Take charge of your health plan. High quality care at lower cost. NorthStar Preferred Care Engaging members and improving health When making purchases of any kind, you look for the best value. You want great quality at a reasonable cost. That’s what NorthStar Preferred Care is all about. When members choose high quality, more cost-efficient providers and hospitals, they pay less.

NorthStar Preferred Care Highlights Members can trust in Southcoast • NorthStar Preferred Care plans are designed Committed to quality and safety, Southcoast to encourage members to seek care from has been named one of America’s 100 Best Southcoast Health System hospitals and the Hospitals for overall heart care and cardiac Southcoast Physician Network. These are the surgery by Healthgrades®, the country’s leading NorthStar Preferred Care Tier 1 providers independent health care ratings organization. • Members save the most on their out-of-pocket costs when they use Tier 1 Providers. Cost Health Plans, Inc. and sharing increases when the member uses Harvard Pilgrim Health Care providers in the other tiers Harvard Pilgrim Health Care (HPHC), the • Employers benefit from preferred Southcoast nation’s number one ranked health plan ten Health System pricing and reduced administrative years running (U.S. News & World Report/ costs that come from being self-funded NCQA), offers a world-class network that includes over 28,000 doctors and clinicians and How the Tiers Work an additional 135 hospitals. NorthStar Preferred Care plans offer up to three levels Health Plans, a Harvard Pilgrim company, is of coverage. When members use Tier 1 providers, they New England’s largest Third Party Administrator will always benefit from the lowest out-of-pocket costs. of self-funded benefit plans. With over thirty Members designate a primary care physician, but years of experience, Health Plans provides referrals to specialists are never required. Below is an cost-effective, flexible administration including example of how members can maximize their benefits integrated health management services and on a NorthStar Preferred Care plan. robust program reporting.

Tiered Employee Cost Sharing Tier 1 Tier 2 Tier 3 PCP office visit copayment $ $$ $$$ Specialist office visit copayment $ $$ $$$ Inpatient/outpatient hospital copayment $ $$ $$$ High Tech Imaging copayment $ $$ $$$ Deductible $ $$ $$$ Tier 1 Hospitals: Southcoast Health System - Lowest member out-of-pocket costs

Charlton Memorial Hospital (MA) St. Luke’s Hospital (MA) Tobey Hospital (MA) Tier 2 Hospitals: Harvard Pilgrim and other preferred provider networks - Moderate member out-of-pocket costs

Addison Gilbert Hospital (MA) Elliot Hospital (NH) Mary Hitchcock Memorial Hospital (NH) Rehabilitation Hospital of Rhode Alice Peck Day Memorial Hospital (NH) (MA) Mary Lane Hospital (MA) Island (RI) Anna Jaques Hospital (MA) Exeter Hospital (NH) Massachusetts Eye And Ear Rhode Island Hospital (RI) (MA) (MA) Infirmary (MA) Roger Williams Medical Center (RI) Baystate Medical Center (MA) Faulkner Hospital (MA) Melrose Wakefield Hospital (MA) Saint Joseph Health Services (RI) Beth Israel Deaconess Hospital (MA) Franklin Regional Hospital (NH) Memorial Hospital (RI) (MA) Beth Israel Needham Campus (MA) Frisbie Memorial Hospital (NH) Mercy Medical Center (MA) (MA) Beverly Hospital (MA) Harrington Memorial (MA) MetroWest Medical Center (MA) (MA) Boston Children’s Hospital (MA) Hasbro Children’s Hospital (RI) Milford Regional Hospital (MA) Southern New Hampshire Medical (MA) HealthAlliance Burbank Hospital (MA) (MA) Center (NH) Bradley Hospital (RI) Heywood Hospital (MA) Miriam Hospital (RI) South County Hospital (RI) (MA) Holyoke Hospital Inc. (MA) Monadnock Community Hospital (NH) Speare Memorial Hospital (NH) Butler Hospital (RI) Huggins Hospital (NH) Mt. Auburn Hospital (MA) St. Joseph Hospital (NH) (MA) Jordan Hospital Inc. (MA) Cottage Hospital (MA) (MA) (MA) Kent Hospital (RI) New England Baptist Hospital (MA) The Westerly Hospital (RI) Catholic Medical Center (NH) Lahey Medical Center (MA) New London Hospital (NH) Valley Regional Hospital (NH) Cheshire Medical Center (NH) Lakes Regional General Hospital (NH) Newport Hospital (RI) Wentworth-Douglass Hospital (NH) Clinton Hospital/UMASS Health Lawrence General Hospital (MA) Newton Wellesley Hospital (MA) Whidden Memorial Hospital (MA) System (MA) Lawrence Memorial Hospital (MA) Noble Hospital (MA) (MA) Concord Hospital (NH) (MA) North Adams Regional Hospital (MA) Wing Memorial (MA) Cottage Hospital (NH) Marlborough Hospital (MA) North Shore Medical (Salem or Union) (MA) Women & Infants Hospital (RI) Dana-Farber Cancer Institute (MA) Martha’s Vineyard Hospital (MA) Parkland Medical Center (NH) Tier 3 Hospitals: All other non-preferred and out-of-network hospitals - Highest member out-of-pocket costs

Androscoggin Valley Hospital (NH) Franklin Medical Center (MA) Morton Hospital (MA) St. Elizabeth’s Hospital (MA) (MA) Good Samaritan Hospital (MA) Nashoba Valley Medical Center (MA) (MA) Brigham & Women’s Hospital (MA) Holy Family Hospital (MA) New England Sinai (MA) Sturdy Memorial Hospital (MA) (MA) Landmark Medical Center (RI) (MA) UMass Memorial Medical Center (MA) Cooley Dickinson Hospital (MA) Littleton Regional Hospital (NH) Portsmouth Regional Hospital (NH) Upper CT Valley Hospital (NH) Duncan Lodge (RI) Massachusetts General Hospital (MA) Providence VA Medical Center (RI) Weeks Medical Center (NH) Eleanor Slater Hospital (RI) Memorial Hospital (NH) (MA) Fairview Hospital (MA) Merrimack Valley Hospital (MA) St. Anne’s Hospital (MA)

Note: The plan’s tiering structure uses quality and cost-effective measures to tier providers. A hospital’s benefit tier may change annually on January 1. Please refer to the provider search tool at www.HealthPlansInc.com/NorthStar, or call toll-free at 855-675-3636 to speak with a customer service representative.

With NorthStar Preferred Care, members have the choice to switch providers and find lower cost options. Members decide what works best for them. Administered by:

P.O. Box 5199 Westborough, MA 01581

toll-free 800.987.6151

With locations in Portland, Quincy & Woburn

www.HealthPlansInc.com/NorthStar

rev. 1/20/2014