COVERAGE THAT S THERE

COVERAGE THAT S THERE You NEED IT. WHEN Community Blue Flex PPO

INTRODUCING COMMUNITY BLUE FLEX PPO... COVERAGE THAT LETS YOU CHOOSE AND SAVE Quality and value. With Highmark's newest product Community Blue Flex PPO you get both! Two Levels of In-Network Choice for Added Cost Savings Community Blue Flex PPO features a benefit design that offers two levels of in-network benefits for certain health care services: Enhanced Value and Standard Value When you choose certain network providers, your services are covered at the enhanced value level and you save money. At both benefit levels, members receive high-quality care: Enhanced Value Benefits: Members have lower cost-sharing when they receive care from in-network quality and cost-effective providers. Standard Value Benefits: When members receive care from other in-network providers, members have higher cost-sharing. Community Blue Flex PPO members also can choose out-of-network coverage at the highest level of cost-sharing. A High-Quality Network of Health Care Providers Community Blue Flex PPO provides access to the region's leading health care providers, including those from Allegheny Health Network and nearly 60 community and specialty hospitals in western Pennsylvania. And for those who want it, Community Blue Flex PPO also provides options for accessing care from certain University of Pittsburgh Medical (UPMC) physicians and hospitals as outlined below: HOSPITALS IN WESTERN PENNSYLVANIA Community Blue Flex PPO provides access to nearly 60 community hospitals and more than 7,600 physicians in western Pennsylvania alone. You ll also have access to all UPMC facilities outside of the Pittsburgh region, as shown in the hospital listing in this brochure. At the enhanced value benefits level, you will have access to exceptional cancer services available through Allegheny Health Network and its partner Johns Hopkins Kimmel Cancer. Access to cancer centers jointly operated by UPMC and other community hospitals is also covered at the enhanced value benefits level. And at the standard value benefits level, you will have access to oncology services at Hillman Cancer and all other UPMC wholly owned or managed care facilities and physicians. Erie Crawford Venango Mercer Allegheny Health Network hospitals McKean Potter Warren Forest Elk Cameron CONTINUATION OF CARE FOR MEMBERS IN TREATMENT NOW If you or a family member are in the midst of a course of treatment with any UPMC provider no matter what the diagnosis you can continue to see that provider at the standard value benefits level. It s your choice, and you ll want to work with your doctor to make the right decision about continuing care with your current provider. A SAFETY NET FOR ALL MEMBERS If you don t have any specific health problems but you have seen a UPMC physician in 2014, you won't have to change providers in 2015. For example, you may have a UPMC primary care physician or OB/GYN. Or you may also have seen a UPMC specialist recently. If you received care in 2014 from a UPMC provider and cannot find an alternative provider in your area, you can continue to receive care from that same provider in 2015 at the standard value benefits level. After 2015, you ll need to change providers if you want care at the standard value benefits level. If you choose to stay with a UPMC provider after 2015, any care you receive from that provider will be paid at the out-of-network benefit level. Lawrence Beaver Washington Greene Butler Allegheny Clarion Jefferson Clearfield Armstrong Indiana Cambria Blair Westmoreland Bedford Fayette Somerset Centre Huntingdon

WHY COMMUNITY BLUE FLEX PPO? 1 Your Choices Can Save You Money Every time you need care from a network doctor, hospital or medical center, you can choose a provider whose services are covered at either the Enhanced Value Benefits level or Standard Value Benefits level. At both benefit levels, you get responsive, high-quality care. However, with Enhanced Value Benefits, you will enjoy a lower deductible and lower cost-sharing. If you choose out-of-network providers, you ll pay more out of your own pocket. The amount you ll pay depends on your specific benefit design. Most out-of-network providers can also balance bill you up to the actual charge. Enhanced Standard Out of Network If you use UPMC providers that aren t in our network, they can only balance bill you up to 60 percent of their actual charge. 2 3 4 5 You Have Access to Thousands of Primary Care Providers and Specialists The Community Blue network encompasses thousands of primary care physicians and specialists. You also have access to world-renowned women s care and children s care. Notable specialties include oncology, cardiology, orthopedics and more. You are Covered Wherever You Live, Work or Travel As a Blue Plan, Community Blue Flex PPO covers your care everywhere around the corner and around the world. In fact, more than 92 percent of all U.S. physicians and more than 97 percent of all hospitals will accept your coverage! You Enjoy the Freedom and Flexibility of a Blue PPO Plan Community Blue Flex PPO is a Preferred Provider Organization (PPO) plan. That means you do not need a referral to see a specialist. With Community Blue Flex PPO you can go directly to any provider within the network. Finding a Provider is Easy Call mycare Navigator at 1-888-BLUE-428 for help finding local and out-of-area providers and to learn which providers services are covered at the Enhanced Value Benefits level. 92 percent of U.S. physicians 97 percent of U.S. hospitals LOOKING FOR A HIGHMARK HEALTH CARE PROVIDER? Call mycare Navigator SM at 1-888-BLUE-428. As with all health coverage, it s always a good idea to check with out-of-network providers to ensure they accept Highmark.

EVERY KIND OF CARE... CONVENIENT AND COVERED With vast experience in behavioral health, cancer care, cardiology, children s care, neuroscience, orthopedics and rehabilitation, transplant surgery and women s care, the network of Community Blue Flex PPO providers gives members easy access to every kind of care service. A QUICK LOOK AT SELECT COMMUNITY BLUE FLEX PPO PROVIDER FACTS AND ACHIEVEMENTS: Cancer Care Aligned with the Johns Hopkins Kimmel Cancer, a National Cancer Institute-designated comprehensive cancer center, to provide a broad, impressive scope of oncology expertise that is unsurpassed in the region. State-of-the-art, patient-centered medical, surgical and radiation oncology services. More than 125,000 patients served annually in Allegheny Health Network alone. Includes Hillman Cancer and all other UPMC-owned or managed cancer facilities and physicians. Cardiology and Cardiovascular (Heart Care) Performed the region s first total artificial heart implantation. Pioneering minimally-invasive innovative robotic procedures. The region s only dedicated cardiac MRI facility. Leader in treatment of atrial fibrillation (a-fib). Children s Care Comprehensive children s care consistently recognized for quality and innovation by U.S. News & World Report. Behavioral Health Care National leader in the diagnosis, management and treatment of behavioral health and addictive disorders. Recognized and funded by NIMH (National Institute of Mental Health) for leading-edge research into behaviors, treatments and therapies. Emergency and Burn Care Level I Trauma care - the highest certification level achievable. First burn center to receive verification honors. If you receive care at any UPMC hospital emergency room it will be covered on an in-network basis. This includes not only the emergency room visit but also any inpatient admissions and continued care. As is the practice now, patients and their doctors will determine if and when a transfer to another facility may be appropriate. Neuroscience (Brain, Spine & Nervous System) American Stroke Association s Gold Plus Performance Achievement Award for excellent evidence-based care for stroke patients. Developed guidelines for severe head injury treatments. Pioneering devices for spinal cord stimulation and the treatment of epilepsy. Research and clinical leadership in brain injury, Parkinson s disease, stroke, multiple sclerosis, epilepsy, cerebral aneurysm and dementia. Orthopedics and Rehabilitation One of only six leading regional medical providers selected by the United States Olympic Committee to provide comprehensive medical services to elite Team USA athletes. Ranked by U.S. News and World Report among the top 50 centers in the nation for quality orthopedic care. Official medical provider for the Pittsburgh Pirates, Pittsburgh Riverhounds professional soccer team and more than 20 western Pennsylvania colleges and high schools. Transplant Surgery Specialists focusing on single and complex multi-organ transplants, including kidney, heart, liver and pancreas. Rated among the nation s top 25 adult transplant programs with positive one- and three-year patient outcomes. Women s Care Care providers are among the best in the country for patient-centered care for women at all stages of life. From preventive health screenings to state-of-the-art, roboticassisted and minimally-invasive surgeries, these quality care services include: Well-woman gynecology care Diagnostic services including mammograms, breast imaging, pelvic exams, PAP tests and ultrasound Laboratory services Obstetric care including high-risk obstetrics, prenatal genetic counseling, maternal fetal medicine and high-risk pregnancy Menopause care including bone density testing Heart care Autoimmune care

EVERY TIME YOU GET CARE, YOU CAN SAVE MONEY! This chart provides an example of how Community Blue Flex PPO works and how Enhanced Value Benefits save on your coverage costs, including deductibles, coinsurance and copayments. IN-NETWORK Enhanced Value Benefits Standard Value Benefits Out-of-Network Deductible Individual Family $500 $1,000 $1,500 $3,000 $3,000 $6,000 Coinsurance 100% 70% 50% Out-of-Pocket Individual Family $2,500 $5,000 $5,000 $10,000 Total Maximum Out-of-Pocket* Individual Family $6,600 $13,200 $6,600 $13,200 Primary Care Provider Office Visit $20 copayment $40 copayment 50% after deductible Specialist Office Visit $20 copayment $40 copayment 50% after deductible Preventive Care (adult & pediatric) 100% (deductible does not apply) 100% (deductible does not apply) 50% after deductible Therapy Services $15 $30 50% after deductible Emergency Room Services 100% after $75 copayment (waived if admitted) 100% after $75 copayment (waived if admitted) 100% after $75 copayment (waived if admitted) Physical, Speech, Occupational Therapy (limit 20 visits/benefit period) Diagnostic Services (advanced and standard imaging, medical and lab services) Hospital Services Inpatient $20 copayment $40 copayment 50% after deductible 100% after deductible 70% after deductible 50% after deductible 100% after deductible 70% after deductible 50% after deductible Outpatient 100% after deductible 70% after deductible 50% after deductible *Includes: deductible, coinsurance, copays and other qualified medical expense (in-network only). Once met, the plan pays 100% of covered services for the rest of the benefit period.

In 2015, Community Blue Flex PPO will connect you to a health care provider network that offers patient-focused care with state-of-the-art technologies. In western Pennsylvania, this network includes nearly 60 community and specialty hospitals and more than 7,600 physicians. With vast experience in cancer, heart, behavioral health, children s and women s care, your provider network can address any care need you may have... conveniently, compassionately and expertly. ALLEGHENY Allegheny General Hospital Allegheny Valley Hospital Children s Hospital of Pittsburgh of UPMC Forbes Hospital Heritage Valley Sewickley Jefferson Hospital Ohio Valley General Hospital St. Clair Hospital West Penn Hospital Western Psychiatric Institute and Clinic ARMSTRONG Armstrong County Memorial Hospital BEAVER Heritage Valley Beaver BEDFORD UPMC Bedford Memorial BLAIR Nason Hospital Tyrone Hospital UPMC Altoona BUTLER Butler Memorial Hospital CAMBRIA Conemaugh Memorial Medical Conemaugh Miners Medical CLARION Clarion Hospital Enhanced Standard CLEARFIELD Clearfield Hospital Dubois Regional Medical CRAWFORD Meadville Medical Titusville Area Hospital ELK Elk Regional Health ERIE Corry Memorial Hospital Millcreek Community Hospital Saint Vincent Hospital UPMC Hamot FAYETTE Highlands Hospital Uniontown Hospital GREENE Southwest Regional Medical HUNTINGDON J. C. Blair Memorial Hospital INDIANA Indiana Regional Medical JEFFERSON Brookville Hospital Punxsutawney Area Hospital LAWRENCE Ellwood City Hospital Jameson Memorial Hospital MCKEAN Bradford Regional Medical Kane Community Hospital MERCER Edgewood Surgical Hospital Grove City Medical Sharon Regional Health System UPMC Horizon POTTER Charles Cole Memorial Hospital SOMERSET Conemaugh Meyersdale Medical Somerset Hospital Windber Medical VENANGO UPMC Northwest WARREN Warren General Hospital WASHINGTON Advanced Surgical Hospital Canonsburg Hospital Monongahela Valley Hospital Washington Hospital WESTMORELAND Excela Frick Hospital Excela Latrobe Area Hospital Excela Westmoreland Hospital Note: The following western Pennsylvania hospitals are out-of-network for this product: Magee Womens Hospital of UPMC UPMC Presbyterian- Shadyside UPMC East UPMC McKeesport UPMC Mercy UPMC St. Margaret UPMC Passavant For help finding providers, call mycare Navigator SM at 1-888-BLUE-428. As of Jan. 1, 2015. Highmark Blue Cross Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association. Health care benefit programs are issued or administered by Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Keystone Health Plan West. Information is issued by Highmark Blue Cross Blue Shield on behalf of these companies, which serve the 29 counties of western Pennsylvania and are independent licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross Blue Shield companies. 26531 9/14 CS201265 C000006187