Highmark Agent Field Guide 2020

HIGHMARK SENIOR MARKETS Highmark Agent Field Guide 2020

Confidential & Proprietary — For Agent Use Only

Dear Highmark Agent:

Welcome to Highmark Senior Markets!

You are a valued member of our sales team. And you are the face of Highmark.

Change is happening throughout the health care industry, and Highmark is playing a leading role in driving that transformation. We are proud to make a difference in the lives of the nearly 5 million members that we serve.

As a Highmark field agent, you’re often our first point of contact with consumers who are shopping for quality health coverage that is both accessible and affordable.

That’s why we’re here to support you. And it’s why we’re providing you with this Highmark Agent Field Guide.

This helpful resource puts a wealth of information at your fingertips — including details about our Medicare products, important policies, and everything you need to know about doing business with Highmark. On the following pages, you’ll also find guidance on using the Highmark producer web portal, information on the Medicare Star ratings, and other insights to help ensure you’re “Ready to Sell” Highmark products as the ideal solution to your customers’ needs.

So please keep this guide handy. It can help you prepare to have more productive meetings with your clients as they search for a health plan offering both comprehensive coverage and real value.

Thank you for representing Highmark! And please know that we’re always here to help you — to make your job easier and to help you remain successful.

Sincerely, The Highmark Senior Markets Team

3 Confidential & Proprietary — For Agent Use Only

Table of Contents

Section I: Highmark Snapshot — Who Are We? ��7

Section II: Producer Portal and ShopPRO Resources ��9

Section III: Ethics and Integrity �� 19

Section IV: Commissions, Compliance, and Agent Oversight — Are You “Ready to Sell?” �� 23

Section V: Enrollment Process and Eligibility �� 31

Section VI: Highmark’s Medicare Products Star Ratings �� 33

Section VII: Highmark Senior Markets Medicare Products �� 37

Section VIII: Regions: Products and Pricing by County �� 41

Section IX: Additional Enrollment Resources for Part B & Part D, IRMAA, PACE/PACENET �� 69

Appendix A: Agent Sales Checklist �� 75

Appendix B: Medical Underwriting Guidelines �� 76

Appendix C: Scope of Sales Appointment Confirmation Form �� 80

Appendix D: Highmark Phone Numbers and Websites �� 82

Appendix E: Glossary �� 84

5 Confidential & Proprietary — For Agent Use Only

SECTION I: Highmark Snapshot: Who Are We?

7 Confidential & Proprietary — For Agent Use Only SECTION I: HIGHMARK SNAPSHOT — WHO ARE WE?

Highmark Snapshot: Who Are We?

Welcome to Highmark Health, a national health and wellness organization with more than 43,000 employees. We’re proud to serve the health and wellness needs of millions of Americans in all 50 states and the District of Columbia. We share a unique commitment to getting health care right for our customers. We’re transforming health care in bold new ways that deliver greater value and a better overall experience for our customers along their health care journeys. Highmark Health’s portfolio of Leading Health Care Companies

Highmark Inc. | Pittsburgh, PA

Highmark is one of America’s leading health insurance organizations. Our mission is to create a remarkable health experience, freeing people to be their best. Highmark and its Blue-branded affiliates proudly cover the insurance needs of millions of individuals, families, and seniors, offering a variety of products and services to meet their health care needs. Highmark and its Blue-branded affiliates represent the third largest Blue Cross and Blue Shield-affiliated organization in the United States and operate health insurance plans in Pennsylvania, Delaware and West Virginia that serve approximately 4.5 million members and hundreds of thousands of additional individuals through the BlueCard program. Highmark Inc. is an independent licensee of the Blue Cross Blue Shield Association.

United Concordia Dental is a leading national dental solutions Allegheny Health Network provides health care delivery, company focused on delivering high-quality, cost-effective research, medical education, and wellness services through a dental care. The company has nearly 8.6 million members, of leading integrated delivery network of eight hospitals, more the nation’s largest dentist networks, an AM Best A- (excellent) than 2,400 staff physicians, and key clinical and research rating and is licensed in all 50 states, D.C. and Puerto Rico. partnerships.

HM Insurance Group works to protect businesses from the HM Home & Community Services provides health care potential financial risk associated with catastrophic health organizations that are accountable for post-acute spend care costs. Through its insurance companies, HM Insurance with customized solutions for the entire episode following Group holds insurance licenses in 50 states and the District of hospitalization, achieving higher levels of performance Columbia and maintains sales offices across the country. including lower costs, improved health outcomes, and a better patient experience.

HM Health Solutions provides innovative, technology- based solutions that support the multiple product lines of health plans, now managing more than 10 million health plan members on its platforms.

8 Confidential & Proprietary — For Agent Use Only SECTION II: Producer Portal and ShopPRO Resources

9 Confidential & Proprietary — For Agent Use Only SECTION II: PRODUCER PORTAL AND SHOPPRO RESOURCES

Doing Business with Highmark Senior Markets

The Producer Portal Working with Highmark is easy when you use the tools we’ve provided. One of these helpful resources is our online Producer Portal — producer.highmark.com. This user-friendly website gives you many informational tools to help you have productive conversations with your clients. And it will help you build a greater knowledge base about Highmark as well.

The Producer Portal enables you to: • Enroll Medicare clients online • Check the status of applications • Order customized enrollment kits through ShopPRO • Request CMS approved marketing materials • View and download important documents • Access the most recent version of this Field Guide

10 Confidential & Proprietary — For Agent Use Only SECTION II: PRODUCER PORTAL AND SHOPPRO RESOURCES

Enroll Your Clients with Ease To enroll your clients faster and easier, utilize the online enrollment tool. The online enrollment tool also provides instant confirmation that an application has been received by Highmark. To use the online enrollment tool: 1. Log into the Producer Portal 5. You will have the option to upload your Scope 2. Select the “New Business” tab, then the “Medicare” of Appointment and accept the Statement of option, followed by the “Enroll” link. Understanding. 3. Enter the Zip Code, select the county the beneficiary 6. When you have completed entering all of the required resides in, enter their date of birth, and choose the plan information, you will come to the “Review” screen. in which they are enrolling. At this screen, you will be able to print out a summary of the application. 4. After starting the application, you will be required to enter your producer information, including NPN. 7. After you submit the application, you will be directed to a confirmation screen. Here you can e-mail yourself a confirmation for your records.

11 Confidential & Proprietary — For Agent Use Only SECTION II: PRODUCER PORTAL AND SHOPPRO RESOURCES

Checking the Status of an Application Once you submit an application to Highmark via online enrollment, you may check the status of the application through the Producer Portal. To do so:

1. Log into the Producer Portal 2. _Click on “New Business” at the top of the page, followed by “Check Application Status”

Alternately: 1. Click on the “Reports” tab to connect to your B360 Dashboard. 2. Next, select “Application Status” and enter the required information to search application statuses.

Viewing and Downloading Documents The Producer Portal houses many important documents that producers can use to market and sell Highmark Senior Products. To access these documents, click on the “Resources” tab. All documentation available to producers will be under the “Medicare” heading.

12 Confidential & Proprietary — For Agent Use Only SECTION II: PRODUCER PORTAL AND SHOPPRO RESOURCES

Using ShopPRO – Ordering Enrollment Kits and Support Materials Highmark Medicare Producers have one website for all of their Medicare Marketing Materials and Enrollment Kits. To get started, log into Highmark Producer Portal (producer. highmark.com). You may access ShopPRO by selecting the “New Business” tab, then the “Medicare” option, followed by “Enrollment Kit Supplies.” 1. Home Page — Click here to return to the home 3. Search — Search any product on ShopPRO by page at any time. typing it here. 2. User Account — Click here to see your order 4. Shopping Cart — Products that you order will history, profile, address book, saved files, saved appear here. To learn more about the shopping jobs, downloads and to log out of your account on cart, see page 13. ShopPRO. To learn more about the User Account 5. Categories — You can find your products divided up drop down, see page 12. into their appropriate category in this column.

13 Confidential & Proprietary — For Agent Use Only SECTION II: PRODUCER PORTAL AND SHOPPRO RESOURCES

ShopPRO User Account

1. Order History & Status — Click here to view your order history and its current status. 2. My Profile — Click here to view or edit your profile including your email, shipping information and phone number. 3. Address Book — Click here to view or add to your address book. 4. My Saved Files & My Downloads — Click here to view your saved files, and downloaded PDFs. 5. Logout — Click here to logout of ShopPRO.

Products & Categories All products are organized into categories. You can view all of your categories by clicking the View All button at the top of the column.

14 Confidential & Proprietary — For Agent Use Only SECTION II: PRODUCER PORTAL AND SHOPPRO RESOURCES

Ordering a Product

To order a product, begin by selecting a category. You may have to also navigate through subcategories to get to products. The selected category will populate the screen with appropriate products. To order most types of products, type or select the amount you would like to order in the text field and click Order Now. Once you click Order Now, the product will appear in your shopping cart. In some cases, you may be automatically directed to your shopping cart after clicking Order Now. Simply click the Continue Shopping button in the bottom right to be directed back to the category page you were on. Repeat this process for all of the products you would like in your order.

Product Types Some products require your input before you can order them. Upon pressing “Order Now”, a pop-up will appear that asks for further clarification or for you to fill out some fields. Once you finish providing the information the product requires, pressing “Order Now” on the pop-up will add the product to the cart.

15 Confidential & Proprietary — For Agent Use Only SECTION II: PRODUCER PORTAL AND SHOPPRO RESOURCES

Shopping Cart Once you have added all of your desired items, click the Shopping Cart link located in the top right corner.

1. Product — The products you ordered along with the quantity, unit price and total will appear here. If you need to change the item quantity, you can do so by typing in the updated amount in the Quantity text field and pressing Enter on your keyboard. 2. Save/Delete Product — You can save the product in your cart for a later date by clicking the “Save For Later” link. Or you can delete the product from your order entirely by clicking the “Remove” link. 3. Order Total — The total amount for your order will appear here, if applicable. 4. Proceed to Checkout — This button will take you through the remaining check out screens. Be sure your cart is accurate before clicking this button. 5. Clear Cart — This button will remove everything from your cart. You cannot undo this action. When your order is complete, click “Proceed to Checkout” to be taken to the Shipping screen.

Shipping Information The shipping screen is where you enter the shipping address. The shipping address will automatically populate the address that is associated with your profile. If you would like to change this default address, you can do so by editing your profile. You can also type in a different address or select one from your address book.

16 Confidential & Proprietary — For Agent Use Only SECTION II: PRODUCER PORTAL AND SHOPPRO RESOURCES

Payment Information Once you click “Proceed to Payment” you will be taken to the payment page in the check out process. Depending on the items ordered, you may see a Zero Payment or an option to pay by Credit Card. If you have Zero Payment, click Place My Order. If a credit card payment is required, you will be redirected to a site to enter you payment information. Once complete, you must return to this site to finalize the order.

Order Confirmation When you place your order, you will be directed to the Order Confirmation page. This page includes your order number, the status, the products in the order and who placed the order. If you need to change your order for any reason after the order confirmation, you will need to contact [email protected] with you order number.

Frequently asked questions ShopPRO won’t open on my browser, what should I do? Try updating your current browser or downloading a different browser from the browser’s website. If you are still experiencing technical difficulties, please contact Highmark Senior Markets.

My order says it needs approval, what does that mean? Certain products may need administrative approval before the order can be released. Orders requiring approval will be automatically routed for approval; you do not need to do anything additional.

If my order contains a backorder item, will the rest of my order be shipped? Yes, if your order contains a back-ordered item we will process a partial shipment until the back-ordered item arrives.

I placed an order but I need to cancel it. What should I do? If you placed an order and received the order confirmation number, you will need to contact Highmark Senior Markets at [email protected] as soon as possible to cancel the order.

How much will my order cost? ShopPRO offers items for zero payment, with the exception of postage for postcards.

17 Confidential & Proprietary — For Agent Use Only

SECTION III: Ethics and Integrity

19 Confidential & Proprietary — For Agent Use Only SECTION III: ETHICS AND INTEGRITY

Ethics and Integrity

Highmark is committed to complying with all applicable • Make a conscientious effort to ascertain and understand Federal and State regulatory requirements. all relevant circumstances pertaining to the client in order to recommend appropriate benefit plans. • Inventory current benefit plans with the client to avoid selling duplicative insurance benefits. • Honestly assess the likelihood that a client will meet underwriting and financial requirements and discover any adverse factor(s), to reduce false expectations of acceptance and adequacy of benefit plan. • Possess a comprehensive understanding of products in order to honestly, openly, and effectively portray benefit plans and determine a client understanding of key benefits and limitations. • Clarify and verify the client’s grasp of information and review pertinent issues. • Protect proprietary and competitive information. • Protect protected health information, confidential and Highmark’s policies and procedures deal with pretty financial information in compliance with existing state black and white situations. But more often than not, life and federal laws and regulations. happens in gray areas. This is where the Code of Business Conduct comes in. • Obey all laws, including antitrust, governing business and professional activities and represent products in The Code outlines Highmark’s ethical standards and an ethical manner without fraud, misrepresentation, behavioral expectations. exaggeration, coercion, scare tactics, or concealment of You are required to read, understand and agree to abide pertinent facts. by the Highmark Health Third Party Code of Business • At all times, fully disclose commission and Conduct. compensation arrangements to the client. As our Appointed Producer, you have the responsibility to • Ensure appropriate relationships by not offering or comply with our Third Party Code of Business Conduct1. accepting any inducements that might compromise You are required to conduct business activities and a reasonable business decision. Avoid any conflict of interactions ethically and with integrity. You must adhere interest or the appearance of any conflict of interest. to the following standards: • Use only authorized promotional materials unless prior • Seek to truthfully, carefully, and accurately present a written approval has been obtained, and fairly focus true picture of covered benefits by learning about and your presentation on positive benefit comparisons keeping abreast of all relevant products, benefit plans, rather than disparaging remarks about the competition. and applicable legislation and regulation, to the best of your ability. • Treat a client or a potential client with courtesy, respect and priority in accordance with thoughtful, ethical, and legal business practices.

1 A copy of Highmark Health’s Third Party Code of Business conduct may be found at https://www.highmarkhealth.org/hmk/pdf/ highmarkHealthThirdPartyCodeBusinessConduct.pdf

20 Confidential & Proprietary — For Agent Use Only SECTION III: ETHICS AND INTEGRITY

You are obligated to report any questionable behavior by Highmark Health employees, a Third Party and/or its employees and agents or potential noncompliance situation, or if you suspect potential or actual fraud, waste, or abuse (“FWA”), you should contact the Highmark Health Integrity and Compliance Department. In addition to being a resource for Highmark Health employees, the Integrity and Compliance Department is available for questions by Highmark Health business partners like you. When a report is made to the Integrity and Compliance Department, appropriate action is taken to review and/or investigate the report to reduce the potential for recurrence and ensure ongoing compliance. Third Parties are expected to cooperate with the investigation of a suspected violation of this Third Party Code or violation of any governmental law or regulation. In addition, as required and/or appropriate, the Integrity and Compliance Department may disclose investigation matters to applicable law enforcement or regulatory entities. Failure to promptly report a known violation may result in action up to and including termination of the business relationship and is the sole discretion of Highmark Health. There are various methods for reporting concerns: • 24/7 Helpline: 1-800-985-1056 • U.S. Post Office Box: Highmark Health Integrity and Compliance Department, P. O. Box 22492, Pittsburgh, PA 15222 • Fax: Camp Hill 717-302-3650 or Pittsburgh 412-544-2475 • Email: [email protected]

All inquiries to the Integrity and Compliance Department are confidential, subject to limitations imposed by law. When using the Integrity Helpline, you may remain anonymous. If you choose to make an anonymous report, you should provide enough information about the situation to allow the Integrity and Compliance Department to properly perform an investigation. If you do not provide enough details, the ability to pursue the matter will be limited. Highmark Health maintains a reprisal-free environment and has a policy of non-retaliation and non-intimidation to encourage employees, Third Parties and their employees to raise ethical or legal concerns in good faith. Third Parties who raise questions or report concerns regarding potential or actual FWA matters in connection with any of Highmark Health’s government programs are protected from retaliation and retribution for False Claims Act complaints, as well as any other applicable anti-retaliation protections. All inquiries are confidential, subject to limitations imposed by law. The Third Party Code sets forth general principles with which Third Parties must comply. More restrictive requirements may be set forth in the contracts between Third Parties and Highmark Health

21 Confidential & Proprietary — For Agent Use Only

SECTION IV: Commissions, Compliance, and Agent Oversight

23 Confidential & Proprietary — For Agent Use Only SECTION IV: COMMISSIONS, COMPLIANCE AND AGENT OVERSIGHT Section VI: Commissions, Compliance and Agent Oversight

Compensation • Complete the Individual Medicare annual certification process, including market-specific product training(s) Compensation includes monetary or non-monetary for MA/MAPD plans, to receive renewal commission remuneration of any kind relating to the sale or renewal for policies active in the current year, and meet other of a policy including, but not limited to, commissions, requirements set forth in your contract. bonuses, gifts, prizes, awards, and referral/finder’s fees. • Be in good standing with plan. Disciplinary action may Compensation DOES NOT include: result in the disqualification of commission. • The payment of fees to comply with state In addition, to receive renewal commission in January for appointment laws business sold in prior years, you must complete the annual • Training certification process by December 31. • Certification Note: The annual certification process must be completed by December 31 to receive renewal commissions in January. If you choose to recertify after • Testing costs December 31, prorated renewal commission payments to you will resume the first month after certification is complete. You will not be eligible for any • Reimbursement for mileage to, and from, missed commission payments during your lapse period. appointments with beneficiaries • Reimbursement for actual costs associated with Compliance beneficiary sales appointments such as venue rent, Highmark is committed to full compliance with Federal snacks, and materials and State regulatory requirements applicable to its Medicare Advantage and Medicare Prescription Drug Commissions Plan business. Highmark’s Medicare commission schedule for each Highmark, its employees, and contractors are expected agent and the administrative fee schedule for each to meet the contractual obligations set forth in the agent is available through their GA or FMO. We pay a company’s contracts with the Centers for Medicare and commission to agents for each person they enroll in Medicaid Services (“CMS”). a Highmark Medicare product in accordance with the In order to achieve these objectives, Highmark conducts CMS requirements, agent eligibility, and our commission its business in compliance with – and does not tolerate schedules. The compensation year is January 1 through any violation of - applicable Federal and State health care December 31, regardless of beneficiary enrollee date. regulations. To qualify for commissions, agents must: The purpose of this section is to ensure that all producers • Not be on Office of the Inspector General (OIG) and/or representing Highmark are complying with all applicable the General Services Administration-System for Award Federal and State standards, including Medicare laws, Management (SAM). We check them initially and every regulations, reporting requirements, CMS instructions, month thereafter. and Medicare Parts C and D User’s Manuals. • Complete the contract, state licensing, appointment, Potential consequences of engaging in inappropriate and certification process prior to the sale of the policy. or prohibited marketing activities include disciplinary (You will not receive commissions for applications actions, termination and forfeiture of compensation. submitted before all contracting and certification requirements are met).

24 Confidential & Proprietary — For Agent Use Only SECTION IV: COMMISSIONS, COMPLIANCE AND AGENT OVERSIGHT

Brokers for Highmark’s covered programs are required At the time of contract the following will be verified: to comply with the new ACA Section 1557 regulations as • Active License (with Accident & Health Line of Authority) of July 18, 2016. Any broker that engages in prohibited discrimination in connection with the marketing of a • Annual Certification including the Annual FWA & Highmark covered program will be subject to disciplinary Compliance training and Integrity training action including the termination with cause of his or her • Appointments to the appropriate Highmark companies Producer Agreement.

In addition, ongoing communication will occur through email blasts, webinars, group meetings, and one-on-one consultations. Training will reinforce the need for strict compliance and will advise producers that any failure to comply will be documented and may result in disciplinary action up to and including possible termination.

Agent Oversight Highmark employs several monitoring procedures to • Untimely Application Tracking ensure that certified agents are complying with all CMS –– Highmark investigates, monitors and tracks any and sales and marketing guidelines and Highmark Senior all applications received after 48 hours. Markets Sales policies. If any compliance deficiencies are identified through these monitoring procedures, the • Scope of Appointment Audits agent is subject to the disciplinary action process outlined –– Highmark expects that all producers maintain later in this section. Violations could result in agent’s complete and separate records of all transactions receiving education, non-commissionable sales or even and documents pertaining to applications submitted termination. to and accepted by Highmark for a period of at least These procedures include: ten (10) years after the contract year. –– To ensure that all producers are complying with the • Secret Shop Evaluations CMS guidelines that require records to be kept for –– Highmark utilizes a vendor to conduct periodic ten years, a random sample of producer submitted secret shopper evaluations of producers selling agreements will be selected and the producer will be Highmark Medicare products. required to provide the Scope of Appointment. –– Highmark Senior Markets Sales reviews the • Rapid Disenrollment & Cancellation Tracking evaluations reported to verify that the producer –– Highmark’s Producer Agreement stipulates that: is complying with all applicable CMS sales and marketing guidelines »» The total Initial or Renewal commission will be charged back if the enrollee disenrolls in • Telephonic Phone Surveys an unreasonably short time frame (i.e., rapid –– Highmark calls a random sample of members disenrollment). enrolled through producers as part of the New »» An “unreasonably short time frame” is defined as Member Welcome Call process and requests that less than three months after enrollment. the member complete a survey addressing the producer sales process »» Upon receipt of a notice of disenrollment that occurs three months or more after enrollment, • Complaint Allegation Tracking Highmark will withhold or withdraw (“charge –– Highmark investigates, monitors and tracks any and back”) commission payments on a pro-rata all complaints that are received against producers monthly basis to the effective date of the disenrollment. »» Highmark will also assess chargeback for rapid disenrollments in accordance with CMS guidelines.

25 Confidential & Proprietary — For Agent Use Only SECTION IV: COMMISSIONS, COMPLIANCE AND AGENT OVERSIGHT

Sales and Marketing Events • You will not receive commission for any sale that results from an unreported marketing/sales event. Failure During marketing/sales events, plan representatives may to report events can result in termination of your discuss plan-specific information (i.e., premiums, cost Highmark Medicare contract. sharing and benefits), distribute health plan brochures and enrollment materials, and accept and perform • New agents received marketing/sales event reporting enrollments. information during their certification training. This information is also located in agent annual training/ There are two types of Sales and Marketing Events (both testing material, CMS Medicare Marketing Guidelines, follow the same CMS marketing guidelines). this Highmark Medicare Producer Guide and on the • Formal: Typically in an audience/presenter format with Highmark Producer Portal. an agent, broker or producer formally providing specific • All documentation must be saved for at least 10 years plan or product information via a presentation. and available upon request by Highmark or CMS. • Informal: Conducted with a less structured presentation or in a less formal environment. Typically utilizes a table, kiosk or a recreational vehicle (RV) staffed by a plan The following five activities are mandatory. representative who can discuss the merits of the plan’s You must: products. Beneficiaries must approach you first. 1. Report all marketing/sales events prior to advertising the event or 21 days prior to the Key requirements and event’s scheduled date, whichever is earlier. important notes: 2. Use one of our CMS-approved sales • Use only our CMS-approved sales scripts, presentations presentations from beginning to end every and sales presentations notes/talking points during all time you meet with a beneficiary to discuss Highmark marketing/sales events. our MA/MAPD or PDP products and 2) read • Formal and informal marketing/sales events do not the sales presentation notes/talking points require documentation of beneficiary agreement on a as part of the script. If you use the MAPD or Scope of Appointment form. Do not request or obtain PDP sales presentation video, you must use it one. CMS views this as pressuring for personal contact in conjunction with the CMS-approved sales information. presentation. • A beneficiary may complete a Scope of Appointment at 3. Announce all products or plan types to a marketing/sales event for a future appointment. be covered during the presentation at the beginning of the presentation (i.e., HMO, PPO, • Upon arrival to an informal or formal event, check in PDP, etc.). with the venue so they know you are on site, and have the verification form signed at that time. 4. When providing an enrollment form, you must also provide the following materials: • Do not market non-health care related products, such as annuities and life insurance (cross-selling) –– Star Ratings information, 2) Summary of to prospective enrollees during MA/MAPD or PDP Benefits, and 3) Multi-Language Insert. marketing/sales events. 5. If using non-Highmark sign-in sheets, clearly • All marketing/sales events must meet event write in large letters across the top “Completion requirements. Exception: If only one beneficiary attends of any contact information is optional.” a formal event, you can discuss the MA/MAPD and/ or PDP products on an individual basis (must go with attendee’s preference – full presentation or informal discussion). A Scope of Appointment is not required under this exception.

26 Confidential & Proprietary — For Agent Use Only SECTION IV: COMMISSIONS, COMPLIANCE AND AGENT OVERSIGHT

Prohibited Activities: Scope of Appointment Form • Conducting health screening, genetic testing, or other The Centers for Medicare and Medicaid Services like activities that give the impression of “cherry picking.” requires agents to document the scope of a marketing • Requiring beneficiaries to provide any contact appointment prior to any face-to-face or telephonic information as a prerequisite for attending an event. sales meeting to ensure understanding of what will This includes requiring an email address or any other be discussed between the agent and the Medicare contact information as a condition to RSVP for an event beneficiary. online or through the mail. If the agent would like to discuss additional products • Using personal contact information for any other during the appointment, the agent must document a purpose other than to notify individuals of a raffle or second Scope of Appointment (SOA) for the additional drawing winning. product type. • Comparing Highmark to another organization or plan • It is the responsibility of the agent to secure a Scope of by name unless you obtain written consent from all Appointment (SOA) for every sales appointment organizations or plans being compared. You must • The agent must retain a copy of the SOA for ten (10) provide this written consent to us for submission to years after the contract year per CMS regulations – CMS. whether an enrollment is received or not • Providing meals to attendees. However, light snacks and • All information provided on the form is confidential and refreshments are permitted. should be completed by each person with Medicare • Asking a beneficiary for a referral. • When conducting a sales meeting, the agent may not • Soliciting or accepting an enrollment application for a market any health care related product beyond what January 1 effective date prior to the start of the Annual was agreed upon to on the Scope of Appointment (SOA) Enrollment Period (October 15 to December 7) unless form. the beneficiary is entitled to another enrollment period. Note: A copy of the Highmark Scope of Appointment (SOA) can be found in the Appendix at the end of this guide. • Marketing or advertising Medicare plans or events for the upcoming plan year prior to October 1. • Using absolute superlatives like “the best” “highest ranked” or “rated number 1,” or qualified superlatives like “one of the best,” or “among the highest ranked,” unless they are substantiated with supporting data provided to CMS as a part of the marketing review process. • Claiming you or Highmark are recommended or endorsed by CMS, Medicare or the Department of Health & Human Services. • Offering nominal gifts in the form of cash or other monetary rebates, even if their worth is $15 or less. Cash gifts include charitable contributions made on behalf of potential enrollees, and those gift certificates and gift cards that can be readily converted to cash.

27 Confidential & Proprietary — For Agent Use Only SECTION IV: COMMISSIONS, COMPLIANCE AND AGENT OVERSIGHT

Broker Disciplinary Policy for Minor and Severe Violations Minor Violations Minor violations are taken seriously and may require Minor Violation Disciplinary Procedure: immediate disciplinary action. Disciplinary action may • First Offense: A first violation committed by the include, but is not limited to, withholding commissions producer will result in an Official Warning to the and/or the retraction of commissions. The results of each producer and/or their General Agency or FMO, as investigation will be reviewed by the Senior Markets Sales applicable, alerting them of the infraction. Department to determine the appropriate disciplinary • Second Offense: A second violation committed action. Minor Violations are tracked over a rolling two year by the producer will result in a period. –– Secondary Warning and Education on Violations in this category include, but are not limited to: Highmark’s policies and procedures. • Untimely broker application submissions • Third Offense: A third violation will result in –– Highmark requires Medicare Advantage applications withholding or retraction of commissions on any to be submitted within 48 hours of signature sale or application(s) relating to the violation. from the customer. This pertains to both online Depending on the nature of the third offense, the enrollments and paper applications. commission retraction could be one or multiple applications relating to the offense. This is at • Rapid Disenrollments the sole discretion of the Senior Markets Sales –– Rapid Disenrollments will be reviewed for any trends Department. or patterns amongst individual agents. • Persistent Minor Violations: Persistent violations –– Highmark’s Producer Agreement (Schedule C, disciplinary action may include, but not limited Section B, Subparts 5 and 6) stipulate that: to, suspension and/or termination of contract. »» The total Initial or Renewal commission will be Any producer found to have committed a minor charged back (as set forth below) if an enrollee violation may be educated by the appropriate disenrolls in an unreasonably short time frame member of the Senior Markets Sales Department. (i.e. rapid disenrollment). An “unreasonably short The producer may be required to repeat the time frame” is defined as less than 90 days after company’s Medicare sales training program before enrollment. s/he is permitted to resume selling Highmark Senior »» Upon receipt of a notice of disenrollment Markets products. that occurs 90 days or more after enrollment, Committing a minor violation may be considered Highmark will withhold or withdraw (“charge grounds for further action to be taken, including back”) commission payments on a pro-rata but not limited to suspension, termination, and/or monthly basis to the effective date of the retraction of commissions. disenrollment. Highmark will also assess charge backs for rapid disenrollments in accordance with CMS guidelines. • Founded Complaints Tracking Module (CTM) or Member Service complaint –– Each complaint independently investigated by Highmark compliance individual • CMS compliance violation during sales interaction • Presenting competitor information during Highmark event or Highmark scheduled appointment

28 Confidential & Proprietary — For Agent Use Only SECTION IV: COMMISSIONS, COMPLIANCE AND AGENT OVERSIGHT

Severe Violations Severe violations are non-compliant activities deemed • Marketing or selling Medicare Advantage or Part D products egregious in nature, which may result in immediate for a contract year prior to taking the annual Highmark contract suspension, termination, and/or retraction of specific training on Medicare rules and regulations and commissions. passing the test with a score of at least 85%. All allegations of severe violations are investigated by the Senior Markets Sales Department with support from the Severe Violation Disciplinary Procedure: Medicare C&D Compliance Department. • A severe violation committed by the producer Violations in this category include, but are not limited to: will result in a notification to the producer and/ • Dishonesty or theft. or their General Agency or FMO, as applicable, alerting them of the infraction. This notification • Threatening, coercing, intimidating or deceiving a will alert the producer and/or their General member or prospective member, or the use of any other Agency or FMO, as applicable, that they have unethical sales tactics. been accused of a severe violation and that an • Door-to-door solicitation. investigation will be conducted. • Misrepresentation of the product, the purpose of the • After the investigation is completed, if it is confirmed producer’s visit, or an implication that the visit is in any that the producer committed the infraction, way connected with the government. immediate contract suspension, termination, and/or • Forging or knowingly accepting a forged signature on retraction of commissions may result. an enrollment form. • The results of each investigation will be reviewed • Mistreatment of Highmark employees and/or by the Senior Markets Sales Department to contractors. determine the appropriate disciplinary action, at which point the producer will be notified of their • Deliberate or negligent omission or falsification of contract status with Highmark. significant information on any company form. Highmark will report any disciplinary action • Sales of a product by any individual other than the that results from an investigation of a complaint licensed producer who presented the product and to CMS in accordance with the CMS Reporting signed the enrollment form. Requirements. Disciplinary action taken could • Accepting any monetary or other rewards, including fall within a broad continuum, from manager- but not limited to rewards for influencing the enrollee’s coaching, documented verbal warning, re-training, choice of physician, medical center or pharmacy. a documented corrective action plan, suspension, • Willful use (with intent to misrepresent) of marketing commission retraction, or termination of material(s) not provided by the company, and therefore employment or contract. not filed with and approved by CMS for use. Highmark will report the termination of any • Rebating or splitting commissions with another person who producers and the reasons for the termination to is not a licensed and contracted producer (i.e., payment the State in which the producer has been appointed of any kind or amount to a member or non-member as in accordance with the State appointment law. reimbursement for a referral name on the condition that the Highmark will make the report available upon CMS’ referred person purchases one of our products). request until further guidance has been issued regarding designated reporting dates to CMS. • Any marketing activity that is a violation of Highmark’s, CMS, or DOI regulations In addition, Highmark will report incidences of submission of applications by unlicensed producers • Marketing or selling Medicare Advantage or Part D products to the authority in the State where the application for the following year prior to the CMS determined Annual was submitted. Enrollment Period (AEP) marketing date.

29 Confidential & Proprietary — For Agent Use Only

SECTION V: Enrollment Process and Eligibility

31 Confidential & Proprietary — For Agent Use Only SECTION V: ENROLLMENT PROCESS AND ELIGIBILITY

Enrollment

Before completing an enrollment application with a beneficiary, you must confirm that the prospect is eligible, i.e., entitled to Medicare Part A and Part B benefits as of the effective date of coverage under the plan. Below are examples of acceptable proof of eligibility: • Copy of Medicare card • Copy of Medicaid award letter for dual-eligible Special Needs Plans • Social Security Administration award notice • Railroad Retirement Board letter of verification • Statement from the Social Security Administration or Railroad Retirement Board verifying the consumer’s Medicare eligibility When you make a presentation to any prospect, be sure to use only current Highmark CMS-approved sales presentation to ensure you’ve covered all required information Once you have completed the application, you may submit it to Highmark via either of the two methods below: 1. Secure Fax: 1-888-663-0258 –– Applications will not be accepted via any other fax number –– Applications must be faxed within 48 hours of receipt. 2. Online through the Highmark Producer Portal – https://producer.highmark.com

What happens next? If the enrollment application is complete, Highmark will submit the complete enrollment application to the Centers for Medicaid and Medicare Services (CMS). CMS will determine approval for requested coverage Once the enrollment application is approved by CMS, the member will receive: • Enrollment Verification Letter • Welcome Kit (mailed within seven days of CMS acceptance) • ID Card (mailing within 10 days of CMS acceptance) If the enrollment application is denied, the member will receive a Denial Letter with the reason for denial. This is mailed within 10 days of the application denial. If the enrollment application is incomplete, Highmark will Reach out to the member and/or agent by phone and/or written communication to obtain the missing information. If the missing information is received within 21 days, or the end of the current month (whichever is later), the enrollment application will be submitted to CMS. CMS will determine approval for the requested coverage. If the missing information is not received in time, the application will be denied.

32 Confidential & Proprietary — For Agent Use Only SECTION VI: Highmark’s Medicare Products Star Ratings

33 Confidential & Proprietary — For Agent Use Only SECTION VI: HIGHMARK MEDICARE PRODUCTS STAR RATINGS

Highmark Medicare Products Star Ratings

The Centers for Medicare & Medicaid Services (CMS) created the Part C & D Star Ratings to provide quality and performance information to Medicare beneficiaries to assist them in choosing their health plan.

What do the Medicare Advantage Star Ratings Really Mean? Each Medicare Advantage contract receives a single Stars Plans offering prescription drug coverage are scored on Rating from CMS annually. A contract is made up of one the quality of many different measures that fall into four or more Product Benefit Plans (PBPs) or simply “plans.” categories: Performance data for members enrolled in those plans 1. Drug Plan Customer Service are collectively used to calculate the contract’s overall –– Star Rating. The Star Rating associated with each plan Includes how well the plan handles member appeals represents the overall contract’s Stars Rating. 2. Member Complaints and Changes in the Drug Plan’s Plans offering access to health services are scored on Performance the quality of many different measures that fall into five –– Includes how often Medicare found problems with categories: the plan and how often members had problems with the plan 1. Staying Healthy: Screenings, Tests, and Vaccines –– –– Includes whether members got various screening Also includes how much the plan’s performance has tests, vaccines, and other check-ups that help them improved (if at all) over time. stay healthy 3. Member Experience with the Plan Drug 2. Managing Chronic (Long-Term) Conditions –– Includes ratings of member satisfaction with the plan –– Includes how often members with different 4. Drug Safety and Accuracy of Drug Pricing conditions got certain tests and treatments that help –– Includes how accurate the plan’s pricing information them manage their condition is and how often members with certain medical 3. Member Experience with the Health Plan conditions are prescribed drugs in a way that is safer and clinically recommended for their condition –– Includes ratings of member satisfaction with the plan 4. Member Complaints and Changes in the Health Plan’s Performance –– Includes how often Medicare found problems with the plan and how often members had problems with the plan –– Also includes how much the plan’s performance has improved (if at all) over time 5. Health Plan Customer Service –– Includes how well the plan handles member appeals

34 Confidential & Proprietary — For Agent Use Only SECTION VI: HIGHMARK MEDICARE PRODUCTS STAR RATINGS

Why Do Star Ratings Matter? How Can You Positively Impact • Achieving strong Star Ratings helps Highmark sustain Star Ratings? choice and affordability for Medicare-eligible customers You are the “face of our plan” and how you portray our in our service area. plans and interact with your clients can positively affect • Our Star Ratings performance reflects our commitment our Star Ratings. Your professionalism and accuracy are and ongoing investment in improving the health care very important to some of the performance categories experience for our members. measured by CMS, especially for the member satisfaction category. You can positively impact these measures • The financial benefit of favorable Star Ratings will by being accurate when you present a plan and by also help us keep a strong and consistent option for encouraging members to use their benefits, complete Medicare Advantage customers. an annual wellness visit, seek appropriate care, complete • Plans that achieve a rating of five stars are considered preventive screening and tests, and adhere to their to be the top quality performers in serving Medicare medications. You must be able to: beneficiaries. Beneficiaries are able to switch into a • Know the benefits you are selling, accurately explain five-star plan at any time throughout the year, once per the plan, and determine the best fit for the consumer. calendar year. This supports the consumer with their plan selection, • Low-performing plans (below three stars) are at risk of strengthens your relationship, and may also help avoid having enrollment blocked by the federal government complaints. or being removed entirely from the Medicare program. • Encourage consumers and members to use their benefits because Star Ratings are influenced by whether Lagging Timeline or not our members obtain specific services, such Star Ratings are not on the typical one-year planning as: receiving annual screenings and preventive care, cycle, where what we do this year impacts next year. visiting their primary care physician (PCP), and properly Instead, the annual Star Ratings reflect performance using their medications (referred to as “medication from two years prior. For example, how we performed in adherence”). calendar year 2018 was used by CMS for our 2019 Star • Reduce the chance that any type of complaint would be Ratings and will determine our payments for 2020. filed by doing what is required in all sales presentations and appointments and lending proper support to your consumers. • Earn high scores on your sales events if you are secret- shopped by mentioning all required statements and showing consumers all required materials. One of the things you are required to cover is information on Star Ratings.

35 Confidential & Proprietary — For Agent Use Only SECTION VI: HIGHMARK MEDICARE PRODUCTS STAR RATINGS

Highmark 2019 Star Ratings1 Highmark Senior Health Company (Freedom Blue PPO and Community Blue Medicare PPO)

Highmark Choice Company (Community Blue Medicare HMO and Security Blue HMO-POS)

HM Health Insurance Company (Blue Rx PDP)

Highmark Senior Solutions Company (Freedom Blue PPO – West Virginia)

Highmark has the largest 4.5 star plans in PA. There are only 63 plans in the United States who have been awarded 4.5 stars, and Highmark has two of these plans.

1 Reference medicare.gov or www.cms.gov/Medicare/Prescription-Drug Coverage/PrescriptionDrugCovGenIn/PerformanceData.html.

36 Confidential & Proprietary — For Agent Use Only SECTION VII: Highmark Senior Markets Medicare Products

37 Confidential & Proprietary — For Agent Use Only SECTION VII: HIGHMARK SENIOR MARKETS MEDICARE PRODUCTS

Overview

What is Medicare? Who is eligible for it, and how does it work? Medicare is health insurance that the U.S. government provides for people over 65, or for some disabled persons. Medicare is made up of four parts – Part A, Part B, Part C, and Part D. Parts A and B comprise what is known as Original Medicare, for which most people are eligible when they turn 65. Part A is automatic. Parts B, C, and D are optional.

Part A Part C Part A is hospital insurance that helps pay for things like Private insurance companies like Highmark offer Part C inpatient hospital stays, skilled nursing care, hospice, and plans, which are called Medicare Advantage. These plans limited home health care. If your prospective client or their act as primary insurance instead of Original Medicare. spouse has worked a minimum of 10 years and paid in at These plans help with the hospital costs, doctor visits, least 40 quarters of Medicare taxes, they are automatically and other medical services that are covered by Original enrolled in Part A with no monthly premium. Medicare. Plus, these plans offer worldwide emergency and urgent care, and many include coverage for Part B prescription drugs, routine vision, hearing, dental, and even gym memberships. Part B is medical insurance that helps pay for doctor visits, outpatient procedures, diagnostic tests, medical supplies, and vaccines. Preventive benefits, like certain screenings Medicare Part D such as mammograms, diabetes, and prostate screenings, Insurance companies like Highmark also offer Medicare are also included. Most people have to sign up for Part B, Part D, and it helps pay for prescription drugs. and it typically comes with a standard monthly premium Each prescription drug plan has a list of generic and that is determined by income. brand-name drugs that are covered by that plan, and that list is called a formulary. Each drug is assigned to a tier, Medigap Plans which determines how much your client will pay for that drug. Highmark has a transition process to accommodate Medicare Supplement plans, also known as Medigap the needs of new enrollees whose current regimens plans, act as secondary insurance to Medicare. Medigap include drugs that are not on the plan’s formulary or those plans are designed to help cover some of the costs not drugs that require prior authorization. You may find the covered by Original Medicare Parts A and B, such as appropriate formulary on the Producer Portal. deductibles, copays, and coinsurance. With Medigap plans, you can also choose any doctor or health care provider who accepts Medicare. Medigap plans don’t cover things like vision, hearing, dental, or long-term care—and they don’t cover prescription drugs (neither do Medicare Parts A and B). That’s where Medicare Part D comes in (see Medicare Part D section).

38 Confidential & Proprietary — For Agent Use Only SECTION VII: HIGHMARK SENIOR MARKETS MEDICARE PRODUCTS

Community Blue Medicare HMO Advantage PPO Network Sharing networks that span counties in 37 states and Puerto Rico, or out of the Community Blue Medicare HMO is a Medicare Advantage network anywhere you may travel. Health Maintenance Organization that covers all Medicare-covered benefits, including preventive care, doctor visits, hospital stays and more. Plus you get added Security Blue HMO-POS benefits like routine dental, vision and hearing care. Security Blue HMO-POS is a plan with point-of-service Community Blue Medicare HMO includes a high-value out-of-network coverage for certain benefits. Security network of select providers, PLUS an enhanced service Blue HMO-POS covers all Medicare-covered benefits, model to assist in finding doctors, making medical including preventive care, doctor visits, hospital stays and appointments and coordinating your health information more. Plus you get added benefits like routine dental, between doctors and hospitals. vision and hearing care. You can choose a plan with Part Community Blue Medicare HMO is a limited network plan. Please verify that D Prescription Drug coverage, giving you access to most the client’s providers are participating before enrolling. If a provider does not participate, neither Medicare nor Community Blue Medicare HMO will be drugs allowed by Medicare. With Security Blue HMO- responsible for the costs. POS, you get all covered care from its large network of providers in 28 counties in western Pennsylvania. Community Blue Medicare PPO/ Plus PPO Medigap Blue Community Blue Medicare PPO is a Medicare Advantage Medigap Blue plans help pay for costs that are not covered Preferred-Provider Organization that gives you coverage by Original Medicare, such as deductibles, coinsurance for every need — health, prescription drugs, routine and copayments. Medigap Blue offers you a choice of dental, vision, hearing and preventive care. Community eight plans — Plan A, B, C, D, F, F High Deductible, G, and Blue Medicare PPO includes a high-value network of N. With Medigap Blue, you have the ability to choose any select providers, PLUS an enhanced service model to assist doctor, specialist or hospital that accepts Medicare — in finding doctors, making medical appointments and with no limitations or no referrals. Like other Medicare coordinating your health information between doctors Supplement plans, Medigap Blue does not come with and hospitals. With Community Blue Medicare PPO, you Part D prescription drug coverage. Please note that you have access to a select network of community doctors cannot enroll in Plans C and F if turning 65 after 1/1/20. and hospitals in 27 counties in western Pennsylvania and In 2019, we added the Whole Health Balance program. 30 counties in north east and central Pennsylvania. Plus This program allows members to add vision, hearing, you also have the additional freedom to travel across the dental, and fitness benefits to their Highmark Medigap United States and find in-network coverage. Blue plan for an additional premium. Community Blue Medicare PPO is a plan with in and out-of-network Medigap Blue Plan B is currently available only in Pennsylvania coverage. UPMC hospitals and physicians are accessible at a higher, out- and Delaware. of-network copay. If your client wants in-network access to Highmark’s full provider network, including UPMC hospitals and physicians, you may wish to consider offering our Security Blue HMO-POS and Freedom Blue PPO Medicare Advantage products. Blue Rx PDP Blue Rx PDP is a stand-alone Medicare Prescription Drug Freedom Blue PPO Plan from HM Health Insurance Company. Both of our Blue Rx PDP plans provide coverage for generic and Freedom Blue PPO is a Medicare Advantage Preferred- brand name drugs allowed by Medicare. A complete Provider Organization that gives you coverage for every list of prescription drugs can be found in the Highmark need — health, prescription drugs, routine dental, vision, Medicare-Approved Formulary. Prescriptions can be filled hearing and preventive care. Freedom Blue PPO allows at more than 58,000 participating retail pharmacies or you to choose where you receive your care, throughout through our home delivery service. the Freedom Blue PPO network and combined Medicare

39 Confidential & Proprietary — For Agent Use Only SECTION VII: HIGHMARK SENIOR MARKETS MEDICARE PRODUCTS

Highmark Medicare Plan Advantages Below is a list of unique advantages that come with a Highmark Medicare plan. Members of certain Highmark Medicare plans have access to special programs and services designed to improve wellness and manage health conditions. Exclusive Highmark Medicare plan membership benefits and services include:

• Highmark Clinical Care Team: This group of medical • Highmark House Call: Once a year, a licensed health professionals works together to help you manage your care provider will come to your client’s home to review health. This collaborative team consists of physicians, their medications, answer health-related questions and pharmacists, social workers, medical case managers, make sure their medical history is current. and disease managers. • People Able to Lend Support (PALS): This volunteer • Blue on CallSM: Highmark’s health coaches are available program provides non-medical assistance to Highmark 24/7 to answer general medical questions. members in need. Volunteers are able to assist with –– Help your clients understand a recent diagnosis, everyday activities such as grocery shopping, household treatment options, or lab tests chores, yard work, light meal preparation, errands, and friendly phone calls or visits. To find out more about this –– Review your client’s symptoms and help them program, please call 1-800-988-0706 between 8:30 a.m. decide where to receive care and 4:30 p.m., Monday – Friday. –– Ensure that your clients are taking medications properly • SilverSneakers®: This benefit provides access to fitness and wellness classes at health clubs across the country –– Provide support for losing weight, managing stress, at no cost. Your clients can get fit, make friends, and live or quitting smoking a healthier, more active life with this program. Clients –– Answer medical questions and provide information will have access to over 14,000 facilities nationwide- To speak to a Health Coach 24 hours a day, seven days a with cardio and weight equipment, pools, saunas, week, call 1-888-258-3428. and exercise classes taught by certified senior fitness instructors. Call 1-888-423-4632 or visit • AIS Home Visit Program: When dealing with a serious SilverSneakers.com to take advantage of this medical condition, we can provide an extra layer of valuable program.* support in your home to help you and your family throughout the course of your illness. Advanced Illness *Benefits vary by plan. Services are available 24 hours a day, seven days a week • Highmark Passport Rewards: With our rewards to help your clients focus on what matters most to program benefits, your clients can earn gift cards them. Learn more about the services provided by the for taking positive actions that promote health and AIS Home Visit Program by contacting 1-877-317-0216. wellbeing.

Pharmacy Network 2020 Updates • Continuing in 2020: Preferred Value Pharmacy Network (PVN) with most major pharmacy chains as well independents. • $0 Tier 1 Generics at Preferred Pharmacies in all 2020 Plans. • PVN will be applied to all direct pay products in 2020 except Western PA Security Blue HMO-POS Standard & Deluxe • Other major pharmacies are included in the PVN, including CVS, Rite Aid, Giant Eagle, Walmart, Sam’s Club, Giant Food, Martin’s, Costco, Weis, and many independent Note: Pharmacy network is subject to change. Refer to highmarkbcbs.com for the most current pharmacy network listing.

40 Confidential & Proprietary — For Agent Use Only SECTION VIII: Regions: Products and Pricing by County

41 Confidential & Proprietary — For Agent Use Only SECTION VIII: REGIONS: PRODUCTS AND PRICING BY COUNTY 1 PIKE BUCKS WAYNE PHILADELPHIA MONROE NORTHAMPTON MONTGOMERY DELAWARE LEHIGH CARBON LACKAWANNA CHESTER WPA BERKS SUSQUEHANNA - WYOMING LUZERNE LANCASTER SCHUYLKILL COLUMBIA LEBANON SULLIVAN BRADFORD NORTH MONTOUR YORK UMBERLAND DAUPHIN LYCOMING & COMPETITIVELY SENSITIVE COMPETITIVELY & UNION SNYDER ADAMS PERRY TIOGA JUNIATA CUMBERLAND MIFFLIN CLINTON FRANKLIN CENTRE POTTER CONFIDENTIAL *Pricing is subject to CMS approval CMS to subject is *Pricing FULTON Medicare HMO HMO Medicare HMO WC HMO HUNTINGDON CAMERON CB BLAIR Community Blue Medicare HMO WC HMO Blue Medicare Community (Products and pricing by county) and pricing by (Products BEDFORD CLEARFIELD ELK n MCKEAN

CAMBRIA Blue JEFFERSON INDIANA SOMERSET FOREST WARREN and Pricing by County by Pricing and CLARION WESTMORELAND ARMSTRONG FAYETTE VENANGO Community Blue Medicare HMO – WPA HMO – Blue Medicare Community BUTLER ERIE HMO SW HMO ALLEGHENY CRAWFORD Community Blue Medicare HMO SW Blue Medicare Community MERCER GREENE CB WASHINGTON BEAVER n CMS is subject to approval *Pricing LAWRENCE Community Availability

42 Confidential & Proprietary — For Agent Use Only

Prestige $0 Copay $20 Copay $30 Copay $30 Copay $25 Copay $225/admit $225/admit $100 Copay $125 Copay SW: $246.00 SW: Not Covered Base (Venture) cataract eyewear. $20 Copay (8 visits) $20 Copay $25 Copay (10 visits) $25 Copay Office/Lab: $0 Copay Office/Lab: $0 Outpatient: $10 Copay Outpatient: ASC: $75 / Facility: $200 Copay ASC: $75 / Facility: with a maximum $250 Allowance. with a maximum $250 Allowance. TruHearing Premium - $799 copay Premium TruHearing Network: $6,700 / Catastrophic: N/A Network: $6,700 / Catastrophic: Covered in Full (Office visit copay may apply) copay visit (Office in Full Covered $0-$25 Copay (Coverage limited to certain to limited conditions) (Coverage $0-$25 Copay coinsurance) Brand (25% coinsurance including 70% discount) (25% coinsurance Brand coinsurance) including 70% discount) (25% coinsurance Brand coinsurance) Exam: $25 Copay (1 Every Year) TruHearing Advanced - $499 copay; Advanced TruHearing Year) (1 Every Exam: $25 Copay Preferred Retail: Tier 1: $0, Tier 2: $13, Tier 3: $45, Tier 4: $95, Tier 5: 33% Tier 4: $95, Tier 3: $45, Tier 2: $13, Tier 1: $0, Tier Retail: Preferred Preferred Mail: Tier 1: $0, Tier 2: $27, Tier 3: $115, Tier 4: $275, Tier 5: 33% Tier 4: $275, Tier 3: $115, Tier 2: $27, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $5, Tier 2: $19, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $19, Tier 1: $5, Tier Retail: Standard Standard Mail: Tier 1: $15, Tier 2: $57, Tier 3: $141, Tier 4: $300, Tier 5: 33% Tier 4: $300, Tier 3: $141, Tier 2: $57, Tier 1: $15, Tier Mail: Standard Standard Retail: Generics: Tier 1 ($5) Generics: Tier 2 ($19) Generics Tiers 3-5 (25% Tiers 2 ($19) Generics Tier 1 ($5) Generics: Tier Retail: Generics: Standard Preferred Retail: Generics: Tier 1 ($0) Generics: Tier 2 ($13) Generics Tiers 3-5 (25% Tiers 2 ($13) Generics Tier 1 ($0) Generics: Tier Retail: Generics: Preferred Office Visit: $15 Copay (1 Every Six Months) X-ray: $15 Copay (1 Every (1 Every X-ray:Copay Six Months) $15 (1 Six Copay Months) Visit: $15 Office are covered in full. A $150 benefit maximum applies to non-standard frames and frames a to non-standard A $150 benefit maximum applies in full. covered are $150 benefit maximum for specialty contact lenses. $200 benefit maximum for post for specialty $200 benefit maximum contact lenses. $150 benefit maximum Exam: $0 Copay (1 Every Year) Standard Eyeglass lenses and frames or contact lenses lenses and frames Eyeglass Standard Year) (1 Every Exam: $0 Copay Restorative Services, Prosthodontics, Other Oral/Maxillofacial Surgery: Services, Prosthodontics, Restorative 50% Coinsurance $0 Copay $40 Copay $45 Copay $90 Copay $50 Copay Part D Drugs 20% Coinsurance 20% Coinsurance Covered in Full IN in Full Covered

$0/day (days 1-20); $178/day (days 21-100) (days 1-20); $178/day (days $0/day Greater of: 5% or $3.60 Gen/Pref. Multi Source or $8.95 for all others or $8.95 for Multi Source of:Greater 5% or $3.60 Gen/Pref.

$0 Copay. Covered only if trip is part of continued acute care after discharge from ER. from only if trip after is part discharge care acute of continued Covered $0 Copay. $0 Copay discount) discount) Signature $30 Copay $40 Copay $35 Copay $30 Copay $295/admit $250 Copay $275 Copay SW/WC: $0.00 $20 Copay (4 visits) $20 Copay (4 visits) $30 Copay Lean (Performance) Lean Office/Lab: $0 Copay Office/Lab: $0 Outpatient: $30 Copay Outpatient: $25 Allowance Quarterly$25 Allowance ASC: $225 / Facility: $275 Copay ASC: $225 / Facility: TruHearing Premium - $999 copay Premium TruHearing Network: $6,700 / Catastrophic: N/A Network: $6,700 / Catastrophic: $425/day (days 1-3), $0/day (days 4-90) (days 1-3), $0/day (days $425/day Covered in Full (Office visit copay may apply) copay visit (Office in Full Covered Coinsurance with a maximum $500 Allowance. with a maximum $500 Allowance. Coinsurance $0-$30 Copay (Coverage limited to certain to limited conditions) (Coverage $0-$30 Copay Exam: $30 Copay (1 Every Year) TruHearing Advanced - $699 copay; Advanced TruHearing Year) (1 Every Exam: $30 Copay Preferred Retail: Tier 1: $0, Tier 2: $5, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $5, Tier 1: $0, Tier Retail: Preferred Preferred Mail: Tier 1: $0, Tier 2: $12, Tier 3: $120, Tier 4: $275, Tier 5: 33% Tier 4: $275, Tier 3: $120, Tier 2: $12, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $7, Tier 2: $15, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $15, Tier 1: $7, Tier Retail: Standard Office Visit: $0 Copay (1 Every Six Months) X-ray: $0 Copay (1 Every Year) Every (1 Every X-ray:Copay $0 (1 Copay Six Months) Visit: $0 Office Standard Mail: Tier 1: $21, Tier 2: $45, Tier 3: $141, Tier 4: $300.00, Tier 5: 33% Tier 4: $300.00, Tier 3: $141, Tier 2: $45, Tier 1: $21, Tier Mail: Standard Standard Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% (25% coinsurance Brand Retail: Generics (25% coinsurance) Standard Preferred Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% (25% coinsurance Brand Retail: Generics (25% coinsurance) Preferred Restorative Services, Prosthodontics, Other Oral/Maxillofacial Surgery, Extractions: Other Oral/Maxillofacial50% Surgery, Services, Prosthodontics, Restorative Exam: $0 Copay (1 Every Year) Standard Eyeglass lenses and frames or contact lenses are lenses and frames Eyeglass Standard Year) (1 Every Exam: $0 Copay maximum for specialty contact lenses. $200 benefit maximum for post cataract eyewear. specialty $200 benefit maximum contact lenses. maximum for covered in full. A $100 benefit maximum applies to non-standard frames and a $100 benefit frames to non-standard A $100 benefit maximum applies in full. covered (Products and pricing by county) and pricing by (Products WPA HMO – Blue Medicare Community

Advanced Imaging Advanced X-Rays Out-of-Pocket Maximum Out-of-Pocket Formulary Outpatient Outpatient Therapy Occupational Mental Health Outpatient Abuse Substance Outpatient Surgical Outpatient Preventive/Screening Therapy & Speech Physical Outpatient Ambulance Routine Dental Monthly Plan Premium Monthly Plan PCP Visit Office Dental - Supplemental Comprehensive Routine Chiropractic Routine Podiatry Generic 1: Preferred Tier 2: Generic Tier 5: Specialty Tier Tier 3: Preferred Brand 3: Preferred Tier Drug 4: Non-Preferred Tier Transportation Emergency Room Care Urgent Inpatient Hospital Stay Lab and Diagnostic Tests Lab and Diagnostic Benefit Fitness Services Telehealth Additional B Drugs Part Routine Vision (Eyewear) Specialist Visit Office 90 up to sharing is for (Mail Cost Order: Initial Coverage supply) Specialty 31 days tier (up to supply except day Gap Coverage $6,350 Threshold: OOP Catastrophic Inpatient Psych Stay Inpatient Psych Skilled Nursing Facility Home Health MedicalDurable Equipment OTC Routine Hearing

43 Confidential & Proprietary — For Agent Use Only 2

SECTION VIII: REGIONS: PRODUCTS AND PRICING BY COUNTY PIKE BUCKS WAYNE MONROE NORTHAMPTON MONTGOMERY DELAWARE PHILADELPHIA LEHIGH CARBON LACKAWANNA CHESTER WPA BERKS SUSQUEHANNA - WYOMING LUZERNE SCHUYLKILL PPO WC LANCASTER COLUMBIA LEBANON CB SULLIVAN NORTH YORK BRADFORD MONTOUR Community Blue Medicare PPO WC PPO Blue Medicare Community UMBERLAND DAUPHIN n

LYCOMING & COMPETITIVELY SENSITIVE COMPETITIVELY & UNION SNYDER ADAMS PERRY TIOGA JUNIATA CUMBERLAND MIFFLIN CLINTON FRANKLIN CENTRE *Pricing is subject to CMS approval CMS to subject is *Pricing POTTER CONFIDENTIAL FULTON HUNTINGDON PPO SW CAMERON BLAIR CB Community Blue Medicare PPO SW Blue Medicare Community (Products and pricing by county) and pricing by (Products BEDFORD CLEARFIELD ELK MCKEAN n CAMBRIA

JEFFERSON INDIANA SOMERSET FOREST WARREN CLARION ARMSTRONG WESTMORELAND FAYETTE Community Blue Medicare PPO - WPA PPO - Blue Medicare Community VENANGO BUTLER ERIE PPO NW ALLEGHENY Community Blue Medicare PPO NW Blue Medicare Community CRAWFORD CB MERCER GREENE LAWRENCE Community Blue Medicare PPO Medicare Blue Community Availability and Pricing by County BEAVER WASHINGTON n CMS is subject to approval *Pricing

44 Confidential & Proprietary — For Agent Use Only

Distinct SW/WC $35.00 (days 4-90) OON (days Network: $5,900 cataract eyewear. $500 allowance OON $500 allowance Catastrophic: $10,000 Catastrophic: $0 Copay IN; $0 Copay OON IN; $0 Copay $0 Copay $30 Copay IN; $30 Copay OON IN; $30 Copay $30 Copay OON IN; $40 Copay $30 Copay $25 Copay IN; $40 Copay OON IN; $40 Copay $25 Copay OON IN; $50 Copay $40 Copay OON IN; $50 Copay $40 Copay OON IN; $50 Copay $45 Copay $20 Copay IN; $30 OON (4 visits) $20 Copay $30 Copay IN; $30 OON (4 visits) $30 Copay $275/admit IN; $350/admit OON $225 Copay IN; $325 Copay OON IN; $325 Copay $225 Copay Emergent/Non-Emergent: $250 IN; Emergent/Non-Emergent: ASC: $200 Copay IN; $350 Copay OON IN; $350 Copay ASC: $200 Copay Non-Emergent: 30% Coinsurance OON 30% Coinsurance Non-Emergent: Facility: $250 Copay IN; $325 Copay OON IN; $325 Copay $250 Copay Facility: Exam:$0 Copay IN; $50 Copay OON (1 Every Year) OON (1 Every IN; $50 Copay Exam:$0 Copay Exam: $30 Copay IN; $30 Copay OON (1 Every Year) OON (1 Every IN; $30 Copay Exam: $30 Copay Covered in Full (Office visit copay may apply) IN/OON copay visit (Office in Full Covered $0-$30 Copay (Coverage limited to certain to IN; limited conditions) (Coverage $0-$30 Copay 30% Coinsurance OON (Coverage limited to certain to limited conditions) OON (Coverage 30% Coinsurance Preferred Retail: Tier 1: $0, Tier 2: $9, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $9, Tier 1: $0, Tier Retail: Preferred $425/day (days 1-3), $0/day (days 4-90) IN; $475/day (days 1-3), $0/day (days 4-90) IN; $475/day (days 1-3), $0/day (days $425/day Preferred Mail: Tier 1: $0, Tier 2: $27, Tier 3: $120, Tier 4: $280, Tier 5: 33% Tier 4: $280, Tier 3: $120, Tier 2: $27, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $7, Tier 2: $20, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $20, Tier 1: $7, Tier Retail: Standard Standard Mail: Tier 1: $21, Tier 2: $60, Tier 3: $141, Tier 4: $300, Tier 5: 33% Tier 4: $300, Tier 3: $141, Tier 2: $60, Tier 1: $21, Tier Mail: Standard TruHearing Advanced - $699 copay; TruHearing Premium - $999 copay IN; - $999 copay Premium TruHearing - $699 copay; Advanced TruHearing OON: A $150 benefit maximum applies to non-standard frames and a $150 frames to non-standard OON: A $150 benefit maximum applies Standard Eyeglass lenses and frames or contact lenses are covered in full. IN/ in full. covered or contact lenses are lenses and frames Eyeglass Standard benefit maximum for specialty contact lenses. $200 benefit maximum for post for specialty $200 benefit maximum contact lenses. benefit maximum

Distinct $90 Copay $50 Copay NW: $35.00 NW: Part D Drugs Network: $5500 (days 4-90) OON (days cataract eyewear. Lean (Performance) Lean $500 allowance OON $500 allowance Catastrophic: $10,000 Catastrophic: $0 Copay IN; $0 Copay OON IN; $0 Copay $0 Copay $25 Copay IN; $25 Copay OON IN; $25 Copay $25 Copay OON IN; $35 Copay $20 Copay $25 Copay IN; $40 Copay OON IN; $40 Copay $25 Copay OON IN; $50 Copay $40 Copay OON IN; $50 Copay $40 Copay OON IN; $50 Copay $45 Copay $20 Copay IN; $25 OON (4 visits) $20 Copay $25 Copay IN; $25 OON (4 visits) $25 Copay $25 Allowance Quarterly$25 Allowance IN/OON $275/admit IN; $350/admit OON $225 Copay IN; $325 Copay OON IN; $325 Copay $225 Copay Emergent/Non-Emergent: $250 IN; Emergent/Non-Emergent: $0 Copay IN; 30% Coinsurance OON IN; 30% Coinsurance $0 Copay ASC: $150 Copay IN; $325 Copay OON IN; $325 Copay ASC: $150 Copay Non-Emergent: 30% Coinsurance OON 30% Coinsurance Non-Emergent: Facility: $225 Copay IN; $325 Copay OON IN; $325 Copay $225 Copay Facility: 20% Coinsurance IN; 30% Coinsurance OON IN; 30% Coinsurance 20% Coinsurance 20% Coinsurance IN; 30% Coinsurance OON IN; 30% Coinsurance 20% Coinsurance Exam:$0 Copay IN; $50 Copay OON (1 Every Year) OON (1 Every IN; $50 Copay Exam:$0 Copay Exam:$25 Copay IN; $25 Copay OON (1 Every Year) OON (1 Every IN; $25 Copay Exam:$25 Copay Covered in Full (Office visit copay may apply) IN/OON copay visit (Office in Full Covered $0-$25 Copay (Coverage limited to certain to IN; limited conditions) (Coverage $0-$25 Copay 30% Coinsurance OON (Coverage limited to certain to limited conditions) OON (Coverage 30% Coinsurance Greater of: 5% or $3.60 Gen/Pref. Multi Source or $8.95 for all others or $8.95 for Multi Source of:Greater 5% or $3.60 Gen/Pref. $0/day (days 1-20); $178/day (days 21-100) IN; 30% Coinsurance OON 21-100) IN; 30% Coinsurance (days 1-20); $178/day (days $0/day Preferred Retail: Tier 1: $0, Tier 2: $9, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $9, Tier 1: $0, Tier Retail: Preferred $425/day (days 1-3), $0/day (days 4-90) IN; $475/day (days 1-3), $0/day (days 4-90) IN; $475/day (days 1-3), $0/day (days $425/day Preferred Mail: Tier 1: $0, Tier 2: $27, Tier 3: $120, Tier 4: $280, Tier 5: 33% Tier 4: $280, Tier 3: $120, Tier 2: $27, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $7, Tier 2: $20, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $20, Tier 1: $7, Tier Retail: Standard Standard Mail: Tier 1: $21, Tier 2: $60, Tier 3: $141, Tier 4: $300, Tier 5: 33% Tier 4: $300, Tier 3: $141, Tier 2: $60, Tier 1: $21, Tier Mail: Standard TruHearing Advanced - $699 copay; TruHearing Premium - $999 copay IN; - $999 copay Premium TruHearing - $699 copay; Advanced TruHearing Covered in Full IN; 50% Coinsurance after a $500 Deductible satisfying OON IN; 50% Coinsurance in Full Covered OON: A $150 benefit maximum applies to non-standard frames and a $150 frames to non-standard OON: A $150 benefit maximum applies Standard Eyeglass lenses and frames or contact lenses are covered in full. IN/ in full. covered or contact lenses are lenses and frames Eyeglass Standard benefit maximum for specialty contact lenses. $200 benefit maximum for post for specialty $200 benefit maximum contact lenses. benefit maximum Office/Lab: $0 Copay IN; $35 Copay OON / Outpatient:$25 Copay IN; $35 Copay OON Copay IN; $35 Copay OON / Outpatient:$25 Copay IN; $35 Copay Office/Lab: $0 Standard Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% discount) (25% coinsurance Brand Retail: Generics Standard (25% coinsurance) Preferred Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% discount) (25% coinsurance Brand Retail: Generics (25% coinsurance) Preferred

$0 Copay IN; 30% Coinsurance OON. Covered only if trip is part of continued acute care after discharge from ER. from only if trip after is part discharge care acute of continued OON. Covered IN; 30% Coinsurance $0 Copay

Office: $15 Copay IN; 30% Coinsurance OON (1 Every Six Months) / X-ray: $15 Copay IN; 30% Coinsurance OON (1 Every Year) Every OON (1 Coinsurance IN; 30% Every Copay X-ray: $15 OON (1 Six / Coinsurance Months) IN; 30% Copay Office: $15

Restorative Services, Prosthodontics, Other Oral/Maxillofacial Surgery, Extractions: 50% Coinsurance with a maximum $750 Allowance IN/OON. with a maximum $750 Allowance Extractions: Other 50% Coinsurance Oral/Maxillofacial Surgery, Services, Prosthodontics, Restorative

NW: $0.00 NW: Signature (days 4-90) OON (days Network: $5,750 cataract eyewear. $500 allowance OON $500 allowance Catastrophic: $10,000 Catastrophic: $0 Copay IN; $0 Copay OON IN; $0 Copay $0 Copay $30 Copay IN; $30 Copay OON IN; $30 Copay $30 Copay OON IN; $35 Copay $20 Copay $30 Copay IN; $50 Copay OON IN; $50 Copay $30 Copay OON IN; $60 Copay $40 Copay OON IN; $60 Copay $40 Copay OON IN; $60 Copay $45 Copay $20 Copay IN; $30 OON (4 visits) $20 Copay $30 Copay IN; $30 OON (4 visits) $30 Copay $275/admit IN; $325/admit OON $250 Copay IN; $300 Copay OON IN; $300 Copay $250 Copay Emergent/Non-Emergent: $275 IN; Emergent/Non-Emergent: ASC: $175 Copay; $325 Copay OON ASC: $175 Copay; $325 Copay Non-Emergent: 30% Coinsurance OON 30% Coinsurance Non-Emergent: Facility: $250 Copay IN; $350 Copay OON IN; $350 Copay $250 Copay Facility: Exam: $0 Copay IN; $50 Copay OON (1 Every Year) OON (1 Every IN; $50 Copay Exam: $0 Copay Exam:$30 Copay IN; $30 Copay OON (1 Every Year) OON (1 Every IN; $30 Copay Exam:$30 Copay Covered in Full (Office visit copay may apply) IN/OON copay visit (Office in Full Covered $0-$30 Copay (Coverage limited to certain to limited IN; conditions) (Coverage $0-$30 Copay 30% Coinsurance OON (Coverage limited to certain to limited conditions) OON (Coverage 30% Coinsurance Preferred Retail: Tier 1: $0, Tier 2: $5, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $5, Tier 1: $0, Tier Retail: Preferred $425/day (days 1-3), $0/day (days 4-90) IN; $500/day (days 1-3), $0/day (days 4-90) IN; $500/day (days 1-3), $0/day (days $425/day Preferred Mail: Tier 1: $0, Tier 2: $12, Tier 3: $120, Tier 4: $275, Tier 5: 33% Tier 4: $275, Tier 3: $120, Tier 2: $12, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $7, Tier 2: $15, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $15, Tier 1: $7, Tier Retail: Standard Standard Mail: Tier 1: $21, Tier 2: $45, Tier 3: $141, Tier 4: $300, Tier 5: 33% Tier 4: $300, Tier 3: $141, Tier 2: $45, Tier 1: $21, Tier Mail: Standard TruHearing Advanced - $699 copay; TruHearing Premium - $999 copay IN; - $999 copay Premium TruHearing - $699 copay; Advanced TruHearing OON: A $150 benefit maximum applies to non-standard frames and a $150 frames to non-standard OON: A $150 benefit maximum applies Standard Eyeglass lenses and frames or contact lenses are covered in full. IN/ in full. covered or contact lenses are lenses and frames Eyeglass Standard benefit maximum for specialty contact lenses. $200 benefit maximum for post for specialty $200 benefit maximum contact lenses. benefit maximum (Products and pricing by county) and pricing by (Products WPA PPO – Blue Medicare Community

Coverage Gap Coverage $6,350 Threshold: OOP Catastrophic Initial Coverage (Mail Order: Cost sharing is for up to 90 day up to sharing is for (Mail Cost Order: Initial Coverage supply)) Specialty 31 days tier (up to supply except Formulary Generic 1: Preferred Tier Monthly Plan Premium Monthly Plan Maximum Out-of-Pocket PCP Visit Office Specialist Visit Office Tests Lab and Diagnostic X-Rays Imaging Advanced Preventive/Screening Therapy & Speech Physical Outpatient Outpatient Therapy Occupational Mental Health Outpatient Abuse Substance Outpatient Surgical Outpatient Skilled Nursing Facility Home Health MedicalDurable Equipment OTC Benefit Fitness Services Telehealth Additional Part B Drugs Part Routine Vision (Eyewear) Ambulance Transportation Emergency Room Care Urgent Inpatient Hospital Stay Stay Inpatient Psych Tier 2: Generic Tier Brand 3: Preferred Tier Drug 4: Non-Preferred Tier 5: Specialty Tier Routine Dental Dental - Supplemental Comprehensive Routine Chiropractic Routine Podiatry Routine Hearing

45 Confidential & Proprietary — For Agent Use Only SECTION VIII: REGIONS: PRODUCTS AND PRICING BY COUNTY 3 PIKE BUCKS WAYNE PHILADELPHIA MONROE NORTHAMPTON MONTGOMERY DELAWARE LEHIGH CARBON LACKAWANNA CHESTER Community Blue Medicare HMO North/East Blue Medicare Community

BERKS CPA/NEPA SUSQUEHANNA n WYOMING LUZERNE LANCASTER SCHUYLKILL COLUMBIA LEBANON SULLIVAN BRADFORD NORTH MONTOUR YORK UMBERLAND DAUPHIN LYCOMING UNION SNYDER ADAMS PERRY TIOGA & COMPETITIVELY SENSITIVE COMPETITIVELY & JUNIATA CUMBERLAND MIFFLIN CLINTON FRANKLIN CENTRE POTTER Community Blue Medicare HMO Harrisburg HMO Harrisburg Blue Medicare Community

n FULTON HUNTINGDON CONFIDENTIAL *Pricing is subject to CMS approval CMS to subject is *Pricing Medicare HMO – HMO Medicare CAMERON BLAIR (Products and pricing by county) and pricing by (Products BEDFORD CLEARFIELD ELK MCKEAN CAMBRIA JEFFERSON INDIANA SOMERSET FOREST WARREN CLARION and Pricing by County by Pricing and WESTMORELAND ARMSTRONG FAYETTE VENANGO BUTLER ERIE ALLEGHENY Community Blue Medicare HMO Lehigh Valley Valley HMO Lehigh Blue Medicare Community CRAWFORD Community Blue Medicare HMO – CPA/NEPA Blue Medicare Community

MERCER GREENE WASHINGTON BEAVER n *Pricing is subject to CMS is subject to approval *Pricing 2020 expansion county LAWRENCE Community Blue Availability 1

46 Confidential & Proprietary — For Agent Use Only

$0 Copay Signature $25 Copay $30 Copay $25 Copay $40 Copay $40 Copay $45 Copay $295/admit $225 Copay $200 Copay $275 Copay $295 Copay 20% Coinsurance Covered in Full IN in Full Covered $20 Copay (4 visits) $20 Copay $25 Copay (4 visits) $25 Copay Lean (Performance) Lean Lehigh Valley: Valley: Lehigh $0.00 2 Hearing Aids Every Year 2 Hearing Every Aids $100 Allowance Quarterly$100 Allowance X-ray: $0 Copay (1 Every Year) (1 Every $0 Copay X-ray: Exam: $0 Copay (1 Every Year) (1 Every Exam: $0 Copay Network: $5,900 / Catastrophic: N/A Network: $5,900 / Catastrophic: Office Visit: $0 Copay (1 Every (1 Copay Six Months) Visit: $0 Office Covered in Full (Office visit copay may apply) copay visit (Office in Full Covered Coinsurance with a maximum $2000 Allowance. with a maximum $2000 Allowance. Coinsurance $0-$25 Copay (Coverage limited to certain to limited conditions) (Coverage $0-$25 Copay TruHearing Advanced - $699 copay TruHearing Premium - $999 copay Premium TruHearing - $699 copay Advanced TruHearing Preferred Retail: Tier 1: $0, Tier 2: $5, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $5, Tier 1: $0, Tier Retail: Preferred Preferred Mail: Tier 1: $0, Tier 2: $12, Tier 3: $120, Tier 4: $275, Tier 5: 33% Tier 4: $275, Tier 3: $120, Tier 2: $12, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $7, Tier 2: $15, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $15, Tier 1: $7, Tier Retail: Standard Standard Mail: Tier 1: $21, Tier 2: $45, Tier 3: $141, Tier 4: $300, Tier 5: 33% Tier 4: $300, Tier 3: $141, Tier 2: $45, Tier 1: $21, Tier Mail: Standard for specialty contact lenses. $200 benefit maximum for post cataract eyewear. specialty $200 benefit maximum contact lenses. for Restorative Services, Prosthodontics, Other Oral/Maxillofacial Surgery, Extractions: Other 50% Oral/Maxillofacial Surgery, Services, Prosthodontics, Restorative Standard Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% discount) (25% coinsurance Brand Retail: Generics (25% coinsurance) Standard Preferred Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% discount) (25% coinsurance Brand Retail: Generics (25% coinsurance) Preferred in full. A $150 benefit maximum applies to non-standard frames and a $150 benefit maximum frames to non-standard A $150 benefit maximum applies in full. Exam: $0 Copay (1 Every Year) Standard Eyeglass lenses and frames or contact lenses are covered covered or contact lenses are lenses and frames Eyeglass Standard Year) (1 Every Exam: $0 Copay $0 Copay $90 Copay $50 Copay Part D Drugs 20% Coinsurance $425/day (days 1-3), $0/day (days 4-90) (days 1-3), $0/day (days $425/day $0/day (days 1-20); $178/day (days 21-100) (days 1-20); $178/day (days $0/day Office/Lab: $0 Copay / Outpatient: $30 Copay $30 / Outpatient: Copay Office/Lab: $0 Greater of: 5% or $3.60 Gen/Pref. Multi Source or $8.95 for all others or $8.95 for Multi Source of:Greater 5% or $3.60 Gen/Pref.

$0 Copay. Covered only if trip is part of continued acute care after discharge from ER. from only if trip after is part discharge care acute of continued Covered $0 Copay. $0 Copay Signature $20 Copay $20 Copay $30 Copay $40 Copay $40 Copay $45 Copay $250/admit $225 Copay $125 Copay $175 Copay $250 Copay Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered 20% Coinsurance Exam: Not Covered Lean (Performance) Lean Harrisburg: $0.00 / North/East:Harrisburg: $0.00 Network: $5,500 / Catastrophic: N/A Network: $5,500 / Catastrophic: Covered in Full (Office visit copay may apply) copay visit (Office in Full Covered $200 benefit maximum for post cataract eyewear. $200 benefit maximum $0-$20 Copay (Coverage limited to certain to limited conditions) (Coverage $0-$20 Copay Preferred Retail: Tier 1: $0, Tier 2: $5, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $5, Tier 1: $0, Tier Retail: Preferred Preferred Mail: Tier 1: $0, Tier 2: $12, Tier 3: $120, Tier 4: $275, Tier 5: 33% Tier 4: $275, Tier 3: $120, Tier 2: $12, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $7, Tier 2: $15, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $15, Tier 1: $7, Tier Retail: Standard Standard Mail: Tier 1: $21, Tier 2: $45, Tier 3: $141, Tier 4: $300, Tier 5: 33% Tier 4: $300, Tier 3: $141, Tier 2: $45, Tier 1: $21, Tier Mail: Standard Standard Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% discount) (25% coinsurance Brand Retail: Generics Standard (25% coinsurance) Preferred Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% discount) (25% coinsurance Brand Retail: Generics (25% coinsurance) Preferred (Products and pricing by county) and pricing by (Products HMO – CPA/NEPA Blue Medicare Community

Outpatient Physical & Speech Therapy & Speech Physical Outpatient PCP Visit Office Specialist Visit Office Tests Lab and Diagnostic X-Rays Imaging Advanced Preventive/Screening Outpatient Therapy Occupational Mental Health Outpatient Abuse Substance Outpatient (ASC) Surgical Outpatient (Facility) Surgical Outpatient Ambulance Transportation Emergency Room Care Urgent Inpatient Hospital Stay Inpatient Psych Stay Inpatient Psych Skilled Nursing Facility Home Health MedicalDurable Equipment OTC Benefit Fitness Coverage Gap Coverage Catastrophic OOP Threshold: $6,350 Threshold: OOP Catastrophic Out-of-Pocket Maximum Out-of-Pocket Additional Telehealth Services Telehealth Additional Part B Drugs Part Routine Vision Routine Vision (Eyewear) Initial Coverage (Mail Order: Cost sharing is for up to 90 day up to sharing is for (Mail Cost Order: Initial Coverage supply)) Specialty 31 days tier (up to supply except Routine Dental Comprehensive Dental - Supplemental Comprehensive Routine Chiropractic Monthly Plan Premium Monthly Plan Tier 2: Generic Tier Brand 3: Preferred Tier Drug 4: Non-Preferred Tier 5: Specialty Tier Routine Hearing Routine Podiatry Formulary Generic 1: Preferred Tier

47 Confidential & Proprietary — For Agent Use Only SECTION VIII: REGIONS: PRODUCTS AND PRICING BY COUNTY 4 PIKE BUCKS WAYNE PHILADELPHIA MONROE NORTHAMPTON MONTGOMERY DELAWARE LEHIGH CARBON LACKAWANNA CHESTER BERKS SUSQUEHANNA Community Blue Medicare PPO North/East Blue Medicare Community CPA/NEPA WYOMING LUZERNE n –

LANCASTER SCHUYLKILL COLUMBIA LEBANON SULLIVAN BRADFORD NORTH MONTOUR YORK UMBERLAND DAUPHIN LYCOMING UNION SNYDER ADAMS PERRY TIOGA & COMPETITIVELY SENSITIVE COMPETITIVELY & JUNIATA CUMBERLAND MIFFLIN CLINTON FRANKLIN CENTRE POTTER Community Blue Medicare PPO Harrisburg Blue Medicare Community FULTON HUNTINGDON CONFIDENTIAL *Pricing is subject to CMS approval CMS to subject is *Pricing n Medicare PPO Medicare CAMERON BLAIR

(Products and pricing by county) and pricing by (Products BEDFORD CLEARFIELD ELK MCKEAN CAMBRIA JEFFERSON INDIANA SOMERSET FOREST WARREN CLARION and Pricing by County by Pricing and WESTMORELAND ARMSTRONG FAYETTE VENANGO BUTLER ERIE Community Blue Medicare PPO – CPA/NEPA Blue Medicare Community ALLEGHENY CRAWFORD Community Blue Medicare PPO Lehigh Valley PPO Lehigh Blue Medicare Community MERCER GREENE WASHINGTON BEAVER n *Pricing is subject to CMS is subject to approval *Pricing 2020 expansion county LAWRENCE Community Blue Availability 1

48 Confidential & Proprietary — For Agent Use Only

Distinct Lean (Performance) Lean $500 allowance OON $500 allowance $0 Copay IN; $0 Copay OON IN; $0 Copay $0 Copay $30 Copay IN; $30 Copay OON IN; $30 Copay $30 Copay $30 Copay IN; $40 Copay OON IN; $40 Copay $30 Copay OON IN; $40 Copay $25 Copay OON IN; $50 Copay $40 Copay OON IN; $50 Copay $40 Copay OON IN; $50 Copay $45 Copay $20 Copay IN; $30 OON (4 visits) $20 Copay IN; $30 OON (4 visits) $30 Copay $325/admit IN; $375/admit OON $225 Copay IN; $300 Copay OON IN; $300 Copay $225 Copay OON IN; $325 Copay $200 Copay OON IN; $325 Copay $275 Copay Emergent/Non-Emergent: $250 IN; Emergent/Non-Emergent: Non-Emergent: 30% Coinsurance OON 30% Coinsurance Non-Emergent: Office/Lab: $0 Copay IN; $40 Copay OON Copay IN; $40 Copay Office/Lab: $0 Network: $5,900 / Catastrophic: $10,000 Network: $5,900 / Catastrophic: Outpatient: $30 Copay IN; $40 Copay OON IN; $40 Copay $30 Copay Outpatient: Exam: $0 Copay IN; $50 Copay OON (1 Every Year) OON (1 Every IN; $50 Copay Exam: $0 Copay Covered in Full (Office visit copay may apply) IN/OON copay visit (Office in Full Covered Coinsurance with a maximum $2000 Allowance IN/OON. with a maximum $2000 Allowance Coinsurance X-ray: $15 Copay IN; 30% Coinsurance OON (1 Every Year) OON (1 Every IN; 30% Coinsurance $15 Copay X-ray: $0-$30 Copay (Coverage limited to certain to IN; limited conditions) (Coverage $0-$30 Copay 30% Coinsurance OON (Coverage limited to certain to limited conditions) OON (Coverage 30% Coinsurance Lehigh Valley: $35.00 / Harrisburg: $35.00 / North/East: $35.00 / Harrisburg: Valley: $35.00 Lehigh contact lenses. $200 benefit maximum for post cataract eyewear. $200 benefit maximum contact lenses. Office Visit: $15 Copay IN; 30% Coinsurance OON (1 Every OON (1 Six Coinsurance Months) IN; 30% Copay Visit: $15 Office Preferred Retail: Tier 1: $0, Tier 2: $5, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $5, Tier 1: $0, Tier Retail: Preferred Preferred Mail: Tier 1: $0, Tier 2: $12, Tier 3: $120, Tier 4: $275, Tier 5: 33% Tier 4: $275, Tier 3: $120, Tier 2: $12, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $7, Tier 2: $15, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $15, Tier 1: $7, Tier Retail: Standard Standard Mail: Tier 1: $21, Tier 2: $45, Tier 3: $141, Tier 4: $300, Tier 5: 33% Tier 4: $300, Tier 3: $141, Tier 2: $45, Tier 1: $21, Tier Mail: Standard TruHearing Advanced - $699 copay; TruHearing Premium - $999 copay IN; - $999 copay Premium TruHearing - $699 copay; Advanced TruHearing Exam: $30 Copay IN; $30 Copay OON (1 Every Year); 2 Hearing Aids Every Year 2 Hearing Every Aids Year); OON (1 Every IN; $30 Copay Exam: $30 Copay Restorative Services, Prosthodontics, Other Oral/Maxillofacial Surgery, Extractions: Other 50% Oral/Maxillofacial Surgery, Services, Prosthodontics, Restorative $425/day (days 1-3), $0/day (days 4-90) IN; $475/day (days 1-3), $0/day (days 4-90) OON (days 1-3), $0/day (days 4-90) IN; $475/day (days 1-3), $0/day (days $425/day Standard Eyeglass lenses and frames or contact lenses are covered in full. IN/OON: A $150 in full. covered or contact lenses are lenses and frames Eyeglass Standard benefit maximum applies to non-standard frames and a $150 benefit maximum for specialty and a $150 benefit maximum frames to non-standard benefit maximum applies Standard Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% discount) (25% coinsurance Brand Retail: Generics Standard (25% coinsurance) Preferred Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% discount) (25% coinsurance Brand Retail: Generics (25% coinsurance) Preferred $90 Copay $50 Copay

$75 Allowance Quarterly$75 Allowance IN/OON $0 Copay IN; 30% Coinsurance OON IN; 30% Coinsurance $0 Copay

20% Coinsurance IN; 30% Coinsurance OON IN; 30% Coinsurance 20% Coinsurance 20% Coinsurance IN; 30% Coinsurance OON IN; 30% Coinsurance 20% Coinsurance

Greater of: 5% or $3.60 Gen/Pref. Multi Source or $8.95 for all others or $8.95 for Multi Source of:Greater 5% or $3.60 Gen/Pref. $0/day (days 1-20); $178/day (days 21-100) IN; 30% Coinsurance OON 21-100) IN; 30% Coinsurance (days 1-20); $178/day (days $0/day Covered in Full IN; 50% Coinsurance after a $500 Deductible satisfying OON IN; 50% Coinsurance in Full Covered Signature $0 Copay IN; 30% Coinsurance OON. Covered only if trip is part of continued acute care after discharge from ER. from only if trip after is part discharge care acute of continued OON. Covered IN; 30% Coinsurance $0 Copay Lean (Performance) Lean $500 allowance OON $500 allowance $0 Copay IN; $0 Copay OON IN; $0 Copay $0 Copay $35 Copay IN; $35 Copay OON IN; $35 Copay $35 Copay $40 Copay IN; $60 Copay OON IN; $60 Copay $40 Copay OON IN; $60 Copay $40 Copay $40 Copay IN; $60 Copay OON IN; $60 Copay $40 Copay OON IN; $60 Copay $40 Copay OON IN; $60 Copay $45 Copay $20 Copay IN; $35 OON (4 visits) $20 Copay $35 Copay IN; $35 OON (4 visits) $35 Copay $270 Copay IN; $370 Copay OON IN; $370 Copay $270 Copay OON IN; $425 Copay $275 Copay OON IN; $425 Copay $325 Copay Emergent/Non-Emergent: $295 IN; Emergent/Non-Emergent: Non-Emergent: 30% Coinsurance OON 30% Coinsurance Non-Emergent: Office/Lab: $0 Copay IN; $40 Copay OON Copay IN; $40 Copay Office/Lab: $0 Network: $6,700 / Catastrophic: $10,000 Network: $6,700 / Catastrophic: Outpatient: $30 Copay IN; $40 Copay OON IN; $40 Copay $30 Copay Outpatient: Exam: $0 Copay IN; $50 Copay OON (1 Every Year) Year) OON (1 Every IN; $50 Copay Exam: $0 Copay Covered in Full (Office visit copay may apply) IN/OON copay visit (Office in Full Covered Coinsurance with a maximum $2000 Allowance IN/OON. with a maximum $2000 Allowance Coinsurance X-ray: $15 Copay IN; 30% Coinsurance OON (1 Every Year) OON (1 Every IN; 30% Coinsurance $15 Copay X-ray: $0-$35 Copay (Coverage limited to certain to IN; limited conditions) (Coverage $0-$35 Copay $395/admit IN; $225/day (days 1-7), $0/day (days 8-90) OON (days 1-7), $0/day (days $395/admit IN; $225/day Lehigh Valley: $0.00 / Harrisburg: $0.00 / North/East: $0.00 / Harrisburg: Valley: $0.00 Lehigh 30% Coinsurance OON (Coverage limited to certain to limited conditions) OON (Coverage 30% Coinsurance contact lenses. $200 benefit maximum for post cataract eyewear. $200 benefit maximum contact lenses. Office Visit: $15 Copay IN; 30% Coinsurance OON (1 Every OON (1 Six Coinsurance Months) IN; 30% Copay Visit: $15 Office Preferred Retail: Tier 1: $0, Tier 2: $5, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $5, Tier 1: $0, Tier Retail: Preferred Preferred Mail: Tier 1: $0, Tier 2: $12, Tier 3: $120, Tier 4: $275, Tier 5: 33% Tier 4: $275, Tier 3: $120, Tier 2: $12, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $7, Tier 2: $15, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $15, Tier 1: $7, Tier Retail: Standard Standard Mail: Tier 1: $21, Tier 2: $45, Tier 3: $141, Tier 4: $300, Tier 5: 33% Tier 4: $300, Tier 3: $141, Tier 2: $45, Tier 1: $21, Tier Mail: Standard TruHearing Advanced - $699 copay; TruHearing Premium - $999 copay IN; - $999 copay Premium TruHearing - $699 copay; Advanced TruHearing Exam: $35 Copay IN; $35 Copay OON (1 Every Year); 2 Hearing Aids Every Year; Year; 2 Hearing Every Aids Year); OON (1 Every IN; $35 Copay Exam: $35 Copay Restorative Services, Prosthodontics, Other Oral/Maxillofacial Surgery, Extractions: Other 50% Oral/Maxillofacial Surgery, Services, Prosthodontics, Restorative $425/day (days 1-3), $0/day (days 4-90) IN; $500/day (days 1-3), $0/day (days 4-90) OON (days 1-3), $0/day (days 4-90) IN; $500/day (days 1-3), $0/day (days $425/day Standard Eyeglass lenses and frames or contact lenses are covered in full. IN/OON: A $100 in full. covered or contact lenses are lenses and frames Eyeglass Standard benefit maximum applies to non-standard frames and a $100 benefit maximum for specialty and a $100 benefit maximum frames to non-standard benefit maximum applies Standard Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% discount) (25% coinsurance Brand Retail: Generics Standard (25% coinsurance) Preferred Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% discount) (25% coinsurance Brand Retail: Generics (25% coinsurance) Preferred (Products and pricing by county) and pricing by (Products PPO – CPA/NEPA Blue Medicare Community

Catastrophic OOP Threshold: $6,350 Threshold: OOP Catastrophic Monthly Plan Premium Monthly Plan Maximum Out-of-Pocket Specialist Visit Office Tests Lab and Diagnostic PCP Visit Office Tier 2: Generic Tier Brand 3: Preferred Tier Drug 4: Non-Preferred Tier 5: Specialty Tier Initial Coverage (Mail Order: Cost sharing is for up to 90 day up to sharing is for (Mail Cost Order: Initial Coverage supply)) Specialty 31 days tier (up to supply except Coverage Gap Coverage Routine Hearing Routine Chiropractic Part B Drugs Part Routine Vision (Eyewear) Routine Podiatry Formulary Generic 1: Preferred Tier Comprehensive Dental - Supplemental Comprehensive X-Rays Therapy & Speech Physical Outpatient Advanced Imaging Advanced Preventive/Screening Outpatient Therapy Occupational Mental Health Outpatient Abuse Substance Outpatient (ASC) Surgical Outpatient (Facility) Surgical Outpatient Ambulance Skilled Nursing Facility Home Health MedicalDurable Equipment OTC Benefit Fitness Services Telehealth Additional Transportation Emergency Room Care Urgent Inpatient Hospital Stay Stay Inpatient Psych Routine Dental

49 Confidential & Proprietary — For Agent Use Only SECTION VIII: REGIONS: PRODUCTS AND PRICING BY COUNTY 5 Lancaster - PIKE BUCKS WAYNE PHILADELPHIA MONROE NORTHAMPTON MONTGOMERY DELAWARE LEHIGH CARBON LACKAWANNA CHESTER BERKS SUSQUEHANNA WYOMING LUZERNE LANCASTER SCHUYLKILL COLUMBIA LEBANON SULLIVAN BRADFORD NORTH MONTOUR YORK UMBERLAND DAUPHIN LYCOMING & COMPETITIVELY SENSITIVE COMPETITIVELY & UNION SNYDER ADAMS PERRY TIOGA JUNIATA CUMBERLAND MIFFLIN CLINTON FRANKLIN CENTRE POTTER CONFIDENTIAL *Pricing is subject to CMS approval CMS to subject is *Pricing Medicare HMO and PPO and HMO Medicare FULTON HUNTINGDON Community Blue Medicare PPO Lancaster Blue Medicare Community CAMERON n BLAIR

(Products and pricing by county) and pricing by (Products BEDFORD CLEARFIELD ELK MCKEAN Blue CAMBRIA JEFFERSON INDIANA SOMERSET FOREST WARREN and Pricing by County by Pricing and CLARION WESTMORELAND ARMSTRONG FAYETTE VENANGO BUTLER ERIE ALLEGHENY CRAWFORD Community Blue Medicare HMO Lancaster Blue Medicare Community MERCER GREENE CB HMO Lancaster WASHINGTON BEAVER Community Availability *Pricing is subject to CMS is subject to approval *Pricing n LAWRENCE Community Blue Medicare HMO and PPO - Lancaster Blue Medicare Community

50 Confidential & Proprietary — For Agent Use Only OON OON

Coinsuranc %

IN; ) conditions

$35.00 certain $0 Copay Distinct PPO to ed after discharge from ER. from after discharge limit $45 Copay IN; $50 Copay OON IN; $50 Copay $45 Copay $40 Copay IN; $50 Copay OON IN; $50 Copay $40 Copay $25 Copay IN; $25 Copay OON IN; $25 Copay $25 Copay $30 Copay IN; $50 Copay OON IN; $50 Copay $30 Copay $25 Copay IN; $35 Copay OON IN; $35 Copay $25 Copay $25 Copay IN; $50 Copay OON IN; $50 Copay $25 Copay

$20 Copay IN; $25 OON (4 visits) $20 Copay IN; $25 OON (4 visits) $25 Copay $275/admit IN; $325/admit OON $200 Copay IN; $325 Copay OON IN; $325 Copay $200 Copay OON IN; $325 Copay $275 Copay $175 Copay IN; $275 Copay OON IN; $275 Copay $175 Copay $75 Allowance Quarterly$75 Allowance IN/OON Emergent/Non-Emergent: $250 IN; Emergent/Non-Emergent: $0 Copay IN; 30% Coinsurance OON IN; 30% Coinsurance $0 Copay $999 copay IN; $500 allowance OON IN; $500 allowance $999 copay Non-Emergent: 30% Coinsurance OON 30% Coinsurance Non-Emergent: Lab/Office: $0 Copay IN; $35 Copay OON Copay IN; $35 Copay Lab/Office: $0 Network: $5,900 / Catastrophic: $10,000 Network: $5,900 / Catastrophic: Outpatient: $30 Copay IN; $35 Copay OON IN; $35 Copay $30 Copay Outpatient: 20% Coinsurance IN; 30% Coinsurance OON IN; 30% Coinsurance 20% Coinsurance 20% Coinsurance IN; 30% Coinsurance OON IN; 30% Coinsurance 20% Coinsurance Covered in Full (Office visit copay may apply) copay visit (Office in Full Covered Exam: $0 Copay IN; $50 Copay OON (1 Every Year) OON (1 Every IN; $50 Copay Exam: $0 Copay Exam: $25 Copay IN; $25 Copay OON (1 Every Year) OON (1 Every IN; $25 Copay Exam: $25 Copay (Coverage y X-ray:$0 Copay IN; 30% Coinsurance OON (1 Every Year) OON (1 Every IN; 30% Coinsurance Copay X-ray:$0 Coinsurance with a maximum $2000 Allowance IN/OON. with a maximum $2000 Allowance Coinsurance Copa Greater of: 5% or $3.60 Gen/Pref. Multi Source or $8.95 for all others or $8.95 for Multi Source of:Greater 5% or $3.60 Gen/Pref. Office Visit: $0 Copay IN; 30% Coinsurance OON (1 Every OON (1 Six Coinsurance Months) IN; 30% Copay Visit: $0 Office 5 $0/day (days 1-20); $178/day (days 21-100) IN; 30% Coinsurance OON 21-100) IN; 30% Coinsurance (days 1-20); $178/day (days $0/day Preferred Retail: Tier 1: $0, Tier 2: $5, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $5, Tier 1: $0, Tier Retail: Preferred Preferred Mail: Tier 1: $0, Tier 2: $12, Tier 3: $120, Tier 4: $275, Tier 5: 33% Tier 4: $275, Tier 3: $120, Tier 2: $12, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $7, Tier 2: $15, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $15, Tier 1: $7, Tier Retail: Standard Standard Mail: Tier 1: $21, Tier 2: $45, Tier 3: $141, Tier 4: $300, Tier 5: 33% Tier 4: $300, Tier 3: $141, Tier 2: $45, Tier 1: $21, Tier Mail: Standard Covered in Full IN; 50% Coinsurance after a $500 Deductible satisfying OON IN; 50% Coinsurance in Full Covered for specialty contact lenses. $200 benefit maximum for post cataract eyewear. specialty $200 benefit maximum contact lenses. for $0-$2 Standard Eyeglass lenses and frames or contact lenses are covered in full. IN/OON: A in full. covered or contact lenses are lenses and frames Eyeglass Standard 2 Hearing Aids Every year; TruHearing Advanced - $699 copay TruHearing Premium - Premium TruHearing - $699 copay Advanced TruHearing 2 Hearing Every Aids year; $150 benefit maximum applies to non-standard frames and a $150 benefit maximum frames to non-standard $150 benefit maximum applies Restorative Services, Prosthodontics, Other Oral/Maxillofacial Surgery, Extractions: Other Oral/Maxillofacial50% Surgery, Services, Prosthodontics, Restorative $0 Copay IN; 30% Coinsurance OON. Covered only if trip is part care acute of continued OON. Covered IN; 30% Coinsurance $0 Copay

OON

30% Coinsurance Coinsurance 30%

$90 Copay $50 Copay Part D Drugs Lean (Performance) Lean $0 Copay Signature PPO Signature after discharge from ER. from after discharge $45 Copay IN; $60 Copay OON IN; $60 Copay $45 Copay $40 Copay IN; $60 Copay OON IN; $60 Copay $40 Copay $30 Copay IN; $30 Copay OON IN; $30 Copay $30 Copay $30 Copay IN; $60 Copay OON IN; $60 Copay $30 Copay $30 Copay IN; $60 Copay OON IN; $60 Copay $30 Copay $25 Copay IN; $50 Copay OON IN; $50 Copay $25 Copay $20 Copay IN; $30 OON (4 visits) $20 Copay IN; $30 OON (4 visits) $30 Copay $225 Copay IN; $450 Copay OON IN; $450 Copay $225 Copay OON IN; $450 Copay $300 Copay $270 Copay IN; $370 Copay OON IN; $370 Copay $270 Copay $75 Allowance Quarterly$75 Allowance IN/OON Emergent/Non-Emergent: $275 IN; Emergent/Non-Emergent: $0 Copay IN; 30% Coinsurance OON IN; 30% Coinsurance $0 Copay Non-Emergent: 30% Coinsurance OON 30% Coinsurance Non-Emergent: Lab/Office $0 Copay IN; $40 Copay OON Copay IN; $40 Copay Lab/Office $0 $0.00 (with $20 Part-B Premium buyback) Premium $0.00 (with $20 Part-B Network: $6,700 / Catastrophic: $10,000 Network: $6,700 / Catastrophic: Outpatient: $30 Copay IN; $40 Copay OON IN; $40 Copay $30 Copay Outpatient: 20% Coinsurance IN; 30% Coinsurance OON IN; 30% Coinsurance 20% Coinsurance 20% Coinsurance IN; 30% Coinsurance OON IN; 30% Coinsurance 20% Coinsurance Covered in Full (Office visit copay may apply) copay visit (Office in Full Covered Exam: $0 Copay IN; $50 Copay OON (1 Every Year) OON (1 Every IN; $50 Copay Exam: $0 Copay Exam: $30 Copay IN; $30 Copay OON (1 Every Year) OON (1 Every IN; $30 Copay Exam: $30 Copay X-ray: $0 Copay IN; 30% Coinsurance OON (1 Every Year) OON (1 Every IN; 30% Coinsurance $0 Copay X-ray: Coinsurance with a maximum $2000 Allowance IN/OON. with a maximum $2000 Allowance Coinsurance TruHearing Premium - $999 copay IN; $500 allowance OON IN; $500 allowance - $999 copay Premium TruHearing $395/admit IN; $275/day (days 1-5), $0/day (days 6-90) OON (days 1-5), $0/day (days $395/admit IN; $275/day 2 Hearing Aids Every year; TruHearing Advanced - $699 copay Advanced TruHearing 2 Hearing Every Aids year; Preferred Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% discount) (25% coinsurance Brand Retail: Generics (25% coinsurance) Preferred Greater of: 5% or $3.60 Gen/Pref. Multi Source or $8.95 for all others or $8.95 for Multi Source of:Greater 5% or $3.60 Gen/Pref. Office Visit: $0 Copay IN; 30% Coinsurance OON (1 Every OON (1 Six Coinsurance Months) IN; 30% Copay Visit: $0 Office $0/day (days 1-20); $178/day (days 21-100) IN; 30% Coinsurance OON 21-100) IN; 30% Coinsurance (days 1-20); $178/day (days $0/day Preferred Retail: Tier 1: $0, Tier 2: $5, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $5, Tier 1: $0, Tier Retail: Preferred Preferred Mail: Tier 1: $0, Tier 2: $12, Tier 3: $120, Tier 4: $275, Tier 5: 33% Tier 4: $275, Tier 3: $120, Tier 2: $12, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $7, Tier 2: $15, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $15, Tier 1: $7, Tier Retail: Standard Standard Mail: Tier 1: $21, Tier 2: $45, Tier 3: $141, Tier 4: $300, Tier 5: 33% Tier 4: $300, Tier 3: $141, Tier 2: $45, Tier 1: $21, Tier Mail: Standard Covered in Full IN; 50% Coinsurance after a $500 Deductible satisfying OON IN; 50% Coinsurance in Full Covered for specialty contact lenses. $200 benefit maximum for post cataract eyewear. specialty $200 benefit maximum contact lenses. for $0-$30 Copay (Coverage limited to certain conditions) IN; IN; conditions) certain to limited (Coverage Copay $0-$30 Standard Eyeglass lenses and frames or contact lenses are covered in full. IN/OON: A in full. covered or contact lenses are lenses and frames Eyeglass Standard $100 benefit maximum applies to non-standard frames and a $100 benefit maximum frames to non-standard $100 benefit maximum applies Restorative Services, Prosthodontics, Other Oral/Maxillofacial Surgery, Extractions: Other Oral/Maxillofacial50% Surgery, Services, Prosthodontics, Restorative $0 Copay IN; 30% Coinsurance OON. Covered only if trip is part care acute of continued OON. Covered IN; 30% Coinsurance $0 Copay $425/day (days 1-3), $0/day (days 4-90) IN; $500/day (days 1-3), $0/day (days 4-90) OON (days 1-3), $0/day (days 4-90) IN; $500/day (days 1-3), $0/day (days $425/day 4-90) OON (days 1-3), $0/day (days 4-90) IN; $475/day (days 1-3), $0/day (days $425/day

$0.00 $0 Copay $0 Copay $45 Copay $40 Copay $20 Copay $40 Copay $20 Copay $30 Copay $250/admit $125 Copay $175 Copay $250 Copay $225 Copay for all others for Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Signature HMO Signature $275, Tier 5: 33% Tier $275, $100, Tier 5: 33% Tier $100, 5: 33% Tier $100, 5: 33% Tier $300, 20% Coinsurance 20% Coinsurance Exam: Not Covered Lab/Office: $0 Copay Lab/Office: $0 Outpatient: $30 Copay Outpatient: care after discharge from ER. from after discharge care Network: $5,500 / Catastrophic: N/A Network: $5,500 / Catastrophic: $425/day (days 1-3), $0/day (days 4-90) (days 1-3), $0/day (days $425/day $0/day (days 1-20); $178/day (days 21-100) (days 1-20); $178/day (days $0/day Covered in Full (Office visit copay may apply) copay visit (Office in Full Covered $200 benefit maximum for post cataract eyewear. $200 benefit maximum Preferred Retail: Tier 1: $0, Tier 2: $5, Tier 3: $47, Tier 4: Tier 3: $47, Tier 2: $5, Tier 1: $0, Tier Retail: Preferred $0-$20 Copay (Coverage limited to certain to limited conditions) (Coverage $0-$20 Copay Preferred Mail: Tier 1: $0, Tier 2: $12, Tier 3: $120, Tier 4: Tier 3: $120, Tier 2: $12, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $7, Tier 2: $15, Tier 3: $47, Tier 4: Tier 3: $47, Tier 2: $15, Tier 1: $7, Tier Retail: Standard Standard Mail: Tier 1: $21, Tier 2: $45, Tier 3: $141, Tier 4: Tier 3: $141, Tier 2: $45, Tier 1: $21, Tier Mail: Standard $0 Copay. Covered only if trip is part acute of continued Covered $0 Copay. (Products and pricing by county) and pricing by (Products HMO and PPO – Lancaster Blue Medicare Community

Outpatient Surgical (ASC) Surgical Outpatient (Facility) Surgical Outpatient Ambulance Outpatient Substance Abuse Substance Outpatient Lab and Diagnostic Tests Tests Lab and Diagnostic Outpatient Mental Health Outpatient Initial Coverage (Mail Cost Order: Initial Coverage supply except 90 day up to sharing is for supply)) Specialty 31 days tier (up to Tier 5: Specialty Tier Tier 2: Generic Tier Drug 4: Non-Preferred Tier Comprehensive Dental - Supplemental Comprehensive Brand 3: Preferred Tier Gap Coverage $6,350Threshold: OOP Catastrophic or $8.95 Multi Source of: Greater 5% or $3.60 Gen/Pref. Out-of-Pocket Maximum Out-of-Pocket PCP Visit Office Specialist Visit Office Outpatient Outpatient Therapy Occupational Routine Chiropractic Routine Podiatry Formulary Generic 1: Preferred Tier Routine Hearing Routine Dental Monthly Plan Premium Monthly Plan Outpatient Physical & Speech Therapy & Speech Physical Outpatient Advanced Imaging Advanced Preventive/Screening Transportation Fitness Benefit Fitness Additional Telehealth Services Telehealth Additional Part B Drugs Part Routine Vision Routine Vision (Eyewear) X-Rays Emergency Room Care Urgent Inpatient Hospital Stay Home Health Inpatient Psych Stay Inpatient Psych Skilled Nursing Facility MedicalDurable Equipment OTC

51 Confidential & Proprietary — For Agent Use Only 6

SECTION VIII: REGIONS: PRODUCTS AND PRICING BY COUNTY PIKE BUCKS WAYNE MONROE NORTHAMPTON MONTGOMERY DELAWARE PHILADELPHIA LEHIGH CARBON LACKAWANNA CHESTER BERKS SUSQUEHANNA WYOMING LUZERNE SCHUYLKILL LANCASTER COLUMBIA LEBANON SULLIVAN NORTH YORK BRADFORD MONTOUR UMBERLAND DAUPHIN LYCOMING & COMPETITIVELY SENSITIVE COMPETITIVELY & UNION SNYDER ADAMS PERRY TIOGA JUNIATA CUMBERLAND MIFFLIN CLINTON FRANKLIN CENTRE *Pricing is subject to CMS approval CMS to subject is *Pricing POTTER CONFIDENTIAL FULTON HUNTINGDON CAMERON BLAIR (Products and pricing by county) and pricing by (Products BEDFORD CLEARFIELD ELK MCKEAN CAMBRIA JEFFERSON INDIANA SOMERSET FOREST WARREN CLARION ARMSTRONG WESTMORELAND Community Blue Medicare Plus PPO Plus Blue Medicare Community FAYETTE PPO 4 County VENANGO BUTLER ERIE Plus ALLEGHENY Community Blue Medicare Plus PPO Plus Blue Medicare Community CRAWFORD MERCER GREENE CB LAWRENCE Community Blue Medicare PPO Medicare Blue Community Availability and Pricing by County *Pricing is subject to CMS is subject to approval *Pricing n BEAVER WASHINGTON

52 Confidential & Proprietary — For Agent Use Only

$35.00 Distinct $0 Copay IN; $0 Copay OON IN; $0 Copay $0 Copay $30 Copay IN; $30 Copay OON IN; $30 Copay $30 Copay OON IN; $50 Copay $35 Copay OON IN; $40 Copay $25 Copay OON IN; $50 Copay $40 Copay OON IN; $50 Copay $40 Copay OON IN; $50 Copay $45 Copay $20 Copay IN; $30 OON (4 visits) $20 Copay IN; $30 OON (4 visits) $30 Copay $225 Copay IN; $375 Copay OON IN; $375 Copay $225 Copay OON IN; $375 Copay $275 Copay Emergent/Non-Emergent: $250 IN; Emergent/Non-Emergent: Non-Emergent: 30% Coinsurance OON 30% Coinsurance Non-Emergent: Network: $5,900 / Catastrophic: $10,000 Network: $5,900 / Catastrophic: with a maximum $2,000 Allowance IN/OON. with a maximum $2,000 Allowance Exam: $30 Copay IN; $30 Copay OON (1 Every Year) OON (1 Every IN; $30 Copay Exam: $30 Copay Office Visit: $0 Copay IN; $50 Copay OON (1 Every Year) Every OON (1 Copay IN; $50 Copay Visit: $0 Office lenses. $200 benefit maximum for post cataract eyewear. $200 benefit maximum lenses. X-ray: $15 Copay IN; 30% Coinsurance OON (1 Every Year) OON (1 Every IN; 30% Coinsurance $15 Copay X-ray: $0-$30 Copay (Coverage limited to certain to IN; limited conditions) (Coverage $0-$30 Copay $375/admit IN; $200/day (days 1-5), $0/day (days 6-90) OON (days 1-5), $0/day (days $375/admit IN; $200/day 30% Coinsurance OON (Coverage limited to certain to limited conditions) OON (Coverage 30% Coinsurance Office Visit: $15 Copay IN; 30% Coinsurance OON (1 Every OON (1 Six Coinsurance Months) IN; 30% Copay Visit: $15 Office Preferred Retail: Tier 1: $0, Tier 2: $5, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $5, Tier 1: $0, Tier Retail: Preferred Preferred Mail: Tier 1: $0, Tier 2: $12, Tier 3: $120, Tier 4: $275, Tier 5: 33% Tier 4: $275, Tier 3: $120, Tier 2: $12, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $7, Tier 2: $15, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $15, Tier 1: $7, Tier Retail: Standard Standard Mail: Tier 1: $21, Tier 2: $45, Tier 3: $141, Tier 4: $300, Tier 5: 33% Tier 4: $300, Tier 3: $141, Tier 2: $45, Tier 1: $21, Tier Mail: Standard $425/day (days 1-3), $0/day (days 4-90) IN; $475/day (days 1-3), $0/day (days 4-90) OON (days 1-3), $0/day (days 4-90) IN; $475/day (days 1-3), $0/day (days $425/day maximum applies to non-standard frames and a $150 benefit maximum for specialtycontact and a $150 benefit maximum frames non-standard maximum applies to Standard Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% discount) (25% coinsurance Brand Retail: Generics Standard (25% coinsurance) Preferred Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% discount) (25% coinsurance Brand Retail: Generics (25% coinsurance) Preferred TruHearing Advanced - $699 copay; TruHearing Premium - $999 copay IN; $500 allowance OON IN; $500 allowance - $999 copay Premium TruHearing - $699 copay; Advanced TruHearing Standard Eyeglass lenses and frames or contact lenses are covered in full. IN/OON: A $150 benefit in full. covered or contact lenses are lenses and frames Eyeglass Standard Restorative Services, Prosthodontics, Other Oral/Maxillofacial Surgery, Extractions: Other 50% Coinsurance Oral/Maxillofacial Surgery, Services, Prosthodontics, Restorative $90 Copay $50 Copay Part D Drugs $270 Copay IN; $370 Copay OON IN; $370 Copay $270 Copay $75 Allowance Quarterly$75 Allowance IN/OON

Covered in Full (Office visit copay may apply) IN/OON copay visit (Office in Full Covered

Greater of: 5% or $3.60 Gen/Pref. Multi Source or $8.95 for all others or $8.95 for Multi Source of:Greater 5% or $3.60 Gen/Pref. $0/day (days 1-20); $178/day (days 21-100) IN; 30% Coinsurance OON 21-100) IN; 30% Coinsurance (days 1-20); $178/day (days $0/day Covered in Full IN; 50% Coinsurance after a $500 Deductible satisfying OON IN; 50% Coinsurance in Full Covered Lab/Office: $0 Copay IN; $40 Copay OON / Outpatient: $30 Copay IN; $40 Copay OON Copay IN; $40 Copay $30 OON / Outpatient: Copay IN; $40 Copay Lab/Office: $0 $0.00 $0 Copay IN; 30% Coinsurance OON. Covered only if trip is part of continued acute care after discharge from ER. from only if trip after is part discharge care acute of continued OON. Covered IN; 30% Coinsurance $0 Copay Signature Lean (Performance) Lean $0 Copay IN; $0 Copay OON IN; $0 Copay $0 Copay $35 Copay IN; $35 Copay OON IN; $35 Copay $35 Copay OON IN; $60 Copay $40 Copay OON IN; $60 Copay $40 Copay OON IN; $60 Copay $40 Copay OON IN; $60 Copay $40 Copay OON IN; $60 Copay $45 Copay $20 Copay IN; $35 OON (4 visits) $20 Copay $35 Copay IN; $35 OON (4 visits) $35 Copay $275 Copay IN; $425 Copay OON IN; $425 Copay $275 Copay $325 Copay IN; $425 Copay OON IN; $425 Copay $325 Copay Emergent/Non-Emergent: $295 IN; Emergent/Non-Emergent: Non-Emergent: 30% Coinsurance OON 30% Coinsurance Non-Emergent: Network: $6,700 / Catastrophic: $10,000 Network: $6,700 / Catastrophic: with a maximum $2,000 Allowance IN/OON. with a maximum $2,000 Allowance $200 benefit maximum for post cataract eyewear. $200 benefit maximum Exam:$35 Copay IN; $35 Copay OON (1 Every Year) OON (1 Every IN; $35 Copay Exam:$35 Copay $0-$35 Copay (Coverage limited to certain to limited conditions) (Coverage $0-$35 Copay Office Visit: $0 Copay IN; $50 Copay OON (1 Every Year) Every OON (1 Copay IN; $50 Copay Visit: $0 Office X-ray: $15 Copay IN; 30% Coinsurance OON (1 Every Year) OON (1 Every IN; 30% Coinsurance $15 Copay X-ray: $395/admit IN; $275/day (days 1-5), $0/day (days 6-90) OON (days 1-5), $0/day (days $395/admit IN; $275/day 30% Coinsurance OON (Coverage limited to certain to limited conditions) OON (Coverage 30% Coinsurance Office Visit: $15 Copay IN; 30% Coinsurance OON (1 Every OON (1 Six Coinsurance Months) IN; 30% Copay Visit: $15 Office Preferred Retail: Tier 1: $0, Tier 2: $5, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $5, Tier 1: $0, Tier Retail: Preferred Preferred Mail: Tier 1: $0, Tier 2: $12, Tier 3: $120, Tier 4: $275, Tier 5: 33% Tier 4: $275, Tier 3: $120, Tier 2: $12, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $7, Tier 2: $15, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $15, Tier 1: $7, Tier Retail: Standard Standard Mail: Tier 1: $21, Tier 2: $45, Tier 3: $141, Tier 4: $300, Tier 5: 33% Tier 4: $300, Tier 3: $141, Tier 2: $45, Tier 1: $21, Tier Mail: Standard $425/day (days 1-3), $0/day (days 4-90) IN; $500/day (days 1-3), $0/day (days 4-90) OON (days 1-3), $0/day (days 4-90) IN; $500/day (days 1-3), $0/day (days $425/day Standard Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% discount) (25% coinsurance Brand Retail: Generics Standard (25% coinsurance) Preferred Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% discount) (25% coinsurance Brand Retail: Generics (25% coinsurance) Preferred TruHearing Advanced - $699 copay; TruHearing Premium - $999 copay IN; $500 allowance OON IN; $500 allowance - $999 copay Premium TruHearing - $699 copay; Advanced TruHearing Standard Eyeglass lenses and frames or contact lenses are covered in full. IN/OON: A $100 benefit in full. covered or contact lenses are lenses and frames Eyeglass Standard Restorative Services, Prosthodontics, Other Oral/Maxillofacial Surgery, Extractions: Other 50% Coinsurance Oral/Maxillofacial Surgery, Services, Prosthodontics, Restorative maximum applies to non-standard frames and a $100 benefit maximum for specialtycontact lenses. and a $100 benefit maximum frames non-standard maximum applies to (Products and pricing by county) and pricing by PPO (Products Blue Medicare Community

Monthly Plan Premium Monthly Plan Maximum Out-of-Pocket Routine Hearing Routine Dental Catastrophic OOP Threshold: $6,350 Threshold: OOP Catastrophic Coverage Gap Coverage Initial Coverage (Mail Order: Cost sharing is for up to 90 up to sharing is for (Mail Cost Order: Initial Coverage supply)) Specialty 31 days tier (up to supply except day Tier 2: Generic Tier Brand 3: Preferred Tier Drug 4: Non-Preferred Tier 5: Specialty Tier Routine Chiropractic Comprehensive Dental - Supplemental Comprehensive Formulary Generic 1: Preferred Tier Routine Podiatry Part B Drugs Part Routine Vision (Eyewear) Transportation Emergency Room Care Urgent Inpatient Hospital Stay Stay Inpatient Psych Skilled Nursing Facility Home Health MedicalDurable Equipment OTC Benefit Fitness Services Telehealth Additional PCP Visit Office Specialist Visit Office Tests Lab and Diagnostic X-Rays Imaging Advanced Preventive/Screening Therapy & Speech Physical Outpatient Outpatient Therapy Occupational Mental Health Outpatient Abuse Substance Outpatient (ASC) Surgical Outpatient Outpatient Surgical (Facility) Surgical Outpatient Ambulance

53 Confidential & Proprietary — For Agent Use Only 7

SECTION VIII: REGIONS: PRODUCTS AND PRICING BY COUNTY PIKE BUCKS WAYNE PHILADELPHIA MONROE NORTHAMPTON MONTGOMERY DELAWARE Blair/Potter LEHIGH CARBON LACKAWANNA CHESTER BERKS SUSQUEHANNA WYOMING LUZERNE SCHUYLKILL LANCASTER COLUMBIA LEBANON SULLIVAN Security Blue HMO-POS NORTH YORK BRADFORD MONTOUR UMBERLAND n WPA Blair/Potter (OWC) DAUPHIN LYCOMING & COMPETITIVELY SENSITIVE COMPETITIVELY & UNION SNYDER ADAMS PERRY TIOGA JUNIATA CUMBERLAND West Central Central West MIFFLIN POS - POS CLINTON FRANKLIN - CENTRE POTTER CONFIDENTIAL CONFIDENTIAL *Pricing is subject to CMS approval CMS to subject is *Pricing FULTON HUNTINGDON CAMERON BLAIR Security Blue HMO-POS (Products and pricing by county) and pricing by (Products CLEARFIELD BEDFORD ELK MCKEAN n West Central West CAMBRIA JEFFERSON INDIANA SOMERSET Southwest Southwest FOREST WARREN Security Blue HMO-POS - WPA Security Blue HMO-POS - CLARION ARMSTRONG WESTMORELAND FAYETTE VENANGO BUTLER ERIE ALLEGHENY Security Blue HMO-POS CRAWFORD MERCER GREENE Southwest WASHINGTON BEAVER Security Blue HMO Blue Security Availability& Pricing *Pricing is subject to CMS is subject to approval *Pricing n LAWRENCE

54 Confidential & Proprietary — For Agent Use Only

N/A N/A N/A Deluxe SW: $267.50 SW: WC: $226.50 conditions) IN conditions) $125 Copay IN $125 Copay Base (Venture) Network: $4,500 Blair/Potter: $226.50 Blair/Potter: Catastrophic: $10,000 Catastrophic: $25 Copay IN (12 visits) $25 Copay $20 Copay IN (10 visits) $20 Copay Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 5: 33% Tier 4: $250, Tier $0 Copay IN; $0 Copay POS IN; $0 Copay $0 Copay $15 Copay IN; $30 Copay POS IN; $30 Copay $15 Copay $25 Copay IN; $25 Copay POS IN; $25 Copay $25 Copay $25 Copay IN; $30 Copay POS IN; $30 Copay $25 Copay $25 Copay IN; $30 Copay POS IN; $30 Copay $25 Copay $210/admit IN; $260/admit POS $100 Copay IN; $150 Copay POS IN; $150 Copay $100 Copay ASC: $75 Copay IN; $125 Copay POS IN; $125 Copay ASC: $75 Copay Office/Lab:$0 Copay IN; $15 Copay POS Copay IN; $15 Copay Office/Lab:$0 Facility: $200 Copay IN; $250 Copay POS IN; $250 Copay $200 Copay Facility: Outpatient: $10 Copay IN; $15 Copay POS IN; $15 Copay $10 Copay Outpatient: $0-$25 Copay (Coverage limited to certain to limited (Coverage $0-$25 Copay (25% coinsurance including 70% discount) (25% coinsurance Covered in Full (Office visit copay may apply) copay visit (Office in Full Covered - $499 copay TruHearing Premium - $799 copay Premium TruHearing - $499 copay Standard Retail: Tier 1: $0, Tier 2: $13, Tier 3: $42, Tier 2: $13, Tier 1: $0, Tier Retail: Standard Standard Mail: Tier 1: $0, Tier 2: $32.5, Tier 3: $105, Tier 2: $32.5, Tier 1: $0, Tier Mail: Standard Standard Retail: Generics: Tier 1 ($0) Generics: Tier Tier 1 ($0) Generics: Tier Retail: Generics: Standard 2 ($13) Generics Tiers 3-5 (25% coinsurance) Brand 3-5 (25% coinsurance) Tiers 2 ($13) Generics Exam: $0 Copay (1 Every year) TruHearing Advanced Advanced TruHearing (1 Every year) Exam: $0 Copay

N/A N/A N/A Standard SW: $200.50 SW: WC: $186.50 conditions) IN conditions) $175 Copay IN $175 Copay Base (Venture) Network: $5,000 4: $100, Tier 5: 33% Tier 4: $100, Blair/Potter: $186.50 Blair/Potter: Catastrophic: $10,000 Catastrophic: $20 Copay IN (8 visits) $20 Copay $30 Copay IN (10 visits) $30 Copay Tier 4: $250, Tier 5: 33% Tier 4: $250, Tier $0 Copay IN; $0 Copay POS IN; $0 Copay $0 Copay $20 Copay IN; $35 Copay POS IN; $35 Copay $20 Copay $30 Copay IN; $30 Copay POS IN; $30 Copay $30 Copay $30 Copay IN; $35 Copay POS IN; $35 Copay $30 Copay $30 Copay IN; $35 Copay POS IN; $35 Copay $30 Copay $335/admit IN; $385/admit POS $150 Copay IN; $200 Copay POS IN; $200 Copay $150 Copay ASC: $125 Copay IN; $175 Copay POS IN; $175 Copay ASC: $125 Copay Office/Lab: $0 Copay IN; $15 Copay POS Copay IN; $15 Copay Office/Lab: $0 Facility: $225 Copay IN; $275 Copay POS IN; $275 Copay $225 Copay Facility: Outpatient: $10 Copay IN; $15 Copay POS IN; $15 Copay $10 Copay Outpatient: $0-$30 Copay (Coverage limited to certain to limited (Coverage $0-$30 Copay (25% coinsurance including 70% discount) (25% coinsurance Covered in Full (Office visit copay may apply) copay visit (Office in Full Covered - $699 copay; TruHearing Premium - $999 copay Premium TruHearing - $699 copay; Standard Mail: Tier 1: $0, Tier 2: $32.5, Tier 3: $110, Tier 2: $32.5, Tier 1: $0, Tier Mail: Standard Standard Retail: Generics (25% coinsurance) Brand Retail: Generics Standard (25% coinsurance) Standard Retail: Tier 1: $0, Tier 2: $13, Tier 3: $44, Tier Tier 3: $44, Tier 2: $13, Tier 1: $0, Tier Retail: Standard Exam: $0 Copay (1 Every year) TruHearing Advanced Advanced TruHearing (1 Every year) Exam: $0 Copay Greater of: 5% or $3.60 Gen/Pref. Multi Source or $8.95 for all others or $8.95 for Multi Source of:Greater 5% or $3.60 Gen/Pref. $90 Copay $50 Copay $0 Copay IN $0 Copay Part D Drugs

Covered in Full IN in Full Covered 20% Coinsurance IN 20% Coinsurance

20% Coinsurance IN; 30% Coinsurance POS IN; 30% Coinsurance 20% Coinsurance $0/day (days 1-20); $178/day (days 21-100) IN (days 1-20); $178/day (days $0/day $200 benefit maximum for post cataract eyewear. for post cataract eyewear. $200 benefit maximum ValueRx SW: $64.00 SW: WC: $59.50 conditions) IN conditions) $225 Copay IN $225 Copay Network: $5,500 4: $95, Tier 5: 33% Tier 4: $95, 4: $275, Tier 5: 33% Tier 4: $275, 4: $300, Tier 5: 33% Tier 4: $300, 4: $100, Tier 5: 33% Tier 4: $100, Blair/Potter: $59.50 Blair/Potter: Lean (Performance) Lean Catastrophic: $10,000 Catastrophic: $40 Copay IN (8 visits) $40 Copay $20 Copay IN (6 visits) $20 Copay $0 Copay IN; $0 Copay POS IN; $0 Copay $0 Copay Office Visit: $15 Copay IN (1 Every Six Months) / X-ray: $15 Copay IN (1 Every Year) Every IN (1 Every Copay X-ray: $15 IN (1 Six Copay / Months) Visit: $15 Office $25 Copay IN; $40 Copay POS IN; $40 Copay $25 Copay $40 Copay IN; $40 Copay POS IN; $40 Copay $40 Copay $40 Copay IN; $45 Copay POS IN; $45 Copay $40 Copay $40 Copay IN; $45 Copay POS IN; $45 Copay $40 Copay $200 Copay IN; $250 Copay POS IN; $250 Copay $200 Copay (days 1-5), $0/day (days 6-90) POS (days 1-5), $0/day (days ASC: $175 Copay IN; $225 Copay POS IN; $225 Copay ASC: $175 Copay Office/Lab: $0 Copay IN; $25 Copay POS Copay IN; $25 Copay Office/Lab: $0 Facility: $250 Copay IN; $300 Copay POS IN; $300 Copay $250 Copay Facility: Outpatient: $20 Copay IN; $25 Copay POS IN; $25 Copay $20 Copay Outpatient: $0-$40 Copay (Coverage limited to certain to limited (Coverage $0-$40 Copay (25% coinsurance including 70% discount) (25% coinsurance (25% coinsurance including 70% discount) (25% coinsurance Covered in Full (Office visit copay may apply) copay visit (Office in Full Covered $699 copay; TruHearing Premium - $999 copay Premium TruHearing $699 copay; Standard Retail: Generics (25% coinsurance) Brand Retail: Generics (25% coinsurance) Standard Preferred Retail: Generics (25% coinsurance) Brand Retail: Generics (25% coinsurance) Preferred Preferred Mail: Tier 1: $0, Tier 2: $27, Tier 3: $115, Tier Tier 3: $115, Tier 2: $27, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $5, Tier 2: $19, Tier 3: $47, Tier Tier 3: $47, Tier 2: $19, Tier 1: $5, Tier Retail: Standard Preferred Retail: Tier 1: $0, Tier 2: $13, Tier 3: $45, Tier Tier 3: $45, Tier 2: $13, Tier 1: $0, Tier Retail: Preferred $220/day (days 1-5), $0/day (days 6-90) IN; $270/day (days 1-5), $0/day (days $220/day Standard Mail: Tier 1: $15, Tier 2: $57, Tier 3: $141, Tier Tier 3: $141, Tier 2: $57, Tier 1: $15, Tier Mail: Standard Exam: $0 Copay (1 Every year) TruHearing Advanced - Advanced TruHearing (1 Every year) Exam: $0 Copay $10 Copay IN. Up to 24 One-way trips. Trip limit waived if trip is part of continued acute care after discharge from ER. from if trip after is part discharge care limit waived acute of continued Trip 24 One-way IN. Up to trips. $10 Copay

IN Basic SW: $55.00 SW: WC: $58.50 Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered $125 Copay IN $125 Copay Network: $5,900 (Products and pricing by county) and pricing by (Products WPA Security Blue HMO-POS - Blair/Potter: $58.50 Blair/Potter: Catastrophic: $10,000 Catastrophic: $30 Copay IN (8 visits) $30 Copay $20 Copay IN (6 visits) $20 Copay $0 Copay IN; $0 Copay POS IN; $0 Copay $0 Copay $25 Copay IN; $40 Copay POS IN; $40 Copay $25 Copay $30 Copay IN; $30 Copay POS IN; $30 Copay $30 Copay $30 Copay IN; $45 Copay POS IN; $45 Copay $30 Copay $30 Copay IN; $45 Copay POS IN; $45 Copay $30 Copay $340/admit IN; $390/admit POS $100 Copay IN; $175 Copay POS IN; $175 Copay $100 Copay ASC: $100 Copay IN; $250 Copay POS IN; $250 Copay ASC: $100 Copay Office/Lab: $0 Copay IN; $30 Copay POS Copay IN; $30 Copay Office/Lab: $0 Facility: $200 Copay IN; $250 Copay POS IN; $250 Copay $200 Copay Facility: Outpatient: $20 Copay IN; $30 Copay POS IN; $30 Copay $20 Copay Outpatient: Covered in Full (Office visit copay may apply) copay visit (Office in Full Covered $699 copay; TruHearing Premium - $999 copay Premium TruHearing $699 copay; Exam: $0 Copay IN (1 Every year) Standard Eyeglass lenses and frames or contact lenses are covered in full. A $150 benefit maximum applies to non-standard frames and a $150 benefit maximum for specialty contact lenses. and a $150 benefit maximum frames to non-standard A $150 benefit maximum applies in full. covered or contact lenses are lenses and frames Eyeglass Standard IN (1 Every year) Exam: $0 Copay Exam: $0 Copay (1 Every year) TruHearing Advanced - Advanced TruHearing (1 Every year) Exam: $0 Copay $0-$30 Copay (Coverage limited to certain to limited conditions) (Coverage $0-$30 Copay

Ambulance Formulary Routine Podiatry Generic 1: Preferred Tier Skilled Nursing Facility Home Health MedicalDurable Equipment Benefit Fitness Services Telehealth Additional Routine Dental Routine Chiropractic Part B Drugs Part Routine Vision (Eyewear) Routine Hearing X-Rays Initial Coverage (Mail Cost Order: Initial Coverage supply 90 day up to sharing is for Specialty 31 days tier (up to except supply)) Gap Coverage Tier 2: Generic Tier Brand 3: Preferred Tier Drug 4: Non-Preferred Tier 5: Specialty Tier Out-of-Pocket Maximum Out-of-Pocket PCP Visit Office Monthly Plan Premium Monthly Plan Transportation Emergency Room Care Urgent Stay Inpatient Hospital/Psych Advanced Imaging Advanced Preventive/Screening Catastrophic OOP Threshold: $6,350 Threshold: OOP Catastrophic Specialist Visit Office Outpatient Physical, Speech, and Physical, Outpatient Therapy Occupational Lab and Diagnostic Tests Tests Lab and Diagnostic Outpatient Mental Health Outpatient Outpatient Surgical Outpatient

55 Confidential & Proprietary — For Agent Use Only 8

SECTION VIII: REGIONS: PRODUCTS AND PRICING BY COUNTY PIKE BUCKS WAYNE PHILADELPHIA MONROE NORTHAMPTON MONTGOMERY DELAWARE LEHIGH CARBON LACKAWANNA CHESTER BERKS SUSQUEHANNA WYOMING LUZERNE SCHUYLKILL LANCASTER COLUMBIA LEBANON SULLIVAN NORTH YORK BRADFORD MONTOUR UMBERLAND DAUPHIN LYCOMING & COMPETITIVELY SENSITIVE COMPETITIVELY & UNION SNYDER ADAMS PERRY TIOGA JUNIATA CUMBERLAND WPA MIFFLIN - CLINTON FRANKLIN CENTRE West Central Central West POTTER CONFIDENTIAL CONFIDENTIAL *Pricing is subject to CMS approval CMS to subject is *Pricing FULTON HUNTINGDON CAMERON West Central West BLAIR BEDFORD (Products and pricing by county) and pricing by (Products CLEARFIELD ELK MCKEAN Freedom Blue PPO Freedom CAMBRIA n Freedom Blue PPO - WPA Blue PPO - Freedom JEFFERSON SOMERSET INDIANA FOREST WARREN Southwest Southwest CLARION ARMSTRONG WESTMORELAND FAYETTE VENANGO No service area changes for 2019. BUTLER ERIE ALLEGHENY Freedom Blue PPO Freedom CRAWFORD MERCER GREENE Southwest WASHINGTON LAWRENCE Note: Note: Freedom Blue PPO Blue Freedom Availability& Pricing BEAVER *Pricing is subject to CMS is subject to approval *Pricing n

56 Confidential & Proprietary — For Agent Use Only

Classic Tier 5: 33% Tier Tier 5: 33% Tier conditions) Base (Venture) Network: $4,500 Catastrophic: $10,000 Catastrophic: $0 Copay IN; $0 Copay OON IN; $0 Copay $0 Copay SW: $292.00 / WC: $268.50 $292.00 / SW: $25 Copay IN; $25 Copay OON IN; $25 Copay $25 Copay $25 Copay IN; $25 Copay OON IN; $25 Copay $25 Copay $15 Copay IN; $15 Copay OON IN; $15 Copay $15 Copay $25 Copay IN; $25 Copay OON IN; $25 Copay $25 Copay $210/admit IN; OON $210/admit IN; OON $125 Copay IN; $125 Copay OON IN; $125 Copay $125 Copay Emergent/Non-Emergent: $125 IN; Emergent/Non-Emergent: TruHearing Advanced - $699 copay; Advanced TruHearing ASC: $75 Copay IN; $200 Copay OON IN; $200 Copay ASC: $75 Copay Non-Emergent: 30% Coinsurance OON 30% Coinsurance Non-Emergent: $20 Copay IN; $25 Copay OON (10 visits) IN; $25 Copay $20 Copay $25 Copay IN; $25 Copay OON (12 visits) IN; $25 Copay $25 Copay Office/Lab: $0 Copay IN; $10 Copay OON Copay IN; $10 Copay Office/Lab: $0 Facility: $200 Copay IN; $200 Copay OON IN; $200 Copay $200 Copay Facility: Outpatient: $10 Copay IN; $10 Copay OON IN; $10 Copay $10 Copay Outpatient: (25% coinsurance including 70% discount) (25% coinsurance (25% coinsurance including 70% discount) (25% coinsurance Generics Tiers 3-5 (25% coinsurance) Brand 3-5 (25% coinsurance) Tiers Generics Generics Tiers 3-5 (25% coinsurance) Brand 3-5 (25% coinsurance) Tiers Generics Exam: $0 Copay IN; $25 Copay OON (1 Every Year) Year) OON (1 Every IN; $25 Copay Exam: $0 Copay 30% Coinsurance OON (Coverage limited to certain to limited OON (Coverage 30% Coinsurance Standard Retail: Generics: Tier 1 ($5) Generics: Tier 2 ($19) Tier 1 ($5) Generics: Tier Retail: Generics: Standard Preferred Retail: Generics: Tier 1 ($0) Generics: Tier 2 ($13) Tier 1 ($0) Generics: Tier Retail: Generics: Preferred $0-$25 Copay (Coverage limited to certain to limited IN; conditions) (Coverage $0-$25 Copay Preferred Retail: Tier 1: $0, Tier 2: $13, Tier 3: $45, Tier 4: $95, Tier 3: $45, Tier 2: $13, Tier 1: $0, Tier Retail: Preferred TruHearing Premium - $999 copay IN; $500 allowance OON IN; $500 allowance - $999 copay Premium TruHearing Standard Retail: Tier 1: $5, Tier 2: $19, Tier 3: $47, Tier 4: $100, Tier 3: $47, Tier 2: $19, Tier 1: $5, Tier Retail: Standard

Select $90 Copay $50 Copay Tier 5: 33% Tier 5: 33% Tier conditions) Part D Drugs Base (Venture) Network: $5,000 Catastrophic: $10,000 Catastrophic: $0 Copay IN; $0 Copay OON IN; $0 Copay $0 Copay SW: $171.00 / WC: $132.50 $171.00 / SW: $30 Copay IN; $30 Copay OON IN; $30 Copay $30 Copay $30 Copay IN; $30 Copay OON IN; $30 Copay $30 Copay $25 Copay IN; $25 Copay OON IN; $25 Copay $25 Copay $30 Copay IN; $30 Copay OON IN; $30 Copay $30 Copay $350/admit IN; OON $350/admit IN; OON $150 Copay IN; $150 Copay OON IN; $150 Copay $150 Copay Emergent/Non-Emergent: $175 IN; Emergent/Non-Emergent: TruHearing Advanced - $699 copay; Advanced TruHearing $0 Copay IN; 30% Coinsurance OON IN; 30% Coinsurance $0 Copay ASC: $125 Copay IN; $225 Copay OON IN; $225 Copay ASC: $125 Copay Non-Emergent: 30% Coinsurance OON 30% Coinsurance Non-Emergent: $20 Copay IN; $30 Copay OON (8 visits) IN; $30 Copay $20 Copay $30 Copay IN; $30 Copay OON (10 visits) IN; $30 Copay $30 Copay Office/Lab: $0 Copay IN; $15 Copay OON Copay IN; $15 Copay Office/Lab: $0 Facility: $225 Copay IN; $225 Copay OON IN; $225 Copay $225 Copay Facility: Outpatient: $15 Copay IN; $15 Copay OON IN; $15 Copay $15 Copay Outpatient: (25% coinsurance including 70% discount) (25% coinsurance (25% coinsurance including 70% discount) (25% coinsurance 20% Coinsurance IN; 30% Coinsurance OON IN; 30% Coinsurance 20% Coinsurance 20% Coinsurance IN; 30% Coinsurance OON IN; 30% Coinsurance 20% Coinsurance Exam: $0 Copay IN; $30 Copay OON (1 Every Year) Year) OON (1 Every IN; $30 Copay Exam: $0 Copay Standard Retail: Generics (25% coinsurance) Brand Retail: Generics (25% coinsurance) Standard Preferred Retail: Generics (25% coinsurance) Brand Retail: Generics (25% coinsurance) Preferred 30% Coinsurance OON (Coverage limited to certain to limited OON (Coverage 30% Coinsurance Covered in Full (Office visit copay may apply) IN/OON copay visit (Office in Full Covered $0-$30 Copay (Coverage limited to certain to IN; limited conditions) (Coverage $0-$30 Copay Preferred Retail: Tier 1: $0, Tier 2: $13, Tier 3: $45, Tier 4: $95, Tier 3: $45, Tier 2: $13, Tier 1: $0, Tier Retail: Preferred TruHearing Premium - $999 copay IN; $500 allowance OON IN; $500 allowance - $999 copay Premium TruHearing Standard Retail: Tier 1: $5, Tier 2: $19, Tier 3: $47, Tier 4: $100, Tier 3: $47, Tier 2: $19, Tier 1: $5, Tier Retail: Standard Greater of: 5% or $3.60 Gen/Pref. Multi Source or $8.95 for all others or $8.95 for Multi Source of:Greater 5% or $3.60 Gen/Pref.

$0/day (days 1-20); $178/day (days 21-100) IN; 30% Coinsurance OON 21-100) IN; 30% Coinsurance (days 1-20); $178/day (days $0/day Preferred Mail: Tier 1: $0, Tier 2: $27, Tier 3: $115, Tier 4: $275, Tier 5: 33% Tier 4: $275, Tier 3: $115, Tier 2: $27, Tier 1: $0, Tier Mail: Preferred Standard Mail: Tier 1: $15, Tier 2: $57, Tier 3: $141, Tier 4: $300, Tier 5: 33% Tier 4: $300, Tier 3: $141, Tier 2: $57, Tier 1: $15, Tier Mail: Standard

Covered in Full IN; 50% Coinsurance after a $500 Deductible satisfying OON IN; 50% Coinsurance in Full Covered

frames and a $150 benefit maximum for specialty contact lenses. $200 benefit maximum for post cataract eyewear. cataract for post for specialty $200 benefit maximum contact lenses. and a $150 benefit maximum frames Office Visit: $15 Copay IN; 30% Coinsurance OON (1 Every Six Months) X-ray: $15 Copay IN; 30% Coinsurance OON (1 Every Year) Every OON (1 Coinsurance IN; 30% Every X-ray:Copay $15 OON (1 Six Coinsurance Months) IN; 30% Copay Visit: $15 Office ValueRx Tier 5: 33% Tier 5: 33% Tier conditions) $10 Copay IN; 30% Coinsurance OON. Up to 24 One-way trips. Trip limit waived if trip is part of continued acute care after discharge from ER. from if trip after is part discharge care limit waived acute of continued Trip 24 One-way OON. Up to trips. IN; 30% Coinsurance $10 Copay Network: $5,500 Coinsurance OON Coinsurance Lean (Performance) Lean Catastrophic: $10,000 Catastrophic: SW: $76.00 / WC: $73.50 $76.00 / SW: $0 Copay IN; $0 Copay OON IN; $0 Copay $0 Copay 1-5), $0/day (days 6-90) OON (days 1-5), $0/day 1-5), $0/day (days 6-90) OON (days 1-5), $0/day $40 Copay IN; $40 Copay OON IN; $40 Copay $40 Copay $40 Copay IN; $40 Copay OON IN; $40 Copay $40 Copay $25 Copay IN; $25 Copay OON IN; $25 Copay $25 Copay $40 Copay IN; $40 Copay OON IN; $40 Copay $40 Copay $200 Copay IN; $200 Copay OON IN; $200 Copay $200 Copay TruHearing Advanced - $699 copay; Advanced TruHearing ASC: $175 Copay IN; $250 Copay OON IN; $250 Copay ASC: $175 Copay $20 Copay IN; $40 Copay OON (6 visits) IN; $40 Copay $20 Copay $40 Copay IN; $40 Copay OON (8 visits) IN; $40 Copay $40 Copay Office/Lab: $0 Copay IN; $20 Copay OON Copay IN; $20 Copay Office/Lab: $0 Facility: $250 Copay IN; $250 Copay OON IN; $250 Copay $250 Copay Facility: Outpatient: $20 Copay IN; $20 Copay OON IN; $20 Copay $20 Copay Outpatient: (25% coinsurance including 70% discount) (25% coinsurance (25% coinsurance including 70% discount) (25% coinsurance Exam: $0 Copay IN; $40 Copay OON (1 Every Year) Year) OON (1 Every IN; $40 Copay Exam: $0 Copay Standard Retail: Generics (25% coinsurance) Brand Retail: Generics Standard (25% coinsurance) Preferred Retail: Generics (25% coinsurance) Brand Retail: Generics (25% coinsurance) Preferred 30% Coinsurance OON (Coverage limited to certain to limited OON (Coverage 30% Coinsurance Emergent/Non-Emergent: $225 IN; Non-Emergent: 30% $225 IN; Non-Emergent: Emergent/Non-Emergent: Exam: $0 Copay IN; $50 Copay OON (1 Every Year) Standard Eyeglass lenses and frames or contact lenses are covered in full. IN/OON: A $150 benefit maximum applies to non-standard IN/OON: A $150 benefit maximum applies in full. covered or contact lenses are lenses and frames Eyeglass Standard Year) OON (1 Every IN; $50 Copay Exam: $0 Copay (Products and pricing by county) and pricing by (Products WPA Blue PPO - Freedom $0-$40 Copay (Coverage limited to certain to limited IN; conditions) (Coverage $0-$40 Copay $220/day (days 1-5), $0/day (days 6-90) IN; $220/day (days (days 6-90) IN; $220/day (days 1-5), $0/day (days $220/day $220/day (days 1-5), $0/day (days 6-90) IN; $220/day (days (days 6-90) IN; $220/day (days 1-5), $0/day (days $220/day Preferred Retail: Tier 1: $0, Tier 2: $13, Tier 3: $45, Tier 4: $95, Tier 3: $45, Tier 2: $13, Tier 1: $0, Tier Retail: Preferred TruHearing Premium - $999 copay IN; $500 allowance OON IN; $500 allowance - $999 copay Premium TruHearing Standard Retail: Tier 1: $5, Tier 2: $19, Tier 3: $47, Tier 4: $100, Tier 3: $47, Tier 2: $19, Tier 1: $5, Tier Retail: Standard

Routine Chiropractic Routine Dental Routine Podiatry Formulary Tier 1: Preferred Generic 1: Preferred Tier 2: Generic Tier 5: Specialty Tier $6,350 Threshold: OOP Catastrophic Tier 3: Preferred Brand 3: Preferred Tier Drug 4: Non-Preferred Tier Initial Coverage (Mail Order: Cost sharing is for up to 90 up to sharing is for (Mail Cost Order: Initial Coverage supply)) Specialty 31 days tier (up to supply except day Gap Coverage Part B Drugs Part Routine Vision (Eyewear) Routine Hearing Emergency Room Transportation Care Urgent Inpatient Hospital Stay Ambulance Stay Inpatient Psych Skilled Nursing Facility Home Health MedicalDurable Equipment Benefit Fitness Services Telehealth Additional Outpatient Surgical Surgical Outpatient Outpatient Mental Health Outpatient Preventive/Screening Therapy Speech, & Occupational Physical, Outpatient Advanced Imaging Advanced X-Rays Lab and Diagnostic Tests Tests Lab and Diagnostic Specialist Visit Office PCP Visit Office Out-of-Pocket Maximum Out-of-Pocket Monthly Plan Premium Monthly Plan

57 Confidential & Proprietary — For Agent Use Only 9

SECTION VIII: REGIONS: PRODUCTS AND PRICING BY COUNTY PIKE BUCKS WAYNE PHILADELPHIA MONROE NORTHAMPTON MONTGOMERY DELAWARE LEHIGH CARBON LACKAWANNA CHESTER BERKS SUSQUEHANNA WYOMING LUZERNE SCHUYLKILL LANCASTER COLUMBIA LEBANON SULLIVAN NORTH YORK BRADFORD MONTOUR UMBERLAND DAUPHIN LYCOMING UNION SNYDER & COMPETITIVELY SENSITIVE COMPETITIVELY & ADAMS PERRY TIOGA JUNIATA CUMBERLAND CPA/NEPA MIFFLIN CLINTON – FRANKLIN CENTRE NEPA POTTER *Pricing is subject to CMS approval CMS to subject is *Pricing CONFIDENTIAL FULTON HUNTINGDON CAMERON BLAIR BEDFORD (Products and pricing by county) and pricing by (Products CLEARFIELD ELK MCKEAN Freedom Blue PPO Freedom CAMBRIA n JEFFERSON SOMERSET INDIANA FOREST WARREN Freedom Blue PPO – CPA/NEPA Freedom CLARION ARMSTRONG WESTMORELAND FAYETTE VENANGO No service area changes for 2019. BUTLER ERIE ALLEGHENY Freedom Blue PPO East Central Blue PPO East Central Freedom

CRAWFORD MERCER GREENE WASHINGTON LAWRENCE BEAVER Note: Note: *Pricing is subject to CMS is subject to approval *Pricing n Freedom Blue PPO Blue Freedom Availability & Pricing

58 Confidential & Proprietary — For Agent Use Only

Deluxe $288.50 Base (Venture) $8.95 for all others $8.95 for Tier 4: $95, Tier 5: 33% Tier 4: $95, Tier Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier Tier 4: $275, Tier 5: 33% Tier 4: $275, Tier 5: 33% Tier 4: $300, Tier $5 Copay IN; $5 Copay OON IN; $5 Copay $5 Copay $10 Copay IN; $10 Copay OON IN; $10 Copay $10 Copay $30 Copay IN; $30 Copay OON IN; $30 Copay $30 Copay $30 Copay IN; $30 Copay OON IN; $30 Copay $30 Copay $30 Copay IN; $30 Copay OON IN; $30 Copay $30 Copay $235/admit IN; OON $100 Copay IN; $100 Copay OON IN; $100 Copay $100 Copay Emergent/Non-Emergent: $150 IN; Emergent/Non-Emergent: conditions) IN; 30% Coinsurance OON IN; 30% Coinsurance conditions) ASC: $100 Copay IN; $200 Copay OON IN; $200 Copay ASC: $100 Copay Non-Emergent: 30% Coinsurance OON 30% Coinsurance Non-Emergent: (Coverage limited to certain to limited conditions) (Coverage $30 Copay IN; $30 Copay OON (12 visits) IN; $30 Copay $30 Copay $20 Copay IN; $30 Copay OON (10 visits) IN; $30 Copay $20 Copay Office/Lab: $0 Copay IN; $10 Copay OON Copay IN; $10 Copay Office/Lab: $0 Facility: $200 Copay IN; $200 Copay OON IN; $200 Copay $200 Copay Facility: Network: $4,500 / Catastrophic: $10,000 Network: $4,500 / Catastrophic: $5-$30 Copay (Coverage limited to certain to limited (Coverage $5-$30 Copay Outpatient: $10 Copay IN; $10 Copay OON IN; $10 Copay $10 Copay Outpatient: (25% coinsurance including 70% discount) (25% coinsurance (25% coinsurance including 70% discount) (25% coinsurance Premium - $799 copay IN; $500 allowance OON IN; $500 allowance - $799 copay Premium TruHearing Advanced - $499 copay; TruHearing TruHearing - $499 copay; Advanced TruHearing Preferred Mail: Tier 1: $0, Tier 2: $27, Tier 3: $115, Tier 2: $27, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $5, Tier 2: $19, Tier 3: $47, Tier 2: $19, Tier 1: $5, Tier Retail: Standard Preferred Retail: Tier 1: $0, Tier 2: $13, Tier 3: $45, Tier 2: $13, Tier 1: $0, Tier Retail: Preferred Greater of: 5% or $3.60 Gen/Pref. Multi Source or Multi Source of:Greater 5% or $3.60 Gen/Pref. Standard Mail: Tier 1: $15, Tier 2: $57, Tier 3: $141, Tier 2: $57, Tier 1: $15, Tier Mail: Standard Standard Retail: Generics: Tier 1 ($5) Generics: Tier Tier 1 ($5) Generics: Tier Retail: Generics: Standard Preferred Retail: Generics: Tier 1 ($0) Generics: Tier Tier 1 ($0) Generics: Tier Retail: Generics: Preferred Exam: $0 Copay IN; $30 Copay OON (1 Every Year); Year); OON (1 Every IN; $30 Copay Exam: $0 Copay 2 ($13) Generics Tiers 3-5 (25% coinsurance) Brand 3-5 (25% coinsurance) Tiers 2 ($13) Generics 2 ($19) Generics Tiers 3-5 (25% coinsurance) Brand 3-5 (25% coinsurance) Tiers 2 ($19) Generics

$185.50 Standard Base (Venture) $8.95 for all others $8.95 for Tier 4: $95, Tier 5: 33% Tier 4: $95, Tier Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 5: 33% Tier 4: $275, Tier Tier 4: $300, Tier 5: 33% Tier 4: $300, Tier $5 Copay IN; $5 Copay OON IN; $5 Copay $5 Copay $20 Copay IN; $20 Copay OON IN; $20 Copay $20 Copay $35 Copay IN; $35 Copay OON IN; $35 Copay $35 Copay $35 Copay IN; $35 Copay OON IN; $35 Copay $35 Copay $35 Copay IN; $35 Copay OON IN; $35 Copay $35 Copay $475/admit IN; OON $150 Copay IN; $150 Copay OON IN; $150 Copay $150 Copay Emergent/Non-Emergent: $175 IN; Emergent/Non-Emergent: conditions) IN; 30% Coinsurance OON IN; 30% Coinsurance conditions) ASC: $150 Copay IN; $250 Copay OON IN; $250 Copay ASC: $150 Copay Non-Emergent: 30% Coinsurance OON 30% Coinsurance Non-Emergent: $20 Copay IN; $35 Copay OON (8 visits) IN; $35 Copay $20 Copay (Coverage limited to certain to limited conditions) (Coverage $35 Copay IN; $35 Copay OON (10 visits) IN; $35 Copay $35 Copay Office/Lab: $0 Copay IN; $15 Copay OON Copay IN; $15 Copay Office/Lab: $0 Facility: $250 Copay IN; $250 Copay OON IN; $250 Copay $250 Copay Facility: Network: $5,000 / Catastrophic: $10,000 Network: $5,000 / Catastrophic: $5-$35 Copay (Coverage limited to certain to limited (Coverage $5-$35 Copay Outpatient: $15 Copay IN; $15 Copay OON IN; $15 Copay $15 Copay Outpatient: (25% coinsurance including 70% discount) (25% coinsurance (25% coinsurance including 70% discount) (25% coinsurance Premium - $999 copay IN; $500 allowance OON IN; $500 allowance - $999 copay Premium TruHearing Advanced - $699 copay; TruHearing TruHearing - $699 copay; Advanced TruHearing Preferred Mail: Tier 1: $0, Tier 2: $27, Tier 3: $115, Tier 2: $27, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $5, Tier 2: $19, Tier 3: $47, Tier 2: $19, Tier 1: $5, Tier Retail: Standard Preferred Retail: Tier 1: $0, Tier 2: $13, Tier 3: $45, Tier 2: $13, Tier 1: $0, Tier Retail: Preferred Greater of: 5% or $3.60 Gen/Pref. Multi Source or Multi Source of:Greater 5% or $3.60 Gen/Pref. Standard Mail: Tier 1: $15, Tier 2: $57, Tier 3: $141, Tier 2: $57, Tier 1: $15, Tier Mail: Standard Exam: $0 Copay IN; $35 Copay OON (1 Every Year); Year); OON (1 Every IN; $35 Copay Exam: $0 Copay Standard Retail: Generics (25% coinsurance) Brand Retail: Generics Standard (25% coinsurance) Preferred Retail: Generics (25% coinsurance) Brand Retail: Generics (25% coinsurance) Preferred

$90 Copay $50 Copay Part D Drugs

$0 Copay IN; 30% Coinsurance OON IN; 30% Coinsurance $0 Copay 20% Coinsurance IN; 30% Coinsurance OON IN; 30% Coinsurance 20% Coinsurance 20% Coinsurance IN; 30% Coinsurance OON IN; 30% Coinsurance 20% Coinsurance Covered in Full (Office visit copay may apply) IN/OON copay visit (Office in Full Covered $70.00 ValueRx $0/day (days 1-20); $178/day (days 21-100) IN; 30% Coinsurance OON 21-100) IN; 30% Coinsurance (days 1-20); $178/day (days $0/day $8.95 for all others $8.95 for Covered in Full IN; 50% Coinsurance after a $500 Deductible satisfying OON IN; 50% Coinsurance in Full Covered Lean (Performance) Lean Tier 4: $95, Tier 5: 33% Tier 4: $95, Tier Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 5: 33% Tier 4: $275, Tier Tier 4: $300, Tier 5: 33% Tier 4: $300, Tier $5 Copay IN; $5 Copay OON IN; $5 Copay $5 Copay $25 Copay IN; $25 Copay OON IN; $25 Copay $25 Copay $40 Copay IN; $40 Copay OON IN; $40 Copay $40 Copay $40 Copay IN; $40 Copay OON IN; $40 Copay $40 Copay $40 Copay IN; $40 Copay OON IN; $40 Copay $40 Copay maximum for specialty contact lenses. $200 benefit maximum for post cataract eyewear. specialty $200 benefit maximum contact lenses. maximum for $200 Copay IN; $200 Copay OON IN; $200 Copay $200 Copay (days 1-5), $0/day (days 6-90) OON (days 1-5), $0/day (days Emergent/Non-Emergent: $200 IN; Emergent/Non-Emergent: conditions) IN; 30% Coinsurance OON IN; 30% Coinsurance conditions) ASC: $200 Copay IN; $275 Copay OON IN; $275 Copay ASC: $200 Copay Non-Emergent: 30% Coinsurance OON 30% Coinsurance Non-Emergent: $20 Copay IN; $40 Copay OON (6 visits) IN; $40 Copay $20 Copay $40 Copay IN; $40 Copay OON (8 visits) IN; $40 Copay $40 Copay (Coverage limited to certain to limited conditions) (Coverage Office/Lab: $0 Copay IN; $20 Copay OON Copay IN; $20 Copay Office/Lab: $0 Facility: $275 Copay IN; $275 Copay OON IN; $275 Copay $275 Copay Facility: Network: $5,500 / Catastrophic: $10,000 Network: $5,500 / Catastrophic: $5-$40 Copay (Coverage limited to certain to limited (Coverage $5-$40 Copay Outpatient: $20 Copay IN; $20 Copay OON IN; $20 Copay $20 Copay Outpatient: (25% coinsurance including 70% discount) (25% coinsurance (25% coinsurance including 70% discount) (25% coinsurance Premium - $999 copay IN; $500 allowance OON IN; $500 allowance - $999 copay Premium TruHearing Advanced - $699 copay; TruHearing TruHearing - $699 copay; Advanced TruHearing Preferred Mail: Tier 1: $0, Tier 2: $27, Tier 3: $115, Tier 2: $27, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $5, Tier 2: $19, Tier 3: $47, Tier 2: $19, Tier 1: $5, Tier Retail: Standard Preferred Retail: Tier 1: $0, Tier 2: $13, Tier 3: $45, Tier 2: $13, Tier 1: $0, Tier Retail: Preferred Greater of: 5% or $3.60 Gen/Pref. Multi Source or Multi Source of:Greater 5% or $3.60 Gen/Pref. Standard Mail: Tier 1: $15, Tier 2: $57, Tier 3: $141, Tier 2: $57, Tier 1: $15, Tier Mail: Standard Exam: $0 Copay IN; $40 Copay OON (1 Every year); IN; $40 Copay Exam: $0 Copay Standard Retail: Generics (25% coinsurance) Brand Retail: Generics (25% coinsurance) Standard Preferred Retail: Generics (25% coinsurance) Brand Retail: Generics (25% coinsurance) Preferred $245/day (days 1-5), $0/day (days 6-90) IN; $245/day (days 1-5), $0/day (days $245/day

Office Visit: $15 Copay IN; 30% Coinsurance OON (1 every Six Months) / X-ray: $15 Copay IN; 30% Coinsurance OON (1 every Year) every OON (1 Coinsurance IN; 30% every X-ray:Copay OON (1 $15 Coinsurance Six / Months) IN; 30% Copay Visit: $15 Office $10 Copay IN; 30% Coinsurance OON. Up to 24 One-way trips. Trip limit waived if trip is part of continued acute care after discharge from ER. from if trip after is part discharge care limit waived acute of continued Trip 24 One-way OON. Up to trips. IN; 30% Coinsurance $10 Copay Basic $92.00 Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered (Products and pricing by county) and pricing by (Products Blue PPO – CPA/NEPA Freedom $25 Copay IN; $25 Copay OON IN; $25 Copay $25 Copay $35 Copay IN; $35 Copay OON IN; $35 Copay $35 Copay $35 Copay IN; $35 Copay OON IN; $35 Copay $35 Copay $10 Copay IN; $10 Copay OON IN; $10 Copay $10 Copay OON IN; $35 Copay $35 Copay $340/admit IN; OON $150 Copay IN; $150 Copay OON IN; $150 Copay $150 Copay Emergent/Non-Emergent: $125 IN; Emergent/Non-Emergent: conditions) IN; 30% Coinsurance OON IN; 30% Coinsurance conditions) ASC: $100 Copay IN; $200 Copay OON IN; $200 Copay ASC: $100 Copay Non-Emergent: 30% Coinsurance OON 30% Coinsurance Non-Emergent: $20 Copay IN; $35 Copay OON (8 visits) IN; $35 Copay $20 Copay (Coverage limited to certain to limited conditions) (Coverage $35 Copay IN; $35 Copay OON (10 visits) IN; $35 Copay $35 Copay Office/Lab: $0 Copay IN; $20 Copay OON Copay IN; $20 Copay Office/Lab: $0 Facility: $200 Copay IN; $200 Copay OON IN; $200 Copay $200 Copay Facility: Network: $5,900 / Catastrophic: $10,000 Network: $5,900 / Catastrophic: Outpatient: $20 Copay IN; $20 Copay OON IN; $20 Copay $20 Copay Outpatient: $10-$35 Copay (Coverage limited to certain to limited (Coverage $10-$35 Copay Exam: $0 Copay IN; $50 Copay OON (1 every Year) Standard Eyeglass lenses and frames or contact lenses are covered in full. IN/OON: A $150 benefit maximum applies to non-standard frames and a $150 benefit frames to non-standard IN/OON: A $150 benefit maximum applies in full. covered or contact lenses are lenses and frames Eyeglass Standard Year) OON (1 every IN; $50 Copay Exam: $0 Copay Premium - $999 copay IN; $500 allowance OON IN; $500 allowance - $999 copay Premium TruHearing Advanced - $699 copay; TruHearing TruHearing - $699 copay; Advanced TruHearing Exam: $0 Copay IN; 35 Copay OON (1 Every year); IN; 35 Copay Exam: $0 Copay

Ambulance X-Rays Advanced Imaging Advanced Preventive/Screening Speech, and Physical, Outpatient Therapy Occupational Outpatient Mental Health Outpatient Outpatient Surgical Surgical Outpatient Emergency Room Transportation Care Urgent Stay Inpatient Hospital/Psych Skilled Nursing Facility Home Health MedicalDurable Equipment Benefit Fitness Services Telehealth Additional Part B Drugs Part Routine Vision (Eyewear) Routine Hearing Tier 2: Generic Tier Brand 3: Preferred Tier Drug 4: Non-Preferred Tier 5: Specialty Tier Initial Coverage (Mail Cost Order: Initial Coverage supply except 90 day up to sharing is for supply)) Specialty 31 days tier (up to Coverage Gap Coverage Monthly Plan Premium Premium Monthly Plan Maximum Out-of-Pocket PCP Visit Office Specialist Visit Office Lab and Diagnostic Tests Lab and Diagnostic Tier 1: Preferred Generic 1: Preferred Tier Formulary Routine Dental Routine Podiatry Routine Chiropractic Catastrophic OOP Threshold: $6,350 Threshold: OOP Catastrophic

59 Confidential & Proprietary — For Agent Use Only 10

SECTION VIII: REGIONS: PRODUCTS AND PRICING BY COUNTY JEFFERSON oln, Wayne BERKELEY MORGAN , Wood HAMPSHIRE HARDY MINERAL GRANT Freedom Blue PPO Standard Only Blue PPO Standard Freedom Blue PPO Distinct & Freedom Blue PPO Standard Freedom Blue PPO Distinct Only Freedom n n n CMS is subject to approval *Pricing WV North: Berkeley, Harrison, Mar sha ll, Ohio Morgan, Mineral, Kanawha,WV Linc South: Cabell, PENDLETON TUCKER PRESTON RANDOLPH BARBOUR TAYLOR POCAHONTAS MONONGALIA UPSHUR MARION HARRISON LEWIS WEBSTER (Products and pricing by county) and pricing by (Products OHIO MONROE GREENBRIER BROOKE HANCOCK WETZEL MARSHALL BRAXTON DODDRIDGE TYLER GILMER NICHOLAS SUMMERS Freedom Blue PPO – WV Blue PPO – Freedom CLAY RITCHIE FAYETTE MERCER CALHOUN RALEIGH WIRT ROANE PLEASANTS WOOD KANAWHA WYOMING JACKSON MCDOWELL BOONE LOGAN PUTNAM MASON LINCOLN CABELL MINGO WAYNE

60 Confidential & Proprietary — For Agent Use Only

OON $167.00 Standard Not Covered Not Covered 70% discount) allowance OON allowance Network: $5,900 Lean (Performance) Lean Catastrophic: $10,000 Catastrophic: $5 Copay IN; $5 Copay OON IN; $5 Copay $5 Copay $35 Copay IN; $35 Copay OON IN; $35 Copay $35 Copay OON IN; $25 Copay $25 Copay OON IN; $35 Copay $35 Copay OON IN; $35 Copay $35 Copay $20 Copay IN; $35 OON (8 visits) $20 Copay $100 Copay IN; $100 Copay OON IN; $100 Copay $100 Copay $35 Copay IN; $35 OON (10 visits) $35 Copay Emergent/Non-Emergent: $175 IN Emergent/Non-Emergent: Non-Emergent: 30% Coinsurance OON 30% Coinsurance Non-Emergent: 20% Coinsurance IN; 30% Coinsurance OON IN; 30% Coinsurance 20% Coinsurance Exam:$0 Copay IN; $35 Copay OON (1 Every Year) OON (1 Every IN; $35 Copay Exam:$0 Copay $200 benefit maximum for post cataract eyewear. $200 benefit maximum part of continued acute care after discharge from ER. from afterpart discharge care acute of continued Covered in Full (Office visit copay may apply) IN/OON copay visit (Office in Full Covered X-ray: $15 Copay IN; 30% Coinsurance OON (1 Every Year) OON (1 Every IN; 30% Coinsurance $15 Copay X-ray: $5-$35 Copay (Coverage limited to certain to limited IN; conditions) (Coverage $5-$35 Copay 30% Coinsurance OON (Coverage limited to certain to limited conditions) OON (Coverage 30% Coinsurance Office: $15 Copay IN; 30% Coinsurance OON (1 Every OON (1 Six Coinsurance Months) IN; 30% Copay Office: $15 Preferred Retail: Tier 1: $0, Tier 2: $13, Tier 3: $45, Tier 4: $95, Tier 5: 33% Tier 4: $95, Tier 3: $45, Tier 2: $13, Tier 1: $0, Tier Retail: Preferred Preferred Mail: Tier 1: $0, Tier 2: $27, Tier 3: $115, Tier 4: $275, Tier 5: 33% Tier 4: $275, Tier 3: $115, Tier 2: $27, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $5, Tier 2: $19, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $19, Tier 1: $5, Tier Retail: Standard Standard Mail: Tier 1: $15, Tier 2: $57, Tier 3: $141, Tier 4: $300, Tier 5: 33% Tier 4: $300, Tier 3: $141, Tier 2: $57, Tier 1: $15, Tier Mail: Standard Preferred Retail: Generics (25% coinsurance) Brand (25% coinsurance including (25% coinsurance Brand Retail: Generics (25% coinsurance) Preferred TruHearing Advanced - $499 copay; TruHearing Premium - $799 copay IN; $500 - $799 copay Premium TruHearing - $499 copay; Advanced TruHearing Exam: $0 Copay IN; $50 Copay OON (1 Every Year); Standard Eyeglass lenses and Eyeglass Standard Year); OON (1 Every IN; $50 Copay Exam: $0 Copay to non-standard frames and a $150 benefit maximum for specialtycontact lenses. and a $150 benefit maximum frames non-standard to ASC: $100 Copay IN; $200 Copay OON / Facility: $200 Copay IN; $200 Copay OON IN; $200 Copay $200 Copay OON / Facility: IN; $200 Copay ASC: $100 Copay $150/day (days 1-7) IN, $0/day (days 8-90) IN; $150/day (days 1-7), $0/day (days 8-90) (days 1-7), $0/day (days 8-90) IN; $150/day (days 1-7) IN, $0/day (days $150/day frames or contact lenses are covered in full. IN/OON: A $150 benefit maximum applies in full. covered or contact lenses are frames Office/Lab: $0 Copay IN; $10 Copay OON / Outpatient:$10 Copay IN; $10 Copay OON Copay IN; $10 Copay OON / Outpatient:$10 Copay IN; $10 Copay Office/Lab: $0 $10 Copay IN; 30% Coinsurance OON. Up to 24 One-way trips. Trip limit waived if trip is limit waived Trip 24 One-way OON. Up to trips. IN; 30% Coinsurance $10 Copay $150/day (days 1-7), $0/day (days 8-90) IN; $150/day (days 1-7), $0/day (days 8-90) OON (days 1-7), $0/day (days 8-90) IN; $150/day (days 1-7), $0/day (days $150/day $90 Copay $50 Copay Part D Drugs

$0 Copay IN; 30% Coinsurance OON IN; 30% Coinsurance $0 Copay

20% Coinsurance IN; 30% Coinsurance OON IN; 30% Coinsurance 20% Coinsurance

Covered in Full IN; 50% Coinsurance after a $500 Deductible satisfying OON IN; 50% Coinsurance in Full Covered

Distinct North: $35.00 South: $25.00 Network: $6,700 discharge from ER. from discharge Lean (Performance) Lean Catastrophic: $10,000 Catastrophic: post cataract eyewear. $0 Copay IN; $0 Copay OON IN; $0 Copay $0 Copay $35 Copay IN; $35 Copay OON IN; $35 Copay $35 Copay OON IN; $50 Copay $40 Copay $35 Copay IN; $35 Copay OON IN; $35 Copay $35 Copay OON IN; $35 Copay $25 Copay $20 Copay IN; $35 OON (8 visits) $20 Copay $450/admit IN; $500/admit OON $275 Copay IN; $325 Copay OON IN; $325 Copay $275 Copay $35 Copay IN; $35 OON (10 visits) $35 Copay Emergent/Non-Emergent: $250 IN Emergent/Non-Emergent: Non-Emergent: 30% Coinsurance OON 30% Coinsurance Non-Emergent: $25 Allowance Once Per Quarter IN/OON Per Once $25 Allowance 20% Coinsurance IN; 30% Coinsurance OON IN; 30% Coinsurance 20% Coinsurance Exam: $35 Copay IN; $35 Copay OON (1 Every Year) OON (1 Every IN; $35 Copay Exam: $35 Copay Covered in Full (Office visit copay may apply) IN/OON copay visit (Office in Full Covered Coinsurance with a maximum $500 Allowance IN/OON. with a maximum $500 Allowance Coinsurance X-ray: $15 Copay IN; 30% Coinsurance OON (1 Every Year) OON (1 Every IN; 30% Coinsurance $15 Copay X-ray: $0-$35 Copay (Coverage limited to certain to IN; limited conditions) (Coverage $0-$35 Copay 30% Coinsurance OON (Coverage limited to certain to limited conditions) OON (Coverage 30% Coinsurance Office: $15 Copay IN; 30% Coinsurance OON (1 Every OON (1 Six Coinsurance Months) IN; 30% Copay Office: $15 Preferred Retail: Tier 1: $0, Tier 2: $9, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $9, Tier 1: $0, Tier Retail: Preferred Preferred Mail: Tier 1: $0, Tier 2: $27, Tier 3: $120, Tier 4: $280, Tier 5: 33% Tier 4: $280, Tier 3: $120, Tier 2: $27, Tier 1: $0, Tier Mail: Preferred Standard Retail: Tier 1: $7, Tier 2: $20, Tier 3: $47, Tier 4: $100, Tier 5: 33% Tier 4: $100, Tier 3: $47, Tier 2: $20, Tier 1: $7, Tier Retail: Standard Standard Mail: Tier 1: $21, Tier 2: $60, Tier 3: $141, Tier 4: $300, Tier 5: 33% Tier 4: $300, Tier 3: $141, Tier 2: $60, Tier 1: $21, Tier Mail: Standard ASC:$225 Copay IN; $350 Copay OON / Facility: $300 Copay IN; $350 Copay OON IN; $350 Copay $300 Copay OON / Facility: IN; $350 Copay ASC:$225 Copay Office/Lab: $0 Copay IN; $20 Copay OON / Outpatient:$10 Copay IN; $20 Copay OON Copay IN; $20 Copay OON / Outpatient:$10 Copay IN; $20 Copay Office/Lab: $0 Restorative Services, Prosthodontics, Other Oral/Maxillofacial Surgery, Extractions: Other 50% Oral/Maxillofacial Surgery, Services, Prosthodontics, Restorative $425/day (days 1-3), $0/day (days 4-90) IN; $500/day (days 1-3), $0/day (days 4-90) OON (days 1-3), $0/day (days 4-90) IN; $500/day (days 1-3), $0/day (days $425/day (Products and pricing by county) WV and pricing by (Products Blue PPO – Freedom Exam: $0 Copay IN; $50 Copay OON (1 Every Year); Standard Eyeglass lenses and frames or lenses and frames Eyeglass Standard Year); OON (1 Every IN; $50 Copay Exam: $0 Copay $0 Copay IN; 30% Coinsurance OON. Covered only if trip after is part care acute of continued OON. Covered IN; 30% Coinsurance $0 Copay frames and a $100 benefit maximum for specialty contact lenses. $200 benefit maximum for for specialty $200 benefit maximum contact lenses. and a $100 benefit maximum frames contact lenses are covered in full. IN/OON: A $100 benefit maximum applies to non-standard IN/OON: A $100 benefit maximum applies in full. covered contact lenses are Preferred Retail: Generics (25% coinsurance) Brand (25% coinsurance including 70% discount) (25% coinsurance Brand Retail: Generics (25% coinsurance) Preferred TruHearing Advanced - $699 copay; TruHearing Premium - $999 copay IN; $500 allowance OON IN; $500 allowance - $999 copay Premium TruHearing - $699 copay; Advanced TruHearing

Formulary Tier 1: Preferred Generic 1: Preferred Tier 2: Generic Tier 5: Specialty Tier Tier 3: Preferred Brand 3: Preferred Tier Drug 4: Non-Preferred Tier Routine Chiropractic Routine Podiatry Part B Drugs Part Lab and Diagnostic Tests Lab and Diagnostic Imaging Advanced Preventive/Screening Therapy Speech, & Occupational Physical, Outpatient Mental Health Outpatient Surgical Outpatient Stay Inpatient Psych Skilled Nursing Facility Home Health MedicalDurable Equipment OTC Benefit Fitness Services Telehealth Additional Routine Vision (Eyewear) Ambulance Out-of-Pocket Maximum Out-of-Pocket PCP Visit Office Specialist Visit Office X-Rays Transportation Emergency Room Care Urgent Inpatient Hospital Stay Initial Coverage (Mail Order: Cost sharing is for up to 90 up to sharing is for (Mail Cost Order: Initial Coverage supply)) Specialty 31 days tier (up to supply except day Routine Dental Comprehensive Dental - Supplemental Comprehensive Monthly Plan Premium Monthly Plan Routine Hearing Gap Coverage $6,350 Threshold: OOP Catastrophic

61 Confidential & Proprietary — For Agent Use Only SECTION VIII: REGIONS: PRODUCTS AND PRICING BY COUNTY PIKE BUCKS WAYNE PHILADELPHIA MONROE NORTHAMPTON MONTGOMERY DELAWARE LEHIGH CARBON LACKAWANNA CHESTER BERKS SUSQUEHANNA WYOMING LUZERNE SCHUYLKILL LANCASTER COLUMBIA LEBANON SULLIVAN NORTH YORK BRADFORD MONTOUR UMBERLAND DAUPHIN LYCOMING UNION SNYDER ADAMS PERRY TIOGA JUNIATA CUMBERLAND MIFFLIN JEFFERSON CLINTON FRANKLIN CENTRE BERKELEY POTTER FULTON HUNTINGDON MORGAN CAMERON BLAIR BEDFORD CLEARFIELD ELK HAMPSHIRE MCKEAN HARDY CAMBRIA MINERAL JEFFERSON SOMERSET INDIANA GRANT FOREST (Products and pricing by county) and pricing by (Products WARREN *Pricing is subject to CMS is subject to approval *Pricing PENDLETON CLARION TUCKER ARMSTRONG WESTMORELAND FAYETTE PRESTON VENANGO RANDOLPH BUTLER ERIE BARBOUR TAYLOR Blue Rx PDP – PA and WV and Blue Rx PDP – PA ALLEGHENY POCAHONTAS MONONGALIA UPSHUR MARION CRAWFORD MERCER GREENE WASHINGTON LAWRENCE BEAVER HARRISON LEWIS WEBSTER OHIO MONROE GREENBRIER BROOKE HANCOCK WETZEL MARSHALL BRAXTON DODDRIDGE TYLER GILMER NICHOLAS SUMMERS CLAY RITCHIE FAYETTE MERCER CALHOUN RALEIGH WIRT ROANE PLEASANTS WOOD KANAWHA WYOMING JACKSON BOONE MCDOWELL LOGAN PUTNAM MASON LINCOLN CABELL MINGO WAYNE

62 Confidential & Proprietary — For Agent Use Only (PA and WV) (PA Blue Rx PDP Blue Rx PDP

$0.00 $168.00 Complete Tier 4: 35%, Tier 5: 33% Tier 4: 35%, Tier 5: 33% Tier 4: 50%, Tier including 70% discount) including 70% discount) 50% NonPref Drug, 33% Specialty Drug, 50% NonPref 35% NonPref Drug, 33% Specialty Drug, 35% NonPref Preferred Mail: Tier 1: $0, Tier 2: $12.50, Tier 3: $100, Tier 2: $12.50, Tier 1: $0, Tier Mail: Preferred Standard Mail: Tier 1: $10, Tier 2: $25, Tier 3: $112.50, Tier 2: $25, Tier 1: $10, Tier Mail: Standard Preferred Retail: $0 Pref. Gen, $5 Generic, $40 Pref. Brand, Brand, Gen, $40 Pref. $5 Generic, Retail: $0 Pref. Preferred Standard Retail: $4 Pref. Gen, $10 Generic, $45 Pref. Brand, Brand, Gen, $45 Pref. $10 Generic, Retail: $4 Pref. Standard Standard Retail: Generics: Tier 1 (15%) Generics: Tier 2 (15%) Tier 1 (15%) Generics: Tier Retail: Generics: Standard Preferred Retail: Generics: Tier 1 (10%) Generics: Tier 2 (10%) Tier 1 (10%) Generics: Tier Retail: Generics: Preferred Generics Tiers 3-5 (25% coinsurance) Brand (25% coinsurance (25% coinsurance Brand 3-5 (25% coinsurance) Tiers Generics Generics Tiers 3-5 (25% coinsurance) Brand (25% coinsurance (25% coinsurance Brand 3-5 (25% coinsurance) Tiers Generics Greater of: 5% or $3.60 Gen/Pref. Multi Source or $8.95 for all others or $8.95 for Multi Source of:Greater 5% or $3.60 Gen/Pref.

Plus $93.00 $435.00 Tier 4: 40%,Tier 5: 25% 4: 40%,Tier Tier Tier 4: 50%, Tier 5: 25% Tier 4: 50%, Tier including 70% discount) 50% NonPref Drug, 25% Specialty Drug, 50% NonPref 40% NonPref Drug, 25% Specialty Drug, 40% NonPref (25% coinsurance including 70% discount) (25% coinsurance Standard Mail: Tier 1: $10, Tier 2: $30, Tier 3: 25%, Tier 2: $30, Tier 1: $10, Tier Mail: Standard Preferred Mail: Tier 1: $0, Tier 2: $17.50, Tier 3: 20%, Tier 2: $17.50, Tier 1: $0, Tier Mail: Preferred Preferred Retail: Generics (25% coinsurance) Brand Retail: Generics (25% coinsurance) Preferred Preferred Retail: $0 Pref. Gen, $7 Generic, 20% Pref. Brand, Brand, Gen, 20% Pref. $7 Generic, Retail: $0 Pref. Preferred Standard Retail: $4 Pref. Gen, $12 Generic, 25% Pref. Brand, Brand, Gen, 25% Pref. $12 Generic, Retail: $4 Pref. Standard Greater of: 5% or $3.60 Gen/Pref. Multi Source or $8.95 for all others or $8.95 for Multi Source of:Greater 5% or $3.60 Gen/Pref. Standard Retail: Generics (25% coinsurance) Brand (25% coinsurance (25% coinsurance Brand Retail: Generics Standard (25% coinsurance) (Products and pricing by county) WV and pricing by (Products and Blue Rx PDP – PA

Catastrophic OOP Threshold: $6,350 Threshold: OOP Catastrophic Coverage Gap Coverage Initial Coverage (Mail Order: Cost sharing is for up to 90 day supply 90 day up to sharing is for (Mail Cost Order: Initial Coverage supply)) Specialty 31 days tier (up to except Monthly Plan Premium Monthly Plan Deductible Tier 1: Preferred Generic 1: Preferred Tier 2: Generic Tier Brand 3: Preferred Tier Drug 4: Non-Preferred Tier 5: Specialty Tier

63 Confidential & Proprietary — For Agent Use Only SECTION VIII: REGIONS: PRODUCTS AND PRICING BY COUNTY

Pending CMS Approval CPA and NEPA Freedom Blue PPO, Community Blue Medicare HMO, Community Blue Medicare Plus PPO, and Community Blue Medicare PPO In-Network Hospitals

Facilities Freedom Blue PPO Community Blue Community Blue Community Blue Medicare HMO Medicare Plus PPO Medicare PPO Adams County WellSpan Gettysburg Hospital √ √ √ √ Berks County Penn State Health St. Joseph Medical Center √ √ √ √ Reading Hospital √ √ √ Surgical Institute of Reading √ √ √ Bradford County Guthrie Robert Packer Hospital √ √ √ √ Guthrie Towanda Memorial Hospital √ √ √ √ Guthrie Troy Community Hospital √ √ √ √ Carbon County St. Luke’s Gnaden Huetten Campus √ St. Luke’s Palmerton Campus √ Centre County Mount Nittany Medical Center √ √ √ Clinton County Bucktail Medical Center √ √ √ UPMC Susquehanna Lock Haven √ √ √ Berwick Hospital Center √ √ √ √ Geisinger Bloomsburg Hospital √ √ √ Columbia County Berwick Hospital Center √ √ √ √ Geisinger Bloomsburg Hospital √ √ √ Cumberland County Geisinger Holy Spirit Hospital √ √ √ √ UPMC Pinnacle Carlisle √ √ √ UPMC Pinnacle West Shore Campus √ √ √ √ Dauphin County Penn State Health Milton S. Hershey Medical Center √ √ √ √ UPMC Pinnacle Community Osteopathic √ √ √ √ UPMC Pinnacle Harrisburg Campus √ √ √ √ Fulton County Fulton County Medical Center √ √ √ Franklin County Chambersburg Hospital √ √ √ √ Waynesboro Hospital √ √ √ √ Lackawanna County Geisinger Community Medical Center √ √ √ Moses Taylor Hospital √ √ √ √ Regional Hospital of Scranton √ √ √ √ Lancaster County Lancaster General Hospital √ √ √ √ UPMC Pinnacle Lititz √ √ √ WellSpan Ephrata Community Hospital √ √ √ √ Lebanon County WellSpan Good Samaritan Hospital √ √ √ √

Subject to change based on provider contracting.

64 Confidential & Proprietary — For Agent Use Only SECTION VIII: REGIONS: PRODUCTS AND PRICING BY COUNTY

Pending CMS Approval CPA and NEPA Freedom Blue PPO, Community Blue Medicare HMO, Community Blue Medicare Plus PPO, and Community Blue Medicare PPO In-Network Hospitals

Facilities Freedom Blue PPO Community Blue Community Blue Community Blue Medicare HMO Medicare Plus PPO Medicare PPO Lehigh County Coordinated Health Hospital of Allentown √ √ √ Lehigh Valley Hospital - 17th Street √ √ √ √ Lehigh Valley Hospital - Cedar Crest √ √ √ √ St. Luke’s Hospital Allentown √ St. Luke’s Sacred Heart Hospital √ Luzerne County Lehigh Valley Hospital - Hazelton √ √ √ √ Wilkes Barre General Hospital √ √ √ √ Lycoming County Geisinger Jersey Shore Hospital √ √ √ UPMC Susquehanna Divine Providence Hospital √ √ √ √ UPMC Susquehanna Muncy √ √ √ √ UPMC Susquehanna Williamsport Regional Medical Center √ √ √ √ Mifflin County Geisinger Lewistown Hospital √ √ √ Monroe County Lehigh Valley Hospital - Pocono √ √ √ Montour County Geisinger Medical Center √ Northampton County Coordinated Health Bethlehem Hospital √ √ √ Easton Hospital √ Lehigh Valley Hospital - Muhlenberg √ √ √ √ St. Luke’s Hospital - Bethlehem √ St. Luke’s Hospital - Easton √ Northumberland County Geisinger Shamokin Area Community Hospital √ √ √ UPMC Susquehanna Sunbury Community Hospital √ √ √ Schuylkill County Lehigh Valley Hospital - Schuylkill E. Norwegian Street √ √ √ √ Lehigh Valley Hospital - Schuylkill S. Jackson √ √ √ √ St. Luke’s Miners Memorial Hospital √ Susquehanna County Barnes - Kasson County Hospital √ √ √ Endless Mountains Health Systems √ √ √ √ Tioga County UPMC Susquehanna Soldiers + Sailors √ √ √ √ Union County Evangelical Community Hospital √ Wayne County Wayne Memorial Hospital √ √ √ √ Wyoming County Tyler Memorial Hospital √ √ √ √ York County OSS Health Orthopaedic Hospital √ √ √ UPMC Pinnacle Hanover √ √ √ UPMC Pinnacle Memorial √ √ √ WellSpan Surgery and Rehabilitation Hospital √ √ √ √ WellSpan York Hospital √ √ √ √

Subject to change based on provider contracting. 65 Confidential & Proprietary — For Agent Use Only SECTION VIII: REGIONS: PRODUCTS AND PRICING BY COUNTY

Pending CMS Approval WPA: Freedom Blue PPO, Security Blue HMO-POS, Community Blue Medicare HMO, and Community Blue Medicare PPO In-Network Hospitals

Facilities Freedom Blue PPO Security Blue HMO-POS Community Blue Community Blue Medicare HMO Medicare PPO Allegheny County AHN Allegheny General Hospital √ √ √ √ AHN Allegheny Valley Hospital √ √ √ √ AHN Forbes Hospital √ √ √ √ AHN Jefferson Hospital √ √ √ √ AHN West Penn Hospital √ √ √ √ Heritage Valley-Sewickley √ √ √ √ Ohio Valley Hospital √ √ √ √ St. Clair Memorial Hospital √ √ √ √ UPMC East √ √ UPMC Magee √ √ UPMC McKeesport √ √ UPMC Mercy √ √ UPMC Passavant √ √ UPMC Presbyterian √ √ UPMC Shadyside √ √ UPMC St. Margaret’s √ √ Armstrong County Armstrong County Memorial Hospital √ √ √ √ Beaver County Heritage Valley-Beaver √ √ √ √ Bedford County UPMC Bedford Memorial √ √ Blair County Conemaugh Nason Medical Center √ √ √ √ Tyrone Hospital √ √ √ √ UPMC Altoona √ √ Butler County Butler Memorial Health System √ √ √ √ Cambria County Conemaugh Memorial Medical Center √ √ √ √ Conemaugh Miners Medical Center √ √ √ √ Clarion County Clarion Hospital √ √ √ √ Clearfield County Penn Highlands Clearfield √ √ √ √ Penn Highlands DuBois √ √ √ √ Crawford County Meadville Medical Center √ √ √ √ Titusville Area Hospital √ √ √ √ Elk County Penn Highlands Elk √ √ √ √ Erie County AHN Saint Vincent Hospital √ √ √ √ Corry Memorial Hospital √ √ √ √ Millcreek Community Hospital √ √ √ √ UPMC Hamot √ √

Subject to change based on provider contracting. 66 Confidential & Proprietary — For Agent Use Only SECTION VIII: REGIONS: PRODUCTS AND PRICING BY COUNTY

Pending CMS Approval WPA: Freedom Blue PPO, Security Blue HMO-POS, Community Blue Medicare HMO, and Community Blue Medicare PPO In-Network Hospitals

Facilities Freedom Blue PPO Security Blue HMO-POS Community Blue Community Blue Medicare PPO Medicare PPO Fayette County Highlands Hospital √ √ √ √ Uniontown Hospital √ √ √ √ Greene County Washington Health System Greene √ √ √ √ Huntingdon County JC Blair Memorial Hospital √ √ √ √ Indiana County Indiana Regional Medical Center √ √ √ √ Jefferson County Penn Highlands Brookville √ √ √ √ Punxsutawny Area Hospital √ √ √ √ Lawrence County Ellwood City Medical Center √ √ √ √ UPMC Jameson √ √ McKean County Bradford Regional Medical Center √ √ √ √ UPMC Kane √ √ Mercer County Edgewood Surgical Hospital √ √ √ √ Grove City Medical Center √ √ √ √ Sharon Regional Medical Center √ √ √ √ UPMC Horizon √ √ Potter County UPMC Charles Cole √ √ √ √ Somerset County Chan Soon-Shiong Medical Center at Windber √ √ √ √ Conemaugh Meyersdale Medical Center √ √ √ √ UPMC Somerset √ √ √ √ Venango County UPMC Northwest √ √ Warren County Warren General Hospital √ √ √ √ Washington County Advanced Surgical Hospital √ √ √ √ AHN Canonsburg Hospital √ √ √ √ Monongahela Valley Hospital √ √ √ √ Washington Hospital √ √ √ √ Westmoreland County Excela Health Frick Hospital √ √ √ √ Excela Health Latrobe Hospital √ √ √ √ Excela Health Westmoreland Hospital √ √ √ √

Subject to change based on provider contracting.

67 Confidential & Proprietary — For Agent Use Only

SECTION IX: Additional Enrollment Resources for Part B & Part D, IRMAA, PACE/PACENET

69 Confidential & Proprietary — For Agent Use Only SECTION IX: ADDITIONAL ENROLLMENT RESOURCES

Part B & D IRMAA

What is the Part B & Part D Income Related Monthly Adjusted Amount (IRMAA)? If your client or prospective client has a higher income, the law requires an adjustment to their monthly premiums Medicare Part B (medical insurance) and Medicare Part D (prescription drug coverage). This adjustment is known as the Income Related Monthly Adjustment Amount (IRMAA). IRMAA is paid directly to Medicare, it is not part of the plan premium. Your client will be notified by Social Security if IRMAA is applicable. The following table is the most current information available as of the date of publication of this guide. Please note that the standard premium for 2019 is $135.50.

File Individual File joint File married and Part B Monthly Part D Monthly tax return* tax return* separate tax return* Premium Increase Premium Increase $85,000 or less $170,000 or less $85,000 or less $0 Plan premium Above $85,000 Above $170,000 Not Applicable $54.10 $12.40 up to $107,000 up to $214,000 Above $107,000 Above $214,000 Not Applicable $135.40 $31.90 up to $133,500 up to $267,000 Above $133,500 Above $267,000 Not Applicable $216.70 $51.40 up to $160,000 up to $320,000 Above $160,000 Above $320,000 Above $85,000 $297.90 $70.90 *Based on 2018 filing for 2019 calendar year. See Social Security Administration Publication No. 05-10536.

70 Confidential & Proprietary — For Agent Use Only SECTION IX: ADDITIONAL ENROLLMENT RESOURCES

Medicare Advantage and Part D Election Periods Initial Election Period (IEP) is the period during which an individual may make an initial election to enroll in an MA Plan. Annual Election Period (AEP) is the period when an individual may enroll or disenroll from an MA Plan. Special Election Period (SEP) is a time frame that allows some individuals to enroll in an MA plan outside of the IEP and AEP if they meet certain requirements. A few examples are people who are eligible for extra help in paying for their Medicare prescription, such as if they qualify for Low Income Subsidy (LIS) or Programs of All-Inclusive Care for the Elderly (PACE), or people who have lost their employer group coverage or relocated outside the plan’s service area. Open Enrollment Period (OEP) Timeframe that allows an individual enrolled in a Medicare Advantage Plan* one-time opportunity to: • Switch to a different Medicare Advantage plan • Drop their Medicare Advantage plan and return to Original Medicare, Part A and Part B • Sign up for a stand-alone Medicare Part D Prescription Drug Plan (if they return to Original Medicare)

Part C Part D Plans Available (Medicare Advantage plans) (Prescription Drug plans) MA/MA-PD PDP Medigap IEP Once per lifetime Starts 3 months before and ends 3 X X X months after month of eligibility — total 7 months AEP Oct. 15 to Dec. 7 Oct. 15 to Dec. 7 X X X SEP All year All year X X X OEP* Jan. 1 to March 31 X X X *Individuals enrolled in Original Medicare, a cost plan, or other plan types, are not eligible to use OEP to enroll in an MA plan. Individuals enrolled in a Part D only plan are not eligible to make changes during OEP.

71 Confidential & Proprietary — For Agent Use Only SECTION IX: ADDITIONAL ENROLLMENT RESOURCES

PACE/PACENET

What is PACE / PACENET Coverage? The Pharmaceutical Assistance Contract for the Elderly or “PACE” program is a lottery funded program that provides prescription drug coverage to PA residents, age 65 and older, who meet the program’s income requirements:

Single Married Copay Copay Income Limit Income Limit Generic Single-Source Brand PACE $14,500 $17,700 $6 $9 PACENET $14,500 – $27,500 $17,700 – $35,500 $8 $15

PACE FAQs Q: If I am enrolled in a Highmark Part D plan, will I still use my PACE or PACENET card? Yes, show both cards at the pharmacy. This will let your pharmacist know to bill Highmark first and bill PACE or PACENET second. It will also let your pharmacist know that you are entitled to all of the drugs that are available under PACE and PACENET.

Q: Will my co-payments be higher with PACE/PACENET and Highmark Part D plan? No, not for medications that are covered by PACE/PACENET. If your Highmark plan charges higher copayments than you were paying under PACE/PACENET, the program will pay the difference if the pharmacy has the capability to bill more than one payer for a prescription claim. If you are taking medications that are not covered by PACE/PACENET, you will pay the Highmark plan’s copay for those drugs. If you run into any confusion at the pharmacy, call the program’s toll-free number at 1-800-225-7223 while you’re still at the pharmacy.

Q: What happens if my Highmark plan charges lower co-payments than PACE/PACENET? You will pay the lower co-payments when the Part D plan pays for medication.

Q: Many Highmark Part D plans stop their coverage after you reach a certain dollar limit. This is referred to as the “donut hole” or “coverage gap.” How will this work if I have PACE/PACENET? You will not experience a “donut hole” or period of time when you have not prescription drug coverage. Instead, the PACE/PACENET program will fill in the gaps for covered medications, so that you can continue to get your prescriptions by only paying the PACE/PACENT copays.

Q: What happens if my Highmark Part D plan doesn’t cover all of the drugs that PACE/PACENET covers? If your Part D plan has a restrictive drug formulary, PACE/PACENET will cover your prescription medications or work directly with the plan to process a prior authorization on your behalf so the drugs will be covered by your Part D plan.

72 Confidential & Proprietary — For Agent Use Only SECTION IX: ADDITIONAL ENROLLMENT RESOURCES

Q: Can I go to any pharmacy I choose if I am in PACE and Medicare Part D? No. You must use the pharmacies that are in your Highmark Part D plan’s network. If you decide to change pharmacies, check with your new pharmacy to make sure they participate in your Highmark Part D plan and PACE.

Q: If my Part D plan offers a mail-order service, can I use it? Yes. However, the mail-order pharmacy must participate with the PACE Program in order for the program to help pay for your extra co-payments. Please have your doctor’s verify if the mail-order pharmacy is in the PACE network prior to submitting prescriptions for processing. Also, when you receive a three month supply of your drug(s) by mail, you will pay up to three PACE/PACENET co-payments at once. For example, a PACE cardholder would pay up to $18 for a 90-day supply of generic medications.

73 Confidential & Proprietary — For Agent Use Only SECTION IX: ADDITIONAL ENROLLMENT RESOURCES

Low Income Subsidy (LIS)

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. The Resource Limits Used to Determine Eligibility for the Low-Income Subsidy (LIS) are as follow:

LIS Level Marital Status 2019 LIS Resource Limit Full Subsidy LIS Single $9,230 Married $14,600 All Other LIS Single $14,390 Married $28,720

The Maximum LIS Beneficiary Cost-Sharing table is as follows:

Copayment up to Copayment above Low-income Out-of-Pocket Out-of-Pocket Subsidy Category Deductible Threshold* Threshold* Institutionalized Full-Benefit Dual Eligible; $0 $0 $0 or Beneficiaries Receiving Home and Community-Based Services Full-Benefit Dual Eligible ≤ 100% Federal $0 $1.25 generic, $0 poverty level (FPL) $3.80 brand Full-Benefit Dual Eligible > 100% FPL; or Medicare Saving $0 $3.40 generic, $0 Program Participant; or SSI (but not Medicaid) Recipient; $8.50 brand or Applicant < 135% FPL Applicant < 135% FPL $85 15% $3.40 generic, $8.50 brand

74 Confidential & Proprietary — For Agent Use Only APPENDIX A: AGENT SALES CHECKLIST

Agent Sales Checklist

¨Ïdentify yourself as a Highmark ¨¨Discuss the differences between licensed sales agent and have your MA and Medicare Supplement plans name badge displayed ¨Ënsure the beneficiary(s) understood ¨¨Confirm the Scope of Appointment each plan(s) network and how they work was completed prior to the start of the meeting ¨Ëxplain how to locate a provider using the Provider Directory and/or ¨Ëxplain that in order to enroll in a Provider Website Medicare Advantage plan, members must be enrolled in Medicare and ¨Ëxplain how to check if drug are continue to pay Part B premium covered in the formulary

¨¨Describe original Medicare and how ¨¨Review the Star Rating for all it works when enrolled in a Medicare applicable plans Advantage plan ¨¨Describe the different enrollment ¨Äccurately describe the plans’ periods including AEP, MAPD, and deductibles, copays, coinsurance, possible SEPs OOP max ¨Ävoid making absolute statements ¨Äccurately describe the copays and deductible for drugs under Part D ¨Ävoid scare tactics ¨¨Fully explain the cost of prescriptions during the coverage gap and ¨Ävoid cross-selling of non-health catastrophic coverage period products

¨¨Explain that certain prescription ¨¨Avoid using unapproved marketing drugs have restrictions such as prior material authorizations or quantity limits

75 Confidential & Proprietary — For Agent Use Only APPENDIX B: MEDICAL UNDERWRITING GUIDELINES

Medical Underwriting Guidelines

Medigap Blue — Pennsylvania Updated Underwriting Guidelines (pending approval)

NEW: Medical underwriting will no longer be required for applicants currently enrolled in another carriers Medicare Supplement product and looking to purchase the same letter plan with Highmark Medigap Blue. Now these individuals have the opportunity to take advantage of Highmark’s Whole Health Balance program, available exclusively for Highmark Medigap Blue members, which provides additional coverage for routine hearing, vision, dental and fitness services – This offers Medigap Supplement enrollees a one stop shop for benefits not covered by Traditional Medicare!

Health Questions to Determine Eligibility - Pennsylvania

Prior to approving an application for enrollment, Highmark reserves the right to review previous and current applications for coverage as well as claims history.

The following questions, if answered yes, will result in a • Heart, Coronary, or Carotid Artery Disease (not member not being eligible for a Medigap Blue plan. including high blood pressure), Heart attack, Aneurysm, • Were you enrolled in Medicare prior to age 65 due to a Congestive Heart Failure or any other type of Heart disability? Failure, Enlarged Heart, Stroke, Transient Ischemic Attacks (TIA), or Hemophilia • Are you now or have you been advised in the next year to be any of the following? • Bone marrow or other organ transplant – Admitted as an inpatient to a hospital • ALS (Lou Gherig’s Disease), Multiple Sclerosis (MS), Parkinson’s, Systemic Lupus Erythematosus (SLE), – Confined to a nursing facility for other than short term Alzheimer’s or Dementia rehabilitation • AIDS, AIDS Related Complex (ARC), or tested positive – Paralyzed, bedridden, or confined to a wheelchair for HIV – Receiving dialysis • Chronic Renal Disease such as ESRD Within the past 2 years, have you been diagnosed or Have you been advised to have a joint replacement in the treated (including prescription drugs) for any of the next year, or have you received a joint replacement within following conditions? Do not include any genetic the past six months? information, such as family medical history or any information related to genetic testing, services or counseling. • Cancer (other than skin cancer), Leukemia or Lymphoma, Melanoma

76 Confidential & Proprietary — For Agent Use Only APPENDIX B: MEDICAL UNDERWRITING GUIDELINES

Health Questions to Determine Eligibility - Pennsylvania (cont.)

The following questions help determine rate. Musculoskeletal Conditions If answer is “no” to the following questions, the application • Amputation due to disease is approved at the preferred rate, unless the BMI is 40 or • Rheumatoid Arthritis greater. If BMI is 40 or greater, the application is approved at the standard rate. • Spinal Stenosis Have you been diagnosed, received treatment (including • Degenerative Disc or Herniated Disc prescription drugs), or had any of the following • Osteoporosis conditions? Heart Conditions Psychological/Mental Conditions • Hearth Rhythm Disorders • Bipolar or Manic Depressive • Schizophrenia Lung Conditions • Chronic Obstructive Pulmonary Disease (COPD) Substance Abuse • Emphysema • Alcohol Abuse or Alcoholism • Drug Abuse or use of illegal drugs Liver Conditions • Cirrhosis of the Liver Within the past 2 years have you ever: • Hepatitis C • Been hospitalized or had inpatient surgery? • Smoked cigarettes or used any tobacco product? Diabetes • Type I or Type II If a “yes” answer is provided for any of these questions, the application is approved at the standard rate. Eye Conditions If a “yes” answer is provided for the tobacco question • Macular Degeneration and there is 1 or more “yes” answer in these questions, the application is denied. Gastrointestinal Conditions If applicant answers “no” to these questions, with • Chronic Pancreatitis exception of “yes” answer to the tobacco question- and the applicant’s BMI is 40 or greater, the application is • Esophageal Varices denied. • Ulcerative Colitis If all answers are no and the tobacco question is answered “yes” and the applicants BMI is less than 40, the application is approved at the standard rate.

The new Medigap Blue underwriting procedures highlighted above will be implemented in the Fall of 2019. Look for additional communications with the effective date and other pertinent information in the near future.

77 Confidential & Proprietary — For Agent Use Only APPENDIX B: MEDICAL UNDERWRITING GUIDELINES

Medigap Blue — West Virginia Updated Underwriting Guidelines (pending approval)

Health Questions to Determine Eligibility - West Virginia

Prior to approving an application for enrollment, Highmark reserves the right to review previous and current applications for coverage as well as claims history.

The following questions help determine rate. • Hepatitis C The following questions, if answered yes, will result in a • Chronic Pancreatitis, Esophageal Varices, or Ulcerative member not being eligible for a Medigap Blue plan. Colitis Were you enrolled in Medicare prior to age 65 due to a • Chronic Renal Disease such as ESRD disability? • Bipolar, Manic Depressive, Schizophrenia, or Are you now or have you been advised in the next year to psychological illness requiring hospitalization be any of the following? Have you been advised to have a joint replacement in the • Admitted as an inpatient to a hospital next year, or have you received a joint replacement within the past six months? • Confined to a nursing facility for other than short term rehabilitation Responses to the following questions will be collected, but • Paralyzed, bedridden, or confined to a wheelchair will not affect the outcome of the review. • Receiving dialysis Have you been diagnosed, received treatment (including prescription drugs), or had any of the following Within the past 2 years, have you been diagnosed or conditions? treated (including prescription drugs) for any of the following conditions? Do not include any genetic Musculoskeletal Conditions information, such as family medical history or any information related to genetic testing, services or • Amputation due to disease counseling. • Rheumatoid Arthritis • Cancer (other than skin cancer), Leukemia or • Spinal Stenosis Lymphoma, Melanoma • Degenerative Disc or Herniated Disc • Heart, Coronary, or Carotid Artery Disease (not • Osteoporosis including high blood pressure), Heart attack, Aneurysm, Congestive Heart Failure or any other type of Heart Liver Conditions Failure, Enlarged Heart, Stroke, Transient Ischemic • Cirrhosis of the Liver Attacks (TIA), Hemophilia or Heart Rhythm Disorders • Diabetes Eye Conditions • Chronic Obstructive Pulmonary Disease (COPD), • Mascular Degeneration Emphysema • Bone marrow or other organ transplant Within the past 2 years have you ever: • ALS (Lou Gherig’s Disease), Multiple Sclerosis (MS), • Been hospitalized or had inpatient surgery Parkinson’s, Systemic Lupus Erythematosus (SLE), • Smoked cigarettes or used any tobacco product? Alzheimer’s or Dementia • AIDS, AIDS Related Complex (ARC), or tested positive If the applicant’s BMI is greater than 40, the application for HIV is denied.

78 Confidential & Proprietary — For Agent Use Only

APPENDIX C: SCOPE OF SALES APPOINTMENT CONFIRMATION FORM

Scope of Sales Appointment Confirmation Form

The Centers for Medicare and Medicaid Services requires agents to document the scope of a marketing appointment prior to any face-to-face sales meeting to ensure understanding of what will be discussed between the agent and the Medicare beneficiary (or their authorized representative). All information provided on this form is confidential and should be completed by each person with Medicare or his/her authorized representative. Please initial below beside the type of product(s) you want the agent to discuss. ¨¨Stand-alone Medicare Prescription Drug Plans (Part D)

Medicare Prescription Drug Plan (PDP) — A stand-alone drug plan that adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans

¨¨Medicare Advantage Plans (Part C)

Medicare Health Maintenance Organization (HMO) — A Medicare Advantage Plan that provides all Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug coverage. In most HMOs, you can only get your care from doctors or hospitals in the plan’s network (except in emergencies).

Medicare Preferred Provider Organization (PPO) Plan — A Medicare Advantage Plan that provides all Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug coverage. PPOs have network doctors and hospitals but you can also use out-of-network providers, usually at a higher cost.

¨¨Medicare Supplement Plans (Medigap)

Medicare Supplement (Medigap) Plan — A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.

By signing this form, you agree to a meeting with a sales agent to discuss the types of products you initialed above. Please note, the person who will discuss the products is either employed or contracted by a Medicare plan. They do not work directly for the Federal government. This individual may also be paid based on your enrollment in a plan. Signing this form does NOT obligate you to enroll in a plan, impact your current or future enrollment status or enroll you in a Medicare plan.

80 Confidential & Proprietary — For Agent Use Only APPENDIX C: SCOPE OF SALES APPOINTMENT CONFIRMATION FORM

Beneficiary or Authorized Representative Signature and Signature Date:

�� Signature: �� Signature Date:

If you are the authorized representative, please sign above and print below: Representative’s Name: �� Your Relationship to the Beneficiary: ��

To be completed by Agent: Agent Name: Agent Phone:

Beneficiary Name: Beneficiary Phone:

Beneficiary Address:

Initial Method of Contact: (Indicate here if beneficiary was a walk-in)

Agent’s Signature:

Plan(s) the agent represented during this meeting:

Date Appointment Completed:

[Plan Use Only:]

*Scope of Appointment documentation is subject to CMS record retention requirements *

If the form was signed by the beneficiary at time of appointment, the Agent MUST provide an explanation why the SOA was not documented prior to meeting on the lines provided below: ��

Y0037_15_0594 Accepted Highmark Senior Health Company, Highmark Choice Company and Highmark Senior Solutions Company are Medicare Advantage plans with a Medicare contract. HM Health Insurance Company is a PDP plan with a Medicare contract. Enrollment in Highmark Senior Health Company, Highmark Choice Company, Highmark Senior Solutions Company and HM Health Insurance Company depends on contract renewal.

81 Confidential & Proprietary — For Agent Use Only APPENDIX D: HIGHMARK PHONE NUMBERS AND WEBSITES

Highmark Senior Markets

Senior Markets Producer Hotline �� 1-800-652-9459 (Option 1- Application Status, Benefit, Claims, Rx and Provider Network questions- M-F 8:00 A.M. – 5:00 P.M.) (Option 2- Commissions, Training, ShopPRO and Producer Portal questions- M-F 8:00 A.M. – 4:00 P.M.)

Senior Markets Producer Enrollment Application Fax Line �� 1-888-663-0258 Note: Enrollment submissions must be faxed to this number within 48 hours of receipt. Enrollment may also be submitted online.

Senior Markets Broker Support E-mail Addresses: Application Status, Benefit, Claims, Rx, and Provider Network questions ��[email protected] Commissions, Training, ShopPRO, and Producer Portal questions �� [email protected]

Highmark Website ��highmarkbcbs.com, highmarkblueshield.com, highmarkbcbswv.com or highmarkbcbsde.com Highmark Producer Portal �� https://producer.highmark.com Senior Markets Broker Support Email �� [email protected] Highmark Integrity Office �� 1-800-985-1056 Highmark Integrity Office Email ��[email protected]

Highmark Customer Service Prospective Members �� 1-866-682-7968 Community Blue Medicare HMO �� 1-888-234-5397 Community Blue Medicare PPO �� 1-888-757-2946 Security Blue HMO-POS �� 1-800-935-2583 Freedom Blue PPO (PA) �� 1-800-550-8722 Freedom Blue PPO (WV) �� 1-888-459-4020 Blue Rx PDP �� 1-800-290-3914 Medigap Blue �� 1-800-345-7808 Blues on Call �� 1-888-258-3428 PALS �� 1-800-988-0706 SilverSneakers �� 1-888-423-4632 Charge it Blue (Premium payments by phone) �� 1-800-472-2738

82 Confidential & Proprietary — For Agent Use Only APPENDIX D: HIGHMARK PHONE NUMBERS AND WEBSITES

Community Resources MEDICARE ��800-MEDICARE (TTY: 1-877-486-2048), available 24 hours a day, 7 days a week Social Security Administration �� 1-888-663-0258 (TTY: 1-800-325-0778), available 7 A.M. to 7:00 P.M., Monday through Friday PACE or PACENET �� 1-800-225-7223 (TTY: 1-800-222-9004), available 9 A.M. to 5:00 P.M., Monday through Friday Apprise �� 1-800-783-7067 Partnership for Prescription Assistance �� 1-888-477-2669 Railroad Retirement Office �� 1-877-772-5772 Veteran’s Affairs �� 1-800-827-1000

83 Confidential & Proprietary — For Agent Use Only APPENDIX E: GLOSSARY

Glossary

Applicable Means any local, state and federal laws, statutes, regulations, rules, codes, ordinances, orders, Law decisions, licensing requirement, regulatory guidance, pronouncements, and instructions, declarations, decrees, directives, legislative enactments, other binding restrictions or requirements of or by any governmental authority, any interpretation of any of the foregoing by a governmental authority having jurisdiction or authority or any modified or supplemented version of the foregoing items, which applies to or affects the services provided or the other obligations of the parties hereunder. “Applicable Law” includes but is not limited to HIPAA, the regulations, guidance and instructions issued by CMS (including but not limited to the MMG), the Medicare Improvement for Patients and Providers Act, the False Claims Act (31 U.S.C. §§ 3729 et seq.), the anti-kickback statute (42 U.S.C. § 1320a-7b(b)), Section 1557 of the Patient Protection and Affordable Care Act, TCPA and state and federal laws applicable to telemarketing, and laws or regulations applicable to insurers, agents and brokers.

CMS The Centers for Medicare & Medicaid Services. The federal agency who administers the Medicare Program.

Field Agent A confidential and proprietary document developed exclusively for Highmark Field Agents. Guide

Highmark Collectively refers to “Highmark Inc.”, d/b/a “Highmark Blue Cross Blue Shield” in the 42 counties of Western and Northeastern Pennsylvania, d/b/a “Highmark Blue Shield,” elsewhere in the state; “Highmark West Virginia Inc., d/b/a Highmark Blue Cross Blue Shield West Virginia”, and “Highmark BCBSD Inc., d/b/a “Highmark Blue Cross Blue Shield Delaware.”

HMO Health Maintenance Organization

Medicare Health insurance provided by the U.S. government for people over 65, or for some disabled persons.

PDP Prescription Drug Plan (Part D)

PPO Preferred Provider Plan (Part C)

Producer The website you will use to Enroll Medicare clients online, check the status of applications, order Portal customized enrollment kits, request CMS approved marketing materials, view and download important documents, and view the most recent version of this Field Guide.

Read to Sell Trained, passed a background check, not be on any exclusion lists, have an active state license, and be appointed by Highmark to sell our products.

We and Us Highmark

You and yours You, the reader.

84 Confidential & Proprietary — For Agent Use Only

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