The Power of Blue

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The Power of Blue

• Individual Family
• Health Plans

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• Blue Cross
• One of Californias largest Individual healthcare
  coverage providers
• Has served three generations
• Has plans to protect your clients health
  financial futures
• Parent Company was named 1 on Fortune magazines
  Most Admired Health Care Company List for an
  unprecedented 5th consecutive year

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Individual Family Health Plans

• Portfolio effective 3/1/04

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Pricing Features

• Younger Spouse rating for couples and families.
• Five-year age bands for 30 to 64 year-old rates.
• 9 Rating Areas more precisely match premiums to
  various regional medical costs.

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Price Benefit Guarantee

• A full six-months
• from the clients
• original effective date

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We offer clients choices!
Greater Share of Cost for Member Lower Premium
Greater Share of Cost for BCC Higher Premium
Richer Benefits
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Factors Driving Rising Premium Costs 2001-2002
Drugs, Medical Devices Medical Advances (22)
General Economic Inflation (18)
Rising Provider Expenses (18)
Government Mandates Regulation (15)
Increased Consumer Deman (15)d

Litigation Risk Management (7)
Other (5)
Source PricewaterhouseCoopers, The Factors
Fueling Rising Health Care Costs, April 2002
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Individual Family Plans from Blue Cross

• Basic (Hospital) PPO 2500 or1000
• PPO Saver
• PPO Share 5000, 2500,1500,1000 or 500
• RightPlan PPO 40
• HMO or HMO Saver

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Expanded Eligibility

• Domestic Partner Coverage
• Declaration of Domestic Partnership filed with
  the California Secretary of State is required to
  enroll
• Submit with Individual Enrollment Application

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PPO Features

• First dollar coverage on
• Office visits, generic drugs, preventive care,
  the most used benefits
• Acupuncture visits on the PPO Share and
  RightPlans
• All except Basic (Hospital) PPO Plans
• Choice of coverage and providers
• Cost savings through network providers

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PPO Features, Continued

• No pre-authorization for most covered services
• Annual out-of-pocket maximum
• 3,500-7,500 depending upon plan
• Combined In- and Out-of-Network
• Once met, plan pays 100 of eligible
  in-network medical costs
• Lifetime maximum up to 5 million

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Annual Out-of-Pocket MaximumIn Out-of-network
Charges Combined

• Plan Per Member (2-member maximum)
• Basic PPO 1000 3,500
• Basic PPO 2500 5,000
• PPO Saver 5,000
• PPO Share 5000 7,500
• PPO Share 2500 7,500
• RightPlan PPO 40 7,500
• PPO Share 1500 6,000
• PPO Share 1000 5,000
• PPO Share 500 5,000
• HMO Saver and Individual HMO 3,000

100 coverage of eligible medical costs
in-network above the annual maximum out-of-pocket
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Share of Cost Definitions

• Share of Cost in-network amount member pays
• In-network cost is based on a negotiated fee
  rate.
• Deductible Unless otherwise indicated, this is
  the amount the member pays before the Share of
  Cost. For a family contract, only 2 members must
  satisfy their individual deductibles.

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Basic (Hospital) PPO 2500/1000 Share of Costs

• Deductible 2500 or 1000
• Hospital 20 (Preferred Participating)
• Professional Services (lab, x-ray, anesthesia,
  surgeon, etc.) 20 hospital only until
  out-of-pocket maximum is met.
• Office visits no coverage until out-of-pocket
  maximum is met
• No Maternity
• Available with or without 1000 Term Life

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PPO Saver Share of Costs

• Deductibles 500 in-hospital 5000 other
  covered services
• Hospital 20 after 500 deductible
• Professional Services
• 20 after 500 deductible for in- and out-patient
  or Ambulatory Surgical Center services
• 20 after 5000 deductible for all other covered
  services.
• Provider discounts apply while member is meeting
  deductible.
• Office visits First 4 child/2 adult visits _at_
  30 copay (deductible waived)
• No Maternity
• Available with or without 1000 Term Life

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PPO Share 5000/2500/1500/1000/500 Plans Share of
Costs

• Deductible 5000, 2500, 1500, 1000 or 500
  depending on plan
• Hospital 30 (Preferred Participating)
• Professional Services 30
• Office Visits 30 (deductible waived)
• Maternity 30

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RightPlan PPOs Share of Costs

• Deductible None
• Office Visit 40 copay
• Hospital 40 of negotiated fee plus 400 copay
  per day/4-day maximum copay per admission
• Professional Services 40
• No Maternity

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RightPlans Special Features

• Single Policy Coverage
• No couple or family contracts
• Each family member gets their own policy
• 3 Pharmacy Options
• None (Lowest Price)
• Generic Only (Lower Price)
• Full Pharmacy (Low Price)
• No Maternity

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HMO and HMO Saver Share of Cost

• Deductible
• None for HMO
• HMO Saver has 1500 deductible for inpatient
  hospital services outpatient ambulatory
  surgical centers only
• Office Visit 10 Copay
• Professional Services Out of hospital 10
• Professional Services In-hospital
• No charge on HMO
• HMO Saver subject to 1,500 deductible

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Formulary Drug Share of Cost Retail or Mail
Order (30-day supply)

• Generic - 10 copay
• Brand - 30 copay (35 on PPO Share 5000)
• Subject to following Brand Deductibles

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Non-Formulary Drug Share of Cost

• Generic
• 50 of drug cost
• Brand Drugs with Generic Equivalent
• Generic Copay Cost Difference between Brand
  Generic after Brand Name Deductible is met
• Brand Drugs without Generic Equivalent
• 50 of drug cost after Brand Name Deductible is
  met

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Emergency Room Copay

• Emergency Services Defined
• Appropriate treatments for a sudden, serious and
  unexpected acute illness, injury, psychiatric or
  medical condition.
• If not admitted to hospital
• Copay required in addition to the coinsurance
• Right Plan PPO 40 30 copay
• All Other Plans 100 copay
• Coinsurance amount is the same as what the plan
  pays for Professional Services

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Preventive Care Share of Cost

• PPO Plans (Deductible Waived)
• Routine mammogram, Pap, PSA tests ordered by a
  physician 30 (20 on PPO Saver)
• Well Baby/Well Child 40 (50 on PPO Saver)
• Not covered on PPO Basic 1000 Plan
• HealthyCheck Center
• 25 or 75 for Basic Screenings
• HMO Plans
• 10 Copay

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We Offer FamilyElect

• Based on needs, each family member can choose his
  or her own plan (including RightPlan PPO 40)
• Family submits an application with one check for
  all premiums
• Once approved for coverage, the family can pay
  for everyone on one bill

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Value-Added Programsfor all members

• Blue Cross Healthy Extensions
• Discounts on a wide range of alternative health
  care and wellness products and services through
  independent vendors.
• Blue Cross MedCall
• For reliable health care information from a
  registered nurse or one of 200 educational audio
  tapes 24-hours a day.
• Blue Cross BabyConnection
• Promotes early and regular prenatal care.

SM
SM
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More Value-Added Programs

• PPO Members
• BlueCard Program is there for clients who travel
  to provide network savings with more than 70 of
  doctors and 80 of hospitals in America.
• HMO Members
• With DirectAccess providers, client can self
  refer to a Participating Specialty Service
  Provider without a Primary Care Physicians
  authorization
• With SpeedyReferral providers, clients get
  immediate referral for certain specialty
  consultations without prior authorization from
  the medical groups management committee

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Payment Billing

• Initial Premium Payment Methods
• Checking Account Deduction
• Credit Card (Visa, MasterCard or Discover)
• Check
• Ongoing Premium Payments
• Monthly
• Checking Account Deduction
• Credit Card
• Bi-monthly or Quarterly Billing

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Tips to Speed Up Submissions

• Always ask client to return application to you
• Verify it is complete
• Fax in your complete application
• To [phone] as listed on the application
• Using any other Fax will cause a delay

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Tips to Speed Up Submissions

• Advise client to use an automatic payment method
  vs. a check.
• Provide clients with the opportunity to submit
  online via the Agent Connect link located on your
  web site.
• More information is available at Agent Services
  at bluecrossca.com

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Exclusions LimitationsThis ends our summary
of medical benefits.For more information about
out-of-network coverage and what the plans do not
cover, please refer to the plan-specific Evidence
of Coverage booklet.
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Individual Dental Products
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Dental Coverage Offered

• Choice of affordable dental plans
• Access to broad networks of dentists including
  specialists
• Three Dental Health Maintenance Organization
  (DHMO) Plans
• One Dental Preferred Provider Organization (PPO)
  Plan

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Blue Cross Individual Dental HMO Features

• Must use the services of a network provider
• Options by premium and plan design
• Low Blue Cross Individual Dental Saver
  SelectHMO
• Medium Blue Cross Individual Dental SelectHMO
• High Blue Cross Individual Dental Premier
  SelectHMO
• No deductibles
• Unlimited maximum benefit

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Blue Cross Individual Dental HMO Plan Share of
Costs

• 5 office visit for preventive care (includes two
  cleanings per member per year)
• Diagnostic services, no charge for oral exam and
  x-rays consultations 46 per session.
• No annual maximums or waiting periods for most
  services
• All services (including specialty) covered for a
  fixed copay amount
• Orthodontia coverage included

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BC Life Health Dental PPO Features

• Choice of any dentist
• Save more if you go to a network dentist
• 50 annual deductible per person
• Maximum three deductibles per family
• Maximum 1,000 coverage per person, per year

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Individual Dental PPO Plan Share of Costs

• Preventive and diagnostic care (includes two
  cleanings and exams per member, per year
• Basic care (including filling) covered after
  three months. All services (including specialty)
  covered for a fixed copay amount
• Major care (including root canal) covered after
  12 months
• Plan pays specified amount or amount of dentist
  charges, whichever is lower

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Affordable Term Life Insurance for Individuals
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BC Life Health Term Life Insurance for
Individuals

• Anyone who qualifies for one of our Level 1 or
  Level 1 20 medical plans can purchase
• Up to 50,000 if over age 19
• Up to 30,000 (age 1-19)

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BC Life Health Term Life Insurance for
Individuals

• Easy to apply
• Applicant completes brief section in the
  Individual Enrollment Application (IU2036)
• No initial premium is required for life insurance
  submissions
• BC Life Health Insurance Company is rated A
  in excellence by AM Best and A in strength by
  Standard Poors

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• Thank You for Selling Blue Cross!