The Benefits of Changing to the Triple Option Plan

1. The Benefits of Changing to the Triple Option Plan CareFirst BlueCross BlueShield is an independent licensee of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst, Inc.

2. BlueChoice Triple Option Plan 3 Health Care Plans in 1

3. BlueChoice Triple Option Plan3 Health Care Plans in 1 • Primary Care Physician • At time of enrollment, you select a Primary Care Physician (PCP). Your PCP will be listed on your ID card. The PCP can be changed at any time, simply contact Member Services (800-628-8549). • Dependents may select their own PCP. Each member will have their own personalized ID card with PCP information

4. BlueChoice Triple Option Plan3 Health Care Plans in 1 • Level 1 (BlueChoice HMO) • Access to care through your Primary Care Physician or Specialist with referral • You pay a $10 PCP or Specialist co-pay • No Deductible • No coinsurance • No need to file claim forms • Independent Lab - Lab Corp

5. BlueChoice Triple Option Plan3 Health Care Plans in 1 • Level 2 (PPO Providers, Local and National) • Access to care through a PPO Provider – no referral required • You pay a $15 co-pay for office visits • After you meet $200 individual deductible, services are covered at 90% AB up to the $500 maximum out-of-pocket. • No need to file claim forms

6. BlueChoice Triple Option Plan3 Health Care Plans in 1 • Level 3 (Participating and Non-Participating Providers) • Direct access to care through participating or non-participating providers • After you meet your annual $300 individual deductible, services are covered at 80% of the allowed benefit up to the $1,000 maximum out-of-pocket. • Participating Providers may not balance bill, however, Non-Participating Providers may balance bill the difference between the allowed benefit and total charge

7. Away From Home Care • Members who live in another part of the country for at least 90 consecutive days may be eligible for “Away From Home Care” • Contact Member Services to enroll (telephone number is on the back of your ID card) and ask for the Away From Home Care Coordinator. • Once enrolled, you have access to routine and urgent care through an affiliated BCBS HMO. • Great program for out-of-state college students

8. BlueChoice Triple OptionHelpful Reminders • Select PCP at time of enrollment. You may change your PCP at any time during the year. • When accessing Level 1 Benefits, remember to get a referral for specialty care from your PCP. Level 2 does not require a referral. • Remember to use Lab Corp for Level 1 Benefits. Quest Diagnostic will be processed under Level 2. • Medical / Vision will be on the same ID Card. Dental will be on a separate ID Card.

9. BlueChoice Triple OptionHelpful Reminders • Visit our website at carefirst.com to find a doctor, PCP or Specialist. You can also find information about our Options discount program, in addition to other services and resources CareFirst offers.

10. BlueChoice Triple Option Questions & Answers