Member Resource Guide 2018 Plan Year

Member Resource Guide2018 Plan YearPPO, Network Only and Qualified High Deductible Health Plan (QHDHP) Medical Plans

AMHIC Member Resource Guide

NOTES


NOTES

- 1 -


MEMBER RESOURCE GUIDE INFORMATIONWe are pleased that your employer is a member of AMHIC, A Reciprocal Association. AMHIC’s PPO, Network Only and Qualified High Deductible Health Plan (QHDHP) medical plans include certain covered benefits, care management programs, and advocacy services that are available to you at no cost. This AMHIC Member Resource Guide contains information regarding these and other important services that are available to you as an AMHIC member. We hope that you will review this information and utilize these services to help you get the most from your participation in one of these medical plans.

A wallet card with important contact information accompanies this guide. Please keep this card in a convenient place to help you get the most out of your AMHIC medical plan.

Page 2 Member Resources Contact Information – This sheet includes contact information and hours of operation for AMHIC providers.

Page 3-4 Preventive Care – Health Care Reform legislation passed in September, 2010 requires that medical plans cover certain preventive services without you having to pay a copayment or coinsurance or meet your deductible. A list of these services is included in this guide.

Page 5-6 Express Scripts – Express Scripts provides pharmacy benefit management services in support of your prescription drug benefit. The company processes pharmaceutical claims for members at network pharmacies and at their own mail order pharmacies. Express Scripts provides integrated pharmacy benefit management services including network-pharmacy claims processing, home delivery services, step therapy and Prior Authorization.

Page 7 Express Scripts - Smart90-CVS Program - Answers to your frequently asked questions regardingyour three month supply network, Smart 90.

Page 8 Immediate Care – You have options when you need medical advice and treatment on an urgent basis. Information on how to locate and access Immediate Care services is included in this guide.

Page 9 MDLIVE Telehealth– This service provides on-demand access to doctors who can assist with non-emergency medical conditions, 24/7/365. Information on conditions appropriate for treatment, and how to access this service via phone or internet are included in this guide.

Page 10 Conifer– Conifer is an industry leader in medical management. Conifer works with you and your physician to help develop and support a customized care treatment plan if you are facing complex medical conditions. The Conifer nurse can also be a great source of information to help you evaluate options and understand your treatment plans. Should you receive a call from Conifer, we strongly encourage you to engage with them to learn about how they can provide support and advocate for you during a difficult situation.

Page 11 Health Advocate – A personal health advocate is a trained professional who understands the intricacies of the healthcare system and how to navigate through it. AMHIC members have access to a personal health advocate for claims assistance, fee negotiation, grievance advice, and basic questions related to your coverage. Members can call Health Advocate an unlimited number of times throughout the year to get assistance.

Page 12 CareFirst Member Discount Programs – CareFirst Administrators offers special member savings while providing health and wellness information, support and services. Choose from a broad range of discounts on wellness services, weight loss programs, fitness centers and much more.

Page 13 CareFirst Personalized Health Ticket – Your one-stop shop for comprehensive information about your health care benefits, as well as a highly specific provider information.

Page 14 CareFirst Network Directory – Internet instructions.

Page 15 ID Card Preview – The back of your ID card enlarged for your convenience.

- 2 -


Medical Plan Benefits AdministrationTo verify provider network participation, call CareFirst Administrators directly or access the network directory from

www.amhic.com – click “Forms & Links” tab

CareFirst Administrators (CFA)Group # DGX

877-889-2478Hours: Mon-Thurs 8:30am-6:00pm EST

Friday 8:30 am to 5:00 pm EST

www.cfablue.com

Prescription Drug Benefits Administration

Express ScriptsGroup # AMHICRX

866-544-2940 (Customer Service)Hours: 24 hours a day, 7 days a week

888-772-5188 (Home Delivery)Hours: Mon-Fri 7:30am-5:30pm CST

www.express-scripts.com

Health Advocate

Health Advocate Group Name: AMHIC

866-695-8622Hours: 24 hours a day, 7 days a week

or via email - [email protected]

www.healthadvocate.com/amhic

Hospitalization Pre-Certification

Conifer 866-475-1256Hours: 8:30am-5:00pm EST www.coniferhealth.com

MDLIVE Telehealth

MDLIVE 888-632-273824/7/365 www.MDLIVE.com/dgx

AMHIC, A RECIPROCAL ASSOCIATION MEMBER RESOURCESwww.AMHIC.com

Contact Information for Members of AMHIC

PPO, NETWORK ONLY AND QUALIFIED HIGH DEDUCTIBLE HEALTH PLAN (QHDHP) MEDICAL PLANS

- 3 -


PREVENTIVE SERVICES COVERED UNDER THE AFFORDABLE CARE ACTIf you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a copayment or coinsurance or meet your deductible. This applies only when these services are delivered by a network provider. For more information, go to www.healthcare.gov/preventive-care-benefits

Covered Preventive Services for Adults

1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked

2. Alcohol Misuse screening and counseling

3. Aspirin use to prevent cardiovascular disease for men and women of certain ages, and for women of childbearing years who are at increased risk of preeclampsia

4. Blood Pressure screening for all adults

5. Cholesterol screening for adults of certain ages at higher risk

6. Colorectal Cancer screening for adults over 50

7. Depression screening for adults

8. Type 2 Diabetes screening for adults with high blood pressure

9. Diet counseling for adults at higher risk for chronic disease

10. Hepatitis B Screening for people at high risk, including U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence

11. Hepatitis C Screening for adults at increased risk, and one time for everyone born between 1945-1965

12. HIV screening for everyone ages 15 to 65, and other ages at increased risk

13. Immunization vaccines for adults--doses, recommended ages, and recommended populations vary:

• Hepatitis A

• Hepatitis B

• Herpes Zoster

• Human Papillomavirus

• Influenza (Flu Shot)

• Measles, Mumps, Rubella

• Meningococcal

• Pneumococcal

• Tetanus, Diphtheria, Pertussis

• Varicella

Covered Preventive Services for Women, Including Pregnant Women1. Anemia screening on a routine basis for pregnant women2. Breast Cancer Genetic Test Counseling (BRCA) for women

at higher risk for breast cancer3. Breast Cancer Mammography screenings every 1 to 2

years for women over 404. Breast Cancer Chemoprevention counseling for women

at higher risk5. Breastfeeding comprehensive support and counseling

from trained providers and access to breastfeeding supplies, for pregnant and nursing women

6. Cervical Cancer screening for sexually active women7. Chlamydia Infection screening for younger women and

other women at higher risk8. Contraception: Food and Drug Administration-approved

contraceptive methods, sterilization procedures, and patient education and counseling, as presscribed by a health care provider for women with reproductive capacity, not including abortifacient drugs

9. Domestic and interpersonal violence screening and counseling for all women

10. Folic Acid supplements for women who may become pregnant

11. Gestational Diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes

12. Gonorrhea screening for all women at higher risk13. Hepatitis B screening for pregnant women at their first

prenatal visit14. HIV screening and counseling for sexually active women

14. Lung Cancer Screening for adults 55-80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years

15. Obesity screening and counseling for all adults

16. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk

17. Syphilis screening for all adults at higher risk

18. Tobacco Use screening for all adults and cessation interventions for tobacco users

- 4 -


Covered Preventive Services for Women, Including Pregnant Women (Continued)15. Human Papillomavirus (HPV) DNA Test: every three years

for women with normal cytology results who are 30 or older

16. Osteoporosis screening for women over age 60 depending on risk factors

17. Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk

18. Sexually Transmitted Infections (STI) counseling for sexually active women

19. Syphilis screening for all pregnant women or other women at increased risk

20. Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users

21. Urinary Tract or other infection screening for pregnant women

22. Well-woman Visits to obtain recommended preventive services for women under 65

Covered Preventive Services for Children1. Alcohol and Drug Use assesments for adolescents2. Autism screening for children at 18 and 24 months3. Behavioral assessments for children of all ages

Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.

4. Blood Pressure screening for childrenAges: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.

5. Cervical Dysplasia screening for sexually active females6. Depression screening for adolescents7. Developmental screening for children under age 38. Dyslipidemia screening for children at higher risk of lipid

disordersAges: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.

9. Fluoride Chemoprevention supplements for children without fluoride in their water source

10. Gonorrhea preventive medication for the eyes of all newborns

11. Hearing screening for all newborns12. Height, Weight and Body Mass Index measurements


13. Hematocrit or Hemoglobin screening for children14. Hemoglobinopathies or sickle cell screening for

newborns15. HIV screening for adolescents at higher risk16. Hypothyroidism screening for newborns

17. Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:

• Diphtheria, Tetanus, Pertussis• Haemophilus influenzae type b• Hepatitis A• Hepatitis B• Human Papillomavirus• Inactivated Poliovirus• Influenza (Flu Shot)• Measles, Mumps, Rubella• Meningococcal• Pneumococcal• Rotavirus• Varicella

18. Iron supplements for children ages 6 to 12 months at risk for anemia

19. Lead screening for children at risk of exposure20. Medical History for all children throughout development


21. Obesity screening and counseling22. Oral Health risk assessment for young children

Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.23. Phenylketonuria (PKU) screening for this genetic disorder

in newborns24. Sexually Transmitted Infection (STI) prevention

counseling and screening for adolescents at higher risk25. Tuberculin testing for children at higher risk of

tuberculosisAges: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.

26. Vision screening for all children

- 5 -


EXPRESS SCRIPTS: MEDICATIONS AND YOUR PRESCRIPTION COVERAGE

HOME DELIVERYIf you fill prescriptions for eligible maintenance drugs at a retail pharmacy, you may be paying more than necessary for your medications. You can save time and money by using home delivery pharmacy services from Express Scripts.1

WHY CHOOSE HOME DELIVERY?• Your medication will usually cost less than at a retail pharmacy.

• Get up to a 90-day supply delivered right to you with free standard shipping.

• It’s easy to order refills online, over the phone, by mail or with the Express Scripts mobile app.

• You can even refill many prescriptions automatically through Worry Free Fills.2

• Express Scripts pharmacists review every prescription and are available 24/7 to answer your questions.

HOW LONG WILL IT TAKE TO PROCESS MY ORDER?When you fill a prescription through the Express Scripts Pharmacy for the first time, you can expect delivery within 2 weeks from the time the prescription is received from your doctor. Keep a 30-day supply of your medication on hand at the time of your order. Refills typically take 3-5 days to process and ship.

1 Includes services provided by the Medco Pharmacy (for specialty drugs) and the Express Scripts Pharmacy2 By calling member services you can enroll in Worry Free Refills to receive automatic refills on maintenance medications. Your medications

will be dispensed when they are slated for a refill. No need to call in or request a refill.3 If you’re a first time visitor to the Express-Scripts website, please take a moment to register. Be sure to have your member ID number.

THREE EASY WAYS TO GET STARTED!

1. Call Member Services at 866-544-2490 to speak with a prescription benefit specialist. With your approval, Express Scripts will reach out to your doctor and make the arrangements for home delivery.

2. Sign in at Express-Scripts.com or StartHomeDelivery.com and scroll down to “Transfer your retail prescriptions to the mail-order pharmacy.”3

3. Ask your doctor to write a new prescription for up to a 90-day supply, plus refills for up to 1 year, if appropriate. For faster service, ask your doctor to send your prescription to Express Scripts through e-prescribing.

Take advantage of the Express Scripts Pharmacy from anywhere! Scan the code below to download

the mobile app today!

Download the app and more at Express-Scripts.com/mobile

PRIOR AUTHORIZATIONExpress Scripts prior authorization program (often called a coverage review) is designed to help keep prescription drugs affordable while providing the medicine you need.

Some drugs need approval, or Prior Authorization, before your plan will cover them. When you receive a prescription for one of these drugs, your personal medical professionals are consulted. This works like a health plan that consults your doctor before covering certain medical tests. Only your own doctor (or in some cases your pharmacist) can provide the information needed to determine if a drug can be covered.

- 6 -


Prescription drugs that need approval are flagged in the pharmacy’s computer with a message saying your prescription needs Prior Authorization. This simply means that more information is needed to determine if your plan can cover the drug.

In the next step, your doctor calls the Express Scripts Prior Authorization phone line at 866-544-2490 - open 24 hours a day, every day. During the call, an Express Scripts agent checks your plan’s guidelines.

For example, a medicine may need Prior Authorization because it can be used for more than one purpose: It’s a medical treatment for skin conditions, but it can also be used cosmetically to reduce wrinkles. Your plan would cover this prescription drug only for medical conditions.

When your plan covers your medication, it helps keep your copayments affordable. If the medication is not covered, your doctor could write a new prescription for a covered drug. Or you can get the original prescription filled by paying full price at your retail pharmacy.

STEP THERAPYYour plan prefers that you first try generic medications to treat a particular condition. These preferred medications are chosen typically because they've been shown to work effectively and cost less than other medications in that category.

WHAT IS STEP THERAPY?Step Therapy is a program designed exclusively for people who have certain conditions - high blood pressure and high cholesterol, for example - that require them to take medications regularly.

Step Therapy drugs are grouped in categories based on cost and effectiveness:

Front-line drugs are generic (Step 1). They have been FDA approved as safe and effective for treating your health condition. These drugs should be tried first because in most cases they will provide the same health benefit at a lower cost.

Back-up drugs are those brand names you see advertised on TV. There are lower-cost brand drugs (Step 2) and higher-cost brand drugs (Step 3). These drugs always cost more than front-line drugs.

HOW IT WORKSThe next time your doctor writes you a prescription:

• Ask your doctor if a generic medication (front line drug) is right for you.

• If you’ve already tried a front-line drug, or your doctor decides one of these drugs isn’t appropriate for you, then your doctor can prescribe a back-up drug. Ask your doctor to call Express Scripts at 866-544-2490 to obtain a suitable prescription for you.

• You can always get a higher-cost brand-name drug at a higher copayment if the front-line or Step 2 back-up drugs aren’t effective for you.

QUESTIONS? Call Express Scripts toll-free at 866-544-2490.

- 7 -


YOUR THREE-MONTH SUPPLY NETWORK

FREQUENTLY ASKED QUESTIONS (FAQS)As part of your plan managed by Express Scripts, you can get a three-month supply of long-term medicines through home delivery from the Express Scripts PharmacySM or from CVSTM.

Getting a single three-month supply saves you money over three, one-month supplies. Plus, you’ll make fewer trips to the pharmacy and you’ll be less likely to miss a dose since you won’t have to refill as often. Below are some frequently asked questions about filling your long-term medicines.

Q. What is a long-term medicine?

A. A long-term medicine is one you take regularly to treat conditions such as high blood pressure, diabetes, or high cholesterol.

Q. What happens if I keep filling my long-term medicine like I’m doing now?

A. Per your plan, if you are filling a one-month supply at CVS instead of a three-month supply, you could miss out on savings.

Q. Why is a three-month supply better with long-term medicine?

A. With a three-month supply, you’re less likely to miss a dose, which can keep you healthier. Also, you don’t have to refill as often, which can save you time and money.

Q. How do I get a three-month supply of my medicine?

A. You can have the Express Scripts Pharmacy deliver it (with FREE standard shipping) by calling 855.778.1444 or visiting express-scripts.com, or you can get it from CVS.

Q. How can I find a retail pharmacy that fills a three-month supply?

A. Log in or register at express-scripts.com, select “Manage Prescriptions,” and click “Locate a Pharmacy” to find your closest pharmacy that fills three-month supplies.

Q. How do I get my medicine delivered from the Express Scripts Pharmacy?

A. You can choose between these easy options:

• Go to express-scripts.com, choose the medicine you want delivered, add it to your cart, then checkout.

OR…

• Call 855.778.1444 and tell us you’d like to have your medicine delivered.

Whichever you choose, we’ll work with your doctor to get you set up, and there’s no additional cost to you. Your medicine will be delivered in a confidential, tamper-proof, weather-resistant package.

Q. How soon will my medicine be delivered after it’s ordered?

A. Orders are usually processed 48 hours from when we get them. Your medicine should be delivered in about 8 days (10-14 days if it’s a new prescription). Please have a one-month supply of your medicine on hand when you place your order. You can check your order status by going online anytime.

- 8 -


IMMEDIATE CAREYour AMHIC benefits provide coverage for immediate care in a variety of settings. Your cost for service and accessibility to providers is outlined below. You choose the location most appropriate and convenient based on your medical situation.

MDLIVE provides on-demand access to doctors via phone or internet, 24/7/365. Details on conditions appropriate for consultation and how to access the service are on page 8. An urgent care center provides walk-in, extended hour access for acute, non-life threatening illness and injury care that is available when the typical provider’s office is closed (evenings, weekends and holidays). There are many studies by the Center for Disease Control and others that identify significant numbers of patients who went to an emergency room and could have been treated in another location. If you have a life threatening condition you should seek care in an emergency facility.

*CDC Wait Time for Treatment in Hospital Emergency Departments: 2009

How do I locate an in-network urgent care center?

You can contact CareFirst Administrators (CFA) by phone or you can access CFA’s website using the instructions on page 13 for a list of participating urgent care centers. You can also contact Health Advocate at 1-866-695-8622 to speak with a professional who can assist you in locating an urgent care center.

Service Provider Availability Member Share of Cost

MDLIVE TELEHEALTH 24/7/365 PPO and Network Only: $10 copayQHDHP: Subject to deductible then 10% copay

Primary Care Physician Varies by practitioner

PPO: $20 copay in-network 70% after deductible out-of-networkNetwork Only: $25 copayQHDHP: 90% after deductible in-network, 70% after deductible out-of-network

Urgent Care Center Extended hours vary by location;no appointment necessary

PPO: $35 copay in-network 70% after deductible out-of-networkNetwork Only: $50 copayQHDHP: 90% after deductible in-network, 70% after deductible out-of-network

Emergency Room Benefits for Accidental Injury or Medical Emergency

24/7/365Seen in order of needAverage U.S. wait time is 58 minutes*

PPO: $100 copay; in- and out-of-network. Waived if admitted.Network Only: $125 copay; Waived if admitted.QHDHP: 90% after deductible; in- and out-of-network

- 9 -


WHEN TO USE MDLIVE

COMMON CONDITIONS WE TREAT

GET STARTED NOW

mdlive.com/dgxDisclaimers: MDLIVE does not replace the primary care physician. MDLIVE operates subject to state regulation and may not be available in certain states. *MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. For complete terms of use visit https://www.mdlive.com/consumer/terms.html 010113

■ Allergies■ Asthma■ Bronchitis■ Cold & Flu■ Constipation■ Diarrhea■ Ear Aches■ Fever■ Headache ■ Infections

■ Insect Bites■ Joint Aches & Pains ■ Poison Ivy■ Rashes■ Respiratory Infections■ Sinus Infections ■ Skin Inflammations■ Sore Throat■ Sports Injuries ■ Urinary Tract Infections

Pediatric Care

■ Cold & Flu■ Constipation■ Ear Aches■ Fever■ Nausea■ Pink Eye■ Vomiting

Welcome to MDLIVE24/7/365 on-demand accessto affordable quality healthcareanytime, anywhere

■ For non-emergency medical issues (especially as an alternative to the high cost of an emergency room or urgent care center)

■ Anytime, anywhere including nights, weekends and even holidays

■ Your doctor or pediatrician is not available on your schedule

■ When it’s not convenient to leave your home or work

■ You are traveling and need medical care

■ You need a prescription or refill*

1-888-632-2738

WHEN TO USE MDLIVE

COMMON CONDITIONS WE TREAT

GET STARTED NOW

mdlive.com/dgxDisclaimers: MDLIVE does not replace the primary care physician. MDLIVE operates subject to state regulation and may not be available in certain states. *MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. For complete terms of use visit https://www.mdlive.com/consumer/terms.html 010113

■ Allergies■ Asthma■ Bronchitis■ Cold & Flu■ Constipation■ Diarrhea■ Ear Aches■ Fever■ Headache ■ Infections

■ Insect Bites■ Joint Aches & Pains ■ Poison Ivy■ Rashes■ Respiratory Infections■ Sinus Infections ■ Skin Inflammations■ Sore Throat■ Sports Injuries ■ Urinary Tract Infections

Pediatric Care

■ Cold & Flu■ Constipation■ Ear Aches■ Fever■ Nausea■ Pink Eye■ Vomiting

Welcome to MDLIVE24/7/365 on-demand accessto affordable quality healthcareanytime, anywhere

■ For non-emergency medical issues (especially as an alternative to the high cost of an emergency room or urgent care center)

■ Anytime, anywhere including nights, weekends and even holidays

■ Your doctor or pediatrician is not available on your schedule

■ When it’s not convenient to leave your home or work

■ You are traveling and need medical care

■ You need a prescription or refill*

1-888-632-2738

- 10 -


Do the Conifer services cost me anything?

No. Conifer’s medical management services are paid by AMHIC.

Can I change Conifer Nurses?

Yes. If for some reason you are not happy with your Conifer nurse, a new nurse will be assigned to you.

How can I contact Conifer?

For pre-certification of a hospital admission, call 866-475-1256.

AMHIC has been assigned Donna Lanoue RN, BSN as its nurse for medical management services, and she can be reached at the phone number and email address below.

Donna Lanoue RN, BSN800-459-2110 ext. [email protected]

My name is Donna Lanoue and I graduated from the University Of Virginia School Of Nursing in 1988. I began my career at Georgetown

University Hospital on the neurology unit. After I married, I followed my husband, who was in the Navy, across the country and worked in acute care hospitals on surgical floors or oncology areas. My most recent hospital employment was on the orthopedic floor at Baltimore Washington Medical Center.

I have been employed as a Personal Health Nurse at Conifer Health Solutions since May 2011 and have enjoyed interacting with my patients to involve them in their health care. In my spare time, I am very active in volunteering in various community groups.

I currently live in Annapolis, Maryland. I have been married for 25 years and have 3 children, 2 cats and 1 dog.

CONIFERCareFirst Administrators has partnered with Conifer, a medical management services company, to provide you and your dependents with FREE access to trained nurses who can help guide you through the sometimes confusing maze of how to handle medical conditions and coordination of medical services.

Who is Conifer?Over the past 10 years, Conifer has become a health care leader by working closely with individuals, physicians, hospitals, health plans and others to promote healthy outcomes and reduce health care costs. Conifer is a private company doing business in over 30 states, supporting quality health care through our medical management programs.

Why should I trust Conifer?Conifer’s operations are regularly reviewed by practicing physicians, including Conifer’s Medical Director Committee made up of national experts. Also, Conifer’s expert clinical team is made up of full-time nurses, who are credentialed and certified through state laws and professional groups. In addition, Conifer medical management operations are accredited by a national quality organization.

Can Conifer make a difference in my life?If you are suffering from complex medical conditions, Conifer can help you and your physician by providing you insights on how to improve your health. Our goal is to work with you and your physician to help develop and support a customized care treatment plan for you. Of course, your willingness to participate in the Conifer medical management program is key to achieve a successful outcome.

Is participation mandatory?You are responsible for ensuring that the pre-certification process is initiated when necessary. Call Conifer at 866-475-1256 prior to admittance (or within one business day after an emergency admission) to a Hospital or other facility Provider. Failure to pre-certify will result in a penalty of 50%, up to a maximum of $500.

Conifer’s medical management services are optional and voluntary. We will not enroll you in our medical management programs without your consent.

- 11 -


HEALTH ADVOCATE - PERSONAL HEALTH ADVOCATEHelp is only a phone call away.

You will be assigned a Personal Health Advocate. You, your spouse, dependent children, parents and parents-in-law are eligible to use our service.

Top Reasons to Call Us...866.695.8622

Find the right doctorsWe’ll aslo locate the right hospitals, dentists and other leading healthcare providers anywhere in the country.

Schedule Appointments We can help expedite the earliest appointments with providers including hard-to-reach specialists and arrange treatments and tests.

Help resolve insurance claimsOur experts get to the bottom of your issue to assist with negotiating billing and payment arrangements.

Assist with eldercareWe address senior issues such as Medicare and related healthcare issues facing your parents and parents in-law.

Get cost estimatesYou’ll receive estimates of common medical procedures in your area to help you make informed decisions.

Work with insurance companiesOur team works on your behalf to obtain appropriate approvals for needed services.

Answer questionsWe help you become informed about test results, treatments and medications prescribed by your physician.

Assist in the transfer of medical recordsWe’ll also handle the details of transferring X-rays and lab results.

- 12 -


VALUE ADDED SERVICES THROUGH CAREFIRST ADMINISTRATORS (CFA)REGISTER AND CREATE AN ACCOUNTCreating an account gives you information regarding your health insurance online. This website gives you access to who is covered on your policy, what is covered, claims history and current amount paid towards your deductible and out-of-pocket maximums. Registering is easy! Just sign on to www.cfablue.com, select the Members option on the upper left side of the screen, click on “Register Now”, and follow the prompts to create a New User Account.

YOUR HEALTH TICKETHealth Ticket provides you with an online provider directory personalized with your benefits. Health Ticket is your one-stop shop for comprehensive information about your health care benefits as well as highly specific provider information. Health Ticket is available 24/7 and your search results are printable so you can take them along with you to medical appointments.

DISCOUNTS ON HEALTH & WELLNESS The following offers and discounts are available to all members enrolled in an AMHIC PPO, Network Only, or Qualified High Deductible Health Plan. For additional details on any of the programs listed, visit www.carefirst.com/wellnessdiscounts and click on a service from the list provided.

ALTERNATIVE THERAPIES & WELLNESS

Up to 30% discounts on chiropractic care, acupuncture, massage therapy, nutritional counseling, personal training, yoga, guided imagery, spa services and more.

ELDERCARE SERVICESFree referral services to help members find qualified providers through ElderCare. Including home health care, home support, assisted living, adult day care, long term care, nursing homes, and support groups for caregivers.

FITNESS CENTERS Discounts on membership fees, initiation fees and more depending on which fitness network and location you choose.

HEARING CARE Free screenings, discounts on hearing aids and more.

LASER VISION CORRECTION & CONTACT LENSES

Discounts on laser vision correction and patient financing with approved credit.

MEDICAL IDS Discounts on personalized medical ID bracelets and necklaces.

RECREATION & TRAVEL Enjoy savings on travel and leisure expenses.

WEIGHT LOSS Nationally recognized weight loss plan discounts at Jenny Craig and NutriSystem.

WORKOUT GEAR 20% off at Reebok.com

CFA ACCOUNT ACCESSwww.cfablue.com

Write your user information here:

Username: __________________

Password: ___________________

- 13 -


INTRODUCING YOUR HEALTH TICKETCareFirst Administrators is pleased to provide your Health Ticket, an exciting online provider directory personalized with your AMHIC benefits. Health Ticket is your one-stop shop for comprehensive information about your health care benefits as well as highly specific provider information.

Health Ticket is available 24/7 and your search results are printable so you can take them along with you to medical appointments.

Your Health Ticket looks similar to your regular ID card, only with greater detail, which will allow you to:

• Keep better control of your out-of-pocket expenses.

• Obtain an in-depth snapshot of each provider you research.

• Use the printable ID card in the event you lose or misplace your regular card.

It’s easy to get started. First, log onto our secure member portal via www.cfablue.com and select the Member Option link. Then, log onto your account. You must be a registered user with a User ID and Password in order to access your Health Ticket. Based on the search criteria you enter, you will easily be able to locate:

• In-network providers by specialty, hospital, facility or geographic location

• Your copay information specific to that provider

• Deductibles and coinsurance information

• Directions to the provider’s office

• Covered services

• Important phone numbers

• And much more!

If you have further questions about Health Ticket, please call CFA at the number on your member ID card.

- 14 -


NETWORK DIRECTORY ASSISTANCE

Via Phone:

CAREFIRST ADMINISTRATORS (CFA)

Phone: 1-877-889-2478

Hours: Monday – Thursday: 8:30 a.m. – 6:00 p.m. EST Friday: 8:30 a.m. - 5:00 p.m. EST

OR

BLUE CARD ACCESS (NATIONAL/INTERNATIONAL)

Phone: 800-810-2583

Hours: 24/7

Internet:

1. Go to www.amhic.com.

2. Click on the “Forms & Links” tab.

3. Scroll down to the “Links” section where the Medical network directories are listed.

4. Click on the “CareFirst Network” link

5. Select the “Members” tab on the top left-hand side of the screen

6. Select “Find a Doctor or Provider” on the left-hand side of the screen

7. Select “Medical Provider Networks”’

8. Select “Medical” or “Mental Health”

9. Select “CareFirst Regional*” (Do not select BlueChoice Advantage)

10. Search by Doctor, Last Name, Specialty or Facility - based on your criteria you may be prompted for additional information. Follow on-screen instructions.

11. Click Search

The provider search creates a directory of providers who, based on our records, participate in the network at the time of the provider search. Every effort is made to ensure the accuracy of the directory at the time of printing; however network changes may occur. Please verify provider participation in the network prior to service.

*If your zip code search is out of the CFA service area, you will receive an error message. Click Show me National Providers and you will be re-directed to the National Provider. In the search screen, be sure to enter “DGX” when prompted to enter “First three letters.”

- 15 -


IMPORTANT INFORMATION ON THE BACK OF YOUR I.D. CARD

For additional member resources, please visit our website:

www.amhic.com

October 19, 2017

Documents

Member Resource Guide 2018 Plan Year