Overview

1. Overview • Why Health AmericaOne? • Product and plan design • Eligibility requirements • Field Underwriting • Benefit Express Quoting and Enrollment

2. Why Health AmericaOne? • The Top Ten Reasons! • No pre-existing waiting period for disclosed medical conditions: Medical conditions disclosed at time of application will be covered without a waiting period if application is approved by underwriting. • Flexible underwriting and rapid turn around time: Over 80% of submitted applications receive an underwritten rate, and 72% of these cases are accepted and placed for coverage. Rapid turnaround time, approx 5 business days for uw decision and final rate generation. Information is not reported to or requested from the Medical Information Bureau.

3. Why Health AmericaOne? • Easy eligibility requirements: Must be under age 65 and not eligible for Medicare, and must reside within our PA/OH service area. Need not be a US citizen, although green card or other documentation may be required for non US citizens. Individuals residing in same household are eligible dependents, including spouses, domestic partners of either gender, grandchildren and dependent children thru age 25 regardless of FTS status. • Comprehensive product portfolio: 16 plans to choose from, including zero deductible/100% plan up to $5,000 deductible. Coinsurance options at 100% 90%, or 80%. 8 QHDHP Plans to choose from. 5 OV Copay Plans to choose from. 3 Deductible & Coinsurance plans to choose from.

4. Why Health AmericaOne? • Rx copay coverage: All Health AmericaOne plans feature Rx copays for both retail and mail order pharmacy. Rx contraceptives covered on all Health AmericaOne plans. • Chiropractic coverage: Coverage provided on new copay plans only, $40 specialist copay applies per visit. Maximum 10 visits per contract year.

5. Why Health AmericaOne? • Secure online quoting and enrollment capability: eHealth quote generation and electronic enrollment and submission to underwriting department. Submit applications to UW up to 5 business days prior to effective date. E mail notification from sales team to broker on missing info requests or final decision made. • Payroll Deduction Program: Business checking accounts may be drafted for Health AmericaOne premiums if the payroll deduction form is signed by the employer and employee. List bill feature available with 5 or more employees participating.

6. Why Health AmericaOne? • Broker training and support Dedicated General Agents, Account Executives, and Account Representatives. • Generous commission and bonus programs. Frequent broker incentives offered. Ask us for all the details!

7. HealthAmericaOne • Developed for individuals and families under the age of 65 and not eligible for Medicare • Preferred Provider Organization (PPO) • Not guaranteed issue • Benefit designs include office visit copayment plans, $0 deductibles, various annual deductibles, varying coinsurance levels and Rx copayments • Rx Contraceptives Now Covered • Chiropractic Care (New OV Copay Plans) • Core benefits only (BBMI Now Covered) • HSA compatible plans

8. Plan Designs • In-network and out-of-network benefit levels • Out-of-pocket maximums • $0 to $5,000 in-network • Unlimited out-of-network • Annual deductibles, varying coinsurance levels, & Rx copayments • Lifetime Maximums • $5,000,000 in-network • $50,000 out-of-network

9. Plan Designs • 5 New PA OV Copay Plans/5 Ohio OV Copay • Deductibles between $0 and $2,000 • Coinsurance levels 100%, 90% • OOP max $0 to $4,000/$8,000 • 8 qualified high deductible health plans • Deductibles between $1,250 and $3,750 • Coinsurance levels 100%, 90%, or 80% • OOP max $3,000/$6,000, $4,000/$8,000 or $5,000/$10,000 • 3 non-qualified plans • Deductibles between $500 and $5,000 • Coinsurance level at 100% or 80% • OOP Max from $2,500 to $5,000

10. Benefit Limitations • Not Covered: • Maternity (except complications) • Voluntary sterilization • Chiropractic care (Except New OV Copay Plans) • Dental/vision care (Vision Discount Plan included) • Hearing aids • Private duty nursing • DME has $7,000 lifetime maximum

11. Eligibility • Eligibility • Subscriber • Under 65, not eligible for Medicare • Under 18, must have guarantor over 18 • Spouse and/or children may be independent applicants • Must reside in PA or OH service area • Dependents • Under 65, not eligible for Medicare • Eligible up to age 25 • Newborns

12. Underwriting & Pricing • Illustrative Rate • Each person evaluated on following demographic factors: age, gender, zip code, and tobacco use • Final Rate • Each person evaluated based on demographic factors, plus medical information on application • Accept, decline or possible rate-up to 50% • Automatic decline List

13. Pre-Existing • Not Subject to pre-ex • Medical conditions disclosed on application & accepted • New medical conditions diagnosed after member’s effective date • Subject to pre-ex • Medical conditions not disclosed on application that were diagnosed before member’s effective date • 6 month look back

14. Service • Wholesale agencies for subproducers • Dedicated HealthAmericaOne Member Services team • 1-866-874-2624

15. HealthAmericaOne -- What’s Next? • Future Enhancements • Mid-Month Effective Dates • Additional Products, including dental benefits and short term plans

17. What Is In the Guide • Producer’s Responsibilities • Health AmericaOne Applications • The Underwriting Process • Health Condition Considerations • Auto Decline List • Build Charts

18. What Is In the Guide, continued • Producer’s responsibilities • Briefly discusses the role of the Producer in providing accurate, complete information on Applicants • Producer must inform the Applicant that prior health history can result in a modified offer of coverage • Coventry has the right to rescind for non-disclosure • “A Producer cannot and must not make any representations or promises regarding claims processing or interpretation of the Policy” • HealthAmericaOne Applications • This section covers application procedures as they relate to Medical Underwriting • “Health condition changes prior to the effective date . . . may result in a re-rate of premium or declination of coverage”

19. What Is In the Guide, continued • The Underwriting Process • Each individual is evaluated and medical underwriting takes the appropriate action based on the severity and prognosis of the condition(s) indicated. Note that this description allows for co-morbidity • As noted, medical underwriting is a process. Date collection is performed in steps. MU only uses the next step if the previous step has not provided complete or enough information • Telephone interviews • Medical records request • Physical examinations • Please note: MU requires recent medical records (must have seen a doctor within the past 2 years) of all Applicants over 50 who are replacing other coverage

20. What Is In the Guide, continued • Health Condition Considerations • This section, organized alphabetically, should be treated as a reference for when Applicants cite a particular condition • The “you should ask” column includes helpful questions and details that should be completed as part of the Application in order to provide the most complete information to MU • The “Probable Action” is just that – a probable action – and not a guarantee – Producers should remember that co-morbidity also plays a factor in the overall offer for coverage • Auto Decline List – since many Producers are used to and comfortable using an Auto Decline List, this was included for convenience. All conditions are also part of the larger Health Condition Considerations section • Auto Decline Medication List • Build Chart

21. What This Guide ISN’T • This guide does NOT replace the Agent Guide – it is a companion piece • A full explanation of the Application process is NOT included • This guide is for use by the Health Plan and Producers ONLY. This guide should not be released to Applicants

22. What If Something Isn’t In the Guide? • Remember-This guide is NOT intended to take the place of medical underwriting • If something isn’t in the guide, the agent should submit the Application and have it be processed as normal and Medical Underwriting will review as normal

23. Application Submission GuidelinesHealthAmericaOne New business submission and application completion guidelines

24. Forms that are needed with every paper application submission: Required: • APPLICATION • TRUST AGREEMENT Suggested: • MRS FORM (applicants under age 2 or over age 50) • PAYROLL DEDUCTION FORM (required for all applications with business banking account info submitted)

25. APPLICATION • Must pick one desired plan in section A and list requested effective date • Applicant must fully complete sections A, B, C, D and sign and date sections E & F ( Be sure to list complete name, address, and phone info for PCP for all applicants) • Broker must sign section G or H depending on which version of the application is used and put GA name as agency representing broker

26. Trust agreement • Make sure the applicant signs, dates and lists their address on the trust agreement.

27. MRS Authorization FORM • Most often required for applicants under age 2 or over age 49. • 50 and older MUST have seen their PCP or had a physical exam within the last 2 years including whatever tests the doctor deems necessary for that individual’s age. • 55 and older MUST have the PE as well, along with the last 5 years of medical records. • Having this form signed along with every application will significantly reduce turnaround time in obtaining medical records.

28. Payroll Deduction Form • Must be submitted if the check has a business name on the account • If self employed, owner fills out both sections and signs both sections • If employer is submitting premium for employee’s insurance the employer and employee will BOTH need to sign the form • Must be submitted along with application in order to process.

29. JET ISSUE PROSPECTS • UNDERWRITING COMPLETED IN 24-48 BUSINESS HOURS • Height/weight must be within standard range • No prior claims history if previously covered with Coventry/Health America • Must be between age 2 and 49 • All application medical questions must be answered “no” • Case will be sent directly to enrollment to be issued. Can still opt out during the 10 day free look period and receive refund if desired

30. Auto Enrollment Procedure AUTO ENROLLMENT PROCESS • Applications that are approved by UW with all family members applying approved with no rate increase will automatically be sent to enrollment to be issued. • General Agents will still receive email confirmation that the case is being "auto enrolled" with rates, eff date, and plan design noted. NO formal acceptance is required by Health America. • The case will be considered "assumed acceptance" if  all family members applying are covered and approved with no rate increase. • Remember:  the policy will be issued and automatic bank drafts will be processed unless customer opts out during the 10 day free look.

31. How to submit new businessapplications • Submit your new business applications through the following channels: • Submit paper applications. There are three ways to have your applications processed: submit via fax at 1-866-347-2380, email CHCHAPA1Indv@cvty.com or by mail; Attention: Individual Medical Underwriting Dept P.O. Box 67103 Harrisburg, PA 17106-7103 • Submit through eHealth, our new electronic tool • Updates from underwriting by email on all cases, sent to General Agents to be forwarded to writing agents

32. Questions? Nancy Dudek, Account Executive (WPA & OH) nadudek@cvty.com 412-577-5409 / 412-849-9150 / 800-735-2202 ext 5409