small group product guide - bcbsgasgplans.bcbsga.com/docs/brochures/53744gaeenbga.pdfsmall group...

We put the same passion into our health plans, that you put into your business

Georgia | Eff ective January 1, 2016

Small Group product guide

53744GAEENBGA 9/15

Welcome to BCBSGa for small businessesRunning a small business takes courage and a lot of hard work. You make

important decisions every day. And choosing the right health plan is

defi nitely one of them.

That’s why we’ve made it easy, with plan designs that speak to who you are,

how you run your business and your bottom line. And because you’re choosing

a Blue Cross and Blue Shield of Georgia (BCBSGa) plan, you can count on the

quality and stability our customers have come to know for over 75 years.

Today, we want you to know, it’s your purpose that’s at the heart of our

promise: To build the ultimate benefi ts package for every single type of

small business and make it accessible, affordable and personal.

Now let’s fi nd you the perfect plan.

accessible

affordable

personal

1

Tell us about youYour size, your people, your budget

Do you like your current plan, but need to lower costs? Check.

Would your employees like incentives to stay healthy? Got them.

Want a high-deductible plan that offers more ways to save? Done.

Are you a big fan of lots of bells and whistles? Ring.

We’re ready to give you that special something you won’t fi nd anywhere else. And like

any great relationship, when you’re happy, we’re happy. And that’s pretty healthy.

So let’s get to it!

1

Welcome to a new kind of doctor-patient relationship created just for BCBSGa members

It’s called Enhanced Personal Health Care and it’s the kind of care everybody wants

Our new model puts patients in a unique circle of care, making them the central focus on a team approach

to their overall health. We do this by:

Paying doctors for value over volume when they improve patient health, meet quality standards and

lower costs.

Giving doctors added support with the right tools and strategies to help strengthen the doctor-patient

relationship so they can spend more time with patients and coordinate their care with other doctors.

Improving the patient experience with better access to a primary care physician (PCP) who cares for the

“whole person” and becomes their health care champion and helps them navigate the health care system.

Enhanced Personal Health Care: a physician’s perspective“This partnership is truly refreshing. It’s a practice that’s centered on the patient. That’s why

we have extended hours and systems in place to try and help the patients receive the care

that they require. It’s a win for everybody. The more doctors we can get involved in the

process, I think the better the health care system in general will be.”– Frank Maselli, M.D., Family Practitioner, Riverdale Family Practice

Accessible

Patients benefi t from

More doctor-patient time

Proactive health and wellness

More convenient access

Providers benefi t from

Better coordinated care

A stronger doctor-patient relationship

A personalized care team

Quality-driven care

Value over volume

Detailed patient reports

Tools and resources Rewards for meeting quality standards

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Enhanced Personal Health Care is patient-centered and compensates doctors for the quality of care they give, not the number of patients they see.

Fewer inpatient and emergency

room visits

Reduced re-admission rates

Signifi cant increase in referrals to

preferred labs

Increased provider follow-up visits

after a patient is discharged

More weekend hours for members

Improved quality and utilization scores

46%of network providers

already participate in EPHC

21%of members are already

attributed to an EPHC provider

54,639 network providersparticipate in Enhanced Personal Health Care (EPHC)

Those providers care for approximately

4.0 million members

Accessible

Th e advantages are undeniable

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Accessible

Employees have access to care, anytime, anywhere with LiveHealth Online — all it takes is an Internet connection

LiveHealth Online delivers high member satisfaction2

With LiveHealth Online, your employees can have face-to-face

conversations with board-certifi ed doctors right from their

computer or mobile device, 24/7. In just seconds, they can connect

to a doctor to address nonemergency health issues right away.

No driving, no waiting, in no time!

LiveHealth Online employee benefi ts

No appointments, no waiting rooms

Easy to use

Board-certifi ed doctors

Available for nonmembers

Doctors diagnose health issues and may

prescribe medicine1

Cost effective (average fee of $49)

LiveHealth Online employer benefi ts

Innovative solution — a quick and easy way for your

employees to see a doctor

Increased productivity — employees will spend less time

traveling to, and waiting at, other sites of care

To learn more, watch the videos at livehealthonline.com

92% 85% 90%85%

ACCESSIBLEDOCTORS AT THE SPEED OF

LIGHT

INNOVATIONS IN CARE

=

had a positiveexperience

resolved their issue

avoided extra costs

reportedsaving time

Accessible

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1 in 3 Americansis covered by a Blue Cross and Blue Shield plan

381 Fortune 500 companieshave a Blue Cross and Blue Shield plan

600K new membersfor 2014, plus 250,000 for 2015

2x total membership than our largest competition

HIGHESTMEMBER SATISFACTION

RATINGS

SIGNIFICANTSAVINGS =

DEEP NETWORKDISCOUNTS

LARGESTNETWORKS+ +

The power behind a Blue Cross and Blue Shield plan

Our strength is backed by some serious numbers

Providing health coverage for more than 100 million members is pretty powerful, but we’re also about creating healthier

communities and investing in the future for our people and our businesses.

That means you, our small business employers. When you choose BCBSGa, you’ll enjoy unparalleled network discounts,

innovative health and wellness programs and access to the highest quality of care.

97%U.S. Hospitals are in the

BlueCard® program1

92%U.S. Doctors are in the BlueCard® program1

To learn more, watch the videos at livehealthonline.com

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Medical plans to fi t every type of business need

With unbeatable health and wellness extras that deliver superior long-term value

Get ready to meet your match! No matter what the size of your business and your unique needs and

preferences, you’ll fi nd the right health plan, right here. We offer a full range of high-quality plans for every

budget. Our commitment to you is to get it exactly right.

Here’s a brief explanation of the types of health plans we offer. For specifi c information, you can refer to the

product grids at the back of this brochure.

.... Affordable

HMO A health maintenance organization only covers services from providers in the HMO plan network.

Members must choose a PCP in the network. If a specialist is needed, the PCP provides a referral.

POS Point of service allows members to see providers in the network or outside of the network. Members pay

substantially less out of pocket when they use a provider in the POS network. To see a specialist, members

must get a referral from their PCP.

PPO A preferred provider organization allows members to see providers in network or out of network.

Members pay substantially less out of pocket when they use a provider in the PPO network. There’s no need

to get a referral to see a specialist.

CDHP Consumer driven health plans feature higher deductibles than traditional insurance plans. They can

be paired with a health savings account or a health reimbursement account allowing members to pay for

qualifi ed out-of-pocket medical expenses.

HSA Health savings account is a savings account members can fund with pretax dollars and

apply toward qualifi ed health care expenses, including prescriptions.

A choice of provider networks

You have a choice of networks. See page 24 for further information.

Balanced funding is a new funding solution for Small Group employers with 10 or more employees.

It’s similar to a fully insured plan where employers pay a fi xed payment based on enrollment each month, but if

employees are healthy and have low usage of benefi ts, then employers could get money back at the end of the year.

6 7

Affordable

Affordable

Affordable

If you’re looking for a new option with savings potential, then balanced funding could be right for you

With a fully insured plan, you pay a set

premium each month (varies only by

enrollment) and no matter how much or

how little your employees use the plan,

you pay the same amount. With BCBSGa

Balanced Funding, you get the same

predictability of a fully insured plan with

fi xed monthly payments, but when your

group’s claims are better than expected,

you could get money back. You can also

save on some of the premium and health

care reform taxes!

Predictable monthly payments with a limit on fi nancial responsibility

Unlike fully insured plans, if you have a healthier than expected year,

you could get money back

You make a fi xed monthly payment that covers all of

your health care costs

How does balanced funding work?

ENJOY COVERAGE FOR

EXCESS CLAIMS

SAVE ONpremium tax and

health care reform taxes

7

Pharmacy benefits Together with medical — better and easier than ever

You may not know it, but pharmacy benefits are the most widely used benefits. At BCBSGa,

we’re not just pricing a bottle of pills, or focusing on pharmacy costs alone — we’re looking

at the bigger picture — the value of better health.

And we make it easy. You can offer your employees access to the care they need and you get

one seamless, simple experience: one website, one contact, one account team, one contract

and one invoice. Our pharmacy and medical experts are at the same table, have the same

resources and work together to help your employees live healthier.

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.Better health and lower costs of care begin with better medication management

With our pharmacy, clinical and cost-of-care programs, we are helping your employees live healthier.

Helping manage chronic conditions

Addressing medication gaps

Improving adherence to taking medications as prescribed

Saving money with generics, home delivery and a broad network of pharmacies

.... Affordable

Medication ReviewA confidential pharmacy summary for

Here’s how we do it

When pharmacy and medical are combined, we can target members with specific

messaging such as cost savings for generics and therapeutic equivalents. And we can coordinate

that messaging between the member and the physician to identify and close gaps in care, switch

members to more effective and less expensive drugs and communicate safety concerns.

Medication Review

A monthly member mailing that

includes recent pharmacy claims,

information about current drugs

they’re taking, safety concerns and

ways to save money.

MyHealth Note

By combining members’ medical,

pharmacy and lab data with benefit

information, we can make

recommendations, coordinate with

doctors and notify members.

MyHealth NoteA confidential health care summary for

8 9

The results speak for themselves

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By combining medical and pharmacy and coordinating these benefits systemwide, we are writing a prescription for more effective and more affordable health care for you and your employees.

MORE accurate

communications sent to members

37%

MORE gaps in care closed within 12 months

26%

MORE gaps in care

identified

28%

Let’s get technical with pharmacy

It’s easy to fill prescriptions, check copays or

coinsurance and more by going to bcbsga.com or downloading our mobile app.

We are closing the gap between giving members

information and getting them to act on it.

Medical Pharmacy More effective and affordable health care

9

For all your health care needs, BCBSGa is your total health solution

See how our medical, dental, vision, life and disability plans work together for your employees health and

your bottom line.

Meet your one carrier, one solution: BCBSGa Whole Health ConnectionSM

We believe health care should serve the whole person — head to toe, at

each stage of life. It should also be easy to administer, so you don’t get

bogged down in paperwork.

Let us tell you about how you can have one solution for all your health

benefi ts needs.

Through electronic health records, we get claims and clinical data

from network dentists, eye doctors, primary care physicians and care

coordinators, which allows us to create more complete health profi les

for our members.

The advantages can’t be matched by even the best stand-alone carriers.

Strong alone, better together

Clinically coordinated care

through our connected

health plan portfolio

Benefi ts from one source,

so you spend less energy

managing multiple plans

Simplifi ed enrollment,

administration and

claims processing

Strong local and

national networks

Competitive pricing

A brand you can trust

.... Affordable

BCBSGa Whole Health Connection

Real choice. Quality care. Lower costs.

of employers say increased provider communications improves care

of employees believe they’d get better service with connected plans

88% 89% 82%

of employers understand that integration saves money

Medical

Vision Life

DisabilityDental

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BCBSGa dental

Our Dental Prime and Dental Complete plans are built for greater choices, better oral health

and ultimate business value.

We’re helping change the face of health care by

simplifying how our medical and dental plans

work together — delivering more complete care

at an affordable cost with less hassle.

Good dental health and early detection can play an important role in helping your employees stay healthy.

In fact, 90% of the body’s diseases show signs and symptoms in the mouth.2

Dentists often have the fi rst opportunity to notice early signs of a chronic disease. Our Dental Prime and Dental

Complete plans offer these benefi ts for optimal oral and overall health.

That’s why many of our plans have 100% coverage for preventive services, such as exams, cleanings and X-rays.

In addition, we have automatic enrollment for an additional cleaning or periodontal treatment for pregnant and

diabetic members engaged in one of our diabetic or maternal health care management programs.

For product details, see the grid at back of this brochure.

Extra cleaning or periodontal treatmentfor pregnant and diabetic members

100% in-network coverage

for cleanings, exams and X-rays

30% to 32% average savings on covered services1

Medical Dental Better overall health

“Ask a hygienist”Email questions to licensed dental professionals and get quick, private personalized advice at no extra cost

Brush biopsybenefi t to help detect oral cancer

Access to one of the largest dental networks in the nation,

with 98,000+ unique dentists and 251,000

access points

International emergencyDental program for emergency services while traveling or working abroad

A huge network

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BCBSGa vision

More doctors, better discounts and

a clear path to overall health with Blue View VisionSM

Vision care plays a powerful role in early detection and more

effective management of chronic conditions. In fact, eye exams

are an important avenue to identify high-risk conditions like

diabetes, high blood pressure and high cholesterol.

When we connect Blue View Vision with our medical plans

through electronic health records, providers can see the

total health of the member which helps them deliver better,

more informed care. It also leads to lower costs and simplifi ed

plan management.

Connection of care2

Claims and clinical data go into members’ electronic health fi les

Vision providers can see information quickly

Automatic referrals go to our ConditionCare program if a health issue is found

For a list of Blue View Vision plans, see the grid at back of this brochure.

At the heart of BCBSGa’s more personalized approach to health care is building better connections between employers and employees, patients and doctors, people and better health.

People are 3x more likely to get an annual eye exam than an annual physical1

3X

.... Affordable

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Bigger discountsThe industry’s best discounts including

35% to 40% off extra glasses3

More doctorsOver 33,000 doctors at more than

26,000 locations nationwide

Less hassleSimplifi ed administration from

enrollment through claims processing

Medical Vision Total health view

Members can use in-network benefi ts and get savings from:

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12 13

Let’s protect your employees against the unexpected

It’s time to talk about life and disability coverage that goes way beyond a check.

When a life-changing event happens, you can count on Greater Georgia Life Insurance Company

(Greater Georgia Life) to be there with superior service from a caring staff, quick payment of claims

and support services for employees and their families. We offer a wide variety of options, so you

can tailor a benefi ts program to your employees’ needs and your budget, all from one

single point of contact.

Life and disability features

Timely payments and support services

Benefi ts employees can use before and after a loss

Simplifi ed benefi t administration and dedicated customer service

Support services that help employees get back to work and back to life

Personalized service from Claims Management team

Life and disability

comprehensive plans with special features

Long-term disability

VoluntaryShort-term disability

Accidental death and

dismembermentLife

ResourceAdvisor

Travel assistance

Benefi ciary Companion

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We can help you with Social Security

disability fi lings and approvals

You get a designated service team with

industry-leading claims turnaround

times with 99.9% accuracy*

Identity theft recovery services

All customer service calls are

answered live

*Internal data 2014

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.... Affordable

When you package disability with one of our medical plans ... your employees are connected with teams of clinical,

behavioral health, vocational rehabilitation and

counseling specialists who can help them get back

to life and back to work.

Medical Disability Improved outcomes

Life and disability

A new way of looking at it

When it comes to life and disability insurance, we do more than just send a check.

We give employees and their families valuable extras.

90%

of disabilities are caused by illness, not accidents1

Travel assistanceMembers with life coverage have a safety net if an emergency arises while they’re more than 100 miles away from home

Benefi ciary CompanionHelp for families after a death, dealing with death

certifi cates, creditors and more for members with life and disability coverage

Resource AdvisorEmotional, legal and fi nancial support for members with life and disability coverage

Newborn Parenting Resources

Provides eight weeks of personal life coaching services to help new mothers transition back to

work and work-life balance2

You get Guaranteed Issue! That means some of our life and disability

coverage options are available without

your employees having to go through

health underwriting — and there are

no health questionnaires to fi ll out.

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When you package disability with one of our medical plans ... your employees are connected with teams of clinical,

behavioral health, vocational rehabilitation and

counseling specialists who can help them get back

to life and back to work.

of disabilities are caused by illness, not accidents1

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.... Affordable

You want to off er dental, vision, life and disability coverage, but you just can’t cover the cost.

Th at’s ok. We’ve got another way.

We understand it can be a tough balancing act. You want to

offer a competitive benefi ts package that helps attract and

retain the best employees, but your dollars only go so far.

That’s why we offer a voluntary portfolio for dental, vision,

life and disability plans at no extra cost to you. You pick the plan

designs and your employees choose the coverage at affordable

group rates. And because the employee pays 100% of these

costs, there is no negative impact on your bottom line.

paid by the employee

100%

16 17

Voluntary plans off er you a way to strengthen the value of your benefi ts plan and improve employee satisfaction, at no extra cost.

No extra cost

17

Take your employees’ health (and yours) to the next level

With our Total Population Health solution

It’s time to get personal. Everyone has their own unique set of health issues and goals. So we built our

wellness programs to speak to everyone on the wellness spectrum — from the super healthy to those

needing immediate support. Our programs are managed by a team of experts who connect members

to the right programs for their specifi c needs. This way, no one falls through the cracks.

Personal

Clinical programs

Medical management

Health coaching/advocacy

Disease management

Behavioral health

Maternity

Gaps in care

Wellness programs

Lifestyle improvement programs

(Healthy Lifestyles)

Preventive alerts

24/7 NurseLine

Online resources

Health assessment

Discounts

Provider cost/quality information

Online wellness coaching

Communication campaigns

Doctor and member connections

Care management nurses Disease managementMedical directors

Total Population Health connects

primary care providers and BCBSGa health

management teams for better results.

Pharmacy Behavioral healthSpecialty

LiveHealth Online

18 19

PersonalFind a whole world of health and wellness programs right here with your BCBSGa plan.

1 Voice of the Customer 2014 Year-End Annual Wellness Report for ConditionCare.

2 Internal Health and Wellness Solutions Member Satisfaction Study, 2014.

3 Prescription availability is defi ned by physician judgment and state regulations. LiveHealth Online is available in most states and is expected to expand to more in the near future. Visit the home page of livehealthonline.com to view the service map by state.

4 Doctors using the LiveHealth Online tool charge an average fee of $49.

MyHealth Advantage is an outreach

program that helps members stay current

with their health care and save money. By

analyzing member health data and history,

the program identifi es possible health risks,

care gaps and savings options. Care gaps are

sent to providers, as well to ensure the best

care possible.

Healthy Lifestyles is an online health

resource that helps members transform

their behaviors and improve their health

in a variety of areas including weight,

nutrition, physical activity, tobacco use,

stress and depression. Some plans may

include incentives.

The ConditionCare program teams up

members with nurse coaches and other

health professionals who give them

holistic, integrated and seamless health

management for chronic conditions

including asthma, chronic obstructive

pulmonary disease (COPD) and heart disease.

Of those members in the program, 90% were

satisfi ed with their ConditionCare nurse

interactions and felt the tools and materials

were easy to understand.1

\\\|

Future Moms helps moms-to-be have a

healthy pregnancy. Experienced nurses

provide individualized care for pregnant

members to help ensure a full-term, healthy

baby. Of those members in the program,

90% said the information and tools helped

them have a healthy pregnancy.2

24/7 NurseLine is staffed with registered

nurses who are just a phone call away at any

time. Nurses can answer questions about a

medical concern or help members choose the

right level of care. Members can call the same

phone line and listen to hundreds of health

topics in the AudioHealth Library. The recordings

are available in English and Spanish.

LiveHealth Online gives members 24/7

access to doctors through a mobile device or

a computer with a webcam. Board-certifi ed

doctors can evaluate nonemergency illnesses

or conditions and prescribe basic

medications, if needed,3 for $49 or less,

depending on health plan benefi ts.4

Case Management nurses help members

deal with complex health issues and

navigate the health care system. Backed by

a team of physicians, pharmacists, exercise

physiologists and others — our nurses have

the latest information on treatment options.

The Cancer Care Quality Program is

a new innovative initiative that allows

oncologists to compare planned cancer

treatments against evidence-based clinical

criteria and potentially receive enhanced

reimbursement. A goal of the program is to

promote access to quality, evidence-based,

affordable health care for our members and

to provide the framework to begin changing

the cancer care paradigm. This program also

allows our members to be identifi ed earlier

for our Case Management program.

19

Personal

Personal

Testimonials

Vince, IT

Future Moms

Vince is the go-to guy for computer issues and

almost everything else technical. Always in

control, no one thought he’d be such a

nervous wreck when he found out his wife,

Mary, was expecting. He’s been hounding

everyone with questions, even the mail lady.

Michelle, the offi ce manager tells him about

BCBSGa’s Future Moms program and gives

him the number. As soon as he gets home,

Vince and Mary call Future Moms and are

connected to Mandie, a registered

nurse who talks to them about risk

factors, screenings and healthy choices

for safe deliveries. Mandie is going to

send them books and more resources

and tells them to call anytime because

Future Moms nurses are available 24/7.

Mary called back twice, that night.

SB OFFICE SUPPLIES

A story of health and

wellness benefi ts in action

Meet SB Offi ce Supplies

Georgi, Accounting

24/7 NurseLine

Georgi’s daughter, Tina, is an 8-year-old soccer fi end who never stops

running and rarely gets sick. So when Georgi hears her crying at 1 a.m.,

she knows something’s defi nitely wrong. Georgi calls 24/7 NurseLine and

tells the nurse Tina’s symptoms. The nurse says Tina’s temperature is a bit

too high and suggests that Georgi take her to an urgent care center. Georgi

thanks the nurse and jumps on her <Anthem> mobile app to get directions

to the nearest urgent care. Soon Tina is back up to speed and Georgi feels

like the best mom in the world because she had these great resources at

her fi ngertips to help her child get better quickly.

Raja, Warehouse

ConditionCare

Raja has dealt with loud warehouse workers for years. Nothing

surprises or scares her, except when she feels an asthma attack

coming on. Because she has <Anthem>, her medical claims were

fl agged and sent to a ConditionCare nurse, Kacey, who called Raja right

away. After yelling at her crew to pipe down, Raja talked with Kacey

about taking her medication, using an inhaler and avoiding triggers.

Kacey promised to follow up with Raja soon, but in the meantime, she

plans to send her information and helpful resources and maybe she’ll

even throw in some earplugs.

Devon, Operations

Healthy Lifestyles

When the offi ce elevator went out, Devon had to

walk up two fl ights of stairs. By the time he got to

his desk, he looked like he was caught in a

downpour. Unfettered, he grabbed his usual

breakfast doughnut and opened his fi rst email.

It was from BCBSGa’s Healthy Lifestyles program

and it was about weight management! He double

checked to see if maybe it was actually from

his wife. But then he remembered doing an

online health survey at bcbsga.com where

he answered questions about his weight

concerns. Maybe it was a sign. He logged

into Healthy Lifestyles, completed his

personalized well-being plan and made

a commitment to start working toward his

health goals. Now he has access to resources

for weight management, online tools for fi tness

and nutrition and support from online coaches

and communities.

Mark, Sales

LiveHealth Online

Mark is a Sales rep who loves to chat, but lately

his coughing and sneezing is making everyone

run and hide. He’s got no time to see a doctor,

so Michelle, the offi ce manager, is brave

enough to pull him into a conference room

and show him how to use LiveHealth Online to

visit a doctor with an app on his smartphone.

Mark can’t believe he’s connected with a

board-certifi ed doctor in seconds who gives

him a diagnosis: “You have a virus. Go home,

get some rest and if you don’t feel better in a

few days, follow up with your primary care

doctor.” Mark follows the doctor’s directions

and the whole offi ce feels better.

Georgi, Accounting

24/7 NurseLine

Georgi’s daughter, Tina, is an 8-year-old

soccer fi end who never stops running and

rarely gets sick. So when Georgi hears her

crying at 1 a.m., she knows something’s

defi nitely wrong. Georgi calls 24/7 NurseLine

and tells the nurse Tina’s symptoms. The nurse

says Tina’s temperature is a bit too high and

suggests that Georgi take her to an urgent care

center. The nurse fi nds several in-network

urgent care centers near Georgi. One of them is

right around the corner. Soon Tina is back up to

speed and Georgi feels like the best mom in the

world because she had these great resources at

her fi ngertips to help her child get better quickly.

Raja, Warehouse

ConditionCare

Raja has dealt with loud warehouse workers for

years. Nothing surprises or scares her, except

when she feels an asthma attack coming on.

Because she has BCBSGa, her medical claims

were fl agged and sent to a ConditionCare

nurse, Kacey, who called Raja right away.

After yelling at her crew to pipe down, Raja

talked with Kacey about taking her medication,

using an inhaler and avoiding triggers.

Kacey promised to follow up with Raja soon,

but in the meantime, she plans to send her

information and helpful resources and maybe

she’ll even throw in some earplugs.

20 21

So what else can we do for you?

A lot! We’ve got great tools and resources to make managing health care easier than ever.

Like any great relationship, we’ll always be right by your side so your employees can find the help they’re

looking for, whatever their health needs and goals. And we’ve made it easy for you to get started.

Here’s what we’re talking about:

A wellness toolkit to help you create a culture of health, right at work

Time Well Spent® is our online health and wellness resource that has all kinds of ways to communicate

important health information to your employees about specific health issues (like diabetes and asthma)

and overall health improvement. It comes at no extra cost to you and has information on dental, vision,

life and disability — and even some in Spanish. Here’s just a sample:

Start your company’s journey to wellness!

Go to timewellspent.bcbsga.com

Easier plan administration

EmployerAccess at bcbsga.com has everything you need for more efficient benefits administration.

Our quick, easy-to-access online tool makes it simple to enroll members, check eligibility, view your

contract, check on coverage and more — in one spot. It’s our job to help you save time and make doing

business with us easier than ever before.

With EmployerAccess, you can:

Process enrollment changes View and pay billsView your group’s benefits Add new subscribers

Health kits Promotional materialsHealth articles Wellness Calendar Employer guide to wellness

PAY BILL

Register online todayJust go to bcbsga.com, select Employer and then your state. It’s that easy.

21

Personal

We’ve also got all this for your employees ...

Connect to care anywhere with our mobile app

Our BCBSGa mobile app can make it easier than ever for your employees to manage their health

care. They can just download the free app and always be prepared.

Download todayAvailable for free from Google PlayTM or the App StoreSM.

Visit bcbsga.com for 24/7 information

Get tools and resources on topics like nutrition, weight loss and tobacco use

Join online communities for added support from people with similar experiences

Find a doctor or hospital in the network and nearby

Compare and evaluate different hospitals for quality and cost

Get discounts on healthy living products and services

Order a new ID card or print a temporary one

View benefi ts or check on a claim

Submit benefi t questions

Find a doctor Compare provider costs and quality

Get a virtual ID card Manage prescription benefi ts

View claims

bcbsga.com

Visit a doctor with our LiveHealth Online app

Employees can connect to a doctor anytime, anywhere. They can sign up for

LiveHealth Online and have a face-to-face conversation on their computer or

mobile device.

22 23

Getting more social

We’re bringing health and wellness to the forefront of daily living by sharing the health with our

members and the entire social stratosphere. So while you’re posting, sharing, tweeting, or just

plain emailing, why not add a little health into the mix?

Just search “AskAnthem”Follow us for motivation, inspiration, recipes, workouts and some great healthy fun.

Bcbsga.com is now available in Spanish: es.bcbsga.com

23

A choice of provider networks

Our innovative network options offer you affordable choices designed to fit your specific business needs.

Here’s a quick look at the differences.

Product PCP selection Specialist referrals Out-of-network benefits

Pathway EnhancedOur most selective and cost-effective network option

HMO Not required Not required Urgent and emergent only

POS Not required Not required Statewide plus urgent and emergent outside Georgia

Blue Choice®

Patient-centered coordinated care through a primary care physician

HMO Required Required Urgent and emergent only

Open AccessOur broadest access to in-network physicians without a referral

HMO Not required Not required Urgent and emergent only

POS Not required Not required Statewide plus BlueCard® network1

1 Nationwide access through the Blue Cross and Blue Shield Association.

More resources to help you

Learn more about ACA, also known as health care reform, by going to our blog at

blog.makinghealthcarereformwork.com. Here you can stay up to date with the impacts

and changes that may affect your business. See what leading industry experts have to say

about ACA, wellness in the workplace and the best ways to manage costs.

24 25

It’s time to meet your matchYou’ll fi nd it here, in one of the most comprehensive product portfolios in the market

We know each employer has a unique mix of employees and needs. So we designed

a great portfolio of plan options that allows you to create the ultimate benefi ts

package that’s perfect for your group. It’s a simple but strong strategy that gets right

to the heart of the matter: the health of your business.

So let’s get started. See which type of plan speaks to what’s most important to you.

Like what you have, but need lower costs?

Employees have healthy

living down to a science?

Want savings for you and your

employees?

How about a health plan with all the

bells and whistles?

26 27

Our Pathway Enhanced Network Plans

For employers who want to keep the type of

plan they have, but need to lower costs

If you like your current plan, but the cost has got

you worried, this can be a great option. Do you like

predictable costs (like knowing copay amounts for

offi ce visits)? You can still offer that, but save money

by moving to a more narrow network:

Same great products and benefi t structure

Narrow network

Lower premiums

In-network preventive care covered 100%

Look for Pathway Enhanced Network plans on the

following page to see all your options.

Healthy Support

If your employees have healthy living down

to a science, you can actually bank on that

There’s value in healthier employees, and here’s a

good way to make that work for everyone. These plans

are like our basic plans, but offer some additional ways

to bring the price down. It also gives employees

incentives for getting healthy and staying healthy:

Narrow networks lower your costs

Drug list is designed for more savings, like

using more generics

Wellness package provides up to $700 in

incentives for employees who take healthy actions


Adult dental and adult vision is covered

Look for our Plus Plans on the following pages to

see all your options.

High-deductible health plans

An alternative benefi t option that offers

savings for you and your employees

When employees have a greater stake in the game,

they’ll most likely make smarter health care

decisions and use their benefi ts more wisely. With

this plan option, employees have more control over

how they spend their health care dollars, and could

save on premiums. These plans, also known as

consumer-driven health plans (CDHP)s, can be paired

with a health savings account (HSA), which offers tax

savings to employees:

Higher deductibles

Lower premiums

HSA-qualifi ed plan options


Traditional HMO and POS plans

The one with all the bells and whistles

These are the plans that your employees may be

most familiar with. They have predictable costs,

like offering lower copays and deductibles. And

employees have access to a strong network of

doctors and hospitals, so there’s a great chance they

can stick with the doctors they know and love:

Rich benefi ts

Large networks

May include Health and Wellness incentives


27

Product details

The plan naming structure includes these elements:

brand + metal tier + network name + product type + copay or deductible/coinsurance/out-of-pocket maximum

Platinum plans

Contract code Plan name

Deductible individual

Deductible family Coinsurance

Out-of-pocket individual Out-of-pocket family Primary care physician Specialist Urgent care Emergency room Outpatient Inpatient Pharmacy

1KKG BCBSHP Platinum BlueChoice HMO 0%/2500 $0 $0 0% $2,500 $5,000 $20 $40 $100 $200 $250 $500 $10/$35/$70/25%

1KJP BCBSHP Platinum BlueChoice HMO 10%/2500 $0 $0 10% $2,500 $5,000 $10 $20 $100 $200 $250 $250 $10/$35/$70/25%

1KKR BCBSHP Platinum Blue Open Access POS 0%/2500 $0 $0 0% $2,500 $5,000 $20 $40 $100 $200 $250 $500 $10/$35/$70/25%

1KJL BCBSHP Platinum Blue Open Access POS 10%/2500 $0 $0 10% $2,500 $5,000 $10 $20 $100 $200 $250 $250 $10/$35/$70/25%

1KJ9 BCBSHP Platinum Blue Open Access POS 10%/3500 Plus $0 $0 10% $3,500 $7,000 $15 $30 $100 $150 $250 $500 $10/$35/$70/25%

1KJB BCBSHP Platinum Pathway Enhanced POS 10%/3500 Plus $0 $0 10% $3,500 $7,000 $15 $30 $100 $150 $250 $500 $10/$35/$70/30%

Gold plans1KL9 BCBSHP Gold BlueChoice HMO 30%/5500 $0 $0 30% $5,500 $11,000 $35 $60 $100 $200 $250 $750 $15/$40/$80/25%

1KJH BCBSHP Gold BlueChoice HMO 500/20%/3500 $500 $1,500 20% $3,500 $7,000 $25 $50 $100 $200 + 20% Deductible/20% Deductible/20% $250 then $15/$40/$80/25%

1KJD BCBSHP Gold BlueChoice HMO 1500/20%/6000 $1,500 $3,000 20% $6,000 $12,000 $10 $35 $100 $200 + 20% Deductible/20% Deductible/20% $15/$40/$80/25%

1KL7 BCBSHP Gold Blue Open Access POS 30%/5500 $0 $0 30% $5,500 $11,000 $35 $60 $100 $200 $250 $750 $15/$40/$80/25%

1ZUW BCBSHP Gold Blue Open Access POS 500/20%/3500 $500 $1,500 20% $3,500 $7,000 $25 $50 $100 $200 + 20% Deductible/20% Deductible/20% $250 then $15/$40/$80/25%

1ZVG BCBSHP Gold Blue Open Access POS 1000/20%/4000 $1,000 $3,000 20% $4,000 $8,000 $15 $50 $100 $200 + 20% Deductible/20% Deductible/20% $250 then $15/$40/$80/25%

1ZV6 BCBSHP Gold Blue Open Access POS 1000/20%/3500 $1,000 $3,000 20% $3,500 $7,000 $25 $50 $100 $250 + 20% Deductible/20% Deductible/20% $10/$35/$70/25%

1ZU1 BCBSHP Gold Blue Open Access POS 1000/20%/4000 $1,000 $3,000 20% $4,000 $8,000 $35 $70 $100 $300 + 20% Deductible/20% Deductible/20% $15/$40/$80/30%

1ZU2 BCBSHP Gold Pathway Enhanced POS 1000/20%/4000 $1,000 $3,000 20% $4,000 $8,000 $35 $70 $100 $300 + 20% Deductible/20% Deductible/20% $15/$40/$80/30%

1KJY BCBSHP Gold Blue Open Access POS 1000/20%/3000 Plus $1,000 $3,000 20% $3,000 $6,000 $20 (limit 3) then deductible/20% $20 (limit 3) then deductible/20% Deductible/20% Deductible/20% Deductible/20% Deductible/20% $15/$40/$80/30%

1KK3 BCBSHP Gold Pathway Enhanced POS 1000/20%/3000 Plus $1,000 $3,000 20% $3,000 $6,000 $20 (limit 3) then deductible/20% $20 (limit 3) then deductible/20% Deductible/20% Deductible/20% Deductible/20% Deductible/20% $15/$40/$80/30%


1ZVE BCBSHP Gold Pathway Enhanced POS 1250/10%/5000 $1,250 $2,500 10% $5,000 $10,000 $35 $70 $100 $300 + 10% Deductible/10% Deductible/10% $15/$40/$80/30%

1KLE BCBSHP Gold Blue Open Access POS 1500/0%/5000 $1,500 $3,000 0% $5,000 $10,000 $30 $60 $100 $200 Deductible/0% Deductible/0% $15/$40/$80/25%

1ZTZ BCBSHP Gold Blue Open Access POS 1500/10%/4500 $1,500 $3,000 10% $4,500 $9,000 $30 $60 $100 Deductible then $300 Deductible then $300

Deductible then $350 $15/$40/$80/30%

1ZU4 BCBSHP Gold Pathway Enhanced POS 1500/10%/4500 $1,500 $3,000 10% $4,500 $9,000 $30 $60 $100 Deductible then $300 Deductible then $300

Deductible then $350 $15/$40/$80/30%

1KKX BCBSHP Gold Blue Open Access POS 1500/15%/4000 $1,500 $3,000 15% $4,000 $8,000 $30 $50 $100 $200 + 15% Deductible/15% Deductible/15% $15/$40/$80/25%

1ZUZ BCBSHP Gold Blue Open Access POS 1500/20%/6000 $1,500 $3,000 20% $6,000 $12,000 $10 $35 $100 $200 + 20% Deductible/20% Deductible/20% $15/$40/$80/25%

1KKC BCBSHP Gold Blue Open Access POS 2000/0%/3500 $2,000 $4,000 0% $3,500 $7,000 $30 $60 $100 $200 Deductible/0% Deductible/0% $15/$40/$80/25%

1KLC BCBSHP Gold Pathway Enhanced POS 2000/0%/3500 $2,000 $4,000 0% $3,500 $7,000 $30 $60 $100 $200 Deductible/0% Deductible/0% $15/$40/$80/25%

1ZUE BCBSHP Gold Blue Open Access POS 2500/0%/3000 $2,500 $5,000 0% $3,000 $6,000 $30 $60 $100 $200 Deductible/0% Deductible/0% $15/$40/$80/25%

1ZUG BCBSHP Gold Pathway Enhanced POS 2500/0%/3000 $2,500 $5,000 0% $3,000 $6,000 $30 $60 $100 $200 Deductible/0% Deductible/0% $15/$40/$80/25%

1 Here’s a reminder of nonembedded versus embedded deductible products: Nonembedded Accumulation: All family members have a shared deductible and out-of-pocket (OOP) maximum, regardless of the number of family members. The entire deductible must be satisfied before any one member of the family can begin receiving benefits. The entire OOP must be satisfied before the family has satisfied the OOP maximum. Embedded Accumulation: Each member has an individual deductible/OOP amount. Any deductible amount contributed by an individual family member will apply to the family deductible amount, but no individual family member is required to contribute more to the family deductible than their individual deductible amount. The OOP accumulates on an embedded basis also.

28 29

The plan naming structure includes these elements:


The below overview represents in-network benefits. For more plan information, please refer to the

Summary of Benefits (SOB). To find a specific SOB for any of these plans, visit sgplans.bcbsga.com.

Platinum plans

Contract code Plan name




1KKG BCBSHP Platinum BlueChoice HMO 0%/2500 $0 $0 0% $2,500 $5,000 $20 $40 $100 $200 $250 $500 $10/$35/$70/25%

1KJP BCBSHP Platinum BlueChoice HMO 10%/2500 $0 $0 10% $2,500 $5,000 $10 $20 $100 $200 $250 $250 $10/$35/$70/25%

1KKR BCBSHP Platinum Blue Open Access POS 0%/2500 $0 $0 0% $2,500 $5,000 $20 $40 $100 $200 $250 $500 $10/$35/$70/25%

1KJL BCBSHP Platinum Blue Open Access POS 10%/2500 $0 $0 10% $2,500 $5,000 $10 $20 $100 $200 $250 $250 $10/$35/$70/25%

1KJ9 BCBSHP Platinum Blue Open Access POS 10%/3500 Plus $0 $0 10% $3,500 $7,000 $15 $30 $100 $150 $250 $500 $10/$35/$70/25%

1KJB BCBSHP Platinum Pathway Enhanced POS 10%/3500 Plus $0 $0 10% $3,500 $7,000 $15 $30 $100 $150 $250 $500 $10/$35/$70/30%

Gold plans1KL9 BCBSHP Gold BlueChoice HMO 30%/5500 $0 $0 30% $5,500 $11,000 $35 $60 $100 $200 $250 $750 $15/$40/$80/25%

1KJH BCBSHP Gold BlueChoice HMO 500/20%/3500 $500 $1,500 20% $3,500 $7,000 $25 $50 $100 $200 + 20% Deductible/20% Deductible/20% $250 then $15/$40/$80/25%

1KJD BCBSHP Gold BlueChoice HMO 1500/20%/6000 $1,500 $3,000 20% $6,000 $12,000 $10 $35 $100 $200 + 20% Deductible/20% Deductible/20% $15/$40/$80/25%

1KL7 BCBSHP Gold Blue Open Access POS 30%/5500 $0 $0 30% $5,500 $11,000 $35 $60 $100 $200 $250 $750 $15/$40/$80/25%

1ZUW BCBSHP Gold Blue Open Access POS 500/20%/3500 $500 $1,500 20% $3,500 $7,000 $25 $50 $100 $200 + 20% Deductible/20% Deductible/20% $250 then $15/$40/$80/25%

1ZVG BCBSHP Gold Blue Open Access POS 1000/20%/4000 $1,000 $3,000 20% $4,000 $8,000 $15 $50 $100 $200 + 20% Deductible/20% Deductible/20% $250 then $15/$40/$80/25%


1ZU1 BCBSHP Gold Blue Open Access POS 1000/20%/4000 $1,000 $3,000 20% $4,000 $8,000 $35 $70 $100 $300 + 20% Deductible/20% Deductible/20% $15/$40/$80/30%

1ZU2 BCBSHP Gold Pathway Enhanced POS 1000/20%/4000 $1,000 $3,000 20% $4,000 $8,000 $35 $70 $100 $300 + 20% Deductible/20% Deductible/20% $15/$40/$80/30%

1KJY BCBSHP Gold Blue Open Access POS 1000/20%/3000 Plus $1,000 $3,000 20% $3,000 $6,000 $20 (limit 3) then deductible/20% $20 (limit 3) then deductible/20% Deductible/20% Deductible/20% Deductible/20% Deductible/20% $15/$40/$80/30%

1KK3 BCBSHP Gold Pathway Enhanced POS 1000/20%/3000 Plus $1,000 $3,000 20% $3,000 $6,000 $20 (limit 3) then deductible/20% $20 (limit 3) then deductible/20% Deductible/20% Deductible/20% Deductible/20% Deductible/20% $15/$40/$80/30%


1ZVE BCBSHP Gold Pathway Enhanced POS 1250/10%/5000 $1,250 $2,500 10% $5,000 $10,000 $35 $70 $100 $300 + 10% Deductible/10% Deductible/10% $15/$40/$80/30%

1KLE BCBSHP Gold Blue Open Access POS 1500/0%/5000 $1,500 $3,000 0% $5,000 $10,000 $30 $60 $100 $200 Deductible/0% Deductible/0% $15/$40/$80/25%

1ZTZ BCBSHP Gold Blue Open Access POS 1500/10%/4500 $1,500 $3,000 10% $4,500 $9,000 $30 $60 $100 Deductible then $300 Deductible then $300

Deductible then $350 $15/$40/$80/30%

1ZU4 BCBSHP Gold Pathway Enhanced POS 1500/10%/4500 $1,500 $3,000 10% $4,500 $9,000 $30 $60 $100 Deductible then $300 Deductible then $300

Deductible then $350 $15/$40/$80/30%

1KKX BCBSHP Gold Blue Open Access POS 1500/15%/4000 $1,500 $3,000 15% $4,000 $8,000 $30 $50 $100 $200 + 15% Deductible/15% Deductible/15% $15/$40/$80/25%

1ZUZ BCBSHP Gold Blue Open Access POS 1500/20%/6000 $1,500 $3,000 20% $6,000 $12,000 $10 $35 $100 $200 + 20% Deductible/20% Deductible/20% $15/$40/$80/25%

1KKC BCBSHP Gold Blue Open Access POS 2000/0%/3500 $2,000 $4,000 0% $3,500 $7,000 $30 $60 $100 $200 Deductible/0% Deductible/0% $15/$40/$80/25%

1KLC BCBSHP Gold Pathway Enhanced POS 2000/0%/3500 $2,000 $4,000 0% $3,500 $7,000 $30 $60 $100 $200 Deductible/0% Deductible/0% $15/$40/$80/25%

1ZUE BCBSHP Gold Blue Open Access POS 2500/0%/3000 $2,500 $5,000 0% $3,000 $6,000 $30 $60 $100 $200 Deductible/0% Deductible/0% $15/$40/$80/25%

1ZUG BCBSHP Gold Pathway Enhanced POS 2500/0%/3000 $2,500 $5,000 0% $3,000 $6,000 $30 $60 $100 $200 Deductible/0% Deductible/0% $15/$40/$80/25%

2 Pharmacy deductible does not apply to tier 1 drugs.

All product offerings are subject to regulatory review and approval. All off-exchange plans listed are calendar year (CY). They are also available as plan year (PY). The three products available on SHOP are only available as CY. When the individual deductible is less than or equal to $1,000, then the family deductible is 3x the individual amount. When the individual deductible is greater than $1,000, then the family deductible is 2x the individual amount.

29

Gold plans (continued)Contract code Plan name




1ZVC BCBSHP Gold Blue Open Access POS 2500/20%/4250 $2,500 $5,000 20% $4,250 $8,500 $20 $40 $100 $200 + 20% Deductible/20% Deductible/20% $15/$40/$80/25%

1ZVH BCBSHP Gold Pathway Enhanced POS 2500/20%/4250 $2,500 $5,000 20% $4,250 $8,500 $20 $40 $100 $200 + 20% Deductible/20% Deductible/20% $15/$40/$80/25%

1ZUQ BCBSHP Gold Blue Open Access POS 3000/0%/4000 $3,000 $6,000 0% $4,000 $8,000 $15 $35 $100 $200 Deductible/0% Deductible/0% $250 then $15/$40/$80/25%

1ZUS BCBSHP Gold Pathway Enhanced POS 3000/0%/4000 $3,000 $6,000 0% $4,000 $8,000 $15 $35 $100 $200 Deductible/0% Deductible/0% $250 then $15/$40/$80/25%

1ZUY BCBSHP Gold Blue Open Access POS 3500/0%/4250 $3,500 $7,000 0% $4,250 $8,500 $20 $40 $100 $200 Deductible/0% Deductible/0% $15/$40/$80/25%

1ZUL BCBSHP Gold Pathway Enhanced POS 3500/0%/4250 $3,500 $7,000 0% $4,250 $8,500 $20 $40 $100 $200 Deductible/0% Deductible/0% $15/$40/$80/25%

1ZUU BCBSGA Gold BlueChoice PPO 500/20%/3500 $500 $1,500 20% $3,500 $7,000 $25 $50 $100 $200 + 20% Deductible/20% Deductible/20% $250 then $15/$40/$80/25%

1ZUX BCBSGA Gold BlueChoice PPO 1000/20%/4000 $1,000 $3,000 20% $4,000 $8,000 $15 $50 $100 $200 + 20% Deductible/20% Deductible/20% $250 then $15/$40/$80/25%

1ZUP BCBSGA Gold BlueChoice PPO 1500/20%/6000 $1,500 $3,000 20% $6,000 $12,000 $10 $35 $100 $200 + 20% Deductible/20% Deductible/20% $15/$40/$80/25%

1ZUN BCBSGA Gold BlueChoice PPO 3000/0%/4000 $3,000 $6,000 0% $4,000 $8,000 $15 $35 $100 $200 Deductible/0% Deductible/0% $250 then $15/$40/$80/25%

1ZUJ BCBSGA Gold BlueChoice PPO 3500/0%/4250 $3,500 $7,000 0% $4,250 $8,500 $20 $40 $100 $200 Deductible/0% Deductible/0% $15/$40/$80/25%

Silver plans

1KK4 BCBSHP Silver Blue Open Access POS 1500/35%/5500 Plus $1,500 $3,000 35% $5,500 $11,000 $35 (limit 3) then deductible/35% $35 (limit 3) then deductible/35% Deductible/35% Deductible/35% Deductible/35% Deductible/35% $500 then $15/$40/$80/30%

1KK6 BCBSHP Silver Pathway Enhanced POS 1500/35%/5500 Plus $1,500 $3,000 35% $5,500 $11,000 $35 (limit 3) then deductible/35% $35 (limit 3) then deductible/35% Deductible/35% Deductible/35% Deductible/35% Deductible/35% $500 then $15/$40/$80/30%

1ZV9 BCBSHP Silver Blue Open Access POS 1750/40%/6850 $1,750 $3,500 40% $6,850 $13,700 $50 $75 $100 $300 + 40% Deductible/40% Deductible/40% $15/$40/$80/25%

1KJX BCBSHP Silver Blue Open Access POS 2000/30%/5500 Plus $2,000 $4,000 30% $5,500 $11,000 $35 (limit 3) then deductible/30% $35 (limit 3) then deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30% $250 then $15/$40/$80/30%

1KJV BCBSHP Silver Pathway Enhanced POS 2000/30%/5500 Plus $2,000 $4,000 30% $5,500 $11,000 $35 (limit 3) then deductible/30% $35 (limit 3) then deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30% $250 then $15/$40/$80/30%

1KKZ BCBSHP Silver Blue Open Access POS 2500/20%/6350 Plus $2,500 $5,000 20% $6,350 $12,700 $30 $60 $100 $300 + 20% Deductible/20% Deductible/20% $500 then $15/$40/$80/30%

1KL1 BCBSHP Silver Pathway Enhanced POS 2500/20%/6350 Plus $2,500 $5,000 20% $6,350 $12,700 $30 $60 $100 $300 + 20% Deductible/20% Deductible/20% $500 then $15/$40/$80/30%

1ZUB BCBSHP Silver Blue Open Access POS 2500/20%/6800 $2,500 $5,000 20% $6,800 $13,600 $35 $70 $100 $300 + 20% Deductible/20% Deductible/20% $15/$40/$80/30%

1ZUA BCBSHP Silver Pathway Enhanced POS 2500/20%/6800 $2,500 $5,000 20% $6,800 $13,600 $35 $70 $100 $300 + 20% Deductible/20% Deductible/20% $15/$40/$80/30%

1ZT2 BCBSHP Silver Blue Open Access POS 2800/20%/3800 w/HSA $2,800 $5,600 20% $3,800 $7,600 Deductible then $20 Deductible then $35 Deductible then $100 Deductible then $300 Deductible/20% Deductible/20% Deductible then $15/$40/$80/25%

1ZT9 BCBSHP Silver Pathway Enhanced POS 2800/20%/3800 w/HSA $2,800 $5,600 20% $3,800 $7,600 Deductible then $20 Deductible then $35 Deductible then $100 Deductible then $300 Deductible/20% Deductible/20% Deductible then $15/$40/$80/25%

1KJZ BCBSHP Silver Blue Open Access POS 3500/0%/4500 Plus $3,500 $7,000 0% $4,500 $9,000 $30 (limit 3) then deductible/0% $30 (limit 3) then deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% $500 then $15/$40/$80/30%

1KJU BCBSHP Silver Pathway Enhanced POS 3500/0%/4500 Plus $3,500 $7,000 0% $4,500 $9,000 $30 (limit 3) then deductible/0% $30 (limit 3) then deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% $500 then $15/$40/$80/30%

1 Here’s a reminder of nonembedded versus embedded deductible products: Nonembedded Accumulation: All family members have a shared deductible and out-of-pocket (OOP) maximum, regardless of the number of family members. The entire deductible must be satisfi ed before any one member of the family can begin receiving benefi ts. The entire OOP must be satisfi ed before the family has satisfi ed the OOP maximum. Embedded Accumulation: Each member has an individual deductible/OOP amount. Any deductible amount contributed by an individual family member will apply to the family deductible amount, but no individual family member is required to contribute more to the family deductible than their individual deductible amount. The OOP accumulates on an embedded basis also.

Product details

The updated naming structure includes these elements:


30 31

Gold plans (continued)Contract code Plan name




1ZVC BCBSHP Gold Blue Open Access POS 2500/20%/4250 $2,500 $5,000 20% $4,250 $8,500 $20 $40 $100 $200 + 20% Deductible/20% Deductible/20% $15/$40/$80/25%

1ZVH BCBSHP Gold Pathway Enhanced POS 2500/20%/4250 $2,500 $5,000 20% $4,250 $8,500 $20 $40 $100 $200 + 20% Deductible/20% Deductible/20% $15/$40/$80/25%

1ZUQ BCBSHP Gold Blue Open Access POS 3000/0%/4000 $3,000 $6,000 0% $4,000 $8,000 $15 $35 $100 $200 Deductible/0% Deductible/0% $250 then $15/$40/$80/25%

1ZUS BCBSHP Gold Pathway Enhanced POS 3000/0%/4000 $3,000 $6,000 0% $4,000 $8,000 $15 $35 $100 $200 Deductible/0% Deductible/0% $250 then $15/$40/$80/25%

1ZUY BCBSHP Gold Blue Open Access POS 3500/0%/4250 $3,500 $7,000 0% $4,250 $8,500 $20 $40 $100 $200 Deductible/0% Deductible/0% $15/$40/$80/25%

1ZUL BCBSHP Gold Pathway Enhanced POS 3500/0%/4250 $3,500 $7,000 0% $4,250 $8,500 $20 $40 $100 $200 Deductible/0% Deductible/0% $15/$40/$80/25%

1ZUU BCBSGA Gold BlueChoice PPO 500/20%/3500 $500 $1,500 20% $3,500 $7,000 $25 $50 $100 $200 + 20% Deductible/20% Deductible/20% $250 then $15/$40/$80/25%

1ZUX BCBSGA Gold BlueChoice PPO 1000/20%/4000 $1,000 $3,000 20% $4,000 $8,000 $15 $50 $100 $200 + 20% Deductible/20% Deductible/20% $250 then $15/$40/$80/25%

1ZUP BCBSGA Gold BlueChoice PPO 1500/20%/6000 $1,500 $3,000 20% $6,000 $12,000 $10 $35 $100 $200 + 20% Deductible/20% Deductible/20% $15/$40/$80/25%

1ZUN BCBSGA Gold BlueChoice PPO 3000/0%/4000 $3,000 $6,000 0% $4,000 $8,000 $15 $35 $100 $200 Deductible/0% Deductible/0% $250 then $15/$40/$80/25%

1ZUJ BCBSGA Gold BlueChoice PPO 3500/0%/4250 $3,500 $7,000 0% $4,250 $8,500 $20 $40 $100 $200 Deductible/0% Deductible/0% $15/$40/$80/25%

Silver plans

1KK4 BCBSHP Silver Blue Open Access POS 1500/35%/5500 Plus $1,500 $3,000 35% $5,500 $11,000 $35 (limit 3) then deductible/35% $35 (limit 3) then deductible/35% Deductible/35% Deductible/35% Deductible/35% Deductible/35% $500 then $15/$40/$80/30%

1KK6 BCBSHP Silver Pathway Enhanced POS 1500/35%/5500 Plus $1,500 $3,000 35% $5,500 $11,000 $35 (limit 3) then deductible/35% $35 (limit 3) then deductible/35% Deductible/35% Deductible/35% Deductible/35% Deductible/35% $500 then $15/$40/$80/30%

1ZV9 BCBSHP Silver Blue Open Access POS 1750/40%/6850 $1,750 $3,500 40% $6,850 $13,700 $50 $75 $100 $300 + 40% Deductible/40% Deductible/40% $15/$40/$80/25%

1KJX BCBSHP Silver Blue Open Access POS 2000/30%/5500 Plus $2,000 $4,000 30% $5,500 $11,000 $35 (limit 3) then deductible/30% $35 (limit 3) then deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30% $250 then $15/$40/$80/30%

1KJV BCBSHP Silver Pathway Enhanced POS 2000/30%/5500 Plus $2,000 $4,000 30% $5,500 $11,000 $35 (limit 3) then deductible/30% $35 (limit 3) then deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30% $250 then $15/$40/$80/30%

1KKZ BCBSHP Silver Blue Open Access POS 2500/20%/6350 Plus $2,500 $5,000 20% $6,350 $12,700 $30 $60 $100 $300 + 20% Deductible/20% Deductible/20% $500 then $15/$40/$80/30%

1KL1 BCBSHP Silver Pathway Enhanced POS 2500/20%/6350 Plus $2,500 $5,000 20% $6,350 $12,700 $30 $60 $100 $300 + 20% Deductible/20% Deductible/20% $500 then $15/$40/$80/30%

1ZUB BCBSHP Silver Blue Open Access POS 2500/20%/6800 $2,500 $5,000 20% $6,800 $13,600 $35 $70 $100 $300 + 20% Deductible/20% Deductible/20% $15/$40/$80/30%

1ZUA BCBSHP Silver Pathway Enhanced POS 2500/20%/6800 $2,500 $5,000 20% $6,800 $13,600 $35 $70 $100 $300 + 20% Deductible/20% Deductible/20% $15/$40/$80/30%

1ZT2 BCBSHP Silver Blue Open Access POS 2800/20%/3800 w/HSA $2,800 $5,600 20% $3,800 $7,600 Deductible then $20 Deductible then $35 Deductible then $100 Deductible then $300 Deductible/20% Deductible/20% Deductible then $15/$40/$80/25%

1ZT9 BCBSHP Silver Pathway Enhanced POS 2800/20%/3800 w/HSA $2,800 $5,600 20% $3,800 $7,600 Deductible then $20 Deductible then $35 Deductible then $100 Deductible then $300 Deductible/20% Deductible/20% Deductible then $15/$40/$80/25%

1KJZ BCBSHP Silver Blue Open Access POS 3500/0%/4500 Plus $3,500 $7,000 0% $4,500 $9,000 $30 (limit 3) then deductible/0% $30 (limit 3) then deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% $500 then $15/$40/$80/30%

1KJU BCBSHP Silver Pathway Enhanced POS 3500/0%/4500 Plus $3,500 $7,000 0% $4,500 $9,000 $30 (limit 3) then deductible/0% $30 (limit 3) then deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% $500 then $15/$40/$80/30%

2 Pharmacy deductible does not apply to tier 1 drugs.






31

Silver plans (continued)Contract code Plan name




1ZTT BCBSHP Silver Blue Open Access POS 3500/0%/3500 w/HSA $3,500 $7,000 0% $3,500 $7,000 Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible

1ZTV BCBSHP Silver Pathway Enhanced POS 3500/0%/3500 w/HSA $3,500 $7,000 0% $3,500 $7,000 Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible

1KJN BCBSHP Silver Blue Open Access POS 3500/10%/6850 $3,500 $7,000 10% $6,850 $13,700 $35 $70 $100 $300 + 10% Deductible/10% Deductible/10% $15/$40/$80/30%

1KK8 BCBSHP Silver Pathway Enhanced POS 3500/10%/6850 $3,500 $7,000 10% $6,850 $13,700 $35 $70 $100 $300 + 10% Deductible/10% Deductible/10% $15/$40/$80/30%

1ZVN BCBSHP Silver Blue Open Access POS 4000/20%/6350 $4,000 $8,000 20% $6,350 $12,700 $50 $75 $100 $300 + 20% Deductible/20% Deductible/20% $250 then $15/$40/$80/25%

1ZVQ BCBSHP Silver Pathway Enhanced POS 4000/20%/6350 $4,000 $8,000 20% $6,350 $12,700 $50 $75 $100 $300 + 20% Deductible/20% Deductible/20% $250 then $15/$40/$80/25%

1ZVA BCBSHP Silver Blue Open Access POS 4500/30%/6000 $4,500 $9,000 30% $6,000 $12,000 $40 $80 $100 Deductible then $300 Deductible then $300

Deductible then $500 $15/$40/$80/30%

1ZV4 BCBSHP Silver Pathway Enhanced POS 4500/30%/6000 $4,500 $9,000 30% $6,000 $12,000 $40 $80 $100 Deductible then $300 Deductible then $300

Deductible then $500 $15/$40/$80/30%

1KJF BCBSHP Silver Blue Open Access POS 5000/20%/6800 $5,000 $10,000 20% $6,800 $13,600 $30 $60 $100 Deductible then $300 Deductible then $300

Deductible then $350 $15/$40/$80/30%

1KJK BCBSHP Silver Pathway Enhanced POS 5000/20%/6800 $5,000 $10,000 20% $6,800 $13,600 $30 $60 $100 Deductible then $300 Deductible then $300

Deductible then $350 $15/$40/$80/30%

1KLA BCBSHP Silver Blue Open Access POS 5000/20%/6350 $5,000 $10,000 20% $6,350 $12,700 $40 $60 $100 $300 + 20% Deductible/20% Deductible/20% $500 then $15/$40/$80/25%

1ZTC BCBSHP Silver Pathway Enhanced POS 5000/20%/6350 $5,000 $10,000 20% $6,350 $12,700 $40 $60 $100 $300 + 20% Deductible/20% Deductible/20% $500 then $15/$40/$80/25%

1ZTE BCBSHP Silver Blue Open Access POS 5000/30%/6000 $5,000 $10,000 30% $6,000 $12,000 $35 $60 $100 $300 + 30% Deductible/30% Deductible/30% $15/$40/$80/25%

1ZTG BCBSHP Silver Pathway Enhanced POS 5000/30%/6000 $5,000 $10,000 30% $6,000 $12,000 $35 $60 $100 $300 + 30% Deductible/30% Deductible/30% $15/$40/$80/25%

1KKP BCBSHP Silver Blue Open Access POS 6350/0%/6350 Plus $6,350 $12,700 0% $6,350 $12,700 $30 $60 $100 $300 Deductible/0% Deductible/0% $15/$40/$80/30%

1KKF BCBSHP Silver Pathway Enhanced POS 6350/0%/6350 Plus $6,350 $12,700 0% $6,350 $12,700 $30 $60 $100 $300 Deductible/0% Deductible/0% $15/$40/$80/30%

1ZVJ BCBSGA Silver BlueChoice PPO 4000/20%/6350 $4,000 $8,000 20% $6,350 $12,700 $50 $75 $100 $300 + 20% Deductible/20% Deductible/20% $250 then $15/$40/$80/25%

1ZT4 BCBSGA Silver BlueChoice PPO 5000/20%/6350 $5,000 $10,000 20% $6,350 $12,700 $40 $60 $100 $300 + 20% Deductible/20% Deductible/20% $500 then $15/$40/$80/25%

Bronze plans1ZTL BCBSHP Bronze Blue Open Access POS 4250/30%/6550 w/ HSA $4,250 $8,500 30% $6,550 $13,100 Deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30%

1ZTN BCBSHP Bronze Pathway Enhanced POS 4250/30%/6550 w/ HSA $4,250 $8,500 30% $6,550 $13,100 Deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30%

1KKV BCBSHP Bronze Blue Open Access POS 5000/10%/6550 w/ HSA $5,000 $10,000 10% $6,550 $13,100 Deductible then $20 Deductible then $40 Deductible then $100 Deductible then $300 Deductible/10% Deductible/10% Deductible then $15/$40/$80/30%

1KKT BCBSHP Bronze Pathway Enhanced POS 5000/10%/6550 w/ HSA $5,000 $10,000 10% $6,550 $13,100 Deductible then $20 Deductible then $40 Deductible then $100 Deductible then $300 Deductible/10% Deductible/10% Deductible then $15/$40/$80/30%

1KK9 BCBSHP Bronze Blue Open Access POS 5900/0%/6850 Plus $5,900 $11,800 0% $6,850 $13,700 $35 (limit 3) then deductible/0% $35 (limit 3) then deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% $500 then $15/$40/$80/30%

Product details




32 33

Silver plans (continued)Contract code Plan name




1ZTT BCBSHP Silver Blue Open Access POS 3500/0%/3500 w/HSA $3,500 $7,000 0% $3,500 $7,000 Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible

1ZTV BCBSHP Silver Pathway Enhanced POS 3500/0%/3500 w/HSA $3,500 $7,000 0% $3,500 $7,000 Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible

1KJN BCBSHP Silver Blue Open Access POS 3500/10%/6850 $3,500 $7,000 10% $6,850 $13,700 $35 $70 $100 $300 + 10% Deductible/10% Deductible/10% $15/$40/$80/30%

1KK8 BCBSHP Silver Pathway Enhanced POS 3500/10%/6850 $3,500 $7,000 10% $6,850 $13,700 $35 $70 $100 $300 + 10% Deductible/10% Deductible/10% $15/$40/$80/30%

1ZVN BCBSHP Silver Blue Open Access POS 4000/20%/6350 $4,000 $8,000 20% $6,350 $12,700 $50 $75 $100 $300 + 20% Deductible/20% Deductible/20% $250 then $15/$40/$80/25%

1ZVQ BCBSHP Silver Pathway Enhanced POS 4000/20%/6350 $4,000 $8,000 20% $6,350 $12,700 $50 $75 $100 $300 + 20% Deductible/20% Deductible/20% $250 then $15/$40/$80/25%

1ZVA BCBSHP Silver Blue Open Access POS 4500/30%/6000 $4,500 $9,000 30% $6,000 $12,000 $40 $80 $100 Deductible then $300 Deductible then $300

Deductible then $500 $15/$40/$80/30%

1ZV4 BCBSHP Silver Pathway Enhanced POS 4500/30%/6000 $4,500 $9,000 30% $6,000 $12,000 $40 $80 $100 Deductible then $300 Deductible then $300

Deductible then $500 $15/$40/$80/30%

1KJF BCBSHP Silver Blue Open Access POS 5000/20%/6800 $5,000 $10,000 20% $6,800 $13,600 $30 $60 $100 Deductible then $300 Deductible then $300

Deductible then $350 $15/$40/$80/30%

1KJK BCBSHP Silver Pathway Enhanced POS 5000/20%/6800 $5,000 $10,000 20% $6,800 $13,600 $30 $60 $100 Deductible then $300 Deductible then $300

Deductible then $350 $15/$40/$80/30%

1KLA BCBSHP Silver Blue Open Access POS 5000/20%/6350 $5,000 $10,000 20% $6,350 $12,700 $40 $60 $100 $300 + 20% Deductible/20% Deductible/20% $500 then $15/$40/$80/25%

1ZTC BCBSHP Silver Pathway Enhanced POS 5000/20%/6350 $5,000 $10,000 20% $6,350 $12,700 $40 $60 $100 $300 + 20% Deductible/20% Deductible/20% $500 then $15/$40/$80/25%

1ZTE BCBSHP Silver Blue Open Access POS 5000/30%/6000 $5,000 $10,000 30% $6,000 $12,000 $35 $60 $100 $300 + 30% Deductible/30% Deductible/30% $15/$40/$80/25%

1ZTG BCBSHP Silver Pathway Enhanced POS 5000/30%/6000 $5,000 $10,000 30% $6,000 $12,000 $35 $60 $100 $300 + 30% Deductible/30% Deductible/30% $15/$40/$80/25%

1KKP BCBSHP Silver Blue Open Access POS 6350/0%/6350 Plus $6,350 $12,700 0% $6,350 $12,700 $30 $60 $100 $300 Deductible/0% Deductible/0% $15/$40/$80/30%

1KKF BCBSHP Silver Pathway Enhanced POS 6350/0%/6350 Plus $6,350 $12,700 0% $6,350 $12,700 $30 $60 $100 $300 Deductible/0% Deductible/0% $15/$40/$80/30%

1ZVJ BCBSGA Silver BlueChoice PPO 4000/20%/6350 $4,000 $8,000 20% $6,350 $12,700 $50 $75 $100 $300 + 20% Deductible/20% Deductible/20% $250 then $15/$40/$80/25%

1ZT4 BCBSGA Silver BlueChoice PPO 5000/20%/6350 $5,000 $10,000 20% $6,350 $12,700 $40 $60 $100 $300 + 20% Deductible/20% Deductible/20% $500 then $15/$40/$80/25%

Bronze plans1ZTL BCBSHP Bronze Blue Open Access POS 4250/30%/6550 w/ HSA $4,250 $8,500 30% $6,550 $13,100 Deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30%

1ZTN BCBSHP Bronze Pathway Enhanced POS 4250/30%/6550 w/ HSA $4,250 $8,500 30% $6,550 $13,100 Deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30%

1KKV BCBSHP Bronze Blue Open Access POS 5000/10%/6550 w/ HSA $5,000 $10,000 10% $6,550 $13,100 Deductible then $20 Deductible then $40 Deductible then $100 Deductible then $300 Deductible/10% Deductible/10% Deductible then $15/$40/$80/30%

1KKT BCBSHP Bronze Pathway Enhanced POS 5000/10%/6550 w/ HSA $5,000 $10,000 10% $6,550 $13,100 Deductible then $20 Deductible then $40 Deductible then $100 Deductible then $300 Deductible/10% Deductible/10% Deductible then $15/$40/$80/30%

1KK9 BCBSHP Bronze Blue Open Access POS 5900/0%/6850 Plus $5,900 $11,800 0% $6,850 $13,700 $35 (limit 3) then deductible/0% $35 (limit 3) then deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% $500 then $15/$40/$80/30%





2 Pharmacy deductible does not apply to Tier 1 drugs.


33

Bronze plans (continued)Contract code Plan name




1KL5 BCBSHP Bronze Pathway Enhanced POS 5900/0%/6850 Plus $5,900 $11,800 0% $6,850 $13,700 $35 (limit 3) then deductible/0% $35 (limit 3) then deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% $500 then $15/$40/$80/30%

1ZTQ BCBSHP Bronze Blue Open Access POS 6000/0%/6000 w/ HSA $6,000 $12,000 0% $6,000 $12,000 Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible

1KKL BCBSHP Bronze Pathway Enhanced POS 6000/0%/6000 w/ HSA $6,000 $12,000 0% $6,000 $12,000 Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible

1KKJ BCBSHP Bronze Blue Open Access POS 6000/30%/6850 Plus $6,000 $12,000 30% $6,850 $13,700 $35 (limit 3) then deductible/30% $35 (limit 3) then deductible/30% Deductible/30% Deductible then $300 Deductible then $300

Deductible then $500

$250 then $15/$40/$80/30%

1ZT7 BCBSHP Bronze Pathway Enhanced POS 6000/30%/6850 Plus $6,000 $12,000 30% $6,850 $13,700 $35 (limit 3) then deductible/30% $35 (limit 3) then deductible/30% Deductible/30% Deductible then $300 Deductible then $300


$250 then $15/$40/$80/30%

1ZTJ BCBSHP Bronze Blue Open Access POS 6550/0%/6550 w/ HSA $6,550 $13,100 0% $6,550 $13,100 Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible

1KKE BCBSHP Bronze Pathway Enhanced POS 6550/0%/6550 w/ HSA $6,550 $13,100 0% $6,550 $13,100 Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible

SHOP plans1ZT6 BCBSHP Gold Pathway X Enhanced POS 500/20%/5000 Plus $500 $1,500 20% $5,000 $10,000 $20 (limit 3) then deductible/20% $20 (limit 3) then deductible/20% Deductible/20% Deductible/20% Deductible/20% Deductible/20% $15/$40/$80/30%

1ZT5 BCBSHP Silver Pathway X Enhanced POS 1500/30%/5500 Plus $1,500 $3,000 30% $5,500 $11,000 $35 (limit 3) then deductible/30% $35 (limit 3) then deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30% $500 then $15/$40/$80/30%

1KL2 BCBSHP Bronze Pathway X Enhanced POS 5000/30%/6850 Plus $5,000 $10,000 30% $6,850 $13,700 $30 (limit 3) then deductible/30% $30 (limit 3) then deductible/30% Deductible/30% Deductible then $300 Deductible then $300


$500 then $15/$40/$80/30%

Product details




34 35

Bronze plans (continued)Contract code Plan name




1KL5 BCBSHP Bronze Pathway Enhanced POS 5900/0%/6850 Plus $5,900 $11,800 0% $6,850 $13,700 $35 (limit 3) then deductible/0% $35 (limit 3) then deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% $500 then $15/$40/$80/30%

1ZTQ BCBSHP Bronze Blue Open Access POS 6000/0%/6000 w/ HSA $6,000 $12,000 0% $6,000 $12,000 Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible

1KKL BCBSHP Bronze Pathway Enhanced POS 6000/0%/6000 w/ HSA $6,000 $12,000 0% $6,000 $12,000 Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible

1KKJ BCBSHP Bronze Blue Open Access POS 6000/30%/6850 Plus $6,000 $12,000 30% $6,850 $13,700 $35 (limit 3) then deductible/30% $35 (limit 3) then deductible/30% Deductible/30% Deductible then $300 Deductible then $300


$250 then $15/$40/$80/30%

1ZT7 BCBSHP Bronze Pathway Enhanced POS 6000/30%/6850 Plus $6,000 $12,000 30% $6,850 $13,700 $35 (limit 3) then deductible/30% $35 (limit 3) then deductible/30% Deductible/30% Deductible then $300 Deductible then $300


$250 then $15/$40/$80/30%

1ZTJ BCBSHP Bronze Blue Open Access POS 6550/0%/6550 w/ HSA $6,550 $13,100 0% $6,550 $13,100 Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible

1KKE BCBSHP Bronze Pathway Enhanced POS 6550/0%/6550 w/ HSA $6,550 $13,100 0% $6,550 $13,100 Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible/0% Deductible

SHOP plans1ZT6 BCBSHP Gold Pathway X Enhanced POS 500/20%/5000 Plus $500 $1,500 20% $5,000 $10,000 $20 (limit 3) then deductible/20% $20 (limit 3) then deductible/20% Deductible/20% Deductible/20% Deductible/20% Deductible/20% $15/$40/$80/30%

1ZT5 BCBSHP Silver Pathway X Enhanced POS 1500/30%/5500 Plus $1,500 $3,000 30% $5,500 $11,000 $35 (limit 3) then deductible/30% $35 (limit 3) then deductible/30% Deductible/30% Deductible/30% Deductible/30% Deductible/30% $500 then $15/$40/$80/30%

1KL2 BCBSHP Bronze Pathway X Enhanced POS 5000/30%/6850 Plus $5,000 $10,000 30% $6,850 $13,700 $30 (limit 3) then deductible/30% $30 (limit 3) then deductible/30% Deductible/30% Deductible then $300 Deductible then $300


$500 then $15/$40/$80/30%





2 Pharmacy deductible does not apply to Tier 1 drugs.


35

Plans with more coverage choices

When we created the Dental Prime and Dental

Complete plans, we made sure they could be custom

fi t. That means lots of choices in coverage, including

options for:

Dental implants.

Composite (tooth-colored) fi llings on any tooth, not

just the front teeth.

Orthodontic benefi ts for kids and adults, or kids only.

Annual maximum carryover, which lets members

carry over some unused benefi ts to the next year.

To allow you to control costs without reducing

benefi ts, we offer a choice between our larger

Dental Complete network and our deeper discounted

Dental Prime network.

Value, Classic and Enhanced dental plans

For groups of 2-100, we offer a choice of dental

plans that fall into our Value, Classic and Enhanced

levels. So you can choose the level that fi ts your

needs and budget:

Value dental plans cover the basics like cleanings,

exams, X-rays and fi llings.

Classic dental plans cover basic dental services,

as well as most major services, all with high

annual maximums.

Enhanced dental plans have the most coverage, with

choices for even higher annual maximums and lower

coinsurance for members.

Pediatric dental EHB benefi ts are included with your

health plan. You can also add adult dental coverage or

supplement the pediatric dental EHB to a higher level

of coverage by purchasing one of our standalone

Dental Prime and Dental Complete plans. See the grid

that follows for more information.

Product details

2016 Dental Prime and Dental Complete plans

(new business only)

Dental Prime and Dental Complete

Value Classic Classic Voluntary

Active Passive Passive Passive

Diagnostic and preventive services 100%/100% 100%/100% 100%/100% 100%/100%

Basic services 80%/80% 80%/80% 80%/80% 80%/80%

Major services Not covered 50%/50% 50%/50% 50%/50%

Endodontic, periodontal and oral surgery services Basic Basic or major Basic or major Basic or major

Implants Not covered Not covered Not covered or covered Not covered or covered

Posterior composites Not covered Not covered Not covered or covered Not covered

Orthodontia Not covered Not covered or 50% children onlyNot covered, 50% children only

or 50% children and adultNot covered or 50% children only

Annual deductible (per person/family)

$50/$150 $50/$150 $50/$150 $50/$150

Annual benefi t maximum and orthodontia maximum $500, or $1,000 $1,000 $1500, or $2,000 $1,000, or $1,500

Waiting periods (major and orthodontia)

No waiting period No waiting period No waiting period 12-month waiting period

Annual maximum carryover Not included Not included Optional Not included

Out-of-network reimbursement 90th Maximum allowable charge/90th 90th Maximum allowable charge/90th

Dental network Complete Prime or Complete Complete Complete

36 37

2016 Dental Prime and Dental Complete plans

(new business only)

The above is a summary. See the Certificate of Coverage with the Schedule of Benefits and any riders associated with the plan for complete coverage details and related terms and conditions.

For renewing business, please contact your BCBSGa representative for a complete copy of the plan options available.

Value Classic Classic Voluntary

Active Passive Passive Passive

Diagnostic and preventive services 100%/100% 100%/100% 100%/100% 100%/100%

Basic services 80%/80% 80%/80% 80%/80% 80%/80%

Major services Not covered 50%/50% 50%/50% 50%/50%

Endodontic, periodontal and oral surgery services Basic Basic or major Basic or major Basic or major

Implants Not covered Not covered Not covered or covered Not covered or covered

Posterior composites Not covered Not covered Not covered or covered Not covered

Orthodontia Not covered Not covered or 50% children onlyNot covered, 50% children only

or 50% children and adultNot covered or 50% children only

Annual deductible (per person/family)

$50/$150 $50/$150 $50/$150 $50/$150

Annual benefit maximum and orthodontia maximum $500, or $1,000 $1,000 $1500, or $2,000 $1,000, or $1,500

Waiting periods (major and orthodontia)

No waiting period No waiting period No waiting period 12-month waiting period

Annual maximum carryover Not included Not included Optional Not included

Out-of-network reimbursement 90th Maximum allowable charge/90th 90th Maximum allowable charge/90th

Dental network Complete Prime or Complete Complete Complete

37

Get vision coverage and see increased productivity

Product details

Pediatric full-service vision and an adult routine vision exam is included in all of your Small Group

medical plans. Adult routine vision exam pending approval.

Blue View Vision plans

Plan

Copay1 for Frequency

Eye exam/Eyeglass lenses

Frames/Contact lenses allowance2 Eye exam Eyeglass lenses Frames Contact lenses

Full s

ervic

e

A1 $10/$0 $130/$130 Once per calendar year Once per calendar year Once per calendar year Once per calendar year






B1 $10/$0 $130/$130 Once per calendar year Once per calendar year Once every other calendar year Once per calendar year






C1 $10/$0 $130/$130 Once per calendar year Once every other calendar year Once every other calendar year Once every other calendar year









Mat

eria

l onl

y

MO1 Not covered/$10 $130/$130 Not covered Once per calendar year Once per calendar year Once per calendar year

MO2 Not covered/$10 $130/$130 Not covered Once per calendar year Once every other calendar year Once per calendar year





Exam

onl

y3

E01 $0/Not covered Not covered Once per calendar year Not covered Not covered Not covered





1 Above amounts refl ect in-network copays and allowances.

2 Benefi ts include coverage for member’s choice of eyeglass lenses or contact lenses, but not both. Non-elective contacts covered in full.

3 Retention plans only.

38 39

Pediatric full-service vision and an adult routine vision exam is included in all of your Small Group

medical plans. Adult routine vision exam pending approval.

Blue View Vision plans

Plan

Copay1 for Frequency

Eye exam/ Eyeglass lenses

Frames/Contact lenses allowance2 Eye exam Eyeglass lenses Frames Contact lenses

Full s

ervic

e






















Mat

eria

l onl

y







Exam

onl

y3






1 Above amounts reflect in-network copays and allowances.

2 Benefits include coverage for member’s choice of eyeglass lenses or contact lenses, but not both. Non-elective contacts covered in full.

3 Retention plans only.

39

Request a copy of the Combined Evidence of Coverage/Member Booklet for comprehensive details on covered services,

exclusions and limitations. These exclusions and limitations will apply to all members enrolled in any of the products

described in this brochure unless otherwise noted.

All exclusions and limitations are subject to regulatory review and approval.

1. Acts of war, disasters or nuclear accidentsIn the event of a major disaster, epidemic, war or other event beyond BCBSGa’s control, BCBSGa will make a good faith effort to give you covered services. BCBSGa will not be responsible for any delay or failure to give services due to lack of available facilities or staff. Benefits will not be given for any illness or injury that is a result of war, service in the armed forces, a nuclear explosion, nuclear accident, release of nuclear energy, a riot, or civil disobedience.

2. Administrative charges:a) Charges to complete claim forms.b) Charges to get medical records or reports.c) Membership, administrative, or access fees charged by doctors or other

providers. Examples include, but are not limited to, fees for educational brochures or calling you to give you test results.

3. Alternative/complementary medicineServices or supplies for alternative or complementary medicine. This includes, but is not limited to:a) Acupunctureb) Holistic medicinec) Homeopathic medicined) Hypnosise) Aroma therapyf) Massage and massage therapyg) Reiki therapyh) Herbal, vitamin or dietary products or therapiesi) Naturopathyj) Thermographyk) Orthomolecular therapyl) Contact reflex analysism) Bioenergetic synchronization technique (BEST)n) Iridology — study of the iriso) Auditory integration therapy (AIT)p) Colonic irrigationq) Magnetic innervation therapyr) Electromagnetic therapys) Neurofeedback/biofeedback

4. Before effective date or after termination dateCharges for care you get before your effective date or after your coverage ends, except as written in this plan.

5. Charges over the maximum allowed amountCharges over the maximum allowed amount for covered services.

6. Charges not supported by medical recordsCharges for services not described in your medical records.

7. Complications of noncovered servicesCare for problems directly related to a service that is not covered by this plan. Directly related means that the care took place as a direct result of the noncovered service and would not have taken place without the noncovered service.

8. Cosmetic servicesTreatments, services, prescription drugs, equipment, or supplies given for cosmetic services. Cosmetic services are meant to preserve, change, or

improve how you look or are given for psychiatric, psychological, or social reasons. No benefits are available for surgery or treatments to change the texture or look of your skin or to change the size, shape or look of facial or body features (such as your nose, eyes, ears, cheeks, chin, chest or breasts).This exclusion does not apply to “Reconstructive Surgery” as stated under “Surgery” in the “What’s Covered” section.

9. CrimeTreatment of an injury or illness that results from a crime you committed, or tried to commit. This exclusion does not apply if you were the victim of a crime, including domestic violence.

10. Custodial careCustodial care, convalescent care or rest cures. This exclusion does not apply to hospice services.

11. Dental treatmentDental treatment, except as listed below.Excluded treatment includes but is not limited to preventive care and fluoride treatments; dental X-rays, supplies, appliances and all associated costs; and diagnosis and treatment for the teeth, jaw or gums such as:a) Removing, restoring, or replacing teeth.b) Medical care or surgery for dental problems (unless listed as a covered

service in this booklet).c) Services to help dental clinical outcomes.Dental treatment for injuries that are a result of biting or chewing is also excluded. Exclusion does not apply to services that we must cover by law or to the “Dental Services” described in the “What’s Covered” section of this booklet.

12. Educational servicesServices or supplies for teaching, vocational, or self-training purposes, except as listed in this booklet.

13. Experimental or Investigational servicesServices or supplies that are Experimental or Investigational as defined in the “Definitions” section of this booklet. Except as stated under “Clinical Trials” in the “What’s Covered” section, this exclusion also applies to services related to experimental or investigational services, whether you get them before, during, or after you get the experimental or investigational service or supply.The fact that a service or supply is the only available treatment will not make it covered service if it is experimental or investigational.

14. Eyeglasses and contact lensesEyeglasses and contact lenses to correct your eyesight unless listed as covered in this booklet. This exclusion does not apply to lenses needed after a covered eye surgery.

15. Eye exercisesOrthoptics and vision therapy.

16. Eye surgeryEye surgery to fix errors of refraction, such as near sightedness. This includes, but is not limited to, LASIK, radial keratotomy or keratomileusis, and excimer laser refractive keratectomy.

Exclusions and Limitations

40 41

17. Family membersServices prescribed, ordered, referred by or given by a member of your immediate family, including your spouse, child, brother, sister, parent, in-law, or self.

18. Foot careRoutine foot care unless medically necessary. This exclusion applies to cutting or removing corns and calluses; trimming nails; cleaning and preventive foot care, including, but not limited to:a) Cleaning and soaking the feet.b) Applying skin creams to care for skin tone.c) Other services that are given when there is not an illness, injury

or symptom involving the foot.19. Foot orthotics

Foot orthotics, orthopedic shoes or footwear or support items unless used for an illness affecting the lower limbs, such as severe diabetes.

20. Foot surgerySurgical treatment of flat feet; subluxation of the foot; weak, strained, unstable feet; tarsalgia; metatarsalgia; hyperkeratoses.

21. Free careServices you would not have to pay for if you didn’t have this plan. This includes, but is not limited to government programs, services during a jail or prison sentence, services you get from Workers’ Compensation, and services from free clinics.If Workers’ Compensation benefits are not available to you, this exclusion does not apply. This exclusion will apply if you get the benefits in whole or in part. This exclusion also applies whether or not you claim the benefits or compensation, and whether or not you get payments from any third party.

22. Health club memberships and fitness servicesHealth club memberships, workout equipment, charges from a physical fitness or personal trainer, or any other charges for activities, equipment, or facilities used for physical fitness, even if ordered by a doctor. This exclusion also applies to health spas.

23. Home care:Services given by registered nurses and other health workers who are not employees of or working under an approved arrangement with a Home Health Care Provider:a) Private-duty nursingb) Food, housing, and home delivered mealsc) Homemaker services, except for the homemaker visits described in the

“What’s Covered” section under “Home Care” (prenatal and post partum visits) and under “Hospice.”

24. Infertility treatmentInfertility testing, treatment or procedures not specified in this booklet.

25. Maintenance therapyTreatment given when no further gains are clear or likely to occur. Maintenance therapy includes care that helps you keep your current level of function and prevents loss of that function, but does not result in any change for the better.

26. Medical equipment and supplies:a) Replacement or repair of purchased or rental equipment because

of misuse, abuse, or loss/theft.b) Surgical supports, corsets, or articles of clothing unless needed

to recover from surgery or injury.c) Nonmedically necessary enhancements to standard equipment

and devices.

27. MedicareServices for which benefits are payable under Medicare Parts A, B, and/or D, or would have been payable if you had applied for Parts A and/or B and/or D, except as listed in this booklet or as required by the federal law described under “Medicare” in the “General Provision” section. If you do not enroll in Medicare Part B, BCBSGa will calculate benefits as if you had enrolled. You should sign up for Medicare Part B as soon as possible to avoid large out-of-pocket costs.

28. Missed or canceled appointmentsCharges for missed or canceled appointments.

29. Nonmedically necessary servicesServices that are not medically necessary as defined in the “Definitions” section of this booklet.

30. Nutritional or dietary supplementsNutritional and/or dietary supplements, except as described in this booklet or that we must cover by law. This exclusion includes, but is not limited to, nutritional formulas and dietary supplements that you can buy over the counter and those you can get without a written prescription or from a licensed pharmacist.

31. Out-of-network careServices from a provider that is not in BCBSGa’s network. This does not apply to emergency care, urgent care, or authorized services.

32. Oral surgeryExtraction of teeth, surgery for impacted teeth and other oral surgeries to treat the teeth or bones and gums directly supporting the teeth, except as listed in this booklet.

33. Personal care and convenience:a) Items for personal comfort, convenience, protection, cleanliness such as

air conditioners, humidifiers, water purifiers, sports helmets, raised toilet seats, and shower chairs.

b) First aid supplies and other items kept in the home for general use (bandages, cotton-tipped applicators, thermometers, petroleum jelly, tape, nonsterile gloves, heating pads).

c) Home work out or therapy equipment, including treadmills and home gyms.

d) Pools, whirlpools, spas, or hydrotherapy equipment.e) Hypoallergenic pillows, mattresses, or waterbeds.f) Residential, auto, or place of business structural changes (ramps, lifts,

elevator chairs escalators, elevators, stair glides, emergency alert equipment, handrails).

34. Private-duty nursingPrivate-duty nursing services.

35. ProstheticsProsthetics for sports or cosmetic purposes.

36. ProvidersServices you get from a noncovered provider, as defined in this booklet. Examples of noncovered providers include, but are not limited to, masseurs or masseuses (massage therapists), physical therapist technicians, and athletic trainers.

37. Sex changeServices and supplies for a sex change and/or the reversal of a sex change.

38. Sexual dysfunctionServices or supplies for male or female sexual problems.

39. Smoking cessationPrograms to help you stop smoking.

41

40. Standby chargesStandby charges of a doctor or other provider.

41. Reversal of elective sterilization

42. Surrogate mother servicesServices or supplies for a person not covered under this plan for a surrogate pregnancy (including, but not limited to, the bearing of a child by another woman for an infertile couple).

43. Travel costsMileage, lodging, meals, and other member-related travel costs except as described under “Ambulance Services” in the “What’s Covered” section of this booklet.

44. Vein treatmentTreatment of varicose veins or telangiectatic dermal veins (spider veins) by any method (including sclerotherapy or other surgeries) for cosmetic purposes.

45. Vision services:a) Vision services for members age 19 or older, unless listed as covered

in this bookletb) Eyeglass lenses, frames, or contact lenses for members age 19 and

older, unless listed as covered in this bookletc) Safety glasses and accompanying framesd) For two pairs of glasses in lieu of bifocals plano lenses (lenses that have

no refractive power)e) Lost or broken lenses or frames if the member has already received

benefi ts during a benefi t periodf) Vision services not listed as covered in this bookletg) Cosmetic lenses or optionsh) Blended lensesi) Oversized lensesj) Sunglasses and accompanying framesk) For services or supplies combined with any other offer, coupon or

in-store advertisementl) For members through age 18, no benefi ts are available for frames not on

the BCBSGa formularym) Certain frames in which the manufacturer imposes a no-discount policy

46. Weight-loss programsPrograms, whether or not under medical supervision, unless listed as covered in this booklet.This exclusion includes, but is not limited to, commercial weight-loss programs (Weight Watchers®, Jenny Craig®, LA Weight Loss®) and fasting programs.This exclusion does not apply to the “Diabetes Management” or “Preventive Care” benefi ts or to “Surgery for conditions caused by obesity” under “Surgery” in the “What’s Covered” section.

Important information

The state of Georgia now requires insurers to cover certain

expenses related to the treatment of Autism Spectrum Disorder

(ASD). These changes take effect July 1, 2015, for new groups

and upon renewal, on or after July 1, 2015, for existing groups.

June 26, 2105, the Supreme Court ruled that same-sex couples

have a constitutional right to marry in all states. It also requires

states to recognize same-sex marriages that were validly

performed in other states. BCBSGa will allow insured and

self-insured plans in any state to enroll same-sex spouses.

Exclusions and Limitations

42 43

Notes

43

Notes

44 45

Notes

45

This is not a contract or policy. This brochure is not a contract with Blue Cross and Blue Shield of Georgia. If there is any difference between this brochure and the Evidence of Coverage, Member Booklet, Summaries of Benefi ts, and related Amendments, the provisions of the Evidence of Coverage, Member Booklet, Summaries of Benefi ts and related Amendments will govern. For more information, please call Customer Service.

LiveHealth Online is the trade name of Health Management Corporation, a separate company, providing telehealth services on behalf of Blue Cross and Blue Shield of Georgia.

Life and Disability products are underwritten by Greater Georgia Life Insurance Company (GGL) using the trade name Anthem Life. Blue Cross and Blue Shield of Georgia, Inc., Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. and GGL are independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered trademarks of the Blue Cross and Blue Shield Association.

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