Annual Open Enrollment – Information Update

1. Annual Open Enrollment – Information Update Mark Nicholson, Account Executive May 1, 2014

2. Why are We Here? What is Open Enrollment? It’s the time in the year when you can enroll or change your benefit elections. What if you don’t make any changes? Your next opportunity will be June 1, 2015 unless you have a Qualifying Event. Examples of a Qualifying Event are: Birth or Adoption Death Marriage or Divorce Loss of Job or Reduction of Hours Must notify Sr. Joan within 30 Days from Date of Change. Also notify Sr. Joan of any Beneficiary changes.

3. THANK YOU Roman Catholic Diocese of Worcester! Harvard Pilgrim Health Care is proud to be your Health Insurance Carrier!

4. A decade of excellence: Feel good knowing your plan earns accolades year after year • Nation’s top-ranked plan 10 years in a row! • #1 private health plan* in America again according to an annual ranking of the nation’s best health plans by the National Committee for Quality Assurance (NCQA)*  • Harvard Pilgrim is the only private health plan in the nation to be named #1 for member satisfaction and quality of care for 10 consecutive years * NCQA’s Private Health Insurance Plan Rankings, 2011-14, HMO/POS. NCQA’s Health Insurance Plan Rankings 2010-11 – Private. U.S.News/NCQA America’s Best Health Insurance Plans 2005-2009 (annual). America’s Best Health Insurance Plans is a trademark of U.S News & World Report. NCQA The State of Health Care Quality 2004.

5. An extensive network of doctors and hospitals to meet your needs….. • Doctors and hospitals throughout most of New England accept Harvard Pilgrim, including those near where you live and work. • +28,000 providers • 135 hospitals

6. HEALTH PLAN OPTIONS FOR 6/1/14 – 5/31/15 There are 3 Health Plan Options for you to choose from (no changes from 6/13 – 5/14): • HMO VALUE PLAN • FOCUS NETWORK HMO VALUE PLAN • HMO BEST BUY $1000 PLAN Each of the above plans have the same HMO Core Rules: 1) Must choose a Primary Care Physician 2) Must obtain referrals to Specialists

7. HMO VALUE PLAN- Benefits at a Glance

8. FOCUS NETWORK HMO Value Plan

9. Focus Network – MAOur high performance defined network

10. Focus NetworkSM– MA • This is a side-by-side offering of our full-network HMO Value plan. • Same plan with our new targeted, high performance network – including the local doctors you know and trust • Network includes more than 16,000 physicians and more than 50 hospitals in MA • Includes two types of in-network providers • Easy Access • Authorized Access

11. Easy Access/Authorized Access Providers Easy Access is equivalent to in-network coverage Members choose an Easy Access PCP, and should receive most, if not all, of their care from Easy Access providers and hospitals Authorized Access hospitals/providers are onlyavailable by prior authorization from HPHC when it is determined that an Easy Access provider is unable to provide required care (only for complex or specialty care, not routine care). UMASS Memorial Medical Center and Children’s Hospital Boston are the two Authorized Access Hospitals in the Focus Network. 11

12. Focus NetworkSM– MA: hospitals Addison Gilbert Hospital Anna Jaques Hospital Athol Hospital Baystate Medical Center Berkshire Medical Center Beth Israel Deaconess Hospital – Milton Beth Israel Deaconess Hospital – Needham Campus Beth Israel DeaconessMedical Center Beverly Hospital Boston Medical Center Brockton Hospital Cambridge Hospital Carney Hospital Charlton Memorial Hospital Clinton Hospital Dana-Farber Cancer Institute Emerson Hospital Fairview Hospital Floating Hospital for Children Franklin Medical Center Good Samaritan Medical Center Harrington Healthcare at Hubbard Harrington Memorial Hospital HealthAlliance Hospital Heywood Hospital Holy Family Hospital Holyoke Medical Center Jordan Hospital Lahey Clinic Hospital Lawrence General Hospital Lawrence Memorial Hospital Lowell General Hospital Marlborough Hospital Mary Lane Hospital Melrose-Wakefield Hospital Mercy Medical Center Merrimack Valley Hospital Metrowest Medical Centers Morton Hospital Mt. Auburn Hospital Nashoba Valley Medical Center New England Baptist Hospital Noble Hospital North Adams Regional Hospital Norwood Hospital Quincy Medical Center St. Anne’s Hospital St. Elizabeth’s Medical Center St. Luke’s Hospital Saint Vincent Hospital Saints Medical Center Somerville Hospital Tobey Hospital Tufts Medical Center Whidden Hospital Winchester Hospital Wing Memorial Hospital

13. Focus Network - EXCLUDED MA Hospitals • Brigham & Women’s Hospital • Cape Cod Hospital • Cooley Dickinson Hospital • Falmouth Hospital • Faulkner Hospital • Martha’s Vineyard Hospital • Massachusetts General Hospital • Mass. Eye and Ear Infirmary • Milford Regional Medical Center • Nantucket Cottage Hospital • Newton Wellesley Hospital • North Shore Medical Center • Salem Hospital • South Shore Hospital • Sturdy Memorial Hospital • Union Hospital - Lynn This plan provides access to a limited provider network that is smaller than Harvard Pilgrim’s full provider network. In this plan, members have coverage only from providers in the Focus Network - MA provider network. Please consult the Focus Network - MA provider directory or visit the provider search tool at www.harvardpilgrim.org/focus for a list of providers in the Focus Network - MA. You may also call Harvard Pilgrim to request a paper copy of the provider directory.

14. HMO Best Buy $1000 – Benefits at a Glance

15. Important Terms Deductible An Amount you pay each Plan Year for certain services. Once the deductible has been met, most services that are subject to the deductible are covered in full for the balance of the plan year. (Exception is for ER services, once deductible has been met, there is a $100 co-pay for ER services). Co-payment A Fixed Dollar Amount that you pay the Provider each time you have a service. (Office Visit, Hospitalization, Day Surgery). IMPORTANT POINT: You pay the “co-payment” at the time of the service, but you donot pay the “deductible” at the time of the service.

16. HPHC HMO BEST BUY $1000 - Plan Design NO CHARGE • Select Preventive Tests and Services • Adult annual physical, well child visit, annual GYN exams SUBJECT TO CO-PAYMENT • Exams for illness or injury • Consultation with Specialists • Routine Hearing and Vision Exams SUBJECT TO DEDUCTIBLE, then NO CHARGE • Hospital Inpatient services • Hospital Outpatient services and Day Surgery • Treatments and procedures (chemotherapy, dialysis, surgery) • Diagnostic Procedures (MRI, X-RAY, CAT, PET) • Emergency Room ($100 co-pay > Deductible has been met)

18. Activity Summary gives members easier-to-understand information! 18

19. Harvard Pilgrim Prescription Drug Program

20. More ways to fill prescriptions easily • We cover more drugs than any other plan in the region! • More choice and less restrictions • Large network of pharmacies • More than 50,000 pharmacies nationwide • Members have in-network access to independent stores and major chains (e.g., CVS Pharmacy, Eckerd, Hannaford Pharmacy, K-Mart Pharmacy, Rite Aid, Walgreens and Wal-Mart). • Online pharmacy search • Value-added mail service program through Walgreens.com Order prescriptions on the Web • Home delivery convenience • Plan members receive a 90-day supply for the same cost as a 60-day supply at the retail pharmacy.

21. Our 4-tier Prescription Drug Benefit • How 4-tier works: • Tier 1 features many low-cost generic drugs – you pay just $5 for any prescription drug in Tier 1 at pharmacy • Tier 2 consists primarily of higher-cost generic drugs • Tier 3 consists mostly of brand-name drugs without generic equivalents • Tier 4 consists of drugs that the plan has not included in Tier 1, Tier 2 or Tier 3 • Retail Prescription co-pays • $5 / $20 / $30 / $50 (30-day supply) • Mail Order Prescriptions co-pays • $10 / $40 / $60 / $100 (90-day supply) • Prescription Tier Look up at www.harvardpilgrim.org/4tier

22. Wellness Programs & Member Savings Helping employees stay healthy…for less!

23. Eye and Ear FREE eyewear program at Cambridge Eye Doctors Discounts at many popular locations like Cambridge Eye Doctors, JCPenny Optical, LensCrafters, Pearle Vision, Sears Optical and Target Optical Laser vision correction Hearing Aids by Flynn Associates, HearPO and Speech-Language and Hearing Associates of Greater Boston Nutrition Weight Watchers Jenny Craig Diet.com Dash for Health online program Alternative complementary medicine Acupuncture and chiropractic care Massage Envy Elements Therapeutic Massage NEW Mindfulness-based Stress Reduction course at UMass Medical (Shrewsbury, MA) Fitness reimbursement Additional fitness Discounts at select clubs in MA, NH and ME 15% off footwear at Marathon Sports and Northampton Running Company (MA) and Runner’s Alley (NH) Discounted rate at Genavix online Wellness Network Your Member Savings: discounts to keep you well Members can save on many products and services:

24. Fitness Reimbursement* $150 per Harvard Pilgrim policyholder (i.e., per subscriber) per calendar year Must be a member of both Harvard Pilgrim and a qualified fitness facility for at least four months during the calendar year Qualified fitness facilities are full service, health clubs that include cardiovascular and strength-training equipment and facilities for exercising and improving physical fitness (most “traditional” health clubs, YMCAs and JCCs qualify) * $150 maximum reimbursement per Harvard Pilgrim policy. Restrictions apply. Reimbursement is not available to all members. Visit www.harvardpilgrim.org/reimbursement or call for details. 24

25. Innovation Electronic tools to make life better for employers and members alike

26. More online services at your fingertips: www.harvardpilgrim.org • Find doctors and access contact information and profiles • More resources to help you understand your plan • Take our interactive quizzes, calculate your personal health metrics calculator and use our Symptom Checker • Find up-to-date and credible health information on topics that interest and relate to you • Search over 8,000 health-related topics • And so much more!

27. More ways to use your plan – day or night through HPHConnect online • Account information • Update information • Select a primary care provider (PCP) • Order ID Cards • Take a health assessment to develop your personal action plan • Personal Health Record • Claims - the status and amount of medical bills • Benefits and eligibility - specifics on your coverage and costs • Illnesses/conditions • Medical history - includes immunizations and procedures • Visit summary • Medication profile – personal medication history • Family and social history • Wallet card - create personal portable medical summary

28. Now quicker and easier to get HPHConnect-ed • Members can quickly set up an HPHConnect for Members account and get instant access to our e-tools and resources • To set up an HPHConnect account, members need to: • Visit www.harvardpilgrim.org and select “Members” • Under “Your Account,” select “Create an account” and enter Harvard Pilgrim ID number, birth date, ZIP Code and last four digits of the subscriber’s Social Security number • Choose a username and password to instantly activate their account

29. Coming Soon: Now iKnow Provider Cost Transparency Tool • Now iKnow empowers members to make better decisions about their health care, while also helping to reduce the growth in health care spending. • customized information for consumers based on their specific benefits, deductibles and out-of-pocket costs • View costs for simple treatments and complex bundled treatments • Locate physicians and hospitals and see price comparisons for them. • Shows providers’ quality ratings, using national benchmarking data. • Allows consumers to track yearly deductible totals and out-of-pocket expenses, and to “shop” for alternate physicians and hospitals.

30. Service Count on us for service that’s best in class– from everyday administration to member questions

31. More ways to serve you better • Our Member Services Dept. provides: • Timely and accurate responses to your questions • Extended hours on Mondays and Wednesdays • Interactive Voice Response (IVR) offers 24-hour access to general information • Phone Number is on the back of your HPHC ID card: 1-888-333-4742 Access via www.harvardpilgrim.org - 24/7 • Self-service with HPHConnect • E-mail Member Services and get responses quickly

32. We’re here.