MIIA - Blue Cross Blue Shield Proposed Benefits

1. MIIA - Blue Cross Blue Shield Proposed Benefits

2. Plan Offerings • HMO Blue New England (HMO) • Blue Care Elect Preferred (PPO)

3. HMO Blue New England HMO Blue Use HMO Blue Network Providers PCP Required – Change Anytime Referrals To Network Specialists No Referrals For: OB/GYN Care, Chiropractic Care, Outpatient Behavioral Health Visits, Routine Vision Exam, Emergency Or Out-Of-Area Urgent Care 3

4. Blue Care Elect Preferred (PPO) • No Primary Care Physician Needed • No Referrals Needed For Specialty Care • National Network – Ability to have services rendered out of state at the same out of pocket cost as HMO members

5. Find A Blue Cross Network Provider • Visit www.bluecrossma.com • Call Physician Selection Service 1-800-821-1388 • Ask Your Providers If They Are In The HMO Blue Network

6. Proposed Changes • Addition of a plan year deductible for some services - $250 Per Individual, $750 Per Family • Primary Care Physician Office Visits • Specialist Office Visits • Emergency Room Visits • MRI, CT and PET Scans • Prescription Drugs

7. Services That Are Not Subject to the Deductible SERVICES THAT ARE NOT SUBJECT TO DEDUCTIBLE Preventive Visits, Related Tests & Immunizations: You Pay $0 (no change) Diagnostic PCP, OB/GYN, Nurse Practitioner Visits: You Pay $20 (today you pay $10 to $20 per visit) Mental Health Office Visits You Pay $15 (today you pay $10) Other Professional Providers & Specialist Visits: You Pay $35. (today you pay $25) Prescription Drugs You Pay 10/25/50 for a 30 day supply, 20/50/110 through Mail Service. (today you have a 10/20/40 for retail, 20/40/90 mail.) Chiropractic Visits – You pay $20 (today you pay $15) Short Term Rehabilitation Therapy – You Pay $20 (today you pay $15) Speech, hearing, and language disorder treatment – You Pay $20 (today you pay $15) 7

8. Services Subject To The Deductible After You Pay $250/$750. Plan Year Deductible, Then: Diagnostic Labs, X-Rays & Other Tests: You Pay $0 (today you have no deductible) CT, Pet Scans and MRI - $100 per category of tests ( today you pay $0 with no deductible) Emergency Room: You Pay $100 (today you pay $100 with no deductible). Inpatient Admissions: You Pay $300 at a lower cost hospital, $700 at a higher cost hospital. (today you pay $200 for Lower cost hospitals and $400 for higher cost hospital with no deductible) Surgical Day Care – You Pay $150 per admission after deductible (today you pay $150 and have no deductible) Hospice and Home Health Care - $0 after deductible (today you pay nothing with no deductible) Durable Medical Equipment You Pay $0 after Deductible (today you pay $0 with no deductible) Prosthetic Devices – You pay Nothing after deductible – (today you pay 20% co-insurance) 8

9. Why Change? • Benefits will not change for a period agreed upon by management and labor) • No hidden out of pocket costs • No off anniversary rates increases • Deductible is plan year not calendar year

10. Out-Of-Pocket Maximum Current Plan: $600 Enhanced Tier admission out of pocket maximum $1200 out of pocket maximum for Standard or basic tier admission $300. out of pocket maximum for Surgical Day Care Admissions. New Plan: $1200 out of pocket maximum for all inpatient admissions $600 out of pocket maximum for surgical day care admissions

11. Healthy Living $150 Fitness Benefit $150 Weight Loss Benefit Childbirth Class Benefit Living Healthy Babies Blue Care Line: 1-888-247-BLUE (2583) Living Healthy Vision Discounts Living Healthy Naturally Discounts Safe Beginnings Discounts

12. Member Central Account Visit www.bluecrossma.com Create An Online Account, Then You Can: Change Your PCP Request An ID Card Review Your Plan Benefits Review Your Claims Track Your Deductible & Coinsurance Enroll In My Blue Health

13. Questions? For Provider Information Or Questions On Your Membership, Benefits, Referrals Or Claims Call Member Service Toll-free Number On ID Card Monday - Friday, 8 a.m. - 6 p.m. Or Visit www.bluecrossma.com