Staff Recommendations Seal of Approval March 8, 2007

1. Staff Recommendations Seal of Approval March 8, 2007

2. Agenda • Overview of process • Recommendation of carriers for Connector Seal of Approval • Key features of health benefit plans

3. Overview of Process • Request for responses (RFR) issued on Dec. 6, 2006 • Bidders conference held on Dec. 12, 2006 • Ten carriers submitted responses by due date of Jan. 16, 2007 • Revised submissions requested on Jan. 25, 2007 • Final submissions due on Feb. 16, 2007

4. Carriers submitting proposals: • Blue Cross Blue Shield of Massachusetts • ConnectiCare • Fallon Community Health Plan • Harvard Pilgrim Health Care • Health New England • The MEGA Life and Health Insurance Co. • Mid-West National Life Insurance Co. • Neighborhood Health Plan • Tufts Health Plan • United HealthCare

5. Scoring Criteria • Cost proposal • Individual premium and estimated cost sharing • Composite premium • Technical proposal • Plan designs and preferred features • Marketing plan and marketability • Network access and geographic coverage • Key program elements

6. Final Scores • Neighborhood Health Plan 635 • Tufts Health Plan 614 • Health New England 602 • Fallon Community Health Plan 596 • Blue Cross Blue Shield of MA 583 • ConnectiCare 549 • Harvard Pilgrim Health Care 543 • United Health Care 464 • MEGA Life and Health Insurance 447 • Mid-West Life 447

7. Features of Recommended Carriers • Competitive premiums across all three benefit levels (premier, value and basic) • Innovative plan designs and incorporation of preferred features • Select networks • Marketing plan and marketability

8. Five products offered per carrier • One premier plan based on Connector specifications • Two value plans • One basic plan • One Young Adults plan

9. Premier level plans • No deductibles • $10 office visit co-payments • No charge for inpatient admission • No charge for outpatient surgery • Prescription drug coverage -- $10/$25/$45

10. Value level plans • Broadest choice of products • Provider networks vary by carrier and plan • Five of 14 plans include annual medical deductible (ranging from $500 to $1,000) • After deductible, no cost sharing for hospital inpatient and outpatient surgery • Office visits covered pre-deductible

11. Value level plans (cont.) • Office visit cost-sharing • PCP co-pays range from $15 to $25 • Specialist co-pays range from $15 to $40 • Inpatient admission cost-sharing • From $250 per admission to $500 per day with annual maximum of $2,000 • Prescription drug benefit • Standard formulary and generic-focused formulary

12. Basic level plans • Choice of select provider networks or all-inclusive provider networks • Choice of no annual deductible, $1,000 deductible, $1,500 deductible or $2,000 deductible • Preventive care covered pre-deductible • Three of four plans with $2,000 deductible cover ALL office visits pre-deductible

13. Basic level plans (cont.) • Office visit cost sharing • PCP visits range from $25-$35, with one plan charging 20% co-insurance • Specialist visits range from $25 to $50, with one plan charging 20% co-insurance • Inpatient admission cost-sharing • From no charge after deductible to 35% co-insurance for the plan that does not have an annual deductible

14. Basic level plans (cont.) • Range of outpatient surgery cost-sharing • No charge after deductible • $150 to $250 co-pay after deductible • 20% co-insurance to 35% co-insurance • Rx benefit • Six of seven plans cover prescription drugs prior to the annual deductible • Two plans have separate Rx deductible • $100 (ind.)/$200 (family) • $250 (ind.)/$500 (family)