The Anthem Blue Cross and Blue Shield Ohio 2015 Pathway X Tiered Network Include the Following Hospitals, ASC Facilities and Large PCP Groups

The Anthem Blue Cross and Blue Shield Ohio 2015 Pathway X Tiered Network include the following Hospitals, ASC Facilities and Large PCP Groups:

HOSPITAL COUNTY TIER Adams County Regional Medical Center Adams Tier 1 Bluffton Hospital Allen Tier 1 Lima Memorial Hospital Allen Tier 1 Samaritan Regional Health System Ashland Tier 1 Ashtabula County Medical Center Ashtabula Tier 1 University Hospitals — Conneaut Medical Center Ashtabula Tier 1 University Hospitals — Geneva Medical Center Ashtabula Tier 1 Belmont Community Hospital Belmont Tier 1 East Ohio Regional Hospital (a.k.a., Ohio Valley Medical Center) Belmont Tier 1 Bethesda Butler Hospital Butler Tier 1 Fort Hamilton Hughes Hospital Butler Tier 1 Ohio Valley Medical Center* Clark Tier 1 Clinton Memorial Hospital Clinton Tier 1 East Liverpool City Hospital Columbiana Tier 1 Salem Comm Hospital Columbiana Tier 1 Coshocton County Memorial Hospital Coshocton Tier 1 Bucyrus Community Hospital Crawford Tier 1 Galion Community Hospital Crawford Tier 1 Metrohealth System Medical Center Cuyahoga Tier 1 Parma Comm General Hospital Cuyahoga Tier 1 Southwest General Health Center Cuyahoga Tier 1 St. John Medical Center Cuyahoga Tier 1 St. Vincent Charity Hospital Cuyahoga Tier 1 University Hospitals — Ahuja Medical Center Cuyahoga Tier 1 University Hospitals — Bedford Medical Center Cuyahoga Tier 1 University Hospitals — Case Medical Center Cuyahoga Tier 1 University Hospitals — MacDonald Women's Hospital Cuyahoga Tier 1 University Hospitals — Rainbow Babies and Children's Hospital Cuyahoga Tier 1 University Hospitals — Richmond Medical Center Cuyahoga Tier 1 University Hospitals — Seidman Cancer Center Cuyahoga Tier 1 ProMedica Defiance Regional Hospital Defiance Tier 1 Firelands Regional Medical Center Erie Tier 1 Fairfield Medical Center Fairfield Tier 1 Fayette County Memorial Hospital Fayette Tier 1 Diley Ridge Medical Center Franklin Tier 1 Mount Carmel East Franklin Tier 1 Mount Carmel New Albany Surgical Hospital Franklin Tier 1 Mount Carmel West Franklin Tier 1

Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company. Independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 43323OHMENABS Rev. 08/14 1 of 8

HOSPITAL COUNTY TIER Nationwide Children’s Hospital Franklin Tier 1 St. Ann's Hospital Franklin Tier 1 Community Hospitals and Wellness Centers — Archbold Medical Fulton Tier 1 Center Holzer Medical Center Gallia Tier 1 University Hospitals — Geauga Medical Center Geauga Tier 1 Beavercreek (Soin) Medical Center Greene Tier 1 Greene Memorial Hospital Greene Tier 1 Southeastern Ohio Regional Medical Center (SEORMC) Guernsey Tier 1 Bethesda Hospital Hamilton Tier 1 Christ Hospital Hamilton Tier 1 Cincinnati Children’s Hospital Medical Center Hamilton Tier 1 Good Samaritan Hospital Hamilton Tier 1 TriHealth Evendale Hospital Hamilton Tier 1 Blanchard Valley Hospital Hancock Tier 1 Henry County Hospital Inc Henry Tier 1 Adena Greenfield Medical Center Highland Tier 1 Highland District Hospital Highland Tier 1 Holzer Medical Center Jackson Jackson Tier 1 Trinity Health System Jefferson Tier 1 Lake West Hospital Lake Tier 1 Tripoint Medical Center Lake Tier 1 EMH Regional Medical Center Lorain Tier 1 ProMedica Bay Park Hospital Lucas Tier 1 ProMedica Flower Hospital Lucas Tier 1 ProMedica St. Luke's Hospital Lucas Tier 1 ProMedica Toledo Children’s Hospital Lucas Tier 1 ProMedica Toledo Hospital Lucas Tier 1 Northside Medical Center Mahoning Tier 1 St. Elizabeth Boardman Health Center Mahoning Tier 1 St. Elizabeth Health Center Mahoning Tier 1 Surgical Hospital at Southwoods Mahoning Tier 1 Lodi Community Hospital Medina Tier 1 Dayton Children's Hospital Montgomery Tier 1 Grandview Medical Center Montgomery Tier 1 Kettering Medical Center Montgomery Tier 1 Southview Medical Center Montgomery Tier 1 Sycamore Medical Center (Kettering) Montgomery Tier 1 Genesis Healthcare Systems Muskingum Tier 2

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HOSPITAL COUNTY TIER Paulding County Hospital Paulding Tier 1 Adena Pike Medical Center Pike Tier 1 Robinson Memorial Hospital Portage Tier 1 Adena Regional Medical Center Ross Tier 1 Bellevue Hospital Sandusky Tier 1 Memorial Hospital Sandusky Tier 1 Kings Daughters Medical Center Scioto Tier 1 Southern Ohio Medical Center (SOMC) Scioto Tier 1 ProMedica Fostoria Community Hospital Seneca Tier 1 Wilson Memorial Hospital Shelby Tier 1 Affinity Medical Center — Doctors Campus Stark Tier 1 Alliance Community Hospital Stark Tier 1 Mercy Medical Center Canton Stark Tier 1 Akron General Medical Center Summit Tier 1 Edwin Shaw Rehab Summit Tier 1 Western Reserve Hospital Summit Tier 1 Hillside Rehab Hospital Trumbull Tier 1 St. Joseph Health Center Trumbull Tier 1 Trumbull Memorial Hospital Trumbull Tier 1 Trinity Hospital Twin City Tuscarawas Tuscarawas Tier 1 Van Wert County Hospital Van Wert Tier 1 Marietta Memorial Hospital Washington Tier 1 Selby General Hospital Washington Tier 1 Wooster Community Hospital Wayne Tier 1 Community Hospitals and Wellness Centers — Bryan Hospitals Williams Tier 1 Community Hospitals and Wellness Centers — Montpelier Williams Tier 1 Hospital

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AMBULATORY SURGERY CENTER (ASC) FACILITY COUNTY TIER An ASC is a facility where outpatient surgeries and procedures are performed. The patient is treated and released the same day. Digestive Health Complex Belmont Tier 1 Valley Endoscopy Center Belmont Tier 1 SW Ohio Ambulatory Surg Butler Tier 1 The GI Endoscopy Center Butler Tier 1 Clinton County Outpatient Surgery Center Clinton Tier 1 Wilmington Surgical Services Clinton Tier 1 Big Creek Surgery Center Cuyahoga Tier 1 Legacy Surgery Center Cuyahoga Tier 1 North Ohio Endoscopy Center Cuyahoga Tier 1 North Shore Endoscopy Center Cuyahoga Tier 1 Planned Parenthood of Greater Cleveland Cuyahoga Tier 1 Premier Physicians Ambulatory Surgery Center Cuyahoga Tier 1 The Center of GI Endoscopy Cuyahoga Tier 1 The Surgery Center Cuyahoga Tier 1 The Surgery Center Pearl Cuyahoga Tier 1 University Hospitals Lyndhurst Surgery Center Cuyahoga Tier 1 University Hospitals Westlake Surgery Center Cuyahoga Tier 1 University Suburban Endoscopy Center Cuyahoga Tier 1 NovaMed Surgery Center of Sandusky Erie Tier 1 Affiliated Ambulatory Surgery Center LLC Franklin Tier 1 Planned Parenthood East Columbus Surgical Center Franklin Tier 1 Eastwind Surgical Center Franklin Tier 1 New Albany Surgery Center Franklin Tier 1 Taylor Station Surgery Center Franklin Tier 1 The Eye Center of Columbus Franklin Tier 1 Chardon Surgery Center Geauga Tier 1 Endoscopy Center at Bainbridge Geauga Tier 1 Dayton Eye Surgery Center Greene Tier 1 Dayton Eye Surgery Center Greene Tier 1 Beacon Orthopaedics Surgical Center LLC Hamilton Tier 1 Cincinnati Eye Institute Hamilton Tier 1 Norwood Endoscopy Center Hamilton Tier 1 Planned Parenthood of Southwest Ohio Hamilton Tier 1 The Christ Hospital Spine Surgery Center Hamilton Tier 1 The Urology Center Hamilton Tier 1 Tri State Endoscopy Hamilton Tier 1 Tri State Eye Surgery Center Hamilton Tier 1 University Endoscopy Center Hamilton Tier 1

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ASC FACILITY COUNTY TIER Findlay Surgery Center Hancock Tier 1 Valley Surgery Center Jefferson Tier 1 CDH Endoscopy Center Lake Tier 1 Mentor Surgery Center Lake Tier 1 The Endoscopy Center of Lake County Lake Tier 1 University Hospitals Mentor Surgery Center Lake Tier 1 Premium Surgery Center LLC Lorain Tier 1 Artisan Surgery Center Lucas Tier 1 Northwest Ohio Endoscopy Center Lucas Tier 1 Surgicare Ambulatory Surgery Center Lucas Tier 1 Belmont Eye Surgery Mahoning Tier 1 Center for Advanced Eye Surgery Mahoning Tier 1 Lee Surgery Center Mahoning Tier 1 Mill Creek Endoscopy Suites Mahoning Tier 1 Orthopaedic Surgery Center Mahoning Tier 1 Surgery Center of Canfield LLC Mahoning Tier 1 Digestive Care Inc Montgomery Tier 1 Endoscopy Center Of Dayton North Montgomery Tier 1 Governors Place ASC LLC Montgomery Tier 1 Physicians Ambulatory Surgery Center Pickaway Tier 1 Western Reserve Surgery Center Portage Tier 1 Revision Advanced Surgery Center Inc Richland Tier 1 CG Endoscopy Center Stark Tier 1 Eyes on Stark/Vista Surgery Center Stark Tier 1 Gastroenterology Aso Stark Tier 1 Gastroenterology Spec Stark Tier 1 Global Ambulatory Surgical Center Stark Tier 1 Stark Ambulatory Surgery Center Stark Tier 1 Center for Surgery Summit Tier 1 Digestive Health Center Ltd Summit Tier 1 St Clare Surgery Center Summit Tier 1 Surgery Center at Akron General Health and Wellness Summit Tier 1 System Optics (Novus Clinic) Summit Tier 1 Avamar Center for Endoscopy Trumbull Tier 1 Lippy Surgery Center Trumbull Tier 1 Warren Gastrointestinal Endoscopy Center Trumbull Tier 1 Tuscarawas Amb Surgery Center Tuscarawas Tier 1 Marietta Surgery Center Washington Tier 1 Ohio Valley Ambulatory Surgery Center Washington Tier 1 The Eye Surg Center Wooster Wayne Tier 1 Wooster ASC Wayne Tier 1 Lima Memorial Professional Corporation Allen Tier 1

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LARGER PRIMARY CARE PHYSICIAN GROUPS COUNTY TIER Ashtabula County Medical Center Group Ashtabula Tier 1 University Hospital Medical Group Ashtabula Tier 1 University Hospital Primary Care Practices Ashtabula Tier 1 Group Health — TriHealth Butler Tier 1 Kettering Alliance Butler Tier 1 Queen City Physicians — TriHealth Butler Tier 1 TriHealth Physician Practices LLC Butler Tier 1 Family Physicians of Springfield Clark Tier 1 Providence Medical Group: Medway Medical Clinic Clark Tier 1 Springfield Center for Family Medicine Clark Tier 1 Springfield Health Care Clark Tier 1 Health First Physicians- TriHealth Clermont Tier 1 Blanchester Medical Services Clinton Tier 1 East Clinton Medical Services Clinton Tier 1 Wilmington Medical Aso Clinton Tier 1 Prima Health Care Columbiana Tier 1 Atrium Medical Group Inc Cuyahoga Tier 1 North Ohio Heart Inc Cuyahoga Tier 1 Metrohealth Physicians and Health Centers Cuyahoga Tier 1 Premier Physicians Center Inc Cuyahoga Tier 1 Ridgepark Medical Associates Inc Cuyahoga Tier 1 University Hospital Medical Group Cuyahoga Tier 1 University Hospital Primary Care Practices Cuyahoga Tier 1 Westshore Primary Care Associates Inc Cuyahoga Tier 1 ProMedica Physician Groups Defiance Tier 1 Central Ohio Primary Care Delaware Tier 1 Nationwide Children’s Hospital Delaware Tier 1 North Ohio Heart Inc Erie Tier 1 University Hospital Medical Group Erie Tier 1 University Hospital Primary Care Practices Erie Tier 1 Fairfield Community Health Center Fairfield Tier 1 Fairfield Healthcare Professionals Inc Fairfield Tier 1 Adena Fayette Tier 1 Central Ohio Primary Care Franklin Tier 1 Mt Carmel Health Providers III, LLC Franklin Tier 1 Mt Carmel Health Providers Inc. Franklin Tier 1 Mt Carmel Health System Physicians Franklin Tier 1 Nationwide Children’s Hospital Franklin Tier 1 Pediatric Academic Associates, Inc. Franklin Tier 1

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LARGER PRIMARY CARE PHYSICIAN GROUPS COUNTY TIER Holzer Gallia Tier 1 University Hospital Medical Group Geauga Tier 1 University Hospital Primary Care Practices Geauga Tier 1 Providence Medical Group: Beavercreek Commons Family Practice Greene Tier 1 Greene Memorial Hospital Services- Kettering Greene Tier 1 Kettering Alliance Greene Tier 1 Providence Medical Group: Sugarcreek Family Practice Greene Tier 1 Superior Medical Center Guernsey Tier 1 Bethesda Family Practice — TriHealth Hamilton Tier 1 Group Health — TriHealth Hamilton Tier 1 Queen City Physicians — TriHealth Hamilton Tier 1 The Christ Hospital Medical Associates Hamilton Tier 1 TriHealth Physician Practices LLC Hamilton Tier 1 Blanchard Valley Medical Practice, LLC Hancock Tier 1 Blanchard Valley Medical Practice, LLC Hardin Tier 1 Adena Jackson Tier 1 Holzer Jackson Tier 1 Trinity Family Care Centers (Trinity) Jefferson Tier 1 The Christ Hospital Medical Associates Kenton Tier 1 Lake PHO Lake Tier 1 University Hospital Medical Group Lake Tier 1 University Hospital Primary Care Practices Lake Tier 1 Nationwide Children’s Hospital Lawrence Tier 1 Central Ohio Primary Care Licking Tier 1 Nationwide Children’s Hospital Licking Tier 1 North Ohio Heart Inc Lorain Tier 1 Superior Medical Care Lorain Tier 1 University Hospital Medical Group Lorain Tier 1 University Hospital Primary Care Practices Lorain Tier 1 Westshore Primary Care Associates Inc Lorain Tier 1 Fremont Cooperative Care Lucas Tier 1 ProMedica Physician Groups Lucas Tier 1 Toledo Clinic Lucas Tier 1 Wellcare Physicians Groups LLC Lucas Tier 1 Poland Medical Group Mahoning Tier 1 Prima Health Care Mahoning Tier 1 SCH Professional Group Mahoning Tier 1 Trumbull Mahoning Medical Group (TMMG) Mahoning Tier 1 University Hospital Medical Group Medina Tier 1

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LARGER PRIMARY CARE PHYSICIAN GROUPS COUNTY TIER University Hospital Primary Care Practices Medina Tier 1 Primary Health Network Mercer Tier 1 Kettering Alliance Miami Tier 1 Dayton Children's Professional Montgomery Tier 1 Providence Medical Group: Farmersville Medical Center Montgomery Tier 1 Providence Medical Group: Germantown Medical Associates Montgomery Tier 1 Greene Memorial Hospital Services- Kettering Montgomery Tier 1 Huber Heights Medical Montgomery Tier 1 Kettering Alliance Montgomery Tier 1 Providence Medical Group: Lugo Family Practice Montgomery Tier 1 Main Street Family Practice Montgomery Tier 1 Ohio Pediatrics, Inc. Montgomery Tier 1 Providence Medical Group Montgomery Tier 1 Providence Medical Group: Suburban Family Practice Bennett Montgomery Tier 1 Providence Medical Group: Suburban Family Practice Koren Montgomery Tier 1 Sycamore Primary Care — Kettering Montgomery Tier 1 Genesis Area Muskingum Tier 1 Genesis Primary Care Physicians LLC Muskingum Tier 1 Superior Medical Center Noble Tier 1 PCH Physicians Services Paulding Tier 1 Adena Pickaway Tier 1 Adena Pike Tier 1 University Hospital Medical Group Portage Tier 1 University Hospital Primary Care Practices Portage Tier 1 Aurora Primary Care Portage Tier 1 Brimfield Family Practice Portage Tier 1 Portage Internal Medicine Associates Portage Tier 1 Ravenna Primary Care Portage Tier 1 Robinson Health Affiliates Portage Internal Medicine Portage Tier 1 Streetsboro Family Practice Portage Tier 1 Ulrich Professional Group Portage Tier 1 Blanchard Valley Medical Practice, LLC Putnam Tier 1 MedCentral Professional Foundation Richland Tier 1 Adena Ross Tier 1 Fremont Cooperative Care Sandusky Tier 1 Medical Care Foundation Inc (SOMC) Scioto Tier 1 Wilson Care Shelby Tier 1 Mercy Professional Care Corporation Stark Tier 1 PPG Partners Physician Group (Akron General) Summit Tier 1

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Unity Health Network/SWRH Summit Tier 1 University Hospital Medical Group Summit Tier 1 University Hospital Primary Care Practices Summit Tier 1 SCH Professional Group Trumbull Tier 1 Trumbull Mahoning Medical Group (TMMG) Trumbull Tier 1 Group Health — TriHealth Warren Tier 1 Kettering Alliance Warren Tier 1 Providence Medical Group: Waynesville Healthcare Warren Tier 1 Marietta Healthcare Phys Washington Tier 1 ProMedica Physician Groups Wood Tier 1 Blanchard Valley Medical Practice, LLC Wyandot Tier 1

*ER services are not available at this facility. This listing of 2015 Pathway X Tiered Hospital Network is effective as of August 31, 2014. While we make efforts to ensure it is up to date and accurate, these listings do change periodically. We recommend you contact the provider to confirm that they are in your network prior to your appointment.

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