On Exchange Product Training for 2014

1. On Exchange Product Training for 2014 This presentation is a high-level summary and for general informational purposes only. The information in this presentation is not comprehensive and does not constitute legal, tax, compliance or other advice or guidance. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

2. Our Mission To promote the health and wellness of our members and communities through accessible, cost-effective, quality health care. We are a customer-owned organization and our accountability is clear.

3. Our promise to our members is to make insurance Simple. Affordable. Accessible.

4. Plan Design Components Plan Designs Components • Essential Health Benefits • Deductible and Out-of-Pocket Maximum (OPX) • Per-Occurrence Deductible • Out-of-Network Benefits • Copays • Rx Tiers *Excluded from both: Premiums, Claims for Uncovered Services, and Preauthorization Penalties 2

5. How do Claims Pay Towards OPX and Deductible in the New ACA World? • In 2014, the OPX could be more critical • to the average consumer than their deductible. 4 • Copays and Per-Occurrence Deductibles do not feed into the deductible • These costs go directly to the Out of Pocket Maximums (OPX) • All other eligible expenses go towards the annual deductible • Cost sharing feeds into the OPX • Includes Rx Copays • Includes Office and Hospital Copays • Includes Per-Occurrence Deductibles

6. How Do Per-Occurrence Deductibles Work? 5 *Example Only – Based on In-Network Level of Benefits • Per-Occurrence Deductible Includes: • Emergency Room • Inpatient Hospital Admission • Outpatient Surgery • When a Per-Occurrence Deductible Is Paid: • The amount is subtracted from the claim • The balance of the claim is subject to the annual deductible and coinsurance • The Per-Occurrence Deductible is credited towards the OPX

7. Family Deductible and OPX Summary • If one person meets the individual deductible, the remaining deductible can be met by the rest of the family members. • The one person that meets the individual deductible will start to receive benefits and the coinsurance will begin to be applied towards that person’s OPX. • If the one person that meets the individual deductible meets the individual OPX, he will receive 100% coverage even if the family deductible and OPX has not been met. • The remaining family members can contribute to the balance of the family OPX. • Once the family OPX is met, then all family members will receive 100% coverage. • One person cannot meet the entire family deductible and OPX. Once the deductible is met, coinsurance will be applied. 6

8. Copays • Office Visit copay will cover everything billed as part of office visit (if performed in the same office on the same day) • Exceptions: • Surgery • Physical, Occupational and Speech therapy • Chiropractic and Osteopathic manipulation • If services are performed in a separate office or facility and billed separately, then coinsurance and deductible apply • Mental Health and Substance Abuse will be covered the same as any medical service • Inpatient covered at the in-patient per admission rate • Outpatient covered at primary care provider (PCP) rate 8

9. Rx Benefits Structure • Benefit Structures • Drug Card • Coinsurance after Medical Deductible • Formulary • Standard Formulary on PPO Network • Generics Plus formulary on narrow networks • Generics Plus is a leaner version of the standard formulary and includes non-specialty and specialty drugs for all major therapeutic categories • 5-Tier Drug Copays (2-tier Generics) 9

10. Out-of-Network Benefits for PPO and HMO • Out of Network Benefits for PPO plans • Out-of-network office visits (primary and specialist) are subject to deductible and coinsurance, no copays are applied • Inpatient Admission Copay and Outpatient Surgery Copays: $100 increase over In Network copay, per occurrence copay in addition to deductible and coinsurance • All other Out-of-Network services are subject to deductible and coinsurance • Deductible: 2x In-Network up to $25,400 • Out of Pocket: 2x In-Network up to $25,400 • Coinsurance: 20% differential from In-Network level with a floor of 50% • Emergency room services will be the same as In-Network • HMO plans do not include Out of Network benefits • HMO plans do not include ‘Away From Home’ benefits, only BlueCard Worldwide® for emergency and urgent care 7

11. Provider Networks and Plan Designs 13

12. 2014 Retail Provider Networks 14

13. New Mexico Provider Network Service Areas PPO Provider Network Blue Advantage HMO Blue Community HMO New or Modified Network 15

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17. Why Choose Blue • Brand Recognition • Network Strength • Claims Paying Capability • Website Strength – Direct Enrollment • Choices of Plans • PPO • HMO • Catastrophic • New Mexico PPO Provider Network – 12,000 Providers • Blue Community HMO NetworkSM – 5,000 Providers • Blue Advantage HMO NetworkSM – 2,800 Providers • Value Added Benefits • BlueCard Worldwide® We are part of the community! • CareVan Program • Blue Bear Outreach • Healthy Kids, Healthy Families® • Blue Corps Team

18. This presentation is a high-level summary and for general informational purposes only. The information in this presentation is not comprehensive and does not constitute legal, tax, compliance or other advice or guidance. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 20