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TransparencyYou paidhow much?Consumer

Employer SolutionsThe ultimate health careshopping solution

Delivering the leadingtransparency platform tohealth plans for over 8 years.is a portfoliocompany ofCambia HealthSolutions Offers configurable healthcareshopping experiences forhealth plans & employers Enables making smarterchoices around choosingproviders and treatmentsbased on cost, quality,convenience, and social Serving over 65 Health Plansand their employer clients thatcover 100 million membersEmployer Solutions30

We are spending too muchon healthcareEmployer Solutions31

Affordable care options exist todayShoulder arthroscopy 2,000to 18,000 4,000to 22,000In SeattleIn Boston 3,000to 26,000In DallasEmployer Solutions32

Higher Quality AdherenceNo correlation between cost and quality50%Lower Cost

But where can we go for ssmentDMprogramsEmployer Solutions34

GENERICPHOTONO PRICES AVAILABLEDON’T KNOW IF IT’S IN STOCKYOUCAN’TBUY THISHERE.CALL555-5555NOTHING TO SEE HEREWE DON’T HAVE ANY SUGGESTIONS

Are we ready for Health-azon?Employer Solutions36

Regence’s availableshopping solutionsEmployer Solutions37

Understand your options from a high levelEmployer Solutions38

Compare options from a detailed levelProvider AProvider BProvider CProvider DEmployer Solutions39

Our shopping tools are informing decisions Gallbladder RemovalMost expensiveLeast expensiveInpatientAverage CostCost Estimator users chooseNon-users choose 19,10210%Outpatient 11,10770%41%Surgical 6,36020%55%4%(2 year period of regional health plan’s claims history)Employer Solutions40

Informed decisions drive cost savingsGallbladder RemovalMost expensiveLeast expensiveInpatientAverage Cost 19,102Outpatient 11,107Surgical 6,360Average Cost for Cost Estimator users 10,319Average Cost for Non-users 14,195(2 year period of regional health plan’s claims history)Employer Solutions41

Partnering with HealthSparqon customized employerengagement solutionsEmployer Solutions42

How can we engage consumers?Foundational workOpportunity analysisMicrosite accessTargeted promotionsPersonalized alertsConcierge lineTelehealthProactive campaignsConveniencesEmployer Solutions43

Our integrated solutionOn Regence.comtoday (all members)Powered by HealthSparqEmployer customizedbuy-up (250 ee)Powered by HealthSparqTransparency tools thatenable smarter decisionsCustomized strategy totruly engage employees Single Search Real Prices Patient Ratings andReviews Health and WellnessCommunity Analysis andEngagement Services Additional ways toaccess information Proactive Campaigns ConveniencesEmployer Solutions44

Thank you!www.healthsparq.com@HealthSparqEmployer Solutions45

Cost ReductionConsumer

Accountable Care Organization (ACO) EvolutionCURRENTLYBenefitsCOMING SOON2014ACO2015CostPPO

ACO Product EvolutionBenefitsACOACOACOPPOACOACO20152018CostACO

INNOVATIONConsumer

Affordable Care Act Implementation UpdatePresentation to Master Builder’s AssociationSeptember 30, 2014Chris BandoliDirector, Government AffairsRegence BlueShield44 2014 Regence BlueShield

DisclaimerThis presentation is intended solely as a general overview of thesubjects discussed. It is not an exhaustive review of federal or staterequirements, and nothing in this presentation should be consideredto be or relied upon as legal or financial adviceThe materials and discussion represent the presenter’sunderstanding of current federal and state requirements, which aresubject to change at any time and may be subject to differinginterpretationsWhile the information provided is believed to be accurate, it shouldnot be relied upon as a substitute for independent research andconsultation with legal and other experts45 2014 Regence BlueShield

How it was supposed to work in 2014Individual Insurance Guaranteed IssueExpandedCoverage Tax Credits & Small EmployerSubsidiesTax Credit Exchanges forcompetitionMedicaid ExpansionEveryone up to 133% FPL 2014 Regence BlueShield Penalties for notoffering coverage Coverage Mandate46Employer Coverage

2014 - MedicaidJune 2012: U.S. Supreme Court ruled states can’t be forced toexpand Medicaid by threat to withhold all Medicaid fundsWashington expanded Medicaid in 2013 legislative sessionEnrollment: Approximately 300,000 newly eligible adults472014.RegenceRegenceBlueShieldBlueShield of Idaho, all rights reserved. 2014

2014 – Individuals & Small Employers“You canX can’tX might be able to keep your current plan.” Administration announced in late 2013 that, at the discretion of the states,renewals of non-ACA compliant plans will be permitted through Oct. 1,2016 for individuals and small employers Washington said “no” Commissioner Kreidler anticipated around 290,000 cancellations atthe end of 2013 Still a possibility of offering extension to 51-99 size groups in 2016,pending OIC decision 482014.RegenceRegenceBlueShieldBlueShield of Idaho, all rights reserved. 2014

2014 – IndividualsNo changes to penalty provisionsNeed to be aware of open enrollment period and specialenrollment opportunitiesOpen enrollment for 2015 will run November 15, 2014 toFebruary 15, 2015492013.RegenceRegenceBlueShieldBlueShield of Idaho, all rights reserved. 2014

2014 - ExchangesWashington Health Benefit Exchange – “Healthplanfinder” – amongmost successful state exchanges in the nationEnrollment: Approximately 170,000Issues Initial/special enrollment “Aggregating” premiumsBudget HBE wants 19 million increase in 2015 Additional dollars would be funded by assessment on plans sold in Exchange502014.RegenceRegenceBlueShieldBlueShield of Idaho, all rights reserved. 2014

2014 – Large EmployersJuly 2, 2013: Treasury announces no employer penalties for 2014February 10, 2014: Treasury releases final employer shared responsibilityrule and fact sheet announcing more “transitional relief” Employers with less than 100 employees get additional year delay Employers with 100 get some relief as wellTreasury Fact Sheet: /Documents/Fact%20Sheet%20021014.pdfOn July 24, 2014 the Internal Revenue Service released drafts of theforms that individuals, insurers, and employers will use for reportinginformation to the IRS necessary for reconciliation of premium tax creditsand for the enforcement of the individual and employer mandate programs512014.RegenceRegenceBlueShieldBlueShield of Idaho, all rights reserved. 2014

2014 in summary . . .Individual InsuranceExpandedCoverage Guaranteed Issue Penalties for notoffering coverage Coverage Mandate Tax Credits & Small EmployerSubsidiesTax Credit Exchanges forcompetitionMedicaid ExpansionEveryone up to 133% FPL522014.RegenceRegenceBlueShieldBlueShield of Idaho, all rights reserved. 2014Employer Coverage

Looking Ahead: Employers must know FTEsNumber of Full Time Employees working30 hours per week for the month(or at least 130 Hours during the Month) FTEs for theMonth 50 Small50-99 Mid100 LargeFull Time Equivalents: Add all hours in the monthfor part-time employees, then divide by 120 hoursThenTotal all FTEs for all months for the year and divideby 12 to get average FTE per monthNote: Employers may be able to use six months ratherthan full year for initial FTE determination53 2014 Regence BlueShield

2015: Mid-Sized Employers (51-99 FTEs)Employer penalty will not apply until 2016 Employer must certify it meets eligibility requirements on formprescribed by TreasuryRequired to provide coverage to at least 95% of full-timeemployees in 2016 or pay a shared responsibility penaltyNon-calendar year plans have until renewal in 2016 to comeinto complianceLook-back measurement period will be in 2015542014.RegenceRegenceBlueShieldBlueShield of Idaho, all rights reserved. 2014

2015: Large Employers (100 or more FTEs)Employer penalty will apply in 2015Non-calendar year plans can wait until 2015 renewal to comeinto complianceRequired to provide coverage to at least 70% of full-timeemployees for 2015 and 95% of full-time employees for 2016Dependent Coverage requirement will not apply in 2015 tolarge employers that are taking steps to arrange for dependentcoverage in 2016Look-back Measurement Period in 2014 (6 months OK)552014.RegenceRegenceBlueShieldBlueShield of Idaho, all rights reserved. 2014

Association Health PlansACA regulations mandate that association plans be “bona fide” Bona fide certain ERISA and HIPAA standardsOIC enforcing “bona fide” standards upon renewal of theassociation master contract in 2014 Regence Non-Bona Fide AHPs: NET, EST, WBACC Regence Bona Fide AHPs: MBA/BIAW, NMTA, WTIA, WFB, Vigilant, WAIA562013.RegenceRegenceBlueShieldBlueShield of Idaho, all rights reserved. Private and confidential. 2014

2014 State Legislative & Regulatory ActionRegulatory Network Access rules Mental Health rules Filing standardization rules Transgender exclusions banLegislative Innovation Plan Grace Periods Prior ield of Idaho, all rights reserved. Private and confidential. 2014

QUESTIONS? 2014 Regence BlueShield58

INNOVATIONConsumer

Retiree Plans for Medicare eligiblesEmployer Group Waiver Plans

What’s in your wallet?

Regence MedAdvantageWhat is an Employer Group Waiver Plan (EGWP)Program?An exclusive group Medicare option available to retiredemployees of members of the Master BuildersAccess to enhanced benefitsMore flexible enrollment times than traditional Medicaretimeframes

Regence MedAdvantageRegence Medicare Group Retiree PlansMedicare Group Retiree Plans are health plans offeredthrough Centers for Medicare & Medicaid Services (CMS)and administered by Regence.Easy to administer, they help minimize your exposure andaccounting obligations for your retired employees andprotect your business against cost fluctuations, providinga fully insured solution that ensures less disruption andgreater satisfaction for your retirees.

Regence MedAdvantagePotential for lower costsMedicare Group Retiree Plans offer lower-cost coveragethat can result in lower contributions for retirees.You can typically pay lower rates with a group retireeplan. Plus, they give you improved predictability of costswithout significantly increasing retiree contributions.

Regence MedAdvantage PPO planFreedom to use your own doctor and hospitalNo referrals to see specialistsLarge provider and pharmacy networkLowest cost sharing in-networkStill covered out-of-network with slightly higher costsharing, depending on your plan choiceWorldwide Coverage including Worldwide EmergencyCoverage

Where you get in-network vs. out-of-networkcoverage service area map

Nurse Advice Line – 24 hours a dayRound the clock answers from aregistered nurseCall anytime, from anywhere

Case and Condition ManagementNurse case managementsupport for serious illness orcatastrophic injuryDisease management for helpmanaging chronic conditions

SilverSneakers Tools to achieve yourhealth and fitness goals Access to over 245fitness locations Use fitness equipment,pools and saunas* Take SilverSneakersclasses*Find your nearest location at:www.silversneakers.com*Amenities vary by location

Value Added Service: TruHearing Hearing Aid Program

Pharmacy Network*Large national networkLocal and national pharmaciesCostco, Fred Meyer, Walgreens, RiteAid, Safeway, Wal-Mart and more!Fill prescriptions while traveling at anynetwork pharmacyConvenient mail-order options and 90day retain pharmacy options save youtime and money* United States and territories only

EligibilityRetiree Members and their spouses1. Must be entitled to Medicare benefits under Part A andenrolled in Part B2. Must be retired, not active3. Can live anywhere in U.S., not in territories4. Medicare-eligible spouse of an active employee iseligible too!5. Cannot live outside of the U.S. for more than 12 monthsat a time

QUESTIONS?79 2014 Regence BlueShield

ENGAGEMENTConsumer

Regence VitalityImproving Employee Health and ProductivityMichael Cochran, Director of WellnessRegence BlueShield81Regence BlueShield serves select counties in the state of Washingtonand is an Independent Licensee of the Blue Cross and Blue Shield Association