Enroll now to choose BCN Advantage for 2013

Coverage expanded to 42 counties

Preventive care covered at 100%

Free membership in SilverSneakers® fitness program

NEW

Get the BCN Advantage!

BCN Advantage HMO-POS is a health plan with a Medicare contract.

H5883_S_2013URMBT_TCN FVNR 1112

BCN Advantage HMO-POSSM

is a perfect fit for the needs of UAW Trust members

NEW

NEW

Detroit Industry is one of four huge paintings at the Detroit Institute of Arts. Mexican muralist Diego Rivera (1886–1957) completed the series in 1933 as a tribute to the city’s manufacturing base and labor force. Source: www.dia.org/art/rivera-court.aspx.

2

November 2012

Dear UAW Trust Member:

The UAW Retiree Medical Benefits Trust (the “Trust”) provides health care benefits for

UAW Auto retirees and their dependents. In 2013, the Trust will continue to work with

BCN Advantage HMO-POS to offer an additional health plan choice to you.

You may remain with your current health plan or choose a new plan — the choice is yours.

The enclosed material provides detailed information on the benefits of the BCN Advantage

plan. Here are a few key points to keep in mind:

• YourmonthlycontributionstotheTrustremainthesame,regardlessoftheplanyou

are enrolled in.

• YourcurrentprovidersmaynotbeapartoftheBCNAdvantagenetwork.It’s

important to check if your providers are in the BCN Advantage network before

changing from your current plan.

• Youhavecompleteflexibilityinyourchoiceofplan.Ifyouchangeyourmindforany

reason after switching to BCN Advantage, you can switch back at any time without

waiting until the next annual enrollment period.

• ReducedcostscomparedtotheBlueCrossBlueShieldTraditionalCareNetworkplan:

– Zero percent coinsurance

– Unlimited office visits are covered with a $25 copay, $35 for specialists

– Additional wellness programs and discounts

YoucancalltheBCNAdvantageCustomerServicecentertodiscussanyquestionsor

concerns you may have. Contact information is in the enclosed material.

The choice to enroll in a new plan is entirely up to you. If you do not wish to enroll in a

newplan,noactionisrequired.Toenroll,callRetireeHealthCareConnect(RHCC)

at 1-866-637-7555.

Plan changes will become effective the first day of the second month following your change request, no earlier than Jan. 1, 2013.

Sincerely,

3

Get the BCN Advantage!

Welcome to BCN Advantage HMO-POSBCN Advantage is the Medicare Advantage plan in Michigan offered by Blue Care Network,

the HMO affiliate of Blue Cross Blue Shield of Michigan. Our coverage is designed to

promote healthy living, give you access to the doctors and hospitals you want, and help you

get the most value for your health care dollar.

As a Michigan-based plan, we’ve been involved with the auto industry for many years.

We have worked with the UAW Retiree Medical Benefits Trust since its creation to provide

high-quality,member-friendlycoverage.Withmorethan2,300UAW-representedstaff

members, we proudly serve more than 1.1 million autoworkers, retirees and their family

members.AllofusattheBluesworktogethertoprovidequality,affordablecare.

Join us in 2013 to get the coverage you want and the access you need to thousands of

network doctors, from the company you trust.

One amazing card gives you …

• Exceptionalhealthandwellnesssupport

• Valuableonlinetoolstohelpyoutakechargeofyourhealth

• Discountsonhealthandfitnessservices

• $25copaymentonunlimitedofficevisits,$35forspecialists

(see benefit chart on pages 5 through 7)

• Coverageofpreventiveservicessuchasimmunizations,wellnesschecksand

important health screenings

SilverSneakers fitness program, including:

• Afitnesscentermembershipatanyparticipatinglocation

• Conditioningclasses,exerciseequipment,pool,saunaandotheravailableamenities

• CustomizedSilverSneakersclasses,seminarsandothersocialevents

• $0copayforfitnessservices.

FitnessservicesmustbeprovidedatSilverSneakersparticipatinglocations.Youcanfinda

locationorrequestSilverSneakersStepsinformationatwww.silversneakers.com or

1-866-584-7352,Monday–Friday8a.m.to8p.m.TTYuserscall711.

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Our providers have you covered

We have more than 3,870 primary care physicians, nearly 13,000 specialists and 89 hospitals in

our service area, including University of Michigan hospitals, health centers and physicians. Our

growing network* of providers is ready to meet your healthcare needs. Up-to-date information

about doctors, hospitals and other providers is available at www.MiBCN.com/medicare.

We can help sharpen your vision

• Aroutineeyeexamevery12months

• 20%memberdiscountonglasses

For details, call VSP® Vision Care at 1-800-877-7195. Or, go online to vsp.com.

Our BlueCard® program travels with you

• AccessmedicalcareacrosstheU.S.

• Getemergencycareworldwide

YourBCNAdvantagecardtravelswithyou.Noothercardisasrecognizedandacceptedas

the one that carries the Cross and Shield. Our card gives you access to thousands of hospitals

anddoctorsacrosstheU.S.whoparticipatewithBlueplans.Emergencycareiscovered

anywhere in the world.

With BCN Advantage you get more

BCN Advantage is packed with valuable extras to help you save money, stay healthy and get

fit. Use your Blues ID card and our Healthy Blue ExtrasSM program to save money when you

shop with Michigan-based companies. Our Blue365® program offers discounts on weight-

loss programs, sporting goods and more from national retailers. We’ve arranged additional

discounts especially for our BCN Advantage members. Save on personal medical alarms,

homemedicalequipment,yogaclasses,ballroomdancelessons,spatreatmentsandin-home

support services, and more.

* September 2012 statewide provider count

BCBSM maintains bcbsm.com, MiBCN.com and theunadvertisedbrand.com. The Blues do not control any other websites referenced in this publication or endorse their general content.

The “savings” and “discounts” products and services described above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the BCN Advantage HMO-POS grievance process.

5

Get the BCN Advantage!

Deductible, copays and dollar maximums

Deductible Note: Deductible does not apply to Protected Class. Protected Class members are responsible for copays only.

$215 per member$430 per family

Percent copay None

Maximum out-of-pocket $1,000 (includes deductible and fixed dollar copays—allcoinsuranceiszero)

Dollar maximums None

Preventive services

Routine eye exam — VSP 1-800-877-7195 $25 copay — covered once every 12 months

Health maintenance exam Covered—100%

Annual gynecological exam Covered—100%

Medical nutritional therapy Covered—100%

Diabetes self-management training Covered—100%

Pap smear screening — laboratory services only

Covered—100%

Immunizations Covered—100%

Prostate specific antigen (PSA) screening — laboratory services only

Covered—100%

Mammography screening Covered—100%

2013 BCN Advantage Benefits-at-a-Glance for UAW Retiree Medical Benefits Trust membersThisisintendedasaneasy-to-readsummaryofthemostfrequentlyusedbenefits. This provides only a general overview of your benefits and does not serve as a contract. Additional limitations and exclusions can be found along with an official description of your benefitsinyourEvidenceofCoverageandaccompanyingriders.YoucanalwaysviewyourmostcurrentEvidenceofCoverageandridersbysigningintoMemberSecuredServicesatwww.MiBCN.com/URMBTorbyrequestingthemfromCustomerServiceat1-800-222-5992.TTYusersshouldcall711.

Payment amounts are based on the Blue Care Network approved amount, less any applicable deductibleandcopayamountsrequiredbytheplan.Thiscoverageisprovidedinkeepingwith a contract with the federal government. Services must be provided or arranged by the member’s primary care physician or health plan.

6

Physician office services

Office visits Covered — $25 copay per visit

Consulting specialist care — when referred Covered — $35 copay per visit; Protected Class — $25 copay per visit

Emergency medical care

Hospital emergency room — copay waived if admitted; inpatient hospital benefits apply

Covered — $50 copay per visit

Urgent care center Covered — $25 copay per visit

Ambulance services — medically necessary Covered—100%afterdeductible,groundand air service

Ford Protected – $0 copay for emergency room and urgent care

Diagnostic services

Laboratory and pathology tests Covered100%,officevisitcopaymayapplyper member, per visit

Diagnostic tests and x-rays Covered—100%afterdeductible

Radiation therapy Covered—100%afterdeductible

Maternity services provided by a physician

Prenatal and postnatal care Covered — $25 copay per visit

Delivery and nursery care Covered in full for professional services after deductible

Hospital care

Inpatient physician care, general nursing care, hospital services and supplies

Covered—100%afterdeductible,unlimited days

Outpatient surgery Covered—100%afterdeductible

Alternatives to hospital care

Skilled nursing care Covered–100%afterdeductible,upto100days per benefit period, renewable after 60 days of non-confinement

Hospice care Covered—100%afterdeductible

Home health care Covered—100%afterdeductible

Surgical services

Surgery — includes all related surgical services and anesthesia

Covered—100%afterdeductible

Human organ transplants Covered—100%afterdeductible,subjecttomedical criteria

2013 BCN Advantage Benefits-at-a-Glance for UAW Retiree Medical Benefits Trust members (continued)

7

Get the BCN Advantage!

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Benefits, premiums and copayments/coinsurance may change on Jan. 1, 2014. This plan may not be available to you in 2014 because by law plan sponsors can choose not to renew their contracts with CMS or reduce their service areas, and CMS may also refuse to renew a contract, thus resulting in a termination or nonrenewal.You must receive all routine care from plan providers. You must have both Medicare Part A and Part B to enroll. Members may enroll in the plan only during specific times of the year. Contact BCN Advantage for more information. This document may be made available in other formats such as Braille, large print or other alternate formats. For more information, call 1-866-966-2583 from 8 a.m. to 5 p.m. Monday through Friday. TTY users call 711. You may call 1-800-MEDICARE (1-800-633-4227), or visit www.medicare.gov for more information about Medicare benefits and services, including general information about the health or prescription drug benefits. TTY users call 1-877-486-2048. Hours are 24 hours a day, seven days a week.

Mental health care and substance abuse treatment

Inpatient mental health care and substance abuse care

Mental health care: Covered—100%,upto190daysperMedicare lifetime maximum. Additional renewable 45 days per episode of illness after Medicare benefit is exhausted and 60 days of non-confinement.Priorapprovalrequired.Substance abuse care: Covered—100%,unlimiteddays

Outpatient mental health care Covered—100%,unlimitedvisits

Outpatient substance abuse care Covered—100%,unlimitedvisits

Other services

Allergy testing and therapy Covered—100%,afterdeductible

Allergy injections Covered—100%,officevisitcopaymayapply per member, per visit

Chiropractic spinal manipulation — when referred

Covered — $20 copay per visit

Outpatient physical, speech and occupational therapy

Covered—100%(novisitlimit)

Infertility treatment Not covered — exclusion includes in-vitro fertilization,artificialinseminationandinfertility drugs

Durable medical equipment Covered—100%

Prosthetic and orthotic appliances Covered—100%

Hearing aid — hearing examination and aid covered once every 36 months

Covered in full — office visit copay may for examination; binaural hearing aids every 36 months if younger than 19

SilverSneakers fitness program Coveredat100%

With more than 2,300 UAW-represented staff members, we proudly serve more than 1.1 million autoworkers, retirees and their

family members. All of us at Blue Cross Blue Shield of Michigan and Blue Care

Network work together to provide quality, affordable health care.

UAWStrong

CF 12177 OCT 12 R008276

BCN Advantage is open to Trust members residing in the 42-county areashownatright.Youmustreceiveroutine care from plan providers in this area.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayment and restrictions may apply.

You are always covered for emergency and urgent care anywhere in Michigan, the nation or the world.

BCN Advantage Service Area

To join BCN Advantage you must be Medicare eligible and enrolled in

both Medicare Part A and Part B. For a couple, both must be

Medicare eligible and enrolled in Medicare Part A and Part B.