01MK5124 06/12 Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross and Blue Shield Association and incorporated as Louisiana Health Service & Indemnity Company.

f o r S e l f - I n S u r e d G r o u p S

BlueBENEfITServiceSAdminiStrAtive ServiceS

What’s

Inside

3 We’retheSolutionYou’reLookingfor................... .2

3 WhyGoBlue?.............................................................................................4

3 WhatCanWeDoforYou?..........................................................6

n Claimsadministration............................................................................................ .7

n First-classcustomerservice.................................................................................. .7

n Specialstaffsupportandgroupservice.................................................................8

n Extraoptionsandancillaryproducts......................................................................8

n Easyenrollment.......................................................................................................9

n Stop-losssupport................................................................................................. .10

n Pharmacybenefitmanagement.......................................................................... .10

n TheBlueNetwork................................................................................................. .12

n Privacyservices.................................................................................................... .14

n MedicalManagement........................................................................................... .15

n DiseaseManagement........................................................................................... .15

3 WorkplaceWellness............................................................................17

Thisproposalispresentedforgeneralinformationonly.Itisnotacontract,norintendedtobeacontract.Ifthereisanydiscrepancybetweenthisdocumentandthebenefitplan,theprovisionsofthebenefitplanwillgovern.Forcompleteinformation,pleaserefertothebenefitplan.

NOTICE: Healthcareservicesmaybeprovidedtoyouatanetworkhealthcarefacilitybyfacility-basedphysicianswhoarenotinyourhealthplan.Youmayberesponsibleforpaymentofallorpartofthefeesforthoseout-of-networkservices,inadditiontoapplicableamountsdueforcopayments,coinsurance,deductiblesandnon-coveredservices.

Specificinformationaboutin-networkandout-of-networkfacility-basedphysicianscanbefoundatwww.bcbsla.comorbycallingthecustomerservicetelephonenumberonthebackofyourIDcard.

for...

We’rethe

SolutionYou’reLooking

…and this is why:

3 Controlyourriskandyourbudget. Managingyourownriskpoolcanboostyourmargins,butthebackendof

administeringyourcompany’shealthplanwilleatadeepholeinyourbudget.We’llbeyourteam,atapriceyoucan’tbeat.

3 GettheBlueTeamforpenniesonthedollar. We’vegot75yearsinthebusiness,andtogether,ouremployeeshaveabout

50,000yearsofexperienceinadministeringhealthplans.We’vegotthesavvy,theexpertiseandthedependabilityyouneed.

3 Accesstheworld’slargesthealthcarenetwork. ThesunneversetsontheBlueCrossandBlueShieldnetwork,and“goingBlue”means

givingyouremployeesaccesstoanetworkofdoctors,hospitalsandotherhealthcareprovidersaroundtheglobe.

Wenegotiatediscountedrateswithourproviders,andpassthesavingsontoyouandyouremployees.

3 Get21stcenturytoolsfor21stcenturyhealthcare. EveryBlueBenefitServicesplancomeswithasuiteofaward-winningonlinetools

andwellnessbenefitsthatyouremployeescanusetomanagetheirbenefitsandstayhealthy.

3 Customerserviceisjustaphonecallorclickaway. RelieveyourHRteam;we’llhandleanyquestionsyouremployeeshavegotbyphone,

byemailoronlineatwww.bcbsla.com.

3 Unlimitedflexibilityfitsyourbudget. We’vegotlotsofoptionsforyoutobuildanadministrativeplanthatfitsyourbudget.

Andwithancillarybenefitsthroughoursubsidiary,SouthernNationalLife,youcanmanageallofyouremployees’benefitswithonebill.

>>3

>>We’retheSolutionYou’reLookingfor...

WhyGo

Blue?

3 We’vegottheoldest,mosttrustedbrandintheindustry.

We’retheoldestandlargesthealthinsurerinthestateofLouisiana.TheBlueCross/BlueShieldbrandhasbeenaroundsince1929andprovidesservicetoover100millionAmericans.

MorepeoplechooseBlueCrossandBlueShieldthananyotherinsurancegroupforareason.YouandyouremployeescanbeconfidentinyourcoveragewithBlueCross.

3 We’reamember-owned,mutualcorporation. Everyoneofourmemberswithapolicyownsapieceofus.Weanswertothem,

andwetakeourstewardshipseriously.

Unlikeourfor-profitcompetition,wedon’tincreaseratesjusttomeetprofitgoals,andwepassonthediscountswenegotiatewithhealthcareproviderstoourmembers.

3 We’reLouisianastrong. We’reinvestedinourstate,andareproudtobeindustryleaders.Weemploy

almost2,000Louisianiansinninelocationsaroundthestate,andwegeneratemorethan$5billionineconomicimpacteachyear.

ThroughtheBCBSLAFoundationandotherprograms,wegladlyinvestinthehealthandeducationofourcommunities,ourfriendsandourneighbors.

3 Wewerereformingbeforereformwascool. Beforehealthcarereformlawsrequiredit,wewerealreadyspendingbetween

80and90%ofeverypremiumdollaronpayingforourmembers’healtheachyear.

Beforethegovernmentstartedtalkingabout“AccountableCareOrganizations,”wewerealreadypayingdoctorsandhospitalsinournetworkforgivinghigherqualityhealthcare.

>>5

>>WhyGoBlue?

You?

WhatCan

WeDofor

3 Claimsadministration Wehavethetools,theteamandtheexpertisetofullyadministeryouremployees’claims–allsothatyoudon’t

haveto.We’llworkwithyoutointegratewithyourstaffandsoftware,sothatyougetthedataandserviceyouneed,andavoidtheheadachesyoudon’twant.

Weautomaticallyprocessandadjudicateclaimsbasedonthenetworkyouselect,thecontractswenegotiatewithhealthcareprovidersandthetypesofcareyouauthorizeforyouremployees.Oursystemscanfullyintegratewitheligibilityandbillingsystems,tokeepyourbusinessmovingsmoothly.

Claims Processing System

Wecoordinatewithothercommercialcoverageyouremployeeshave,alongwithMedicare,toavoidoverpaymentsandduplicationsincare.Thiskeepsyourbenefitbudgetefficient.

Coordination of Benefits (COB)

YouremployeeswillreceiveaPersonalHealthStatementfromuswhenevertheygetcare.They’llget:

n Benefitsataglance,alongwithclaimdetails

n Customerservicecontactinformation

n Wellnessanddiscountremindersthatwillhelpkeepyouremployeeshealthy

Personal Health Statements (PHS)

3 First-classcustomerservice We’llprovidefirst-classcustomerserviceforyouremployeesbyphone,byemail,onlineorinpersonatone

ofoureightregionaloffices.We’llalsoprovideyouwithadedicatedmemberservicedepartment,whichwillresolveissuesspecifictoyouremployees.

>>7

>>WhatCanWeDoforYou?

3 Specialstaffsupportandgroupservice TakeadvantageoftheBlueteam,andhavemorehandsondeckwithourdedicatedstafffor

self-fundedgroups.

Ourspecialteamofsupportonlyworksforself-fundedgroupslikeyours.They’reattentiveandknowledgeable,knowyourbusinessanditsneeds,andwillhelpyoumeetyourday-to-dayserviceneeds.Thisteamcanhelpyou:

n Maintainandprocessyourgroup’seligibility,includingurgentoremergencyadditionsanddeletions

n ProvideyouremployeeswithextraIDs,benefitsbookletsorothermaterials

n Reportonyourplan’sactivitiesandprogress

n Guidestrategicaccountplanningandcoordination

n Evaluateyoursatisfaction

Dedicated support

Takeadvantageofourcaremanagementandclinicassetsbyaddingthemtoyourstaffatafractionofthecost.We’llworkconstantlyandeffectivelytohelpyoumanageyourtotalcostofcarebyhelpingyouremployeesgettherightcarewhileavoidingwasteorfraud.

n LearnmoreaboutourpharmacybenefitmanagementprogramsonPage10.

n LearnmoreaboutourcaremanagementprogramsonPages14and15.

Targeted care management and clinical expertise

3 Extraoptionsandancillaryproducts Buildthebenefitplanthat’srightforyouremployees.Weofferafullportfoliooffullyinsuredproductsthrough

oursubsidiary,SouthernNationalLife,including:

8<<

3 Easyenrollment Whenit’stimetogetyouremployeessignedup,wemakeiteasy.

Weprovideeasy,understandableenrollmentmaterialsthatarewritteninplainlanguageanddesignedtomaximizeeducationandminimizequestions.

Open enrollment materials

Convenient,electronicenrollmentonlineandthrough834spreadsheetenrollment.

Electronic enrollment

Usethisonlinesuiteoftoolstoenrollmembers,payoradjustyourbill,andmakechangestoyourplan,membershipandotherdetails.

Online solutions through AccessBlue

>>9

>>WhatCanWeDoforYou?

3 Stop-losssupport Don’tletyourgroup’sclaimsgetaheadofyourmargins.

We’llauditstop-lossclaimsabovethethresholdyouchoose,providesupportforyear-endclaims,andhelpyougetservicethroughourstrongrelationshipswithstop-losscarriers.

Operational support

Avoidgettinghitwithunexpectedclaimlevels;weprovidethereportingyouneedtostayontopofyourplan’scosts.

Continuous, accurate reporting

3 Pharmacybenefitmanagement Largeemployersandtheiremployeeshavecomplexpharmacyneeds.Wedesignedourcomprehensive

PharmacyManagementProgramtomeetthem.

Weuseoneeligibilityprocess,oneIDcardandoneaccountteamtoensureseamlessadministrationandcreatemorecost-effectiveoutcomes.

Wealsokeepyourpharmacycostsmanageablebymanagingapreferredlistofdrugstoensureaccesstohighqualitydrugsatlowcost.

Easy administration

Ournationalpharmacynetworkincludesmorethan64,000pharmacies,includingnearlyallchainstoresandmorethan20,000independentpharmacies.

Broad pharmacy network

Youcantakeadvantageofourutilizationprogramstoreducecostsforyouremployeesandyourorganization–programslike:

n LeadwithGenerics–Haveyouremployeestryagenericalternativefirst,beforefillingacostlyname-brandprescription.

n PharmacyPriorAuthorization–Forcertainclassesofdrugs,theprescribingdoctormustfirstgetauthorizationfromustoensureyouremployeeisgettingappropriatecarethatiscoveredbyyourplan.

n QuantityperDispensingLimits/Allowances–Toensuredrugsarenotoverprescribed,welimitthequantityperdaysupply,dispensationorcombination.

n MandatorySpecialtyPharmacyProgram(ERISAself-fundedonly)–Thespecialtypharmacyprogramcovershigh-costspecialtydrugs.Wecontractwithspecialtypharmaciestoprovidehelpfulservices,likecourierdelivery,medicallynecessaryancillarysuppliesandeducationprogramsfocusedonthediseaseforwhichthemedicationisdispensed.

Utilization management program options

10<<

Weperformqualityandsafetychecksoneachprescription,andmonitortopreventfraud,wasteanddrugabuse.

Ourhealthmanagementprogramswilltouchyourmemberswithcomplexhealthneedsindividually.Byworkingwiththemtoensurethey’regettingtherightcareandfollowingtheirdoctors’orders,we’llhelpyouachievebetterhealthoutcomesatamanageablecost.

Personal touch driven by powerful pharmacy data

>>11

>>WhatCanWeDoforYou?

Throughourclinicalprograms,weworkwithyouremployeesandtheirdoctorstoensuremembersaregettingthebestcarepossible.Standardoptionsinclude:

n GapsinCare–Withtimely,accuratereminders,we’llmakesureyourmembersknowaboutthepreventiveandwellnessservicesthatcouldkeepthemhealthy.

n Retrospectivedrugutilizationreview–Weanalyzepatternsinprescriptiontrendsacrossournetworkstohelpdoctorsdetermineanddeliverappropriate,effectiveandcompliantdrugtherapy.Wecanalsoidentifypatternsoffraudandmisuse.

Youcanincludeoptionalclinicalprogramsinyourplan,including:

n FirstFillforFree–Youremployeesmayreceiveafreetrialofonegenericdrug,tohelpthemunderstandthetreatmentpowerandlowercostofgenericsvs.name-branddrugs.

n TurntoGenerics–We’lltargetmemberswhowouldbenefitmostfromswitchingtoagenericdrug,andcontactthemdirectlytourgethemtoconsideragenericalternative.

Clinical programs

3 TheBlueNetwork YouremployeeswillhaveaccesstotheBlueNetwork,themostcomprehensivegroupofhealthcare

professionalsintheworld.

BlueCardisanationalprogramthatwillallowyouremployeestoobtainin-networkhealthcareserviceswhiletravelingorlivinginanotherarea.

BlueCard National Network

Wesupportdoctorsandhospitalsthatdemonstratethehighestqualityofcare.ByaccessingourdirectoryofBlueDistinctionCentersandQualityBlueawardees,youremployeescanfindcarethat’snotonlygood,buttheverybest.

Blue Distinction Centers and Quality Blue

It’seasytofindandcomparecareinournetwork.Weoffer:

n Anonlineproviderdirectory

n Asmartphoneappthatfindsdoctorsalloverthenation

n BeginninginJuly2012,costcomparisonbetweenhealthcareprovidersandpatientreviews

Online tools

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>>13

>>WhatCanWeDoforYou?

3 Privacyservices WearefullyHIPAA-compliantandholdmanyprivacycertificationsfromnationalagenciesand

standard-bearers.Wecanhelpyoumakesurethatyourorganization’sandyouremployees’recordsandinformationaresecure.

Wecanworkwithyourteamtobuildprivacyskillsandprogramsthroughacustomizedplan.Wecanmakesureyourteamisonthecuttingedgeof:

n Privacyprogramassessment

n NoticeofPrivacyPracticesdevelopment

n Complaintresolution

n Administrativerequirementssafeguarding

n Breachassessmentandresolution

n AnnualreportingtoHHS

n Mitigationservices

n Businessassociatesagreementlanguage

Training and consulting

Ifit’sbestforyouandyourplan,outsourceyourprivacyservicestouscompletely.We’llhandlealloftheabove,plusprivacyprogramadministration,distributionofnoticesandvendormanagement.

Outsourcing

3 MedicalManagement ThroughUtilizationandCaseManagement,weworktocoordinateyouremployees’benefits,empowerthemto

choosethebestcare,andimprovetheirhealthoutcomes.Wealsoanalyzeyourplanconstantlytoavoidfraud,abuse,andover-orunderutilization.

OurbaseMedicalManagementpackageincludes:

n Inpatienthospitalservices

n Catastrophiccasemanagement

n Transplantcare

Base package

Therecommendedpackageincludeseverythinginthebasepackage,plus:

n Behavioralhealthservices

n Radiologyservices

n Outpatientservices

n Retrospectiveclaimsreview

Recommended package

Thepremiumpackageincludeseverythinginthebaseandrecommendedpackages,plus:

n Carecoordination

n Maternitymanagementprogram

n Highriskmaternitymanagementprogram

n Post-dischargeoutreachcalls

n Medicationadherence

n ERutilization

Premium package

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>>15

>>WhatCanWeDoforYou?

3 DiseaseManagement ThroughDiseaseManagement,weworkwiththoseofyouremployeeswhohavechronicorlong-termmedical

conditions.Througheducation,coaching,remindersandmonitoring,wecanhelpthemgetthebestcare,whilereducingcostlyredundantcare.

ThroughDiseaseManagement,wecanworkwithyouremployeeswhohave:

n Asthma

n Chronicobstructivepulmonarydisease

n Congestiveheartfailure

n Coronaryheartdisease

n Diabetes

n Endstagerenaldisease

n Chronickidneydisease

n Childrenwithspecialneeds.

Disease Management programs

poweredbyMyHealthMyWay

Workplace

Wellness

Havinghealthyemployeesmeansmoreproductivity,lessabsenteeismandabetterattitudeintheworkplace.WithMyHealth,MyWay,wegiveyouthetoolsyouneedtoengageyouremployeesintheirhealth,including:

n FreePersonalHealthAssessments(PHA)foryouremployees

n Healthylifestyleresources

n Wellnesstrackers

n Accesstohealthyandfuneventsinyourarea

n Localhealthresources

n Exclusivediscountprograms

n Andmore!

Injust15minutes,thisinteractivequestionnairewillhelpyouremployeesunderstandtheirhealthrisks.ThePHAwillalsomakerecommendationsandproposenextsteps.Allinformationprovidedis100%confidentialandheldtothehighestprivacystandards.

Personal Health Assessment

Byloggingintotheironlineaccountsatwww.bcbsla.com,youremployeeswillfindfreetoolsthathelpthemtrackweightloss,eatinghabits,exerciseandmore.They’llalsofindwaystogetandstayinshapethatarelocal,funandsocial.

Online tools and discounts

AlongwithPenningtonBiomedicalResearchCenter,webuilttheLouisiana2Steptokeepourfriendsandneighborshealthywithjusttwosimplesteps:eatrightandmovemore.

WhenyougoBlue,youremployeeshaveaccesstoourcomprehensivelibraryofrecipes,wellnesstrackersandvirtualcoachesatwww.Louisiana2Step.com.

FamiliescanDothe2®together!Kidscanlogintowww.2Step4Kids.comforgames,kid-sizedactivities,wellnesstrackersanda“Me2”characterthattrackspoints.

Louisiana 2 Step®

Return on InvestmentAt Blue Cross and Blue Shield of Louisiana, we’re workplace wellness evangelists. Why? Because we’ve seen the results.

Since we started our own workplace wellness program in 2006, we’ve seen:

• Staff turnover go down by 5%

• Our workers’ compensation costs go down by 13.6%

• A 20% drop in disability costs

• A total employee weight loss of 4,661 pounds in 2010 alone.

>>17

>>WorkplaceWellness

SALES OffICES

Lake Charles 337.562.0595 219 West Prien Lake Road Lake Charles, LA 70601-8450

Monroe 318.323.1479 3130 Mercedes Dr. Monroe, LA 71201

New Orleans 504.832.5800 3501 North Causeway Blvd., Suite 600 Metairie, LA 70002

Shreveport 318.795.0573 411 Ashley Ridge Blvd. Shreveport, LA 71106

Alexandria 318.448.1660

4508 Coliseum Blvd., Suite A Alexandria, LA 71303

Baton Rouge 225.295.2556

5525 Reitz Ave. Baton Rouge, LA 70809-3802

Houma 985.223.3499

1437 St. Charles Street, Suite 135 Houma, LA 70360

Lafayette 337.232.7527

5501 Johnston St. Lafayette, LA 70503

CUSTOMER SERvICE

Baton Rouge 225.295.2556 800.495.2583

5525 Reitz Ave. Baton Rouge, LA 70809-3802