1. BlueEdge HSASM bcbsok.com Rev 11-2013 EMI team
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Copyright © All rights reserved.

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

3. What are the Benefit Differences
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
$ Individual BP/BC/$2,250 Family Embedded*
$1,500 Deductible / $3,000 Family Aggregate*
Coinsurance
80% In Network
80%
Out of Pocket
$4,250 Individual/$12,700 Family Embedded*
$4,000 Individual/$8,000 Family
Aggregate*
Pharmacy Benefits
$4.00 Generic $50.00 Preferred $ 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

4. BlueEdge High Deductible
Office Visit Claim In Network
OFFICE VISIT
Member has an office visit for Bronchitis and seeks services from their PCP
BlueEdge High Deductible
BlueOptions
Total Charge: $300.00
Allowable Charge: $250.00
Deductible: $250.00
Member Responsibility: $250.00
Total Charge: $300.00
Allowable Charge: $250.00
Office Visit Copay: $30.00
Deductible: $0.00
Member Responsibility: $30.00
BlueEdge Plan - The members responsibility is $ 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.

5. BlueEdge High Deductible
Preventative Claim In Network
OFFICE VISIT
Member has a routine physical
BlueEdge High Deductible
BlueOptions
Total Charge: $200.00
Allowable Charge: $175.00
Member Responsibility: $0.00
Total Charge: $200.00
Allowable 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.

6. Taking a look at the Hospitalization Claim – Total Benefit Perspective BlueEdge Vs. BlueOptions
INPATIENT
Member is inpatient and has employee only coverage.
BlueEdge
BlueOptions
Total Charge: $30,000.00
Allowable Charge: $20,000.00
Deductible: $ 1,500.00
20% after Deductible: $ 2,500.00
BCBSOK Paid: $16,000.00
Member Responsibility: $ 4,000.00
Total Charge: $30,000.00
Allowable Charge: $20,000.00
Deductible: $
20% after Deductible: $3,500.00
BCBSOK Paid: $16,000.00
Member Responsibility: $ 4,250.00
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.

7. Hospitalization In-Network
OFFICE VISIT
Member is inpatient and has Family Coverage. No other member has had any claims process for the current year.
BlueOptions
BlueEdge High Deductible
Total Charge: $30,000.00
Allowable Charge: $20,000.00
Deductible: $ 3,000.00
20% after Deductible: $ 5,000.00
BCBSOK Paid: $12,000.00
Member Responsibility: $ 8,000.00
Total Charge: $30,000.00
Allowable Charge: $20,000.00
Deductible: $
20% after Deductible: $ 5,000.00
BCBSOK Paid: $15,750.00
Member Responsibility: $ 4,250.00
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 $ 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.

8. Pharmacy Claim Member fills a brand name prescription at the pharmacy.
BlueEdge High Deductible
BlueOptions
Total Charge: $175.00
Allowable Charge: $125.00
Deductible: $125.00
Member Responsibility: $125.00
Total Charge: $175.00
Allowable Charge: $125.00
Copayment: $ Member Responsibility: $50.00
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.

9. 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 $
$978.96
$251.54
$3,018.48
Employee and Dependent
$890.70
$708.66
$182.04
$2,184.48
Family $ $
$331.24
$3,974.88

10. What is an HSA?
An HSA must be used in combination with a qualified high-deductible health plan (HDHP)
A Health Savings Account (HSA) is a tax-exempt account established exclusively for the purpose of paying qualified medical expenses.
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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High Deductible Health Plan Design
An HSA must be used in conjunction with a qualified high-deductible health plan (HDHP)
A qualified high-deductible health plan has:
A higher annual deductible than typical health plans
The out-of-pocket maximum applies only to covered expenses. Out-of-pocket expenses include copayments, deductible and other amounts, but do not include premiums
May provide preventive care benefits without a deductible or with a deductible below the minimum annual deductible
Preventive care does not include any service or benefit intended to treat an existing illness, injury, or condition 10

11. HSA ADVANTAGES FOR EMPLOYERS FOR EMPLOYEES For Employers For Employees
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
HSA
ADVANTAGES
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HSA Advantages
For Employers
Two integrated HSA banking options – one offers auto debit payment
Lower health insurance premiums by switching to a health insurance plan with a high deductible
A way to assist your employees make better health care choices and spending decisions
For Employees
High deductible insurance and HSA protect against high or unexpected medical bills
Members decide how much money to put into the account and whether to use it to pay for current medical expenses or save the money for future needs
Triple Tax Savings
Tax deductions when members contribute to account
Tax-free earnings through investments
Tax-free withdrawals for qualified medical expenses
Portability
Keep the account even if jobs change or retirement – funds remain in the account from year to year, like an IRA
No “use it or lose it” rules for HSAs 11

12. TO BE ELIGIBLE YOU:
Must be enrolled in an HSA-compatible High 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.
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EMI team
HSA Eligibility
To be an eligible individual and qualify for an HSA you:
Must be enrolled in an HSA-compatible High Deductible Health Plan (HDHP)
May not have other first dollar medical coverage (other types of insurance, accident, disability, etc.)
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. 12

13. HSA CONTRIBUTION RULES
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
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HSA Contribution Rules
If made by the individual outside a cafeteria plan, contributions are an “above-the line” deduction, which is tax-free.
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.
All contributions must be aggregated.
All HSA contributions made by or on behalf of an eligible individual are combined for purposes of applying the limit.

14. U.S. TREASURY GUIDELINES FOR 2015
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
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HSA Contributions. The IRS determines the minimum/maximum amounts. The amounts are adjusted annually for inflation. Employee, employer or any other person may make contributions on behalf of an eligible individual. 14

15. FLEXIBILITY OF THE BlueEdge HSASM
USERS
have multiple options to leverage HSA $$$s
SAVERS
use personal funds to cover expenses and invest excess
HSA account balance
Health Care Transaction
Excess Balance
Investment Options
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EMI team
Flexibility of the BlueEdgeSM HSA
The flexible payment platform of the HSA accommodates both “users” and “savers”
HSA account balance > Health Care Transaction > 1. Users: have multiple options to leverage HSA $$$s
> 2. Savers: use personal funds to cover expenses and invest excess
The excess balance from each can then be used as Investment Option

16. BANKING PARTNER
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17. BlueEdge HSASM Custodian Integration Features
DIMENSIONS OF INTEGRATION
INTEGRATION 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
Communications
BlueEdge Plan communications
Bank custodian communications
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18. THE VALUE OF BlueEdge Banking 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
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
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* All banks may have additional, miscellaneous fees. Refer to each bank’s fee schedule for additional information.

19. Member Experience
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20. AUTOMATIC HSA DEBIT FOR MEDICAL (BenefitWallet)
Member goes to doctor for broken arm
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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EMI team
Automatic HSA debit for Medical
EXAMPLE:
Member goes to doctor for broken arm
Doctor submits claim to BCBSOK
BCBSOK 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
*Assumes PPO network provider. Only available with BenefitWallet
Doctor submits claim to BCBSOK
BCBSOK processes claim, determines out-of-pocket liability for member (copay, coinsurance, deductible)
*Assumes PPO network provider. This feature is only available with BenefitWallet. 20 20

21. AUTOMATIC HSA DEBIT FOR RX (BenefitWallet/Prime)
Member goes to a pharmacy to fill a prescription
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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EMI team
Automatic HSA debit for Rx
EXAMPLE:
Member goes to a pharmacy to fill a prescription
Pharmacy sends claims to PBM
PBM processes claim and determines 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
*Assumes PPO network provider. Only available with BenefitWallet and Prime
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
*Assumes PPO network provider. This feature is only available with BenefitWallet and Prime. 21 21

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24. Other Resources

25. 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
Prim
Refill a mail order prescription
Check the status of an order
Streamlined order refills
Manage payment options
Add alternative mailing address

26. 24/7 800-581-0407 Nurseline Available in English and Spanish
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
Available in English and Spanish

27. Blue Access Mobile BCBSOK App Features: Member resources
Find Doctors or Hospitals near you
Shop for Plans
Text BCBSOK APP to to download* *msg and data rates may apply
Or visit store links below:

28. Online Tools and Resources
Benefits and Claims
ID Card Management
Monthly Health Topics
Health Assessment
Provider Finder®
Be Smart. Be Well.®
eCards for HealthSM
Health Care School
Blue Access for MembersSM
Cost Estimator tool
Member Care Profile
Member Discounts
Member Wellness Portal
Wellness Points
Special Beginnings®´ 28

29. Interactive Video Tutorials
Easy to use, technology-powered video coaching modules that enable the most informed treatment decisions
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

30. 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

31. Lifestyle Management
Weight Management & Tobacco Cessation: Support for a Healthier You
Personalized Coaching
Counseling and coaching with licensed Wellness Coaches
24/7 Nurseline
Referrals when appropriate
Self-Paced Approach
Online programs
Secure outreach keeps members on track

32. 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.