Solutions. Ancillary. Product

Solutions

Ancillary

Product

2015

Life ...3

Disability ...7

Vision ... 13

Dental ... 17

Bundle up & save

We know how important the right benefit package can be to

recruiting and retaining quality employees. That’s why we offer

the

Blue Bundle

. Employers have the option to bundle employee

benefits with affordable, high-quality health and wellness benefits.

With one team to administer all their benefits,

employers save time, and time is money.

We provide employers of all sizes a full suite of employee benefits

that are among the best in the market today. We work with employers

to develop complete and competitive benefit packages that provide

employees protection from the unexpected. We call this package the

Blue Bundle

and it is brought to you by Blue Cross and Blue Shield of

Louisiana and its subsidiaries.

pROTeCTInG

dReaMs FOR THe FuTuRe

TOdaY

SOLUTION. SOURCE. BILL.

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Southern National Life is an independent licensee of the Blue Cross and Blue Shield Association.

EMPLOYEE BENEFITS

A product of Southern National Life Insurance Company, Inc.

OFFeRInG YOuR eMplOYees

peaCe OF MInd

4

Whether your company has two employees or 10,000, we have plans that fit.

Life insurance is something that no one likes to think about. All the same, 86 percent of Americans believe that life insurance is something most people need, and most of us have some.1 _{That’s the good news.} The bad news is that most Americans don’t have enough. More than a third don’t have any life insurance at all, and those who are insured have coverage equal to less than four times their annual income.2 _Most experts believe that coverage equal to 10 times one’s annual income is a more reasonable rule of thumb.

1 _{LIMRA and LIFE Foundation 2011 Insurance Barometer Study} 2 _{LIMRA International, Trends in Life Insurance Ownership, 2011}

BasIC GROup TeRM lIFe/ad&d Employee and dependent

life coverage paid for by the employer.

Did you know…

• Strong life insurance coverage is essential to creating a robust and competitive benefit package for your employees.

• Life insurance offers your employees and their families a safeguard from many unexpected expenses if something should happen to them.

• Employers can offer this high-value benefit at a great price and employer-funded plans generally count as a business deduction for employers.

vOlunTaRY TeRM lIFe/ad&d Optional employee and dependent life

coverage paid for by the employee through the convenience of

payroll deduction.

Did you know…

• Voluntary plans offer extra value to employees at no added cost to the employer’s company. Premiums are payroll-deducted, which means benefits are convenient for employees and economical for employers.

• Voluntary Term Life insurance is a way to provide the same protection as our Basic Group Term Life in a way that is cost-effective to both employers and their employees. • Employers can offer Voluntary Term Life coverage with any Basic Life plan or as a stand-alone plan.

• This option allows employees to purchase additional coverage above what an employer may offer with our Basic Life insurance. This helps provide financial stability and would protect employees’ families from some unexpected expenses, if something were to happen to them.

vOlunTaRY HIGH-lIMIT ad&d Accidental Death & Dismemberment (AD&D) coverage provides protection

for accidents.

Why add Voluntary High-Limit AD&D?

• It’s a fact of life – accidents happen. By choosing Voluntary High-Limit Accidental Death & Dismemberment (AD&D) coverage, employees can give themselves and their family members 24-hour protection in case of accidental loss of life, limb, hearing or sight.

• We offer Voluntary AD&D coverage to employers and their employees at low, affordable rates. This option can also be offered with any group life insurance coverage or as a stand-alone plan.

• Just like with our Voluntary Life coverage, premiums are paid for by the employee through payroll deduction.

lIFe BeneFITs

GROup COnTRIBuTORY vOlunTaRY 100% Participation Required 75% Participation Required Greater of 25% or 10 eligible enrolled

plan Options • Employee Only • Employee + Spouse • Employee, Spouse and Child

standard Features • Accelerated Death Benefit (living benefit)

• Terminally ill employees can receive up to 50% of their voluntary life insurance benefit up to $125,000 while they are still living, if they are given a terminal diagnosis of 12 months or less. • Premium waiver

• Coverage may continue without paying premium if the employee becomes disabled prior to age 60.

• Conversion Privilege

• Employees/dependents may apply to convert all or part of their group life insurance to an individual policy, if they terminate or are no longer eligible for coverage.

• Portability standard with Voluntary Product

• The option to continue a portion or all of their life insurance coverage when employees leave employment.

Optional Features Accidental death & dismemberment

• Accident benefits are equal to the amount of life benefits for accidents resulting in loss of life, limbs, hearing or sight. • Seat belt benefit pays an additional 10% of the principal sum

amount to a maximum of $10,000.

• Air bag banafit pays an additional 5% of the principal sum amount to a maximum of $5,000, if seat belt is also used. • Exposure and disappearance benefit allows covered benefits to

be paid within 12 months of disappearance, if due to a forced landing, stranding, sinking or wrecking of a conveyance.

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Dsabi ity

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Southern National Life is an independent licensee of the Blue Cross and Blue Shield Association.

EMPLOYEE BENEFITS

A product of Southern National

8

IMpaCT OF dIsaBIlITY On THe wORkFORCe

These are alarming statistics. It just goes to show how important protection against lost income can be to a workforce. Unfortunately, many people have not planned for the financial burden they will face if they should become disabled and unable to work for an extended period of time.

Helping employees stay at work.

Our disability coverage encourages employees to continue working as long as they are safely able – protecting their eligibility for benefits and without penalty.

• Employees are able to satisfy the elimination period with only a loss of duties.

• We can extend the elimination period up to a year for disabled employees who do not meet the earnings loss amount. • An employee doesn’t have to be totally disabled to receive benefits.

• Our disability coverage allows disabled employees to return to work for up to one-half of the elimination period without restarting it if they are unable to endure their return to work.

Protecting employers and employees.

Our disability coverage helps protect employees, which in turn protects the employer’s company. Here are a few highlights – see this booklet for more specific details.

• Our disability coverage does not have limitations for symptoms that are self-reported or subjective. We manage all employees’ claims carefully and effectively.

• There is a “treatment-free” period within the pre-existing condition limitation. During this period, if the employee does not receive treatment for the pre-existing condition, he or she may qualify for benefits before completing the continuous days of coverage period.

Almost 3 in 10 workers entering the workforce will become

disabled before age 67.

National Safety Council, Injury Facts, 2010 Ed.

Approximately 90% of disabling accidents and illnesses are not work related; therefore,

not covered by workers’ compensation.

Council for Disability Awareness, CDA 2010 Long Term Disability Claims Review

In the last 10 minutes, 490 Americans became

disabled.

US Social Security Administration, Social Security Basic Facts, Aug. 2009

paYCHeCk

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Dsabi ity

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lOnG-TeRM dIsaBIlITY

GROup COnTRIBuTORY vOlunTaRY 100% Participation Required 75% Participation Required Greater of 25% or 10 eligible enrolled

standard Features • Waiver of premium • Survivor income benefit • Return to work incentive • Workplace modification • Disability guidance (EAP)

• Mental, nervous and substance abuse coverage

Optional Features • Cost of living adjustment • Activities of Daily Living

• Accidental dismemberment/loss of sight benefit

• 24 months own occupation and any occupation thereafter • Loss of one or essential duty during elimination period

product eligibility • Must be in business a minimum of 2 years

• Must not insure more than 50% immediate family members • Can be written stand-alone or with any other life or disability product

sHORT-TeRM dIsaBIlITY

GROup COnTRIBuTORY vOlunTaRY 100% Participation Required 75% Participation Required Greater of 25% or 10 eligible enrolled

standard Features • Group - No Pre-existing limitation • Continuity of coverage

• Maternity included

Optional Features • Totally disabled or disabled and working • Loss of duties and income

product eligibility • Must be in business for 2 years

• Must not insure more than 50% immediate family members

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STD

CLAIM

LTD

CLAIM

At the mid point of STD, the claim is given to an LTD analyst

who manages the end of the STD claim, gathers LTD information and

develops a plan for ongoing claim management.

seaMless dIsaBIlITY ClaIM TRansITIOn

The above illustration assumes disability insurance premiums are not deducted on a pre-tax basis in an employer-sponsored cafeteria plan. Blue Cross and Blue Shield of Louisiana is not engaged in rendering tax, legal or investment advice. We recommend you seek the guidance of a tax professional or financial advisor.

HOw aRe

BeneFITs

Taxed?

Non-Contributory Employer pays 100% ... No ... Yes Contributory Employer pays 50% Employee pays 50% ... 50% ... 50% Voluntary Employee pays 100% ... Yes ... No pReMIuM TaxaBle?

wHO paYs THe pReMIuM? BeneFIT TaxaBle?

TelepHOnIC sTd InTake

Telephonic Intake analyst

Gathers information from employee.

Contacts the employer.

short-Term disability analyst

Reviews employee’s claim based on automatic system prompt or

referral from intake analyst. Utilizes specialized resources to make

decisions and determines ongoing case management plan.

dedicated Rehabilitation expert

Reviews claims for return to work potential at specific intervals. Coordinates with employee, physician

and employer to facilitate faster, smoother return to work.

Dsabi ity

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When an employee becomes disabled, coming back to work is often a long and bumpy road. Our disability coverage provides support to help smooth out the bumps and make a healthy return to work easier for employers and their employees.

Our Disability Guidance service provides insured employees, whether disabled or actively at work, with Long-Term Disability up to five counseling sessions per year that give confidential support for emotional, legal and financial issues.

eMplOYee

assIsTanCe

pROGRaM

Telephonic assessments and counseling that include confidential sessions with a counselor, financial planner and/or an attorney.

24-hour access to counselors with master’s or doctoral degrees in counseling via a dedicated toll-free phone number 365 days a year.

Referrals to resources and services in callers’ communities are provided, such as community and governmental agencies serving the disabled, homemaker services, assistive equipment and day care for children and elderly parents.

Employees are provided access to self-assessment tools, information and other

EMPLOYEE BENEFITS

A product of

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IN-NETWORK BENEFITS (when visiting a Davis Vision Provider) VISION PLAN OPTIONS

plan 1 plan 2 plan 3

Frequency - Once Every: Eye Health Examination Including Dilation (when professionally indicated) 12 Months 12 Months 12 Months

Spectacle Lenses 12 Months 12 Months 12 Months

Frame 12 Months 24 Months 24 Months

Contact Lens Evaluation, Fitting and Follow Up 12 Months 12 Months 12 Months Contact Lenses (in lieu of eyeglasses) 12 Months 12 Months 12 Months Copayments

Eye Health Examination $0 $0 $10

Eyewear (Spectacle Lenses and/or Frames) $0 $15 $25

OuT OF NETWORK BENEFITS Member reimbursment schedule applies

BeneFITs

YOu Can see

standard vision Benefits

national network

Network of more than 45,000 providers including

optometrists, ophthalmologists and regional retail locations.

eye exams

Your employees pay little or no copayment for a comprehensive eye exam.

eyeglass lenses

Your employees pay little or no copayment for single vision, bifocal or trifocal lenses.

eyeglass frames

Your employees pay little or no copayment for frames from the Davis Vision Collection*, or receive up to a $150

allowance toward the cost of other frames.

*Collection is available at most participating independent provider offices.

Contact lenses

Your employees pay no copayment for contact lenses and receive up to a $130 allowance toward the cost of contact lenses.

lasik surgery

Your employees may access discounts from participating providers but this is not an insured benefit.

Davis Vision is an independent company that provides an extensive network of vision care providers on behalf of Blue Cross and Blue Shield of Louisiana.

There’s no such thing as a plan that’s too good. That’s why each of our vision plans is packed with features that don’t cost you or your employees anything extra.

One-year breakage warranty

Eyeglasses covered by your plan come with a one-year

for eyeglasses

warranty for repair or replacement, which begins on the date you receive your glasses. Your plan covers:

• Spectacle lenses

• Davis Vision Collection frames

• National retailer frames, where exclusive collection is not displayed

Medically necessary contacts

Your provider may presrcibe contact lenses in lieu of eyeglasses for treatment of certain conditions. When contact lenses are medically necessary, they will be covered subject to prior approval and applicable copayments and allowances.

Replacement contact lens

It’s easy to replace your contacts through the Lens 1-2-3

program

mail order program. Just call 1-800-LENS-123 or visit www.lens123.com with your prescription to get started.

20% discount

At most of our network retailers, you’ll get a 20%1

discount on items not covered by your plan, like second pairs, sunglasses, etc. In most cases, disposable contact lenses are available at a 10%1 _discount.

laser vision correction

You can get up to 25% off of the cost of laser vision

discounts

correction surgery when you use doctors in the Eye Centers of Excellence network.

For consistency and accuracy, when adding vision benefits to existing medical insurance with a month billing date, the new benefits will have a first-of-the-month effective date. The same applies for groups with a 15th_{-of-the-month billing date.}

Eligibility for actively at work, full-time employees requires a minimum of 30 hours per week for our medical, vision and other ancillary products.

Groups may only choose one vision plan and one premium funding contribution type.

General

Conditions

Features

Groups with 2-9 eligible employees may only choose employer-paid contribution.

employer-paid: Contributory: voluntary:

100% Employer funding 100% of eligible employees must enroll

25%-99% Employer funding Greater of 75% or 10 eligible employees must enroll 0%-24% Employer funding Greater of 25% or five eligible employees must enroll

for groups with 10-50 eligible employees

Greater of 25% or 10 eligible employees enrolled for groups with more than 50 eligible employees

Contribution Requirements participation Requirements

D ntal

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EMPLOYEE BENEFITS

A product of

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• 164 million work hours are lost every year to dental health issues.

1

• Nearly 75 percent of American adults suffer from various forms of gum disease –

from simple inflammation to severe cases – and don’t even know it.

2

• More than 90 percent of all systemic diseases have oral health symptoms.

3

• People with dental coverage exhibit healthier behaviors and better oral health

habits – including brushing with fluoride toothpaste twice a day, flossing daily and

visiting the dentist regularly.

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1_{2010 report from Pew Center} 2_{American Dental Hygienist Association} 3_{Academy of General Dentistry} 4_{2009 report from NADP}

dId YOu knOw?

BeneFITs THaT Make

YOuR eMplOYees sMIle

protecting Your employees’ Oral Health

With the recent research showing how important oral health is to overall health, having a dental insurer who is dedicated to affordable, quality dental care is more important than ever.

Whether you’re looking for a dental plan to fit a business budget or your employees’ checkbooks, Blue Cross has the solution.

Regardless of the dental plan you choose, making the decision to secure dental coverage for your employees is the right choice.

denTal plans

Blue CROss and Blue sHIeld OF lOuIsIana Has

a denTal sOluTIOn THaT’s RIGHT FOR YOu

• Available for groups with a reported Medical Loss Ratio (MLR) employee count of 50 or fewer employees.

• Utilizes the Advantage Plus PPO Network, an extensive network of nationwide dentists.

• Allows employers to give their employees the benefits they want with little or no costs to the employer.

• Choose from three Certified and three Traditional plans that offer a variety of comprehensive dental services.

• Available for groups with a reported MLR employee count of 51+ employees or groups with ASO medical.

• Utilizes the Blue Cross Dental Network, giving your employees the freedom to choose from a large network of Louisiana dentists. • Several cost-effective standardized dental plans are available

Customized plans are also available based on group size. • Fully-insured and ASO funding options are available. • Ideal for individuals and families that do not have dental

insurance offered through their employer.

• Utilizes the Advantage Plus PPO Network, an extensive network of nationwide dentists.

• Choose from three Certified and three Traditional plans offering reliable and convenient dental coverage.

Blue denTal FOR sMall GROups

laRGe GROup denTal Blue denTal FOR IndIvIduals

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If you are like most employers, you consider

dental coverage an essential part of your

employees’ overall health care plan. Our Blue

dental Traditional and Certified plan options

offer a wide range of benefits and services

that will encourage your employees to be the

healthiest and most productive they can be.

We are excited to offer three new Traditional Blue Dental Plans that include comprehensive coverage for adults and children, along with optional cosmetic orthodontic coverage for dependents. These plans are designed for small groups whose required pediatric dental essential health benefits (EHBs) are satisfied through the group’s qualified

health plan.

plan a plan B plan B Ortho

Provides excellent coverage for Diagnostic and Preventive services, along with Basic Services.

All benefits covered in Plan A are included in Plan B. In addition, Plan B includes coverage for Major Services.

Plan B Ortho includes the same benefits as Plan B, with the addition of dependent orthodontic coverage up to age 19.

each Traditional plan includes:

• preventive care incentives to encourage routine oral care. Charges for diagnostic and preventive services, like cleaning and x-rays, will not count toward the annual maximum, leaving more benefit dollars for other covered dental procedures.

• Choice of $1,000, $1,500 or $2,000 annual benefit maximum per member • $50 per member deductible/$150 per family

• no waiting periods

participation:

• Employer Paid: 100% of eligible employees must enroll (group size 2 – 50) • Contributory: Greater of 70% or 10 eligible must enroll (group size 10 – 50) • Voluntary: Greater of 20% or 10 eligible must enroll (group size 10 - 50)

Three Certified Blue Dental plan options are also available, which are CMS certified and include all the required pediatric dental EHBs. If your small group medical policy does not include the pediatric EHB requirements, then a certified Blue Dental plan is right for you.

preferred plus preferred essential

Preferred Plus has the highest adult annual benefit maximum of $1,500 and a $50 annual deductible per member.

The Preferred plan covers the same services as Preferred Plus, but with a lower adult annual benefit maximum of $1,000, with a $50 annual deductible per member.

This lower cost plan option offers a $1,000 annual benefit maximum, $75 annual deductible per adult and $50 annual deductible per child, and a slightly lower level of coverage.

each Certified plan option includes:

• an unlimited annual benefit maximum and no waiting periods for the majority of dental services for children under age 21.

• Traditional and medically necessary orthodontia for dependents up to age 21

participation:

• Greater of 20% or 10 eligible employees with a minimum of 2 eligible employees enrolled (group size 2-50)

CeRTIFIed Blue denTal plans

CeRTIFIed Blue denTal plans

Preferred Plus, Preferred and Essential

TRadITIOnal Blue denTal plans

Plan A, Plan B and Plan B Ortho Pediatric Dental Essential

Health Benefits

Includes all the required Pediatric Dental EHBs

Does not include Pediatric Dental EHBs

Benefits Separate benefits for adults and children under age 21

Same benefits for adults and children

Child Orthodontia Medically necessary and traditional ortho up to age 21; 24-month waiting period

Traditional ortho up to age 19; no waiting period

Waiting Periods Adult waiting period applies No waiting periods for adults or children

Premiums Premium reflects rates per covered persons (member level premium)

Tier-rated premiums

(employee/spouse/child/family)

22

save your employees money:

save your employees time:

Give your employees freedom:

Network dentists have agreed to accept the Blue Cross payment, plus your deductible and coinsurance, as payment in full for covered services. They will not bill for any balance over that amount.

Network dentists automatically file claims with us, so it’s one less thing for your employees to do. Since we pay dentists directly, there’s no waiting for reimbursement.

Neither your employees nor their family members are tied to one dentist. With access to the extensive Advantage Plus network, all family members can choose a dentist they like.

Although you can use any licensed dentist with a Blue Dental plan, a network dentist will:

visit an advantage plus network dentist for Maximum value

With Blue Dental, our members may access the Advantage Plus PPO Network*. This extensive

dental network of nationwide dentists provides our members:

• Access to over 900 dentists and 1,600 locations throughout Louisiana

• Access to over 78,000 credentialed dentists nationally

• 45% of all dentists nationwide participate in-network

• Strong rural and suburban focus

• Over 99% of dentists in-network are accepting new patients

*Advantage Plus Network PPO is administered by United Concordia Companies, Inc. United Concordia is an independent company that administers dental benefits on behalf of Blue Cross and Blue Shield of Louisiana members.

advanTaGe plus ppO neTwORk

Find a dentist:

To find a dentist in the Advantage Plus PPO Network, visit www.bcbsla.com/FindADoctor. If your dentist is not currently participating in the network, you can nominate your dentist by calling 1-800-332-0366.

Blue Cross and Blue shield of louisiana has seven dental options

for large employers that offer a variety of dental services.

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CHOOse THe plan THaT Is RIGHT FOR YOuR GROup

• Seven dental plans to choose from

• Deductibles per benefit period range from $50 to $100 • Maximum benefits per benefit period range from $1,000 to $2,000 • Diagnostic and Preventive Services are covered at 100% with no waiting periods • Basic Services are covered at 80% and coverage for Major Services ranges between 50% and 60% • Coverage for Major Services ranges between 50% and 60% • Traditional orthodontia is covered in some plans

product eligibility

• Large groups with a reported Medical Loss Ratio (MLR) employee count of 51+ employees or groups with ASO medical are eligible to purchase large group dental

• Employer contribution is 50% of employee cost • 50% participation is required

laRGe GROup denTal COveRaGe

Product of Blue Cross and Blue Shield of Louisiana

The Blue Cross Dental Network is a large network of dentists linked together with Blue Cross to bring our members

a more cost-effective dental plan. For a list of dentists in your area, go to www.bcbsla.com/FindaDoctor.

• All benefits are based on allowable charges for covered services and participating dentists have agreed to accept

the Blue Cross payment (plus your deductible and coinsurance) as payment in full for covered services. They will

not bill for any balance over that amount. All claims payments go directly to the participating dentist for covered

services rendered.

• If you choose a non-participating dentist, you may have to file your own claims and be responsible for paying the

dentist for all charges. This amount may include any difference between the Blue Cross allowable charge and the

fee charged by the dentist.

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1-800-495-Blue (2583)

We’re available Monday through Friday, 8 a.m. – 5 p.m.

www.bcbsla.com

Find help online 24 hours a day.

5525 Reitz ave.

Baton Rouge, louisiana 70809

We have eight regional offices around the state. Find us at any of the following locations. We’d love to see you.

phone

Online

Mail

local

We’re easy to find and happy to help you. If you need to reach us:

Alexandria 318-448-1660 4508 Coliseum Blvd., Suite A Alexandria, LA 71303 Baton Rouge 225-295-2556 5525 Reitz Ave. Baton Rouge, LA 70809-3802 Houma 985-223-3499

1437 St. Charles Street, Suite 135 Houma, LA 70360 Lafayette 337-232-7527 5501 Johnston St., Suite 200 Lafayette, LA 70503 Lake Charles 337-562-0595

219 West Prien Lake Road Lake Charles, LA 70601-8450 Monroe 318-323-1479 3130 Mercedes Dr. Monroe, LA 71201 New Orleans 504-832-5800 3501 North Causeway Blvd., Suite 600 Metairie, LA 70002 Shreveport 318-795-0573 411 Ashley Ridge Blvd. Shreveport, LA 71106

Regional Offices

CusTOMeR

seRvICe

Contact your Blue Cross Regional office for more product information and rates.