to members living with chronic or complex View prescription history. See your prescription drug health conditions. claims history, including the medicine, fill date and what you paid. You can easily print your history for your doctor • Call 855-899-6005 to learn more. to review.

Rx Savings Solutions Contact Prime Rx Savings Solutions is a confidential service that gives Boeing Member Website personalized prescription guidance at no cost to help you www.myprime.com/boeing save money. It sends a text or email if you ever pay too much for a prescription. Rx Savings Solutions finds other Boeing Member Services ways to get the same treatment for less money. You can 877-9BOEING (1-877-926-3464) TTY 711 register via the link at www.myprime.com/boeing, the Myprime.com/boeing is designed to work on your Boeing member website. computer, tablet or phone—wherever and whenever you need it. Create or access your account at www.myprime. com/boeing 1  Prime Therapeutics LLC is an independent company providing pharmacy All you need to register at www.myprime.com/boeing benefit management services for Boeing health plan members. Prime Therapeutics has an ownership interest in AllianceRx Walgreens Prime, a is your member ID number and a few clicks. Once you’ve central specialty and mail service company. Myprime.com/boeing is an online resource offered by Prime Therapeutics LLC. registered, you can set your communication preferences, see your benefits and access tools to: Find medicines. Look up different drugs to see if your plan covers them. You can see prices and find out if there’s a generic version to help save you up to 85 percent. If your medicine isn’t covered, talk to your doctor. You may be able to switch to a medicine that’s on the drug list.

www.bcbsil.com/boeing 21 888-802-8776

Important Information

Health care coverage is important for everyone. We provide free communication aids and services for anyone with a disability or who needs language assistance. We do not discriminate on the basis of race, color, national origin, sex, gender identity, age or disability.

To receive language or communication assistance free of charge, please call us at 855-710-6984.

If you believe we have failed to provide a service, or think we have discriminated in another way, contact us to file a grievance. Office of Civil Rights Coordinator Phone: 855-664-7270 (voicemail) 300 E. Randolph St. TTY/TDD: 855-661-6965 35th Floor Fax: 855-661-6960 Chicago, Illinois 60601 Email: [email protected]

You may file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at: U.S. Dept. of Health & Human Services Phone: 800-368-1019 200 Independence Avenue SW TTY/TDD: 800-537-7697 Room 509F, HHH Building 1019 Complaint Portal: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Washington, DC 20201 Complaint Forms: http://www.hhs.gov/ocr/office/file/index.html

www.bcbsil.com/boeing bcbsil.com 888-802-8776

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Important Information

bcbsil.com

www.bcbsil.com/boeing 23 888-802-8776 Contact Information At a Glance For information on benefits for Medicare-eligible or non-Medicare-eligible members, please contact BCBSIL at 888-802-8776 or visit www.bcbsil.com/boeing.

Blue Cross and Blue Shield of Illinois Boeing Member Services: 888-802-8776 Prime Therapeutics: 877-926-3464 or www.myprime.com/boeing Blue Cross Blue Shield Global Core: 800-810-BLUE (2583)/804-673-1177 collect Fraud Hotline: 800-543-0867 Fitness Program: 888-762-BLUE (2583) Boeing Service Center for Health and Insurance: 866-504-4256

Other Boeing Benefits

AllianceRx Walgreens Prime Home Delivery: 877-845-7710

AllianceRx Walgreens Prime Specialty Pharmacy: 855-899-6005

www.bcbsil.com/boeing

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

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