A portfolio of products to complement your group medical ... · your group medical benefits and streamline administration ... from a range of plan variables and out-of-pocket cost

Specialty Products

A portfolio of products to complement your group medical benefits and

streamline administration

CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are both independent licensees of the Blue Cross and Blue Shield Association.

® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc.

You know and trust CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (“CareFirst”) for our core products—comprehensive medical, pharmacy and wellness benefits. But we’re more than a high-quality health care insurer. We also offer specialty products—dental, vision, worksite benefits, life and disability coverage, behavioral health coverage, financial services—that respond to the needs of your employees while delivering value to you at a manageable cost.*

Integrate services with us and concentrate on your core business

Why it pays to integrate with CareFirst:

• Ease of administration—One point of contact.

• Retention—High-quality, wide-ranging benefits help you attract and retain the best and brightest staff.

• Satisfaction—Providing employees with the coverage they need and the peace of mind they want can lead to greater satisfaction in the workplace.

CareFirst is the single-source solution to your specialty coverage needs.

64% of consumers consider workplace insurance attractive due to its reasonable cost.LIMRA, “2012 Insurance Barometer Study”

Health care benefits rank #1 on the list of effective employee retention strategies and dental and vision coverage are important components of an attractive benefits package.WB&A Market Research

*CareFirst BlueCross BlueShield underwrites the CareFirst Dental Plans. All other Specialty Products are underwritten by other vendors.

The CareFirst BlueCross BlueShieldfamily of health care plans.

CareFirst Vision Plans

CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are both independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc.

CareFirst Dental Plans

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CareFirst Dental Plans

CareFirst understands how vital dental care is for you and your employees. We also recognize the realities of cost. With CareFirst Dental, you can customize your dental plan to meet your employees’ needs and your budget. By selecting from a range of plan variables and out-of-pocket cost options, you’ll have more control over your costs and your employees’ contribution.

CareFirst Dental gives you reasons to smile:

• Large national network We have access to one of the largest national networks in overall size—more than 86,000 dentists in the Traditional Plan and 63,000 dentists in the Preferred Plan.

• Superior discounts Savings range from an average of 27% to 30% for our Traditional Plan and 30% to 34% for our Preferred Plan.

• The market leader With 1.3 million dental members, we cover more people than any other dental carrier in Maryland, DC and Northern Virginia.

• Dedicated dental claims and service unit In addition to this dental expertise, we offer utilization review and management programs to control costs and quality of care.

The Surgeon General estimates that adults with oral disease miss approximately 164 million hours of work each year.National Institute of Dental and Craniofacial Research, “Oral Health in America: A Report of the Surgeon General.” Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.

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Compare CareFirst Dental Plans

Traditional Dental Preferred Dental Dental HMO

Freedom of Choice Choice and Savings Savings and predictability

Network Size 86,000 63,000 590

Largest CareFirst Dental Network ✓

National Provider Network ✓ ✓

Freedom of Provider Choice ✓ ✓

Out-of-Network Benefits ✓ ✓

No Referrals Required ✓ ✓

Available as Voluntary ✓ ✓ ✓

Orthodontia Coverage Available for Children

✓ (included)

✓ (included)

✓ (included)

Orthodontia Coverage Available for Adults

✓ (included)

Note: The information above briefly describes important features about this health care program. It is not a contract. A detailed description of benefits is included in the Evidence of Coverage. Please refer to the Evidence of Coverage for specific terms, conditions, limitations and exclusions.

Under all three plans, your employees will be covered for regular exams and cleanings, X-rays, dental surgery and more.



CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are both independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc. V1


Healthy vision is crucial to productivity in the workplace. Around 72% of the U.S. working population requires some form of vision correction. Vision programs are among the most cost effective of all health care benefits. Research shows that employers gain up to $7 for every $1 they spend on vision coverage.

See the benefits of CareFirst’s vision coverage

• Extensive network More than 30,000 optometrists, ophthalmologists and opticians give your employees the opportunity to choose from private practice and major retailers, including Wal-Mart, Sam’s Club, Sears, Pearle Vision, JC Penney, Target and VisionWorks.

• No copays Zero copays for more than 400 frames, including brand names like Harley Davidson, Guess and Gant. The same goes for popular contact lens brands such as Acuvue 2 and Acuvue Oasys.

• Out-of-network options

Vision disorders account for over $8 billion annually in sick days, lost productivity and medical bills.The Vision Council

50% to 90% of employees suffer from computer vision syndrome. These symptoms include eye strain, dry eyes, blurred and double vision.National Institute of Occupational Safety and Health

We offer employees options if they visit an out-of-network provider.

• Enhanced benefits These include a one-year eyeglass breakage warranty, laser vision correction discounts and additional product discounts.

• Member satisfaction 97% member satisfaction and 98% client retention.

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Compare CareFirst Vision Plans

BlueVision BlueVision Plus

Core to Medical* Upgrade

In-network exam copay $10 $0 or $10Large national network including private practices and retailers ✓ ✓

Available as voluntary ✓

Available as standalone ✓

No benefit waiting periods ✓ ✓

Discounts on frames/lenses and contact lenses ✓

Extensive benefits for frames/lenses and contact lenses ✓

Free frames and contact lenses from the Collection ✓

One year eyeglass breakage warranty ✓

Significant discounts on lens options such as anti-reflective coating, scratch-resistant coating and tinting ✓ ✓

Laser vision correction discounts ✓ ✓

Once a member loses sight, it costs a health plan an average of

$2.5 million for the rest of the members’ life.“Economic Costs Associated with Mental Retardation, Cerebral Palsy, Hearing Loss, and Vision Impairment — United States, 2003,” MMWR Special Report, Centers for Disease Control and Prevention, January 30, 2004, 53(03);57-59.

Note: The information above briefly describes important features about this health care program. It is not a contract. A detailed description of benefits is included in the Evidence of Coverage. Please refer to the Evidence of Coverage for specific terms, conditions, limitations and exclusions.

*BlueVision benefits are included in most of the CareFirst BlueChoice and BluePreferred medical plans.

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Popular brand names are included in the Frame Collection

Bongo®

Cadillac®

Candies®

Catherine Deneuve®

Converse®

Cosmopolitan®

Elizabeth Arden®

Elizabeth Arden®

Gant Women™

Gant®

Garfield®

Harley-Davidson®

Jill Stuart®

Lauren Hutton®

New Balance®

Perry Ellis America®

Perry Ellis®

Petite™

Scooby Doo®

Steve Madden®

CareFirst partners with Davis Vision to offer an extensive national network of optometrists, opthalmologists and opticians. Davis Vision is an independent company that provides administrative services for vision care to CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. members. Davis Vision is solely responsible for the services it provides.

All trademarks are the property of their respective owners.

Collection is subject to change.

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The Contact Lens Collection offers the most frequently prescribed lenses

Type Lens Manufacturer

Planned Replacement Includes two boxes

Frequency Aspheric Biofinity®

CooperVision® CooperVision®

Disposible Includes four boxes

Biomedics 55 ACUVUE® 2 ACUVUE® OASYS®

CooperVision®

Vistakon®

Vistakon®

Daily Disposables Focus Dailies ClearSight (1-Day) (1-Day) ACUVUE® MOIST®

CIBA Vision® CooperVision®

Vistakon®

Toric Disposables (2-week) Avaira Toric* Biomedics Toric ACUVUE® OASYS® for ASTIGMATISM

CooperVision®

CooperVision®

Vistakon®

Multifocal Disposables (2-week)

ACUVUE® OASYS® for PRESBYOPIA

Vistakon®

* Only available at Davis Vision and Empire Vision Stores

Collection is available at most participating provider offices and is subject to change.

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Extensive network of participating local, regional and national retail providers

CareFirst has partnered with Davis Vision to offer an extensive network of ophthalmologists, optometrists and many national and regional retail stores. A large percentage of private practice providers also work in a retail/storefront environment. The following are some of the national and regional retailers that are included in the program:

HVHC Retail*

Proprietary Vision Care CentersBinyon’s Eye WorldCambridge Eye DoctorsDavis Vision Dr. Bizer’s Vision WorldDr. Bizer’s Value Vision Doctor’s Value VisionDoctor’s Visionworks Douglas’ Vision WorldEmpire Vision CentersEye DRx EyeMastersHour EyesStein Optical Total Vision CareVisionworks

Allegany Optical Allegany Optical National OptometryBard OpticalCo/op OpticalCohen’s Fashion OpticalCrown OpticalDr. Tavel Optical Group Dr. Tavel Family Eyecare Dr. Tavel One-Hour OpticalEyecare CenterEye Care Associates of NCEye ExpressEye Mart ExpressFor Eyes Halpern Eye AssociatesHour Glass OpticalJCPenney OpticalMidwest Eye Consultants Nationwide Vision America’s Best* Eyeglass World National Vision Centers National Vision Centers in Walmart The Eyeglass Shoppe The Optical Shoppe (Fred Meyers) National Vision Optical

OptimEyesOptiview Ossip OptometryPearle VisionRosin Eye CareSam’s ClubSears OpticalSchaeffer Eye CenterSEE Inc.Shawnee OpticalShopKo Stores Shopko Eyecare Centers ShopKo Express Eyecare CentersSterling OpticalSVS RetailersTarget OpticalThoma & Sutton EyeCareUnion Eye CareUnited OpticalVision MakersVision ValuesWalmart Vision CentersWhylie Eye Care Centers Wisconsin Vision Wisconsin VisionHeartland Vision

CareFirst partners with Davis Vision to offer an extensive national network of optometrists, opthalmologists and opticians. Davis Vision is an independent company that provides administrative services for vision care to CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. members. Davis Vision is solely responsible for the services it provides.

*Most stores provide same day service capabilities.

Life & Disability Products


CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are both independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc. L1

Life & Disability Products

Life and disability products help your employees protect their families by providing them with the resources necessary to cope during life’s most trying times. CareFirst of Maryland, Inc. (CareFirst) has partnered with USAble Life* to offer you ease in choosing product packages and flexibility in customizing options, as well as giving you the support you need for benefit, enrollment and billing concerns.

1 in 5 workers will be out of work for at least a year due to illness or accident before age 65.Life and Health Insurance Foundation for Education.

Let us protect your employees’ lives and health

• Bundled packages Bundled packages with varying levels of Term Life, Accidental Death & Dismemberment, and Long Term Disability at low monthly premiums for 2-50 groups.

• Centralized claims and customer service Dedicated staff answers questions and processes claims.

• Enrollment support The enrollment center offers open enrollment communication support, in-bound and out-bound call support and participation reporting.

• Online access Enrollment, billing and claims status and express claims are among our value-added online services.

75% of healthy individuals over age 40 will become critically ill at some time in the future.American Heart Association, Heart and Stroke Statistics.

*Life and disability coverage is underwritten and administered by USAble Life, an independent company that provides life and disability insurance services to CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. members. USAble Life does not provide BlueCross BlueShield products or services and is solely responsible for the services it provides.

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Small Group 2-50 Packaged PlansEmployer Sponsored*

Package Options2+ Employees 5+ Employees

Option A Option B Option C Option D Option E Option F

Combined Term Life & Accidental Death Benefit $50,000 $50,000 $70,000 $100,000 $50,000 $100,000

Term Life $25,000 $25,000 $35,000 $50,000 $25,000 $50,000

Spouse $5,000 Coverage ✓ ✓ ✓ ✓ ✓ ✓

Children (over 6 mos) $2,000 Coverage1 ✓ ✓ ✓ ✓ ✓ ✓

Accelerated Death Benefit ✓ ✓ ✓ ✓ ✓ ✓

Waiver of Premium ✓ ✓ ✓ ✓ ✓ ✓

Accidental Death & Dismemberment

$25,000 $25,000 $35,000 $50,000 $25,000 $50,000

Long Term Disability $750 $1,000 $1,500 $2,000

Waiver of Premium ✓ ✓ ✓ ✓

Benefit Duration2 2 Year 2 Year 2 Year 2 Year

Elimination Period3 60 Day 60 Day 60 Day 60 Day

Our Monthly Package Rate (PEPM – Per Employee Per Month) $8.50 (PEPM) $15.50 (PEPM) $21.00 (PEPM) $14.50 (PEPM) $22.50 (PEPM) $34.00 (PEPM)

1 Children aged 14 days to 6 months have $100 in coverage.2 Reducing Benefit Duration (ADEA).3 Rates shown are for 60-day elimination period, 30-day elimination period is available for added

monthly cost.

Life and Disability coverage is underwritten and administered by USAble Life, an independent company that provides life and disability services to CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. members. USAble Life does not provide BlueCross BlueShield products or services and is solely responsible for the services it provides.

*Not all industries are eligible.

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Custom Proposal for Employer Groups 10+Choose from this menu to obtain a customized proposal

Employer Sponsored Group Products

Group Life with AD&D

Group Short Term Disability

Group Long Term Disability

Voluntary Group Products

Voluntary Group Life

Voluntary AD&D

Voluntary Short Term Disability

Voluntary Long Term Disability

ValueAdded Services

Online Enrolling & Processing

W2 Preparation & Filing

FICA Match

EAP with Disability Programs

ID Theft Protection Programs

Travel Assistance

Online Will Preparation

Life and Disability coverage is underwritten and administered by USAble Life, an independent company that provides life and disability services to CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. members. USAble Life does not provide BlueCross BlueShield products or services and is solely responsible for the services it provides.

3 in 10 workers entering the workforce will become disabled before they retire.Social Security Administration Fact Sheet. January 31, 2007

To build your unique benefits programs and gain an affordable quote, contact your CareFirst sales representative.




GeoBlue®

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GeoBlue®

GeoBlue* offers a full suite of concierge-level assistance so employees can live or work abroad with confidence, knowing that access to health care services is being handled by an experienced health coordinator.

With GeoBlue, your traveling employees get timely access to trusted care. Your benefit managers get ease of administration from enrollment and fulfillment to assistance and payment services.

Around the globe access to medical care

• Appointment scheduling Request a convenient, cashless office visit with one of GeoBlue’s trusted English-speaking doctors.

• Chronic care and maternity support GeoBlue lines up the best local resources to manage cancer, heart disease, sports injuries and more.

• Informed choice consultation GeoBlue can help develop a plan for serious unexpected medical problems.

• Comprehensive benefits Includes everything from medical evacuation and hospitalization to treatment for an upset stomach.

• Find a doctor and schedule an appointment Review detailed profiles of contracted doctors to find the best match and locate the office.

• Translate medications Country-specific prescription and OTC names and preparations for 400+ medications.

• Translate medical terms Convert symptoms, diagnoses and treatment plans into the ten most common languages.

• Understand health and security risks Receive daily alerts detailing the latest security and health issues in your employees’ destination.

*GeoBlue is the trade name of Worldwide Insurance Services, LLC, an independent licensee of the Blue Cross and Blue Shield Association. Made available in cooperation with Blue Cross and Blue Shield Companies in select service areas.

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GeoBlue® Benefit Schedule

Benefits Outside the U.S. U.S., In Network U.S., Out-of-Network

Preventative and Office Visits – Insurer waives deductible

Preventive Care 100% 100% 60%

Physician Office Visits 100% 100%, after a $30 copay 60%

Services Provided by a Physician or Provider

Surgical Care 100% 80% 60%

Emergency Care 100% 80% 60%

Services and Supplies Provided by a Hospital

Inpatient Hospital Care 100% 80% 60%

Outpatient Hospital Care 100% 80% 60%

Other Services

Ambulance Transportation 100% 80% 60%

Maternity 100% 80% 60%

Pharmacy Benefits

Generic Drugs All except a $10 copayment per prescription, per 30 day supply

Brand Name Drugs All except a $25 copayment per prescription, per 30 day supply

Global Travel Benefits – Insurer waives deductible

Medical Evacuation Up to $100,000

Repatriation of Remains Up to $25,000

Accidental Death and Dismemberment $50,000

Optional Benefits

Routine Vision Care

Routine Dental Care

The GeoBlue Expat standard plan offers three tiers of coinsurance: 100% outside the U.S.; 80% in-network inside the U.S.; 60% out-of-network inside the U.S. The plan has an unlimited lifetime maximum and a $100,000 maximum benefit for emergency medical evacuation. This Benefit Schedule is a sample plan design. Customized plan designs are also available.



Worksite Benefits

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Worksite Benefits

CareFirst cares about the whole health of your employees. This includes financial well-being should hardships and unexpected events arise. Worksite products can help protect your employees’ finances. CareFirst has partnered with several vendors who provide access to services that support sound fiscal health.

Critical Illness*

Designed to pay a lump-sum benefit when your employees are diagnosed with critical conditions.

Cancer/Specified Disease*

Helps people manage the financial impact of a cancer diagnosis without the added pressures of unexpected bills.

Hospital Indemnity*

Pays a benefit towards daily hospital confinement, intensive care, inpatient physician’s attendance, surgery, anesthesia, transportation and other services.

Accident Insurance*

Gives a financial cushion to help pay for medical expenses and living costs when employees get hurt unexpectedly.

Tax Preparation Services**

A network of certified public accountants (CPAs) takes a strategic approach to taxes that focuses on an individual’s financial picture, goals and personality.

38% of working Americans say they could not pay their bills for more than three months if their employment income was lost.Council for Disability Awareness, Disability Divide Consumer Disability Awareness Study, 2010

*Critical Illness, Cancer/Specific Disease, Hospital Indemnity and Accident Insurance are administered by the Select Benefits Group, an independent company that provides worksite benefits to CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. members. Select Benefit Group is solely responsible for the services it provides. These worksite benefits are underwritten by American Heritage Life Insurance Company, a subsidiary of The Allstate Corporation. The policies provide limited benefit, supplemental insurance, and have limitations and exclusions.

**Tax Preparation Services are administered by Capella Tax Network, an independent company that provides tax preparation services to CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. members. Capella Tax Network is solely responsible for the services it provides.

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Critical Illness Plans

With the advancement in medical technology and treatment, people are living longer and once deadly diseases are being controlled and cured. One way your employees can shield themselves and their dependents from the economic consequences of critical illness is to purchase a critical illness policy, which pays a lump sum benefit (paid directly to the employee, or a beneficiary) when they are diagnosed with critical conditions such as heart attack, stroke, organ transplant, Alzheimer’s disease and end stage renal failure. There is no direct employer cost. This benefit is underwritten by American Heritage Life.*

Critical illness policies can help fill in gaps in medical coverage, and address direct and indirect expenses:

• Lost income

• Child care

• Travel expenses

• Prescription drugs

• Mortgage payments

• Home health care

Complete descriptions, including the limitations and exclusions, can be found in Policy Form CILP1 and Rider Forms WBR5 and CICR1, or state variations thereof.

*These worksite benefits are administered by the Select Benefits Group, an independent company that provides worksite benefits to CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. members. Select Benefit Group is solely responsible for the services it provides. These worksite benefits are underwritten by American Heritage Life Insurance Company, a subsidiary of The Allstate Corporation.

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Critical Illness Plans* — At-a-GlanceMaximum of 100% of basic benefit amount is payable in each category.

Benefit AmountsCategory 1 – Included in Plan A and Plan B Plan A Plan B

Heart Attack – 100% ✓ ✓

Stroke – 100% ✓ ✓

Heart Transplant – 100% ✓ ✓

By-Pass Surgery – 25% ✓ ✓

Angioplasty, Atherectomy, Stent Placement – 25% ✓ ✓

Category 2 – Included in Plan A and Plan B

Major Organ Transplant (other than heart) – 100% ✓ ✓

End Stage Renal Failure – 100% ✓ ✓

Multiple Sclerosis – 25% ✓ ✓

Alzheimer’s Disease – 25% ✓ ✓

Paralysis (not as a result of a stroke) – 50% (2 limbs) & 100% (4 limbs) ✓ ✓

Rider Benefit – Included in Plan A and B (3 units)

Wellness Benefit Rider ✓ ✓

Additional Rider Benefit – Included in Plan B only

Critical Illness Cancer Rider ✓

*These worksite benefits are administered by the Select Benefits Group, an independent company that provides worksite benefits to CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. members. Select Benefit Group is solely responsible for the services it provides. These worksite benefits are underwritten by American Heritage Life Insurance Company, a subsidiary of The Allstate Corporation. Members who have a Cancer/Specified Disease Policy through American Heritage Life Insurance Company are not eligible for the Cancer Rider.

Cancer/Specified Disease Coverage

This type of coverage protects against the double-whammy of a cancer diagnosis and the potential for money difficulties during treatment for cancer and other specified diseases. This voluntary benefit can help your employees keep their finances intact. There is no direct employer cost. These benefits are underwritten by American Heritage Life.*

• Coverage may be purchased by the employee for themselves or can include immediate family.

• Premiums do not change based on age.

• Includes coverage for 20 additional specified diseases, such as multiple sclerosis.

Complete descriptions, including the limitations and exclusions, can be found in Policy Form CP10B and Rider Forms CLR1, WBR5 and ICR2, or state variations thereof.

*These worksite benefits are administered by the Select Benefits Group (http://selectbenefitsgroup.com/), an independent company that provides worksite benefits to CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. members. Select Benefits Group is solely responsible for the services it provides. These worksite benefits are underwritten by American Heritage Life Insurance Company, a subsidiary of The Allstate Corporation.

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Benefit

Surgery and Related Benefits

Inpatient Surgery

Outpatient Surgery

Second Surgical Opinion

Anesthesia

Ambulatory Surgical Center

Hospital Confinement Benefits

Hospital Confinement

Extended Hospital Confinement

Government or Charity Hospital

Private Duty Nursing Services

Extended Care Facility

At Home Nursing

Radiation/Chemotherapy Benefits

Radiation Therapy, Radio-Active Isotopes Therapy, Chemotherapy and Immunotherapy

Blood, Plasma and Platelets

Rider Benefits

Wellness Benefit

Hospital Intensive Care

Cancer Initial Diagnosis

Benefit

Lodging and Transportation Benefits

Ambulance

Non-Local Transportation

Family Member Transportation

Family Member Lodging

Outpatient Lodging

Miscellaneous Benefits

Hospice Care (Freestanding Hospice Care Center or Hospice Care Team); Counseling and Bereavement

Inpatient Drugs and Medicine

Physician’s Attendance

New or Experimental Treatment

Physical or Speech Therapy

Prosthesis

Skin Cancer

Colorectal Cancer Screening Benefit

Waiver of Premium – Cancer Only

Cancer/Specified Disease Plans* — At-a-Glance


Hospital Indemnity Plans

Even a few days in the hospital could be costly for your employees as lost income, medicines and therapies quickly add up. There is no employer cost.

Hospital Indemnity plans cover:

• Daily hospital confinement

• Intensive care

• Inpatient physician’s attendance

• Surgery and anesthesia

• Transportation and other services

Hospital Indemnity plans are considered supplemental health coverage, meaning that they do not coordinate with or reduce any benefits received under your major medical insurance. Major medical insurance will pay the hospital and doctor directly while a hospital indemnity plan will pay benefits directly to the insured. Therefore, benefits are paid regardless of any other coverage. These benefits are underwritten by American Heritage Life.*

Complete descriptions, including the limitations and exclusions, can be found in Policy Form CHC and Rider Forms IHR1, IPBR1, SAR1, OPBR1, OEAR1, AHNR and TR1, or state variation thereof.


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Hospital Indemnity Plans* — At-a-Glance

Benefit Amounts Basic Enhanced Premier

Daily Hospital Confinement Benefit $100 each day $200 each day $300 each day

Hospital Intensive Care Unit $100 each day $200 each day $300 each day

Waiver of Premium Yes Yes Yes

Additional Riders included with the Base

Initial Hospital Rider $500 $1,000 $1,500

Inpatient Physician’s Benefit Rider $25 each day $50 each day $100 each day

Surgical Benefit Rider$20-$500

depending on surgery

$40-$1,000 depending on

surgery

$40-$1,000 depending on

surgery

Anesthesia Benefit 25% surgical benefit

25% surgical benefit

25% surgical benefit

Outpatient Physician’s Benefit Rider $25 each occurrence

$50 each occurrence

$75 each occurrence

Outpatient Emergency Accident Rider $50 each occurrence

$100 each occurrence


At Home Nursing Benefit Rider $50 each day $50 each day $50 each day

Transportation Rider (Ambulance) $100 each occurrence



Transportation Rider (Non-Local Transportation) $200 each trip $200 each trip $200 each trip


Accident Insurance

Accident coverage provides cash benefits for out-of-pocket expenses associated with an accidental injury and can safeguard hard-earned savings should an on- or off-the-job accidental injury occur.

• Benefits are paid directly to employee, unless assigned to a beneficiary.

• Supplemental insurance that works in addition to other insurance employees may have.

• Coverage for employee only, employee and spouse, employee and children, or family.

• Policy can be used on its own or to fill in gaps left by other coverage.

• Choose from varying levels of benefits.

• There is no direct employer cost.

These benefits are underwritten by American Heritage Life.*

A fatal injury occurs every 4 minutes and a disabling injury every 1 second.Injury Facts 2010 Edition, National Safety Council.

Benefits provided by Group Voluntary Policy form GVAP1, or state variations thereof. Complete descriptions, including the limitations and exclusions, can be found in the certificate.


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Accident Insurance Coverage* — At-a-Glance

Benefit Amounts Covered Low Option High Option

Loss of Life or Limbs (per schedule below) (Loss of Life in Common Carrier is 5x amount shown)

Employee Spouse Children

Up to $40,000 Up to $20,000 Up to $10,000

Up to $60,000 Up to $30,000 Up to $15,000

Dislocation or Fracture (see schedule below)Employee

Spouse Children

Up to $4,000 Up to $2,000 Up to $1,000

Up to $6,000 Up to $3,000 Up to $1,000

Initial Hospital ConfinementEmployee

Spouse Children

$1,000 $1,500

Hospital ConfinementEmployee

Spouse Children

$200/day $300/day

Ambulance (needed as a result of accidental injury)Employee

Spouse Children

Regular $200 Air $600

Regular $300 Air $900

Medical ExpensesEmployee

Spouse Children

Up to $500 Up to $750

Outpatient Physician’s TreatmentEmployee

Spouse Children

$50 per visit $75 per visit

Benefit amounts shown below are for Low Option and one occurrence. Covered spouse benefit is 50% of the amounts shown and children is 25%.

For loss of: For the complete dislocation of: For complete, simple or closed fracture of bone or bones of:

Life, or both eyes, or both hands or arms, or both feet or legs, or one hand or arm and one foot or leg

$40,000Hip joint $4,000 Hip, thigh (femur), pelvis*** $4,000

Two or more ribs, fingers or toes, bones of face or nose $600

Knee joint**, bone or bones of the foot**, ankle joint $1,600 Skull*** $3,800

One eye, one hand or arm, or one foot or leg $20,000

Wrist joint $1,400 Arm, between shoulder and elbow (shaft), shoulder blade (scapula), leg (tibia or fibula)

$2,200 One rib, finger or toe, Coccyx $280Elbow joint $1,200

One or more entire toes or fingers $4,000

Shoulder joint $800 Ankle, knee cap (patella), collarbone (clavicle), forearm (radius or ulna)

$1,600Bone or bones of the hand**, Collarbone $600

Two or more fingers or toes $280 Foot***, hand or wrist*** $1,400

One finger or toe $120 Lower jaw*** $800


**Knee joint (except patella). Bone or bones of the foot (except toes). Bones or bones of the hand (except fingers).

***Pelvis (except coccyx). Skull (except bones of the face or nose). Foot (except toes). Hand or wrist (except fingers). Lower jaw (except alveolar process).

Tax Preparation

CareFirst’s partner, the Capella Tax™ Network*, allows your employees to develop a long-term relationship with a CPA for not only tax planning, but also for advice when refinancing, buying/selling a home, divorce and other “life dramas.”

Capella CPAs will also promote other tax-advantaged programs like flexible spending accounts and health savings accounts.

Improve your employees’ financial wellness and increase productivity

We also work to improve the “financial wellness” of your employees, which helps your bottom line through increased productivity and reduced health care costs. Convenient payroll deductions are spread over 12 months and there is no direct employer cost. Employees can use our network of financial experts for:

• Preparation of annual tax return

• Proactive tax planning

• Optimization of existing tax-saving programs such as flexible spending accounts, health savings accounts, 401(k)/403(b) plans

• Life’s unforeseen events

• No minimum employer size or participation requirements**

*Tax preparation services are administered by CapellaTax Network, an independent company that provides tax preparation services to CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. members. CapellaTax Network does not provide BlueCross BlueShield products or services and is solely responsible for the services it provides.

** A one-year commitment is required.

At any given time, 15% or more of [your] workforce is struggling with personal finance wellness.Voluntary Benefits Magazine, Oct 2012, “Why Employers Should Care about their Employees Financial Wellness”

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Employee Assistance Program


CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are both independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc. E1

Employee Assistance Program (EAP)

CareFirst’s Employee Assistance Program (EAP), is a voluntary benefit provided by Magellan Behavioral Health*. It combines comprehensive intervention and prevention services to deliver measurable results for happier, healthier living.

Help your workforce become more productive

• Increased morale Our programs and resources help improve employee functioning, productivity and work satisfaction.

• Enhanced abilities Employees may see a greater capacity to care for themselves and others as a result of using EAP services.

• Health care cost control and containment Having the same provider for EAP and behavioral health can assist in reducing administrative costs. EAPs can also reduce predicted medical expenditures by at least 12%.

In addition to support regarding day-to-day life, the EAP is also an important resource for problem identification, counseling and referral services for employees and their families. Counselors are experienced in providing support, understanding and guidance for a broad range of needs, including:

• Family

• Relationship issues

• Work-life balance

• Grief and loss

• Stress

• Depression and anxiety

• Health and wellness

• Alcohol or drug concerns

* Magellan Behavioral Health, Inc. is an independent company that provides managed health services to CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. members. Magellan Behavioral Health does not provide BlueCross BlueShield products or services and is solely responsible for the services it provides.

The U.S. Department of Labor estimates that for every $1 spent on an EAP, an employer saves anywhere from $5-$16.Institute for Work and Health. (1996). Creating healthier work environments: a critical review of the health impacts of workplace organizational change.

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Clear-cut results with CareFirst’s Employee Assistance Program*

• Integration of care Access a “one-stop shop” of value-added programs and services that integrate physical and emotional wellness, along with other services that have been traditionally stand-alone in the marketplace.

• Expanded reach Offer choices and flexibility, including smart phone applications, to help members search for employee assistance providers.

• Superior web presence Find health articles, calculators, webinars and training sessions on an award-winning website.

• Critical incident services Receive quick and thorough responses to tragedies in the workplace from the only centralized, dedicated Critical Incident Stress Management (CISM) team in the country.

• EAP provider profiling Evaluate high-volume EAP affiliates based on individual performance and other factors to ensure members have the strongest clinicians as a first referral choice.

Core EAP Services

• 24/7 telephonic member support

• Face-to-face counseling• Member website• Program orientations and

trainings

• Workplace support for supervisors

• Progress reports• Critical incident stress

management• Member materials

Optional Services

• Work-life resources Provide information, consultations and pre-screened referrals for a full range of work-life issues, ranging from child and elder care to education and adoption

* Magellan Behavioral Health, Inc. is an independent company that provides managed health services to CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. members. Magellan Behavioral Health does not provide BlueCross BlueShield products or services and is solely responsible for the services it provides.

Payroll and Tax Administration


CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are both independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc. P1

Payroll and Tax Administration

As the financial responsibilities of payroll administration grow ever more complex, managing these functions can distract business owners from growing their enterprises and delivering exceptional service and products to customers. Through PayChoice*, we offer payroll processing, tax administration and customized reporting. You also receive crucial support from a dedicated, FPC-certified service representative who will serve as your single point of contact. You get Fortune 500-style benefits and employee management solutions to keep your company competitive.

Save time and money

• Lower priced than competitors Save at least 15% compared to other payroll service companies.

• No fees No connectivity fee when PayChoice is bundled with CareFirst medical insurance.

• Better customer service with simplified administration Improve accuracy and timeliness with automated transfer of payroll data. Eliminates manual processing and redundant entries with daily data exchanges.

• Access to employee and management tools 24/7 access to HR forms and letters, job descriptions, employee handbooks and more including access to a certified HR professional via phone or online.

The Association of Certified Fraud Examiners reports that the average case of payroll related fraud at a small business creates a $127,500 loss.Resource Nation: http://www.resourcenation.com/article/prevent-fraud-small-business-needs-tighten-payroll-controls/. Accessed February 28, 2013.

*PayChoice is an independent company offering benefit administration services to CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. members. PayChoice does not provide BlueCross BlueShield products or services and is solely responsible for the services it provides.

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Payroll — At-a-Glance

Streamlined administration

Manually entering eligibility information and calculating deductions is time-consuming and takes away from core business functions. We free up your time and resources by providing the following services:

• Daily data exchanges between CareFirst and PayChoice eliminate manual processing and redundant entries

• Coverage elections trigger automatic payroll deductions on the PayChoice payroll platform

• Demographic changes, new hires and terminations are automatically transmitted to CareFirst

• Integrated processing platform is provided at no charge

Improved cash flow

Inaccurate benefits information and billing errors caused by manual entry and duplicate data can disrupt cash flow. We can help with a solution that increases accuracy and decrease the need to devote your resources to tracking data and correcting errors.

Access to employee management tools

• 24/7 access to HR forms and letters, job descriptions, employee handbooks and more

• Certified HR professionals are available via phone or online

• Self-service tools that guide employees to earning statements and W-2s

• Online employee enrollment and benefits administration options

40% of small businesses pay the IRS an average penalty of $845 for improperly filing taxes.The Business of Your Business LLC: http://www.thebyb.com/articles/index.php. Accessed February 28, 2013.

CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association.

® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc.

www.carefirst.com

SUM2032-1E (5/13)


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