Group Health Plan

A high- PPO plan with a tax-advantaged health savings account

Who it’s for employers who want to... Save money with the lowest possible premiums

Reduce long-term costs by maximizing employee engagement in health care decisions

Provide tax-advantaged savings for employees to help offset the burden of increased cost-sharing

Develop a long-term strategy for affordable retiree coverage

SM1 Your plan for better health. bcbsnc.com A cost-saving plan with maximum employee engagement and tax-advantaged savings

Employer objectives The Blue Options HSA solution

Save money with the lowest possible Premiums are lowest for high-deductible plans like this one. Employers can expect premium 1 premiums. savings of up to 30% when compared to our most popular PPO plan.1

Reduce long-term costs by maximizing The dramatic shift in plan design delivered by Blue Options HSA (no copays or coinsurance 2 employee engagement in health care before deductible) exposes employees to the real cost of health care and causes them to think decisions. more carefully before making purchasing decisions, especially when they have options.

Provide tax-advantaged savings for With Blue Options HSA, employees pay a greater portion of the total cost of their health care, 3 employees to help offset the burden of but this cost-sharing can be offset by tax savings. Employees save tax-free, earn interest tax- increased cost-sharing. free and spend tax-free.

Develop a long-term strategy for affordable Blue Options HSA is similar to a 401k for medical expenses. Employees can save tax-free for 4 retiree coverage. medical expenses for when they retire, and employers can contribute tax-free, too. Developing a retiree strategy based on HSA savings can be significantly cheaper than fully funding retiree medical coverage.2,3

How it works

Blue Options HSA pairs a high-deductible plan with a tax- advantaged savings account employees use to pay for all of their – or their dependents’ – covered medical expenses, up to the deductible.2,4

PAGE 2 of 4 A cost-saving plan Benefit design options Plan feature Cost/coverage options with maximum employee engagement and Single deductible5 $1,250; $1,500; $2,000; $2,500; $2,700; $3,000; $3,500; $5,000 tax-advantaged savings Family deductible5 $2,500; $3,000; $4,000; $5,000; $5,450; $6,000; $7,000; $10,000 Coinsurance 100%/70%, 90%/60%, 80%/50%, 50%/50%, 60%/40% (in-network/out-of-network)6

Single out-of-pocket maximum (in-network) $1,250-$5,000, depending on selected combination of deductible/coinsurance

Family out-of-pocket maximum (in-network) $2,500-$10,000, depending on selected combination of deductible/coinsurance

Prescription drugs Integrated with medical deductible, coinsurance and out-of-pocket maximum

You will receive 100% coverage for a broad range of preventive services, including: + Coverage in a wider variety of in-network settings Preventive care7 + no limits on number of visits For a list of covered preventive care services go to bcbsnc.com/preventive. Please contact your Agent or BCBSNC representative with questions.

Popular plan design options

+ More than 70% of large employers contribute to their employees’ HSA fund with $500 – $1,000 being the most popular levels.8

+ For smaller employers, the market is quickly moving toward higher , like a $2,700 single deductible and 100% coinsurance.8

Why Blue?

+ The #1 health brand in North Carolina9

+ No fees for small group employers

+ Flexible large group fee packaging

+ Deep network discounts mean savings before deductible

+ Committed to making the transition to CDH a success – before, during and after enrollment with our dedicated account specialists there to help

+ Integrated fund and plan – managed in a single online location

PAGE 3 of 4 Blue Options HSA is just one of the plans we’ve built to address the changing needs of today’s employers. From our flagship PPO design to the most aggressive consumer- driven health (CDH) plans available, we can help you create a health care strategy that delivers the results you need.

Options (PPO) OptionsHRA OptionsHSA

Our flagship The only plan Our most flexible A CDH plan that Compare Plans product, offering the that offers CDH CDH product drives maximum highest standard of engagement with employee convenience traditional plan engagement design

Employee engagement

Network PPO PPO PPO PPO

Group size 1+ 1+ 100+ 1+

Savings potential

10 4 Fund — —

Tax advantage 2 — — — (for employees)

Limitations and Exclusions

Like most health plans, Blue Options HSA • Services received from an employer-sponsored dental or medical department has some limitations and exclusions. Once • Services received or hospital stays before the effective date you are enrolled, you will receive a member of coverage • Custodial care, domiciliary care or rest cures guide. It will contain detailed information • Eyeglasses or contact lenses or refractive eye surgery except about plan benefits, exclusions and limita- as covered by your health benefit plan • Services to correct nearsightedness or refractive errors tions. Coverage for dependent children ends • Services for cosmetic purposes at age 26. Consult your employer regarding • Services for routine foot care 1 Blue Cross and Blue Shield of North Carolina (BCBSNC) internal data • Travel, except as specifically listed in the member guide 2011. Based on copayment plans that include a $2,000 coinsurance max dependent eligibility requirements. Members • Services for weight control or reduction, except for surgical and $10/$25/$40 copayment structure for prescription drugs. Based on treatment of morbid obesity data for Blue Options Underwritten Groups as of 10/1/2010 with 5 to 20 will be notified 30 days in advance of any • Inpatient admissions that are primarily for physical therapy, subscribers. Pricing is for a single male age 40-44, residing in Durham. 2 Withdrawals are tax-free only if used for qualified medical expenses. change in coverage. diagnostic studies or environmental change Visit www.irs.gov for specific tax information. • Services that are rendered by or on the direction of those 3 For more information on retirement savings regulations, visit www.irs.gov. This brochure contains a summary of benefits other than doctors, hospitals, facility and professional 4. Blue Options HSA combines a high-deductible health plan and a health providers; services that are in excess of the customary charge savings account (HSA). BCBSNC does not administer your HSA and is not only. It is not your insurance policy. Your policy for services usually provided by one doctor when done by affiliated with your HSA custodian or administrator. Your HSA custodiam is your insurance contract. If there is any dif- multiple doctors is The Bank of New York Mellon. • Services that are the result of war or while in military service 5. These amounts may be updated each year to align with IRS guidelines. ference between this brochure and the policy, • Services for which a charge is not normally made in the For the most up-to-date information visit www.bcbsnc.com. the provisions of the policy will control. absence of insurance or services provided by an immediate 6. When using out-of-network providers, in addition to in-network deductible relative and coinsurance amounts, you may be responsible for the difference • Personal hygiene, comfort and/or convenience items between the BCBSNC allowed amount and the provider’s actual charge. This is a partial list of benefits that are not payable: 7. New Preventive care benefits are a result of Health Care Reform require- • Telephone consultations; charges for failure to keep scheduled • Services for or related to conception by artificial means or for ments for non-grandfathered plans. See benefit booklet for any restrictions visits, for completion of any form or for medical information or cost-sharing for out-of-network benefits. reversal of sterilization required by the plan 8. BCBSNC internal data as of 10/1/2010. • Treatment of sexual dysfunction not related to organic disease • Services primarily for educational purposes 9. 2009 W5 Brand Study; December 2009. • Treatment for transsexualism, sex changes or modifications • Maintenance therapy 10. Blue Options HRA combines a preferred provider organization (PPO) including surgery • Services not specifically listed as covered services health plan design and a health reimbursement arrangement (HRA). • Services that are investigational in nature BCBSNC is the administrator for your HRA funds. • Services for complications or side effects arising from excluded services, procedures or treatments An independent licensee of the Blue Cross and Blue Shield Association. ®, SM • Services that are not medically necessary PAGE 4 of 4 Marks of the Blue Cross and Blue Shield Association. SM1 Mark of Blue Cross • Services or expenses that are covered by any governmental and Blue Shield of North Carolina. U4556, 12/10. BOptions HSA, 2/10 unit except as required by federal law

SM1 Your plan for better health. bcbsnc.com