BlueEdge HSA SM A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield.

BlueEdge HSASM

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Copyright © 2013. All rights reserved.

bcbsok.com

2* America’s Health Insurance Plans (AHIP), Center for Policy and Research, 2013Source: BlueEdge Value Story, 2012

• High Deductible Health Plan Benefits – What are the benefits?

• Define the benefits

• Examples

• Difference between BlueEdge/BlueOptions

• Premium Difference

• Health Savings Account

• What is it?

• Advantages

• Eligibility

• Contribution Rules

• Benefit Wallet (Bank)

• Member Experience

BlueEdge HSASM

Discussion Items

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What are the Benefit Differences

BENEFIT BLUEOPTIONS BLUEEDGE PPO

Provider Network BluePreferred (BP) BlueChoice (BC) BlueChoice

Office Visit Copayments $30.00 Primary Care $50.00 Specialist

No Office Visit Copayments

Deductible $750.00 Individual BP/BC/$2,250 FamilyEmbedded*

$1,500 Deductible / $3,000 FamilyAggregate*

Coinsurance 80% In Network 80%

Out of Pocket $4,250 Individual/$12,700 Family Embedded*

$4,000 Individual/$8,000 FamilyAggregate*

Pharmacy Benefits $4.00 Generic$50.00 Preferred

$100.00 Non Preferred

Subject to Deductible and Out of Pocket Maximum – Member must meet deductible before insurance pays

Savings Account with Investment Options

No Yes

Embedded - For services that are subject to the plan deductible, once the Individual Deductible is met, the member does not have to wait for the entire Family Deductible to be satisfied before benefits are payable.

Aggregate - For services that are subject to the plan deductible, the entire Family Deductible must be satisfied before benefits are payable

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Office Visit Claim In Network

OFFICE VISIT Member has an office visit for Bronchitis and seeks services from their PCP

Total Charge: $300.00Allowable Charge: $250.00Deductible: $250.00Member Responsibility: $250.00

BlueEdge Plan - The members responsibility is $250.00 because there is no office visit copayment on the plan. EVERYTHING, except preventative care will apply to the benefit period deductible before health insurance is paid.

Total Charge: $300.00Allowable Charge: $250.00Office Visit Copay: $30.00Deductible: $0.00Member Responsibility: $30.00

BlueEdge High Deductible BlueOptions

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Preventative Claim In Network

OFFICE VISIT Member has a routine physical

Total Charge: $200.00Allowable Charge: $175.00

Member Responsibility: $0.00

Both plans cover preventative care at 100% of allowable charge.

***Preventative care is the ONLY type of services that will be covered at 100% of allowable when deductible and out of pocket have not been satisfied.

BlueEdge High Deductible Total Charge: $200.00Allowable Charge: $175.00

Member Responsibility: $0.00

BlueOptions

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Taking a look at the Hospitalization Claim – Total Benefit PerspectiveBlueEdge Vs. BlueOptions

INPATIENTMember is inpatient and has employee only coverage.

Total Charge: $30,000.00Allowable Charge: $20,000.00Deductible: $ 1,500.00 20% after Deductible: $ 2,500.00 BCBSOK Paid: $16,000.00Member Responsibility: $ 4,000.00

BlueEdge

In this scenario, the member is out of pocket less money because the member out of pocket is lower on the BlueOptions Plan for Employee Only Coverage.

Total Charge: $30,000.00Allowable Charge: $20,000.00Deductible: $ 750.0020% after Deductible: $3,500.00 BCBSOK Paid: $16,000.00Member Responsibility: $ 4,250.00

BlueOptions

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Hospitalization In-NetworkOFFICE VISIT Member is inpatient and has Family Coverage. No other member has had any claims process for the current year.

Total Charge: $30,000.00Allowable Charge: $20,000.00Deductible: $ 3,000.00 20% after Deductible: $ 5,000.00 BCBSOK Paid: $12,000.00Member Responsibility: $ 8,000.00

BlueEdge Plan – • The provider can bill the member $3,000 at the time of service when they verify benefit coverage during

the admissions process. • Family deductible is aggregate which means the entire deductible must be met prior to any payment by

BCBSOK. BlueOptions –• The provider can bill $750.00 at the time of service when they verify benefits coverage during the

admission process. • Family deductible is embedded, unlike the BlueEdge High Deductible plan, the individual only has to meet

their individual deductible and out of pocket maximum amounts.

Total Charge: $30,000.00Allowable Charge: $20,000.00Deductible: $ 750.0020% after Deductible: $ 5,000.00 BCBSOK Paid: $15,750.00Member Responsibility: $ 4,250.00

BlueEdge High Deductible BlueOptions

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Pharmacy Claim Member fills a brand name prescription at the pharmacy.

Total Charge: $175.00Allowable Charge: $125.00Deductible: $125.00Member Responsibility: $125.00

BlueEdge Plan • The member will receive a discount at the time of purchase at the pharmacy. There is no

copayment for the BlueEdge plan so the member will be required to pay the entire discounted amount at the time of purchase. The claim is transmitted to BCBSOK to apply to the deductible.

• When the deductible is satisfied, then the member would only be required to pay 20% at the time of purchase.

Total Charge: $175.00Allowable Charge: $125.00Copayment: $50.00 Member Responsibility: $50.00

BlueEdge High Deductible BlueOptions

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What are the 2015 premium differences

BENEFIT BLUEOPTIONS BLUEEDGE PPO Premium Difference

Annualized

Employee Only Coverage

$491.40 $390.94 $100.46 $1,205.52

Employee and Spouse

$1230.50 $978.96 $251.54 $3,018.48

Employee and Dependent

$890.70 $708.66 $182.04 $2,184.48

Family $1618.86 $1287.62 $331.24 $3,974.88

What is an HSA?An HSA must be used in combination with a qualified high-deductible health plan (HDHP)

• A higher annual deductible

• Out-of-pocket maximum applies only to covered expenses

• No First dollar coverage (100%) except for preventive care benefits without a deductible

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A Health Savings Account (HSA)is a tax-exempt account established exclusively for the purpose of paying qualified medical expenses.

HSA

ADVANTAGES

FOR EMPLOYERS• Lower health insurance premiums

• Employees make better health care choices

FOR EMPLOYEES• Protects against high / unexpected medical bills

• Members decide how much money to put into the account and whether to use it to pay for current qualified medical expenses or save the money for future needs

• Triple Tax Savings

• Portability

• No “use it or lose it” rules

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• Must be enrolled in an HSA-compatibleHigh Deductible Health Plan (HDHP)

• May not have other first dollar medical coverage If an employee enrolls on the HDHP and uses the HSA option,

they could not also be covered under their spouses plan that is NOT HDHP compatible meaning it could not have an office visit copayment, or first dollar coverage under pharmacy.

• May not be claimed as a dependent on another person's tax return

• May not be enrolled in Medicare– An individual can be Medicare eligible and have an HSA. However,

once enrolled in Medicare contributions to the HSA account must stop. The individual can keep any funds in the account prior to enrolling in Medicare and use those funds to pay for qualified medical expenses tax-free.

TO BE ELIGIBLE YOU:

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• If made by the individual outside a cafeteria plan, contributions are a tax-free deduction

• If made by the employer, contributions are not taxable to the employee (excluded from income)

• Contributions can be made by others on behalf of the individual and deducted by the individual

• If an individual has more than one HSA, the aggregate annual contributions made to all the HSAs are subject to the limit

HSA

CONTRIBUTION RULES

U.S. TREASURY GUIDELINES FOR 2015

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Annual Contributions Self-Only Family

HSA Contributions $3,350 $6,650

Minimum Deductible Amounts $1,300 $2,600

Annual Out-of-Pocket (In-network) $6,450 $12,900

“Catch-up” Contributions(Individuals age 55 and older) $1,000*

Amounts are adjusted annually for inflation.

* No change from calendar year 2014

HSA account balance

Health Care Transaction

USERS

have multiple optionsto leverage HSA $$$s

SAVERSuse personal funds to cover expenses and invest excess

Excess Balance InvestmentOptions

FLEXIBILITY OF THE BlueEdge HSASM

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BANKING PARTNER

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DIMENSIONS OF

INTEGRATIONINTEGRATION

FEATURES

Payment Options

Automatic Debit ●

Online bill pay ●

Payment via debit card/checkbook ●

Enrollment & Eligibility Integrated Enrollment File to Bank ●

Web Services

Access to balance & transactional details on BAM via real-time web feed ●

Can access bank via single sign-on ●

Customer Service Integration

BCBS handles all “tier 1” questions ●

Warm transfer to bank for detailed Q’s ●

CommunicationsBlueEdge Plan communications ●

Bank custodian communications ●

BlueEdge HSASM

Custodian Integration Features

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THE VALUE OF BlueEdgeBanking 2015 Financials*

Account Set Up Fees $0

Monthly Maintenance Fees – Accountholder Paid $2.25 waived for balances of $3,000+

Monthly Maintenance Fees – Employer Invoiced/Paid $2.25 waived for balances of $3,000+

Investment Options 20+ highly rated mutual funds

Balance Threshold prior to investing $1,000

Minimum Investment Amount Varies by Fund

Investment Fees $2.90 per month

Interest Rate(subject to change at ANY time)

Flat, earned on first dollar

Miscellaneous Other fees may apply* All banks may have additional, miscellaneous fees. Refer to each bank’s fee schedule for additional information.

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Member Experience

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AUTOMATIC HSA DEBIT FOR MEDICAL (BenefitWallet)

*Assumes PPO network provider. This feature is only available with BenefitWallet.

Member goes to doctor for broken arm

Doctor submits claim to BCBSOKBCBSOK processes claim, determines out-of-pocket liability for member (copay, coinsurance, deductible)

AUTO DEBIT ON*• BCBSOK requests HSA balance

information• If balance available, BCBSOK

pays provider directly• BCBSOK creates consolidated

EOB with HSA dollars used• If any remaining patient share,

member pays doctor after EOB generated

AUTO DEBIT OFF*• BCBSOK creates EOB that

includes patient share• Member receives EOB and pays

doctor patient share using bank debit card, bank checkbook, or personal funds

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AUTOMATIC HSA DEBIT FOR RX(BenefitWallet/Prime)

*Assumes PPO network provider. This feature is only available with BenefitWallet and Prime.

Member goes to a pharmacy to fill a prescription

Pharmacy sends claims to PBM PBM processes claim and determines the out of pocket liability for member (copay, coinsurance, deductible) at the point of sale

AUTO DEBIT ON*• PBM requests HSA balance

information• If balance available, PBM pulls HSA

dollars to pay pharmacy for claim• The pharmacist can see amount due

from member (zero if HSA covered RX cost, or partial balance if funds covered only part of Rx cost)

AUTO DEBIT OFF*• Member pays for the RX at

the point of sale with bank debit card, bank checkbook, or his/her own personal funds

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Other Resources

MyPrime.com and MyPrimeMail.com

Link from Blue Access for Members to:• Locate a pharmacy• Find drugs / formulary• View prescription claim history

• Create personal drug list• Learn about specific drugs

– Rx Cost Calculator – Health information

• PrimeMail – Refill a mail order prescription– Check the status of an order

– Streamlined order refills

– Manage payment options

– Add alternative mailing address

Advice anytime.Advice isn’t just needed from 9 to 5.

Round-the-clock health and the wellness advice from licensed professionals

More than 1,200 AudioHealth Library topics

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Available in English and Spanish800-581-

0407

Nurseline24/7

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BCBSOK AppFeatures: • Member resources• Find Doctors or Hospitals near you• Shop for Plans

Text BCBSOK APP to 33633 to download*

*msg and data rates may apply

Or visit store links below:

Blue Access Mobile

Monthly Health Topics

Benefits and Claims

Member Wellness Portal

Member Care Profile

Health Assessment

Online Tools andResources

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Cost Estimator tool

Provider Finder®

Be Smart. Be Well.®

eCards for HealthSM

Health Care School

Blue Access for MembersSM

ID Card Management

Wellness Points

Member Discounts

Special Beginnings®´

Some of the 180 videos:

• Coronary Artery Disease• Bariatric Surgery• Chronic Low Back Pain• Depression• Diabetes

– Blood Sugar– Insulin Injections– Type 2 Diabetes

• Metabolic Syndrome

Interactive Video TutorialsEasy to use, technology-powered video coaching modules that enable the most informed treatment decisions

Expectant mothers and babies get off to a healthy start with prenatal and postnatal education and support

Enroll in the program to receive guidance from pregnancy to six weeks after delivery

• Pregnancy risk assessment

• Frequent, personal contact based on risk

• Educational materials

• Coordinated care with your physician

• Screening for depression

web text

Lifestyle Management

Self-Paced Approach•Online programs

•Secure email outreach keeps members on track

Personalized Coaching

Weight Management & Tobacco Cessation:Support for a Healthier You

• Counseling and coaching with licensed Wellness Coaches

• 24/7 Nurseline• Referrals when appropriate

Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Health Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. © 012 Health Care Service Corporation. All rights reserved.