2020 SMALL GROUP (2 - 50 LIVES) PLANS

RATED

A+BY

A.M. BEST

THE POWER OF BLUE®

Competitive Benefit Designs at Affordable Prices

n Largest provider network in South Carolina

n Low drug copays and a large covered drug list

n Low copays for urgent care at Doctors Care clinics

n $500 extra for preventive services

Business-Minded Plans

n 43 plan options to fit your clients’ needs and budget

n Comprehensive dental coverage with a large network

Discounts and Added Values

n Discounts on popular health and fitness products

n Discounts on hearing, vision and cosmetic services

Time-Saving Services

n Quick turnaround on quotes and enrollments

n Online access to group renewals

n Online tools and services for group leaders and members

Commitment to South Carolina

n Local service combined with worldwide coverage

n Award-winning customer service center

n A trusted name for more than 72 years

n Financially secure — rated A+ by A.M. Best*

Your small business clients need health insurance their employees can count on. BlueCross BlueShield of South Carolina offers them more plan options, value and service.

‡Rating as of Dec. 18, 2018. For lastest rating, access ambest.com.

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NETWORK SIZE AND STRENGTHOur Business BlueEssentialsSM plans come with access to our Preferred Blue® Network — the largest network in the state.

Members can search for network providers at www.SouthCarolinaBlues/links/providers/PreferredBlue.

Preferred Blue NetworkWith access to more providers, it’s easier for members to make the most of their benefits:

RS AT WW

W.SOUTHCAROLINABLUES/LINKS/PROVIDERS/PREFERREDBLUE.

Coverage Beyond South CarolinaEven small business owners can offer their employees the peace of mind that comes with access to providers across the country and around the world.

n BlueCard®: Let’s members use their health care benefits throughout the country.

n Blue Cross Blue Shield Global Core®: Gives members access to doctors and hospitals around the world.

n GeoBlue® International Health Insurance: Helps members access health care coverage around the world (this is an additional coverage option for your clients traveling overseas).

Urgent Care SavingsWith the Preferred Blue Network, urgent care is convenient and cost-effective. Members can visit any Doctors Care clinic in South Carolina at the same out-of-pocket cost as a primary care physician visit. Members pay the specialist rate or higher at other urgent care facilities.

Members can find the nearest location at www.doctorscare.com/locate.

Out-of-Network CoverageMembers are responsible for 50 percent of allowed amounts, plus any amount in excess of the charges, for covered services. Out-of-network expenses don’t go toward satisfying the deductible or maximum out of pocket.

more than 25,000 providers in south carolina

more than 907,000 doctors and hospitals

across the united states

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PHARMACY SERVICESWith Business BlueEssentials plans, your clients can provide prescription drug benefits that include a rich formulary and a large pharmacy network.

n Mail order: Members can get up to a 90-day supply of their medications at discounted rates with our mail-order program.

n Specialty drugs: Through our specialty pharmacy providers, members can get up to a 31-day supply of specialty medications.

Drug Tiers n Tier 0: Preventive medications under the Affordable Care Act (ACA) — no cost

n Tier 1: Generic — usually costs the least out of pocket

n Tier 2: “Preferred” brand drugs — usually costs less than other brand drugs

n Tier 3: “Non-preferred” brand drugs — usually costs more than other brand drugs; may have generic equivalents

n Tier 4: Drugs for complex conditions — usually very expensive and costs more

Network and Covered Drug List www.SouthCarolinaBlues.com/links/pharmacy/BusinessBlueEssentials

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For Employers Chances are, your small group clients want to spend less time managing their benefits and more time managing their businesses. Our online tools can help.

n BluesEnrollSM: Group leaders can add or delete employees and/or dependents, order new ID cards, pay their bill and much more.

n Blue e-BillSM: Group leaders can access and manage their account 24/7.

n eExchange: Ideal for groups that have their enrollment information with external vendors and in multiple formats, this service consolidates and transmits enrollment data to BlueCross membership systems.

n We also integrate with Employee Navigator benefit administration system, which allows you to transfer and process enrollment data.

ONLINE TOOLS AND SERVICES

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For MembersWhen employees have access to their health benefit information, they are less likely to turn to the group leader with questions. My Health Toolkit® is an online information and service center that allows members to:

n View claims and EOBs

n Check eligibility and benefits

n Send a secure message to customer service

n Verify authorization status

n View deductible and out-of-pocket statuses

n Request a new ID card

n Get a digital ID card

n Compare hospitals using various quality measures

n Compare different benefit plans

n Compare drug costs

n Find a doctor

My Health Toolkit Mobile AppMembers can download the My Health Toolkit app to their mobile devices, letting them have their health information whenever and wherever they need it.

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Fitness and Wellness Discounts

n Memberships to local fitness and exercise centers

n Weight-loss programs and services, such as Jenny Craig

n Indoor allergy relief products

Hearing, Vision and Other Discounts

n Lasik vision correction services

n Vision One eye exams, designer frames, lenses and contacts

n TruHearing hearing aids and exams

n Hair restoration

More Healthy Discountsn BLUE365®: Discounts on everyday products that can help members live healthier, happier lives.

n Natural BlueSM: Access to a discount network of complementary and alternative medicine professionals, as well as discounts on vitamins and supplements, fitness equipment and more.

DISCOUNTS AND ADDED VALUESOur discounts and added value programs help members save money at no additional cost. No claims to file. No annual limits. Just discounted rates for members.

For more information, visit www.SouthCarolinaBlues.com/links/discounts.

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Group leaders can offer a wellness clinic on-site or at a local Doctors Care office. The clinic includes a range of biometric screenings that are free to covered employees and dependents, including:

n Complete blood count (CBC)

n Comprehensive metabolic panel (CMP)

n Thyroid-stimulating hormone

n Lipid panel

n Blood pressure

n Height and weight

n Body mass index (BMI)

n More than 130 additional screenings at a discounted rate for members

A $295 setup fee applies if the event has 29 or fewer participants. The setup fee is waived for 30 or more participants. There’s no setup fee if the clinic takes place at a Doctors Care facility.

Flu Shot ClinicsGroup leaders can also offer flu shot clinics on-site or at a local Doctors Care office.

A $295 fee applies for on-site clinic setup and claim filing. There’s no setup fee when the flu shot clinic is combined with the wellness clinic. There’s also no setup fee when the clinic takes place at a Doctors Care facility.

EMPLOYEE WELLNESSSmall groups need to get the most from every health care dollar they spend. Working with Doctors Care, we offer easy access to wellness screenings and flu shots for employees and dependents.

We want to make these events easy for your clients — and for you. Simply call your marketing representative to register a group. We’ll provide the promotional materials, too.

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PLAN BENEFITS

Essential Health BenefitsAll plans include:

n Ambulatory patient services

n Emergency services

n Hospitalizations

n Maternity and newborn care

n Mental health and substance dependency services

n Prescription drugs

n Rehabilitative and habilitative services and devices

n Routine wellness and preventive services

Sustained Health BenefitBusiness BlueEssentials plans include a Sustained Health Benefit of $500 to use toward preventive services the plan doesn’t cover. We provide this benefit to members to help them pay for common procedures such as:

n Electrocardiograms (EKGs)

n Chest X-rays

n Blood work (except lipid screenings)

n Urinalysis

Business BlueEssentials includes three types of plans: Gold, Silver and Bronze. Each plan has the required minimum essential health benefits. Copays, coinsurance and deductibles vary, depending on the plan. With 43 plans to choose from, you can help your clients find the right plan for their needs.

Our $500 Sustained Health Benefit, combined with our one-of-a-kind discounts, translates into even more savings for members.

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Your clients can give their employees another option for seeking cost-effective care. That’s because each plan includes Blue CareOnDemand. This service allows members to connect with doctors using their computers, smart-phones or tablets. They can consult with a doctor — 24 hours a day — about minor medical conditions such as colds, flu and allergies. The doctor may even be able to write them a prescription.

In most cases, a video consult has a lower copay than a primary care physician visit.

BLUE CARE ON DEMANDSM

To register, members can go to www.BlueCareOnDemandSC.com or download the free app.

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AGENT SERVICESYour clients rely on you for expertise, answers and support. With Business BlueEssentials plans, you’re not on your own. Our agent services will help every step of the way.

Dedicated Account Advocate*Your small group clients require a high level of service. The Small Group Dedicated Account Advocate is here to help you tackle their unique challenges and complex needs. As your agency’s single point of contact, your Dedicated Account Advocate and support team are ready to help you:

n Get answers. We collaborate with you and group leaders to tackle just about any question. Get the information you need about onboarding, benefit changes, renewing a group, HRAs, membership applications and much more.

n Monitor your groups. We can provide status updates, so you can keep track of a group’s process from start to finish.

n Get more from self-service tools. We can show you how to use our tools — such as BluesEnroll and Blue e-Bill — allowing you to simplify enrollment, reporting and group maintenance.

n Keep your clients informed. Request the documents you need to keep your clients in the know, such as Schedule A’s, renewal information and billing inquiries.

n Welcome your clients. We’re here for your clients, too. Upon request, we’ll make a “Welcome Call” to a group to ensure seamless enrollment. We’ll address policy questions, provide information on service offerings and leave them with the right contact numbers.

*If your agency has at least 75 contracts, find out how a Small Group Dedicated Account Advocate can help you by contacting your Marketing Representative.

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BlueCross offers Medicare Supplement plans! Our Medicare Supplement plans offer many of the same benefits as group plans, and members will stay with the same company that covers them today.

We also offer a convenient list bill option for our Medicare Supplement plans.

MEDICARE SUPPLEMENT PLANS Do you have a client with employees approaching Medicare?

Contact your Marketing Representative for more information.

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We will not pay benefits for: n Any services or benefits not specifically covered under the terms of this contract that were received before

this contract went into effect or after it terminates, or claims submitted after the time limit for filing claims has been exceeded.

n Services or charges for which the member is entitled to payment or benefits from other sources (e.g., workers’ compensation) for which the provider does not charge, or for which the member is not legally obligated to pay, including treatment provided in a government hospital or benefits provided under Medicare or other government programs (except Medicaid).

n Cosmetic surgery, or surgery or treatment for the purpose of weight reduction, including any complications from or reversal of these procedures, or reconstructive procedures made necessary by weight loss.

n Refractive care, such as radial keratotomy, laser eye surgery or Lasik. n Services for the detection and correction of structural imbalance, distortion or subluxation (spinal subluxation) to

remove nerve interference except when the optional endorsement is purchased. n Treatment, services or supplies received because of suicide, attempted suicide or intentionally self-inflicted injuries,

unless it results from a medical (physical or mental) condition even if the condition is not diagnosed before the injury. n Treatment resulting from war or acts of war (whether declared or undeclared), while participating in a riot or uprising,

or while in the military service or its auxiliary units. n An illness a member gets or injury a member receives while committing or attempting to commit a crime, felony or

misdemeanor or while engaging or attempting to engage in an illegal act or occupation. n Prescription drugs that are used for or related to non-covered services or conditions, such as, but not limited to,

weight control, obesity, erectile dysfunction, cosmetic purposes (such as Tretinoin or Retin-A), hair growth and hair removal.

Other services this policy does not cover:n Hospital or skilled nursing facility charges when preauthorization is not received. Please see preauthorization in the

Certificate of Coverage. n Services and supplies not medically necessary, investigational/experimental in nature, not needed for the diagnosis

or treatment of an illness or injury, or not specifically listed in Covered Services. n Any service or supply provided by a member of the patient’s family or by the patient, including the dispensing of

drugs. This means the spouse, parent, grandparent, brother, sister, child or spouse’s parent. n Charges for a missed appointment or for filling out claim forms. n Services or supplies related to chewing or bite problems, pain in the face, ears, jaws or neck resulting from problems

of the jaw joint(s) also known as temporomandibular joint disorders (TMJ).

This is a partial list of some of our exclusions. For a full list of excluded services and supplies, or for all limitations, please refer to the Certificate of Coverage.

EXCLUDED SERVICES

BlueCross BlueShield of South Carolina does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation or health status in the administration of the plan, including enrollment and benefit determinations.

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NOTES

2020 BUSINESS BLUE ESSENTIALS PLANS

Group Insurance Plans From Blue Cross Blue Shield Of South Carolina (2-50 Lives)

210791-09-19 BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

BCBSSC

BCBSSC

www.SouthCarolinaBlues.com