1. 2016 Broker Playbook: Individual Business

2. © 2014 Harvard Pilgrim Health Care Agenda  Who We Are / Our Value  Product & Network  More Value-Added Programs & Services  Your member savings  Broker Portal & Support  Product Grids  Contact Information 2

3. Who we are, and why you can count us in:  Harvard Pilgrim, a not for profit health services company founded by doctors in 1969  Harvard Pilgrim is consistently ranked among the nation’s highest-rated private health plans by NCQA*  By the Boston Business Journal (BBJ) –One of the Best Places to Work in Massachusetts (2003 - 2015) –Only company to be named to the BBJ's annual regional awards program for the 13th year in a row. –One of the top 10 Area’s Largest Corporate Charitable Contributors seven out of eight years in a row according to the BBJ’s Corporate Philanthropy Summit (2007 – 2014**)  Our mission is to improve the quality and value of health care for the people and the communities we serve  Local presence in each market served: –Hartford, CT –Quincy, Wellesley, & Worcester, MA –Portland, ME –Manchester, NH *NCQA’s Private Health Insurance Plan Rankings, 2011-15, HMO/POS/PPO. NCQA’s Health Insurance Plan Rankings 2010- 11 – Private. U.S.News/NCQA America’s Best Health Insurance Plans 2005-2009 (annual). America’s Best Health Insurance Plans is a trademark of U.S.News & World Report. NCQA The State of Health Care Quality 2004. ** #11 in 2008

4. Selling the Value of Harvard Pilgrim: Value Proposition Summarized  Strong reputation and nationally recognized for: –Customer satisfaction –Clinical quality and Care Management –Wellness programs –Commitment to diversity and inclusion, Eastern Harmony –Innovation  More value added programs and services, “Your Member Savings”  Easy to use –Dedicated sales and customer service teams for you and your clients –HarvardPilgrim.org, the pathway to online tools and self-service  We Invest and give back to the communities we serve through our Harvard Pilgrim Foundation; we give back $130 million through our Foundation to build healthier communities.

5. Harvard Pilgrim 2016 New Hampshire Marketplace Products

6. © 2014 Harvard Pilgrim Health Care What HPHC offers the consumer  Two defined networks, ElevateHealth and New Hampshire, with multiple plan choices across the metal tier spectrum  On-line tools to help members manage their plan and health  Numerous discount programs to support a healthy lifestyle and more  Naturopathic providers included in all NH networks –Services are covered under the medical benefit –PCP referral is required

7. ElevateHealth and New Hampshire Network Plans

8. Our 2016 ElevateHealth Individual Plans ElevateHealth Gold HMO ElevateHealth Gold HSA HMO ElevateHealth Silver HMO ElevateHealth Silver HSA HMO ElevateHealth Bronze HMO ElevateHealth Bronze HSA HMO Nine plans with the ElevateHealth Network

9. Our 2016 New Hampshire Individual Plans NH Network Gold HMO NH Network Silver HMO Premium NH Network HSA Bronze Three plans with the New Hampshire Network

10. Plan Choice Guide GOLD HMO & HSA HMO Highest premiums Lowest cost share Deductible range of $1,000-$1,500 Co-insurance range of 0%-10% More copay services BRONZE HMO & HSA HMO Lowest premium Highest cost share Deductible range of $4,500-$6,300 Co-insurance range of 0%-50% SILVER HMO & HSA HMO Lower premiums Lower cost sharing Deducible range of $2,400-$3,400 Co-insurance range of 15%-30% CONSUMER Healthy consumers Buying coverage to avoid fines CONSUMER Subsidy eligible Seeks value in coverage CONSUMER Willing to pay for richer benefits

11. Plan Choice Guide – Why an HSA Looking for a tax-advantage fund to pay medical expenses now or in the future? Paying deductible first for office visit is OK? HSA

12. ElevateHealth Network

13. 13  Smaller network for lower premium –700+ primary care physicians –3,300+ specialists  17 Easy Access hospitals –Network coverage in all NH counties except Carroll –Includes Brattleboro Memorial Hospital in Brattleboro VT Note: hospital admitting privileges is not an indication of network participation. To find a provider participating in this network please use the ElevateHealth online directory New for 2016

14. To find ElevateHealth participating providers: Visit www.harvardpilgrim.org/elevatehealthwww.harvardpilgrim.org/elevatehealth 14 1 1.Click on Find a Doctor under quicklinks 2.Make sure the ElevateHealth plan is selected 3.Search by preferred provider type 32

15. ElevateHealth ID card

16. New Hampshire Network

17. 17  All 26 New Hampshire hospitals  Brattleboro Memorial Hospital in Vermont  *Provider groups associated with these hospitals  Only available for our individual members *Note: hospital admitting privileges is not an indication of network participation. To find a provider participating in this network please use the NH Network online directory

18. To find participating providers: Visit www.harvardpilgrim.org/buynh Select New Hampshire Network HMO Make sure the New Hampshire Network HMO is selected Search by preferred provider type 1.

19. New Hampshire Network ID card

20. Defined Networks – How they work  Members must receive all care through a defined network provider –Use our online directory to find a participating provider  Standard HMO rules apply – referrals needed for specialist visit  Member liable if out of network provider is seen, even if referred by PCP  Prior authorization from Harvard Pilgrim is required for complex specialty care not otherwise available within network

21. Defined network facts  Two types of in-network providers –Easy Access Standard HMO rules apply – referrals needed for specialist visit –Authorized Access Hospital and providers require additional prior authorization from Harvard Pilgrim Only for complex specialty care not otherwise available from Easy Access providers

22. General information about our plans

23. 2016 Benefit Changes  Convenience Care Clinic applies the PCP level copay  Free Standing Urgent Care applies specialist level copay  Coverage for Methadone Treatment –Per week copay  Most plans include a deductible for Rx on tier 3 and 4 drugs  Deductible applies to all services including office visits on Bronze plans

24. All Individual Plans share the following:  Most deductibles (HSA and Non HSA) are embedded –The most an individual family member will contribute to the family deductible is the Individual deductible –All Out-of-pocket Maximums cross accumulate  Emergency Care covered in network and out of network –Always covered at the “in-network” benefit level

25. Benefits – Preventive Services  Preventive services are covered in full –Routine physicals and annual gyn exams –Outpatient Prenatal care –Many common preventive tests, including (but not limited to): mammogram and pap smear routine urinalysis immunizations for children and adults non-diagnostic colonoscopy certain tests recommended based on age and habits –Complete list is at www.harvardpilgrim.orgwww.harvardpilgrim.org

26. Benefits – Lab and X-ray (including High End Radiology)  All lab and radiology to diagnose or treat an illness, injury or condition are subject to the deductible and coinsurance –Diagnostics includes lab work, imaging (x-ray, MRI, CT scan) –See Schedule of Benefits for a complete list

27. Pediatric Vision Coverage (for children up to age 19)  Prescription glasses/lenses OR contact lenses –first $100 covered in full  Purchase anywhere prescription eye wear is sold –Member must submit proof of purchase of glasses or contact lenses to HPHC directly for reimbursement –Reimbursement form is available on HPHC.org and from Member Services  Annual eye exam is covered under the medical benefit –Members must receive eye exam from a network participating provider

28. Out of Area Dependent Coverage  All HPHC’s HMO plans include coverage for dependent children under the age of 26 living outside the enrollment area  The subscriber must call Member Services to register the OOA dependent -1 888 333 4742  Routine and non routine services are covered

29. Out of Area Dependent Coverage  Prior approval is needed from HPHC before receiving certain services –Please see member handbook for additional information or call HPHC  Subscribers are referred to the PPO online directory to find Option providers and avoid balance billing issues from non-plan providers  Option providers may not balance bill

30. Value Added Benefits  Acupuncture – 20 visits per calendar year –Must use a network participating provider –Access to discount programs once benefit limit is reached  Chiropractic Care – 12 visits per calendar year –Must use a network participating provider –Access to discount programs once benefit limit is reached  Routine eye exam every 24 months  Multiple Member Savings Programs

31. Prescription Drug Benefit

32. Standard Rx  All Rx costs apply to the single Medical/Rx Out of pocket maximum  Value Formulary –Only excludes drugs that have more cost-effective, FDA- approved alternatives –On average <5% of members have medications that are not covered on the Value formulary  4 Tier Structure  If the cost of the medication is less then the copay, the member only pays the cost of the medication

33. Value Formulary Tiers – Individual Plans Value 4-Tier Generics only - Preferred Brands (some high cost generics) Non-preferred brands and preferred specialty (some higher cost generics) Non-preferred specialty drugs (very high cost brand and generic drugs) Tier 1 Tier 2 Tier 3 Tier 4

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35. Helping members stay healthy, for less! Your Member Savings

36. © 2014 Harvard Pilgrim Health Care36 Count us in for discounts to help members maintain a healthier lifestyle Fitness Reimbursement & Discounts –$150 reimbursement per HP policy holder –Discounts at select clubs in NH, MA and ME –15% off footwear at Runner’s Alley (NH) 20% off Appalachian Mountain Club membership –Discount on exercise equipment and services from Workout Fitness Store (Portland, ME) Eye and Ear –FREE eyewear program at Visionworks (formerly Cambridge Eye Doctors) –Discounts at Visionworks, JCPenny Optical, LensCrafters, Pearle Vision, Sears Optical and Target Optical –Hearing aids Complementary and alternative medicine –10-30% off acupuncture, chiropractic care, yoga, Chinese herbal medicine and more –Massage Envy –Mindful magazine –RESPerRATE blood pressure therapy –Mindfulness-based Stress Reduction course at UMass Medical (Shrewsbury, MA) Dental –30 – 50% off all procedures at participating dentists through Universal Dental Plan Monthly fee as low as $5.74 Eat Right Rewards –Member rewards for healthy food purchases at most grocery stores Nutrition –Jenny Craig –Weight Watchers –Diet.com –iDiet –Meals to Heal Save on many products and services:

37. © 2014 Harvard Pilgrim Health Care Disease & Care Management: Our Programs to Support a Culture of Health  Acute Conditions –Post Hospitalization Calls –Clinical Transitions –Shared Decision Making –High Cost Outreaches –Social Work Program  Chronic Conditions –Cardiac Disease – CAD & CHF –Chronic Lung – Asthma & COPD –Diabetes –Complex care for co-morbidities  Highest Risk –Oncology –Chronic Kidney Disease/ESRD –Rare Diseases –Complex Care –Gender Transition  Utilization Management –Medical Necessity –Pharmacy –Radiology –Home Care / SNF –Spine Management –Outpatient Therapy Review  BeyondHealth –Lifestyle Management & Coaching Hypertension /Cholesterol Smoking Cessation Obesity/ Weight Management Stress Management Nutrition Diabetes –Mind the Moment –EveryBODY Get Healthy 37

38. © 2014 Harvard Pilgrim Health Care38 What HPHConnect for Members offers your enrollees  Members can quickly set up an HPHConnect account and get instant access to our e-tools and resources  Plan Information –Activity Summary –Authorizations –Update information –Select a primary care provider (PCP) –Order ID Cards  Personal Health Record –Claims - the status and amount of medical bills –Benefits and eligibility - specifics on member’s coverage and costs –Continuity of Care Record – summary of health information –Medical history - includes conditions, illnesses, immunizations and procedures –Medication profile – personal medication history –Family and social history new! –Wallet card - create personal portable medical summary

39. © 2014 Harvard Pilgrim Health Care39 Now quicker and easier to get HPHConnect-ed  No more waiting for a temporary password in the mail!  Members can quickly set up an HPHConnect account and get instant access to our e-tools and resources  To set up an HPHConnect account, members need to: –Visit www.harvardpilgrim.org and select “Members”www.harvardpilgrim.org –Under “Your Account,” select “Create an account” and enter Harvard Pilgrim ID number, birth date, ZIP Code and last four digits of the subscriber’s Social Security number –Choose a username and password to instantly activate their account

40. © 2014 Harvard Pilgrim Health Care Now iKnow Highlights  Now iKnow is an online cost and quality tool that helps you: –Compare cost information and quality ratings Estimates for hundreds of services and conditions, based on your specific plan Quality ratings for doctors and hospitals based on national benchmarking data –Prepare financially for all types of care—office visits, surgery and more Up-to-date cost-sharing information for your specific plan—like deductible requirements—so you know what your out-of-pocket costs will be before you get services –Save on health care costs by making more-informed decisions

41. Individual Business – Broker Support New Hampshire Broker Breakfast October 2015

42. © 2013 Harvard Pilgrim Health Care Broker Support  2016 Renewal Process  Consumer Enrollment Tracker  Online Billing Portal  Harvard Pilgrim Online Consumer – Broker Community

43. © 2013 Harvard Pilgrim Health Care 2016 Renewal Process - Support  Off-Marketplace Renewals: Instructions  Brokers will receive a renewal report for their existing book of business  Sample renewal letters  Product Mapping Grid of 2015 products to 2016 products  Renewal Hot Line –Consumer Sales Team will assist with questions regarding benefit changes –Off-Marketplace renewals can be conducted via: Paper enrollment –www.harvardpilgrim.org Phone enrollments by Consumer Sales Team – 844-231-1592 –Broker will remain broker of record unless HPHC is notified otherwise

44. © 2013 Harvard Pilgrim Health Care 2016 Renewal Process Tools Renewal report will be emailed to Brokers & Agencies with their renewal book of business containing: Name of Customer and HP ID# 2015 Premium and Product 2015 Average Premium Tax Credit 2016 Premium and New Product (mapped)

45. © 2013 Harvard Pilgrim Health Care 2016 Renewal Process Tools – Marketplace MARKETPLACE RENEWALS - INSTRUCTIONS  Marketplace Renewals must be completed on the Marketplace to avoid member disruption  Harvard Pilgrim can provide assistance with 2016 benefit questions (877-907-4742 or HPHC) but any plan changes must be completed on the Marketplace  Marketplace changes must be made by December 15, 2015. If no changes made, member will automatically renew  Members have 3 options: –Passive Enrollment - Member likes 2016 plan changes presented in renewal letter, and there are no changes to Marketplace application information Do Nothing. Member automatically enrolled and continues to pay monthly premium. –Active Enrollment - Member likes 2016 plan changes presented in renewal letter, and there are changes to Marketplace application information Take Action. Member must go back to the Marketplace to update information and re-enroll. –Active Enrollment - Member does not like 2016 plan changes presented in renewal letter Take Action. Member has 3 ways to find other plans and enroll Visit HealthCare.gov and look at other Marketplace plans. Visit HealthCare.gov and see if qualify for Medicaid or the Children’s Health Insurance Program. Look at other plans outside the Marketplace.

46. © 2013 Harvard Pilgrim Health Care Broker Support – Tracking Enrollments Introducing the Consumer Enrollment Tracker  Available on Broker web page at harvardpilgrim.org/broker  Brokers will be able to: –Track applications that are submitted – View status of an enrollment Application received /Waiting for payment = application on hold waiting for binder payment Under manual review= missing information requires manual intervention Processing = HPHC has all information and binder is being processed Enrolled= Successfully processed application Cancelled = never received binder payment within 10 days post effective date Termed = Terminated membership with HPHC

47. © 2013 Harvard Pilgrim Health Care Consumer Enrollment Tracker Enter in Username and password provided by Broker Relations click “Login” Displays book of business on and off exchange Use tool bar on left to enter search criteria Broker Name

48. © 2013 Harvard Pilgrim Health Care Broker Support - Online Enrollments

49. © 2013 Harvard Pilgrim Health Care Broker Support – Introducing Online Payment Tool New Option to Pay Now or Pay Later: Paper Check or Money Order select “Pay Later” Payment by Electronic check (ACH), debit & credit cards select “Pay Now”

50. © 2013 Harvard Pilgrim Health Care Pay Now - Online Payment Tool Harvard Pilgrim allows individuals to use credit /debit card for first payments only

51. © 2013 Harvard Pilgrim Health Care Sneak Preview

52. © 2013 Harvard Pilgrim Health Care Harvard Pilgrim Online Consumer Management– Broker Community  Coming soon, Harvard Pilgrim Online Consumer Management, a broker portal to manage your business –Link on hphc.org/broker –Track book of business (Marketplace & off exchange) –Reporting dashboard –Quoting tool with option to email/mail client proposals –Enroll clients (off marketplace only)

53. © 2013 Harvard Pilgrim Health Care Broker - Home Page Calendar will help organize tasks and appointments Commonly-used objects are found by clicking on their tabs which appear at the top of the screen Dashboard snapshots provides a graphical view of reporting By clicking on any graph you are Brought to the Reports section for more detailed information My Tasks lists follow up work that is past due and over next 7 days Using the drop down you can choose what Timeframe of Tasks you want to appear

54. © 2013 Harvard Pilgrim Health Care Create a Quote Filters help narrow down options View SOB, SBC,Provider Directory, Formulary Select plans and then compare to see a side by side comparison

55. © 2013 Harvard Pilgrim Health Care Create a Quote Drop down allows user to compare plans based on specific benefits

56. © 2013 Harvard Pilgrim Health Care Create a Quote Select Delivery Options: Send by Email Send By Mail Save for Later

57. © 2013 Harvard Pilgrim Health Care Email Quote Sample Quote is sent as attachment with SOB and SBC Brokerage contact information

58. © 2013 Harvard Pilgrim Health Care Confirmation Email Enrollee will receive confirmation email once enrollment is complete

59. © 2013 Harvard Pilgrim Health Care Create Quote as PDF Broker Info and Logos Options to Save & Email or Save & Mail

60. © 2013 Harvard Pilgrim Health Care More information and Training will be available soon!!

61. © 2013 Harvard Pilgrim Health Care Questions