What's New for 2014?

(1)

HEALTH CARE SERVICE CORPORATION (HCSC)

Blue Cross Blue Shield of Illinois (BCBSIL)

Blue Cross Blue Shield of Texas (BCBSTX)

Blue Cross Blue Shield of Oklahoma (BCBSOK)

Blue Cross Blue Shield of New Mexico (BCBSNM)

(2)

(3)

MEDICARE PRODUCT THEMES FOR 2014

• Range of products available that can be sold to a variety of

customers (Medicare Advantage, Prescription Drug, and Medicare

Supplement plans)

• Both Medicare Advantage & PDP products will be better in 2014

• Lower cost sharing

• Competitive pricing

• Increased Compensation

• Supplemental benefits

– Dental

– Vision

– Hearing

– SilverSneakers® Fitness Program

– Travel benefit

(4)

IL MEDICARE ADVANTAGE

- MA HMO Service area will continue to be 4 counties in Chicago area (Cook, DuPage, Will and Kane)

New for 2014:

• SilverSneakers® Fitness Program

• Hearing benefit

• Travel benefit

• Worldwide emergency coverage

Benefit

IL Plan Landscape

Current 2013 IL HMO Plan Proposed 2014 IL HMO Plan Comparison

Name Blue Cross Advantage Basic

(HMO)

Plan Number H3822-001 H3822-001

Premium $0 $0 -

MOOP $3,400 $3,400 -

Hosp Inpatient $240 Copay (days 1-7) $225 Copay (days 1-7) +

Primary Care Physician $7 $5 +

Specialist $45 $35 + Hosp Outpatient $300 $200 + PT/SP Therapy $50 $35 + Cardiac/Pul Rehab $50 $30 + RX (Preferred/Non-Preferred) Ded $325 $3/$11/$45/$95/25% $0-$5/$2-$7/$39-$44/$85-$95/33% +

(5)

IL MEDICARE ADVANTAGE – MORE CHOICE

• $0 (POS plan)

–

Basic HMO network with POS option

–

Higher out of pocket costs than HMO (escape hatch)

• $38 (POS plan)

–

Basic HMO network with POS option

–

Richer benefits than $0 POS (escape hatch)

Benefit

IL Plan Landscape

Proposed HMO-POS Proposed Premium HMO-POS

Name Blue Cross Medicare Advantage Basic Plus (POS)

Blue Cross Advantage Premier Plus (POS)

Plan Number H3822-007 H3822-008

Premium $0 $38

MOOP $3,800 $3,500

Hosp Inpatient $250 Copay (days 1-7) $225 Copay (days 1-7) Primary Care Physician $10 $5

Specialist $45 $40 Hosp Outpatient $300 $250 PT/SP Therapy $40 $40 Cardiac/Pul Rehab $40 $40 RX (Preferred/Non-Preferred) $0-$5/$2-$7/$39-$44/$85-$95/33% $0-$5/$2-$7/$39-$44/$85-$95/33%

(6)

IL MEDICARE ADVANTAGE – NETWORK

ADVANTAGE

• Key network partners, physician and system, responsible and

accountable for the quality and cost of patient care.

• Physician led, patient centered care.

• Integrated, team based, coordinated care services across provider

specialties and settings anchored by primary care physicians

meeting the Medicare population needs.

• Aligned incentives designed to promote delivery of cost effective

care and improve health outcomes while maintaining high patient

satisfaction.

Note: Adding Hinsdale Physician Health to our MA network. Allows us

to cover DuPage County more effectively than before.

6

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NM MEDICARE ADVANTAGE

-

MA HMO Service area will expand into 2 additional counties in the Albuquerque area (Bernalillo, Sandoval,

Torrance, Valencia)

-

MA PPO Service area will expand into 12 counties (

Bernalillo, Sandoval, Torrance, Valencia, Cibola,

Guadalupe, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, Socorro

)

*

Counties in bold are new in 2014

Benefit

NM Plan Landscape

Current 2013 NM HMO Plan Proposed 2014 NM HMO Plan Comparison

Name Blue Cross Medicare

Advantage Basic (HMO) Plan Number H3822-002 H3822-002

Premium $0 $0

MOOP $3,000 $2,400 +

Hosp Inpatient $200 Copay (days 1-4) $150 Copay (days 1-5)

$750 annual max +

Primary Care Physician $5 $0 +

Specialist $30 $20 + Ambulatory Surgical Centers (ASCs) $375 $150 + PT/SP Therapy $30 $5 + Cardiac/Pul Rehab $25 $25 - RXRX (Preferred/Non-Preferred) Ded $325 $3/$12/$45/$95/25% $0/5-$2/7-$35/40-$85/95-33% +

(8)

NM MEDICARE ADVANTAGE – MORE CHOICE

Benefit NM Plan Landscape

Proposed 2014 NM Premium HMO Plan Proposed 2014 NM Buy Down HMO

Plan Current 2013 NM HMO-POS Plan Proposed 2014 NM PPO Plan

Name Blue Cross Medicare Advantage Premier (HMO)

Blue Cross Medicare Advantage Value (HMO)

Blue Cross Medicare Advantage

Premier Plus (HMO-POS) Blue Cross Medicare Advantage (PPO) Plan Number H3822-003 H3822-004 H3822-005 H8634-002

Premium $32 $0 $37 $27

MOOP $1,500 $2,800 $2,350 $4,500 $6,500 Hosp Inpatient $100 Copay (days 1-4) $300 Copay (days 1-4) $200 Copay (days 1-4) $150 Copay

(days 1-7)

$300 Copay (days 1-7) Primary Care Physician $0 $5 $5 $10 30% Specialist $15 $20 $20 $35 30% Ambulatory Surgical Centers (ASCs) $150 $200 $200 $125 30% PT/SP Therapy $5 $25 $25 $40 30% Cardiac/Pul Rehab $10 $30 $30 $45 30% RXRX (Preferred/Non-Preferred) $0/5-$2/7-$35/40-$85/95-33% $0/5-$2/7-$35/40-$85/95-33%

$0/5-$2/7-$35/40-$85/95-33% $0/5-$2/7-$35/40-$85/95-33%

$32 premium HMO

• Basic HMO network plan with richer benefits than than the $0 HMO plan

HMO Buy down plan (Part B buy-down of $10)

• Basic HMO network

• Leaner benefits than the $0 HMO, but HCSC contributes to the members Part B premium

$37 HMO-POS

• Basic HMO network with POS option

• Similar benefits to the HMO, but with the ability to go out of network (escape hatch)

$27 Blue Cross Medicare Advantage Choice (PPO) will be offered

• Large PPO network

• Competitive plan for people who like a PPO out of network option

Also new in 2014, an HMO-SNP plan

:

• Blue Cross Medicare Advantage Dual Care (HMO-SNP)

• Eligible for Centennial Care • Enrolled in HCSC Centennial Care • Buy-Down of All Medicare A/B Cost Share • Includes Supplemental Benefits (Dental,

Vision, Hearing aid allowance and SilverSneakers® Fitness Program

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NM MEDICARE ADVANTAGE – NETWORK

ADVANTAGE

• Key physician network partner with ABQ Health Partners

• Physician led, patient driven – centering around patient’s needs

• Team approach – network of nurses, specialists, case managers,

diagnostic team members and others, all working in sync to help our

patients stay healthy

• Total Care Model is a patient-centered comprehensive model

designed to help carefully manager our patient’s health

• Proven to increase quality outcomes and patient satisfaction while

still reducing healthcare costs

(10)

TX MEDICARE ADVANTAGE

Supplemental benefits included on the Texas PPO plans:

• Dental • Vision • Hearing

• SilverSneakers® Fitness Program • Travel benefit

• Worldwide emergency care

-

MA PPO Service area will continue in 15 counties in the Dallas, Austin, and Houston area (Collin, Dallas, Denton,

Tarrant, Fort Bend, Harris, Montgomery, Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis, Williamson)

Benefit

TX Landscape

Current 2013 TX PPO Plan Proposed 2014 TX PPO Plan (high) Proposed 2014 TX PPO Plan (low) Comparison

Plan Number H1666-001 to 003 H1666-001 to 003 H1666-004 to 006

Premium $69.90 $54 $34.00 +

IN OON IN OON IN OON

MOOP $3,400 $5,000 $3,400 $5,000 $3,400 $5,100 - Hosp Inpatient $250 Copay

(days 1-7) $250 Copay (days 1-7) $250 Copay (days 1-7) $400 Copay (days 1-7) $300 Copay (days 1-7) 40% -

Primary Care Physician $15 30% $5 30% $10 40% +

Specialist $45 30% $35 30% $40 40% + Ambulatory Surgical Centers (ASCs) $125 30% $125 30% $125 40% - PT/SP Therapy $45 30% $40 30% $40 40% + Cardiac/Pul Rehab $45 30% $40 30% $40 40% + RX Ded $325 $3/$10/$43/$95/25% $0-$5/$2-$7/$39-$44/$85-$95/33% $0-$5/$2-$7/$39-$44/$85-$95/33% +

(11)

OK MEDICARE ADVANTAGE

-

MA HMO Service area will expand into 8 counties in the OKC area (

Canadian, Cleveland, Grady, Lincoln,

Logan, McClain, Oklahoma, Pottawatomie

)

-

MA PPO Service area will expand into 10 counties in the OKC area (

Comanche

,

Canadian, Cleveland,

Garfield, Grady, Lincoln, Logan, McClain, Oklahoma, Pottawatomie

$0 Basic HMO plan

• Basic HMO network plan with competitive benefits A $39 HMO-POS plan

• Basic HMO network with POS option

• Similar benefits to the HMO, but has the ability to go out of network (escape hatch) A $54 PPO plan

• Large PPO network

• Competitive plan for people who like a PPO out of network option

Benefit

OK Plan Landscape

Proposed 2014 OK HMO Plan

Proposed 2014 OK HMO-POS

Plan Proposed 2014 OK PPO Plan

Name Blue Cross Medicare Advantage Basic (HMO)

Blue Cross Medicare Advantage Premier Plus (HMO-POS)

Blue Cross Medicare Advantage Choice (PPO)

Plan Number H3979-001 H3979-002 H8634-001

Premium $0 $39 $54

IN OON IN OON

MOOP $4,500 $4,500 $3,400 $5,000

Hosp Inpatient $250 Copay (days 1-4) $250 Copay

(days 1-5) $400 per day

$250 Copay (days 1-7)

$325 Copay (days 1-7) Primary Care Physician $5 $10 $50 $10 30%

Specialist $35 $35 $50 $35 30%

Ambulatory Surgical Centers

(ASCs) $175 $175 40% $175 30% PT/SP Therapy $35 $40 40% $35 30% Cardiac/Pul Rehab $35 $35 40% $35 30% RX (Preferred/Non-Preferred) $0-$5/$2-$7/$39-$44/$85-$95/33% $0-$5/$2-$7/$39-$44/$85-$95/33% $0-$5/$2-$7/$39-$44/$85-$95/33%

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Blue Cross MedicareRx Basic (PDP)

SM

_{(NEW PRODUCT FOR 2014)}

• Value Propositions:

–

Provides a low cost option to the healthier “Age In” population and a less expensive alternative for those that

combine Part D with Medicare Supplement.

Only about 40% of our Med Supp members have our Part D

• Benefits & Sales Stories:

–

Monthly premiums at about 50% of the cost of our current Basic Plan offerings; most Tier 1 & 2 drugs can be

obtained for $2 or less; products to compete with United and Humana low cost options

Blue Cross MedicareRx Value (PDP)

SM

• Value Propositions:

–

Lower cost enhanced offering with better benefits than the previous Value Plans. Offers our largest client base a

product with lower deductibles, cost sharing and monthly premiums .

• Benefits & Sales Stories:

–

Monthly premiums are about $2 less than the current Value Plans; all Tier 1 & 2 drugs can be obtained for $2 or

less; lower initial deductible than Value Plans in 2013

Blue Cross MedicareRx Plus (PDP)

SM

• Value Propositions:

–

Improved high end option, that provides less expensive cost sharing levels and coverage on all generics as well

as some brands in the gap.

• Benefits & Sales Stories:

–

All Tier 1 & 2 drugs can be obtained for $2 or less; gap coverage extended from all generics to include some

brands; possible to have $0 cost share until the catastrophic phase with Tier 1 drugs at Preferred Pharmacies

OVERVIEW OF NEW BASIC PLANS AND

IMPROVED VALUE AND PLUS OFFERINGS

13

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ISSUES ADDRESSED WITH THE 2014 BLUE

CROSS MEDICARERX (PDP)

SM

_{PRODUCT DESIGNS}

HISC will offer Basic Plans that are

competitive on benefits and premium

to United and Humana

No “Low Cost” option to compete with

Humana and United’s Plans

2013 Issue or Competitive Deficiency

2014 PDP Plan Solution

Value Plans are not competitive in

terms of premium

For 2014 there will be an inexpensive

Basic offering and the Value Plans will

be about $2 cheaper per month with

better benefits than 2013

Robust offering of Tier 1 generics and

deductible only counting on Tiers 3-5,

were not as beneficial as anticipated

Members will save at least $5 per 30

day on Tiers 1-4 at CVS,

Wal-Mart/Sam’s Club, a local grocer

and an independent pharmacy group

Opportunity for members to fill

prescriptions at a preferred pharmacy

for a discount

The Basic offerings have a deductible

on all tiers and Value/Plus Plans have

narrower Tier 1 formulary; similar to

competitors offerings

(15)

• The preferred network option has no impact on whether a member can fill at any of the

63,000+ network pharmacies nationwide

• Members can save at least $5 per 30 day fill on all three PDP Plans, if they fill at a

preferred pharmacy versus any other network pharmacy

• Tier 1 & 2 drugs on all three PDP Plans can be obtained for $2 or less at a preferred

pharmacy during the initial coverage period (OK is $4 or less on the Basic Plan)

• Discounts not applicable to deductibles, but do apply to gap coverage on the Plus Plans

NEW PREFERRED NETWORK PHARMACIES FOR

ALL STATES IN 2014

Good Neighbor Independent

Pharmacies and PPOK

SuperValu (Jewel/Osco), HEB

& Albertson’s

CVS

Preferred Network Pharmacies for 2014:

Wal-Mart/Sam’s Club

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• We currently don’t have a plan that competes with the price point of the AARP United and

Humana Wal-Mart Plans

• New for 2014 HISC will be introducing a low cost option that will compete well in the

marketplace with existing “low cost” plans

– Meets the needs of a wider spectrum of the over 65 population

– Matches United's and beats Humana’s Tier 1 & 2 pricing at Preferred Pharmacies

– Premium range from $14 to $26 for 2014, which is in line with other similar offerings

BLUE CROSS MEDICARERX BASIC (PDP)

SM

OFFERING DETAILS FOR 2014

Provides alternative to the

healthier Age-In population

that had be unaddressed

Members can obtain Tier 1 & 2

drugs for $2 or under at

Preferred Pharmacies; in OK it

is for $4 or under

Most premiums are in the low

to mid $20’s, in line with United

and Humana Basic Plan

Offerings; NM is $14.90

Highlights and Sales Points on the New Blue MedicareRx Basic Plan in Illinois:

Provides another option to use

in tandem sales with Medicare

Supplement Offerings

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CHANGES TO BLUE CROSS MEDICARERX VALUE

(PDP)

SM

_{IN 2014}

• With the addition of the Blue Cross MedicareRx Basic (PDP)

SM

_{Plan, the Value plan is now an}

“Enhanced Alternative” under CMS guidelines

• Members will not be moved if they are currently a part of the Value Plan

• Deductible is $200 in NM and TX and $275 in IL and OK

• $200 or $275 deductible only

counts towards Tiers 3-5

• Tier 1 drugs are $0 and Tier 2 are

$2 at Preferred Pharmacies

• Out of Preferred Pharmacies, Tier

1 is only $5 and Tier 2 is $7

• Insulin option available on Tier 2

• Premiums around $2 cheaper per

month in all States

• Narrow more focused set of

generics on Tier 1

• $325 deductible only counts

towards Tiers 3-5

• Tier 1 drugs were $3 and Tier 2

were $10-$14 at any Pharmacy

• No discounted cost sharing for

Preferred Pharmacies

• No Insulin option on Tier 1 or 2

• Premiums in high $30’s to low

$40’s in all States

• Broad range of generics on Tier 1

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