To CareFirst BlueCross BlueShield and CareFirst BlueChoice Inc Distributors This by lisashepherd

VIEWS: 252 PAGES: 164

									To:       CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. Distributors


This Individual Product Manual was developed to educate and assist you in selling all
CareFirst BlueCross BlueShield (CareFirst) and CareFirst BlueChoice, Inc. (CareFirst
BlueChoice) products sold in the state of Maryland, DC and Virginia.

Every effort has been made to ensure that the information is complete and accurate. The
information provided in this manual is based on the CareFirst and CareFirst BlueChoice
interpretation of MD, DC and VA legislation in addition to CareFirst and CareFirst
BlueChoice Sales and Underwriting policies and guidelines. These interpretations, policies
and guidelines may be modified at the discretion of CareFirst and CareFirst BlueChoice
and will be communicated as deemed appropriate.

We believe the information here will provide you with the basics to successfully prospect
and sell Individual Products in MD, DC and VA. Please review all sections carefully, as our
guidelines will vary at times based on the product sold.

As our appointed and contracted Distributor, your continued support and adherence to our
policies and guidelines is appreciated. Any questions regarding the information contained
within this manual should be directed to your assigned CareFirst and CareFirst BlueChoice
Broker Representative.




CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc.
CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association.
® Registered trademark of the Blue Cross and Blue Shield Association. ®´ Registered trademark of CareFirst of Maryland, Inc.
The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is
submitted for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This
material may not be duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or
CareFirst BlueChoice, Inc.          V3-100106
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                                                                                                                         PAGE(S)
    Letter to Distributors                                                                                                    A-1
    Contacts                                                                                                                  A-2
                                                 COMMISSIONED PRODUCTS
    Personal Comp – MD                                                                                                   1-1 to 1-16
    BluePreferred                                                                                                        2-1 to 2-15
    BluePreferred Saver                                                                                                 2-16 to 2-29
    BluePreferred HSA                                                                                                   2-30 to 2-44
    BluePreferred – DC Open Enrollment                                                                                       2-45
    BlueChoice                                                                                                           3-1 to 3-16
    BlueChoice Saver                                                                                                    3-17 to 3-29
    BlueChoice HSA                                                                                                      3-30 to 3-43
    Comprehensive Major Medical                                                                                           4-1 to 4-9
    HIPAA Overview                                                                                                            5-1
    HIPAA Questions and Answers                                                                                           5-2 to 5-4
    BluePreferred HIPAA                                                                                                       5-5
    BluePreferred-Saver HIPAA                                                                                                 5-6
    BluePreferred HSA – HIPAA VA Only                                                                                         5-7
    BlueChoice HIPAA                                                                                                          5-8
    BlueChoice HSA HIPAA VA Only                                                                                         5-9 to 5-11
    Comprehensive Major Medical HIPAA – VA Residents Only                                                                    5-12
    Medicare Supplemental Plans – Overview                                                                                    6-1
    MediGap Early Enrollment Discount                                                                                     6-2 to 6-4
    MediGap-65 Standard Plans - MD                                                                                        6-5 to 6-8
    Supplement-65 DC/VA                                                                                                  6-9 to 6-12
    Medi-CareFirst BlueCross BlueShield - Blue Rx Plans (Medicare Part D)                                               6-13 to 6-26
                                             NON-COMMISSIONED PRODUCTS
    Catastrophic                                                                                                              7-1
    Student Health Plan                                                                                                       7-2
    BluePreferred – VA Open Enrollment                                                                                        7-3
    Indemnity Group Conversion - MD                                                                                           7-4
    BluePreferred Group Conversion                                                                                            7-5
    BlueChoice Group Conversion                                                                                               7-6
    Dental                                                                                                                7-7 to 7-8
    Vision                                                                                                               7-9 to 7-10

The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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CONTACTS


         Individual Broker Sales
         Individual Broker Sales Hotline                                                           800-628-4925
         Individual Broker Sales Fax                                                               410-998-8055


         Customer Service
         CareFirst (MD Indemnity Products)                                                          800-843-4280
         CareFirst (DC Products)                                                                 Blue Preferred &
                                                                                                 Comp Major Med:
                                                                                                  202-484-9100
         CareFirst BlueChoice (DC Products)                                                          BlueChoice:
                                                                                                    866-520-6099
         CareFirst (Delaware)                                                                       302-429-0260


         Status – Application Processing
         CareFirst (MD Indemnity Products)                                                         800-972-4609
         CareFirst (DC Products)                                                                   877-746-7515
         The Dental Network                                                                        888-833-8464


         MHIP
         MHIP                                                                                      866-780-7105


         Miscellaneous
         BlueCard®® Program                                                                        410-581-2871
         Medicare Parts A & B                                                                     800-MEDICARE
                                                                                                  (800-633-4223)
         Social Security Administration                                                            800-772-1213
         Group Sales (MD Products)                                                                 800-933-1229
         Group Sales (DC Products)                                                                 202-479-8595




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                               A-2
I. COMMISSIONED PRODUCTS                                                   Personal Comp – Maryland


Overview                       •    An indemnity product that allows the customer to customize their coverage to meet
                                    their needs and budget
                               •    Designed specifically for Maryland residents and their families who don’t have
                                    health insurance benefits through an employer
                               •    Offers comprehensive health coverage, including preventive care
                               •    Extensive benefits are provided for both hospital and physician services,
                                    emergency care for accidental injuries and many other medical services such as
                                    diagnostic testing and prescription drugs
                               •    Customer can add a high-quality, low-cost dental and vision benefit to their program
                                    at any time (see the dental/vision section for additional information)
                               •    Children-only rates are available. If the entire family does not need coverage –
                                    special rates are available for children 1-17. An application for each child would
                                    need to be completed.

Key Selling                    •    Competitive, stable rates
Features                       •    Freedom to choose any doctor or hospital (for most care) with no referrals
                                    (largest provider network in Maryland)
                               •    Maximum flexibility with nine benefit levels and two HSA-compatible benefit levels
                               •    Little or no paperwork
                               •    Optional Dental and Vision programs with large provider networks
                               •    No balance billing when members visit a Blue Cross and Blue Shield contracted
                                    provider
                               •    Up to $3,000,000 of lifetime benefits per member
                               •    Children-only rates
                               •    Discounts on alternative therapies and wellness services through the Options
                                    Discount Program
                               •    BlueCard®® program allows for easy access to benefits while traveling

Calendar or                    •    Calendar Year
Contract Year

Membership                     •    There is a four tier rate structure:
Types                               •    Individual (includes child only)
                                    •    Individual & Child
                                    •    Individual & Adult
                                    •    Family

                               •    Applicant may choose any membership type regardless of marital status.
                               •    Rates for multiple-member policies are determined based on the age of the oldest
                                    applicant.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                   Personal Comp – Maryland



    Membership Type                 A policyholder may change from one Policy category (Individual, Individual and
    Changes                         Child, Individual and Adult, Family) to another Policy category as indicated below.
                                    Changes stated in 1, 2, & 3 will be effective on the first of the month following
                                    receipt and acceptance of the application:


                                    1. A policyholder may add his or her spouse by submitting a medically
                                       underwritten application to CareFirst or CareFirst BlueChoice.
                                    2. A policyholder may add a dependent child through legal guardianship by
                                       submitting a medically underwritten application to CareFirst or CareFirst
                                       BlueChoice.
                                    3. A child whose health insurance coverage is the responsibility of the policyholder
                                       under a medical child support order may be added to this policy by submitting a
                                       medically underwritten application and valid proof of the medical child support
                                       order to CareFirst or CareFirst BlueChoice.
                                    4. A newborn child of the policyholder is automatically covered for the first 31 days
                                       from birth.
                                    5. A grandchild of a policyholder will be automatically covered for 31 days
                                       beginning on the date the grandchild is placed in the court ordered custody of
                                       the policyholder.
                                    6. A child or grandchild that is legally adopted by the policyholder is automatically
                                       covered under the Policy for 31 days from the date of adoption.

                                         Continuing coverage beyond the initial 31 days of automatic coverage for the
                                         child described in Sections 4, 5 and 6 above, will cost an additional premium if
                                         the Policy covers only the policyholder (Individual coverage), the policyholder
                                         and adult (Individual and Adult coverage), or the policyholder and one child
                                         (Individual and Child coverage). If payment of the additional premium is
                                         required, then the policyholder must notify CareFirst or CareFirst BlueChoice
                                         within 31 days of the date of birth, adoption, or court ordered custody of a
                                         grandchild and pay the additional premium within 31 days of receiving the
                                         additional premium bill.



Effective Date                 •    The effective date is when the application is accepted and approved.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                   Personal Comp – Maryland


Waiting Periods                •    There is a ten (10) month waiting period for pre-existing conditions.



Waiver of                      If the prospect chooses to apply for a CareFirst BlueCross BlueShield (CareFirst)
Waiting Period                 Personal Comp product, he/she may be eligible for a waiver of the pre-existing wait
                               clause.
                               To qualify for this waiver, he/she/they must:
                               •    Meet ALL of the criteria listed below in HIPAA Eligibility Requirements.
                               •    Submit evidence of prior coverage (certificate of coverage) with the application. If
                                    there is a delay in obtaining the certificate of coverage, the application should be
                                    submitted with a letter regarding the prior coverage and a statement that the
                                    certificate of coverage has been requested.
                               •    Pass medical underwriting.


                               HIPAA Eligibility Requirements:
                               •    Have 18 or more months of creditable coverage with the most recent coverage
                                    under a group employer sponsored plan, governmental plan, church plan, or a
                                    health benefit plan offered in conjunction with any of these plans. Certificates of
                                    creditable coverage must indicate at least 18 months of aggregate creditable
                                    coverage.
                               •    Have elected and exhausted health insurance benefits through a COBRA or similar
                                    group, state or federal continuation plan, including the Federal Employee Health
                                    Benefits Program (FEHBP), FEHBP Temporary Continuation of Coverage (TCC) or
                                    state continuation coverage, if available. Have no more than a 63-day break in
                                    coverage.
                               •    Not be eligible for Medicare A or B, Medicaid, or any other employer sponsored
                                    plan.
                               •    Not be covered by any other health insurance plan.
                               •    Not have had prior insurance coverage terminated because of failure to pay the
                                    required premium or because of fraud.


                               NOTE: If the prospect is unable to show proof of prior coverage, then the pre-existing
                               waiting period will NOT be waived.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            1-3
I. COMMISSIONED PRODUCTS                                                   Personal Comp – Maryland



Deductible,                    •     The customer can select the deductible and out-of-pocket maximum from a choice
Out-of-Pocket                        of eleven different options to help meet their budget considerations.
Max &                          •     Families never contribute more than the equivalent of two members’ deductibles
Co-insurance                         regardless of the number of family members covered by the policy.
                               •     Two Party/Family needs to meet the family deductible before claims are paid on
                                     HSA options.
                               •     Unlike most insurers, CareFirst includes the deductible in the out-of-pocket
                                     maximum. Non HSA-family coverage, each member must meet the out-of-pocket
                                     maximum before they are covered at 100%. HSA compatible- Two Party/Family
                                     out-of-pocket can be reached by one or more members of the family and the
                                     benefits are payable for the remainder of the calendar year at 100% of the allowed
                                     benefit.

                                     The Deductible and Out-of-Pocket options are shown below:




                                                    Deductible                              Out-of-Pocket Maximum
                                                         $100                                             $1,000

                                                         $200                                             $2,000

                                                         $400*                                            $2,000

                                                         $500                                             $2,000

                                                         $800*                                            $2,000

                                                        $1,000                                            $2,500

                                              $1,700 (HSA-compatible)                                     $4,000

                                                        $2,500                                            $4,000

                                              $2,500 ** (HSA-compatible)                                  $2,500

                                                        $5,000                                            $6,000

                                                       $10,000                                           $10,000


                                   * Plan pays 75% of the allowed benefit – member’s liability is 25% up to $2,000. All other
                                   deductible levels provide coverage at 80% or 100% of the allowed benefit and the member’s
                                   liability is 20% or 0% up to the associated out-of-pocket maximum.

                                   ** Plan pays 100% of the allowed benefit.
                                   All other deductible levels provide coverage at 80% or 75% of the allowed benefit and the
                                   member’s liability is 25% or 20% up to the associated out-of-pocket maximum.


The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                   Personal Comp – Maryland



Preventive                     Includes:
Benefits                       •    Routine physicals, mammograms, immunizations and well child care
                               •    Visits to the doctor for adults and children are $10 when using a Participating
                                    Provider and the member does not have to satisfy the deductible first.
                               •    HSA-Compatible product: Visits to the doctor for adults and children are $30 when
                                    using a Participating Provider and the member does not have to satisfy the
                                    deductible first.



Maternity                      •    Maternity benefits are standard.
Benefits                       •    Benefits are available after a ten (10) month waiting period from the corporate
                                    receipt date of the application at CareFirst.
                               •    Waiting period may be waived if HIPAA eligibility guidelines are met.



Other Benefits                 •    Oral contraceptives are covered.
                               •    Artificial Insemination and In-vitro Fertilization are covered if all guidelines are met.
                               •    A prescription drug card is NOT issued. Pharmacy invoices are attached to a claim
                                    form and mailed to the CareFirst claims department by the member. Any drug
                                    claims count toward the deductible.
                               •    Dental and Vision can be added to the policy.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            1-5
I. COMMISSIONED PRODUCTS                                                   Personal Comp – Maryland



Non HSA-Compatible                   Listed below is a chart outlining some of the non-HSA compatible benefits.
Benefit Chart

                                                                                    80% / 20%                          75% / 25%
                         Benefit                            Covered                 Customer                          Customer
                                                                                  Responsibility                    Responsibility
   Deductible Levels                                                          $100, $200, $500, $1,000                   $400, $800
                                                                               $2500*, $5000,$10,000

   Child or Adult Preventive                                      X                       $10                                $10

   OB/GYN Preventive Care                                         X                       $10                                $10

   Mammography                                                    X                       $10                                $10

   Three Lifetime EKGs (For members over 50                       X                       $10                                $10
   and if done during routine adult physical exam)

   Second Surgical Opinions                                       X                        $0                                 $0

   First $300 of emergency treatment received                     X                        $0                                 $0
   within 72 hours
   (if the deductible is less than $1,500)

   Once the out-of-pocket maximum is met                          X                        $0                                 $0

   Physician Office Visits                                        X           20% AB (after deductible)        25% AB (after deductible)

   365 days of Hospitalization                                    X           20% AB (after deductible)         25% AB (after deductible)

   Ambulatory and Emergency Services                              X           20% AB (after deductible)         25% AB (after deductible)

   Inpatient Physician Services                                   X           20% AB (after deductible)         25% AB (after deductible)

   Maternity and Prenatal Care                                    X           20% AB (after deductible)         25% AB (after deductible)

   Diagnostic Test and X-rays                                     X           20% AB (after deductible)         25% AB (after deductible)

   Physical Therapy / Chiropractic Services                       X           20% AB (after deductible)         25% AB (after deductible)
   (up to 50 visits per year)

   Prescription Coverage                                          X           20% AB (after deductible)         25% AB (after deductible)
   ($500 annual benefit limit per person)
  AB = Allowed Benefit

  *Not HSA –compatible
  NOTE: If a member receives care from a provider that does not participate with CareFirst, they may be billed for the amount
  in excess of the CareFirst allowed benefit.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                   Personal Comp – Maryland



HSA-Compatible                     Listed below is a chart outlining the key HSA-compatible benefits.
Benefit Chart

                                                                                     80% / 20%                         100% / 0%
                          Benefit                            Covered                 Customer                         Customer
                                                                                   Responsibility                   Responsibility
      Deductible Levels                                                                   $1,700                           $2,500
      Well Child Care (up to age 18)                               X                       $30                               $30
      Adult Preventive Physical Exams                              X                       $30                               $30
      OB/GYN Preventive Care                                       X                       $30                               $30
      Cancer Screening Visits                                      X                       $30                               $30
      (no charge for Mammograms, Pap Tests
      and PSAs)
      Three Lifetime EKG’s                                         X                       $30                               $30
      (for Members over 50 and if done during
      routine adult physical exam)
      Physician Office Visits                                      X                     20% AB                              0%
                                                                                    (after deductible)               (after deductible)
      365 Days Hospitalization                                     X                     20% AB                              0%
                                                                                    (after deductible)               (after deductible)
      Emergency Accident Care                                      X                     20% AB                              0%
                                                                                    (after deductible)               (after deductible)
      Inpatient Physician Services                                 X                     20% AB                              0%
                                                                                    (after deductible)               (after deductible)
      Inpatient/Outpatient Surgery                                 X                     20% AB                              0%
                                                                                    (after deductible)               (after deductible)
      Maternity and Prenatal Care                                  X                     20% AB                              0%
                                                                                    (after deductible)               (after deductible)
      Diagnostic Test and X-Rays                                   X                     20% AB                              0%
                                                                                    (after deductible)               (after deductible)
      Physician Therapy / Chiropractic Services                    X                     20% AB                              0%
      (up to 50 visits per year)                                                    (after deductible)               (after deductible)
      Prescription Coverage                                        X                    20% AB                              0%
                                                                                   (after deductible),              (after deductible)
                                                                               $1,000 annual benefit limit      $2,000 annual benefit limit
                                                                                       per person                       per person
     AB = Allowed Benefit




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            1-7
I. COMMISSIONED PRODUCTS                                                   Personal Comp – Maryland



Out-of-Area                    To make sure that CareFirst benefit plans travel easily, Blue Cross and Blue Shield
Coverage                       plans throughout the USA have developed a national electronic data delivery system
                               called BlueCard®.

                               BlueCard® advantages:
                               • Speeds the payment of a member’s claim if they receive treatment outside
                                   of the CareFirst service area
                               • Helps members receive maximum benefits and savings
                               • No claims have to be filed and the member cannot be billed for charges
                                   above the Plan’s approved amount when a CareFirst member receives
                                   care from a provider who participates with the local BCBS plan

Standard Options               See Deductible and Co-insurance section.



Other Options                  •    HIPAA - see HIPAA section of manual.
                               •    Conversion - see Conversion section of manual.



Benefit Upgrades              UPGRADES (e.g. changing from a $500 deductible to a $200 deductible)
                              • All insured covered under the new policy will need to submit a medically
                                underwritten application to CareFirst;
                              • Any material misstatements made on the medically underwritten application
                                for the new policy may result in voiding a new policy issued in reliance upon
                                the medically underwritten application;
                              • The time covered under the prior CareFirst policy will be credited towards all
                                pre-existing conditions waiting periods;
                              • If any person named on the application fails medical underwriting then the
                                upgrade will not be approved and all insureds may continue their present
                                coverage

                               If all persons on the application are accepted by CareFirst and a new policy is
                               issued, then all of the services rendered prior to the new policy’s effective date
                               will not be credited towards:

                               •    The new policy’s deductible;
                               •    The new policy’s out-of-pocket limit; or,
                               •    Any of the new policy’s benefit maximums.


Benefit                        DOWNGRADES (e.g. changing from a $200 deductible to a $500 deductible)
Downgrades                     • Require a member change form
                               • Handled through member services




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            1-8
I. COMMISSIONED PRODUCTS                                                   Personal Comp – Maryland



Jurisdictional                 •    This is a Maryland-based product.
Issues

Eligibility &                  There are many factors that determine participant eligibility when they are enrolling for
Enrollment                     coverage. These factors may be mandated by State law or required by CareFirst.
                               The specific requirements are found in the direct pay contract.
Who is Eligible?
                                •    Applicant cannot be eligible for Medicare benefits
                                •    Applicant must be in reasonably good health
                                •    Individuals age 20 and older must apply separately from family
                                •    A policyholder between the ages of 1 and 64.
                                •    The policyholder’s spouse or eligible domestic partner, under the age of 65.
                                •    The unmarried children of the policyholder or the policyholder’s spouse who are
                                     age 19 years of age or younger, limited to the policyholder or covered spouse’s;
                                     - biological child;
                                     - legally adopted child;
                                     - stepchild;
                                     - grandchild, who is in the court ordered custody of the policyholder or
                                       the policyholder’s spouse;
                                     - ward under legal order of guardianship from a competent court or
                                       administrative agency.
                                •    A child for whom the policyholder has the legal obligation to provide coverage
                                     pursuant to a medical child support order. Enrollment for such a child will not be
                                     denied based on the grounds that the child:
                                     - was born out of wedlock;
                                     - is not claimed as a dependent of the policyholder’s federal tax return;
                               OR
                                 - does not reside with the policyholder.

                                •    CareFirst retains the right to require proof of any relationship described above.
                                •    The policyholder must be a Maryland resident at the time this policy is issued.
                                •    A full-time student carrying at least 12 credits per semester (or 9 credit hours of
                                     graduate courses) may remain on the plan until they reach the age of 25.



Who Is NOT                      • New applicants who are eligible for and receiving Medicare benefits
Eligible?                       • Existing members who are currently enrolled with our MediGap coverage




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                   Personal Comp – Maryland


Medical                        Medical Underwriting is a systematic process that insurers use to collect information
                               about a health insurance applicant. Based on the medical information collected, an
Underwriting
                               insurer can accept or deny certain applicants for coverage, issue a counter-offer or deny
                               coverage completely for all applicants.

                               Medical Underwriting is used to help keep insurance affordable to everyone. CareFirst
                               uses medical information provided on the application, information provided by the
                               applicant’s health care providers (doctors, other healthcare providers and labs) and a
                               review of claims history.



Medical                        The Medical Underwriting process and results are shown below:
Underwriting
Process and
Results


                                                         Process - The underwriting process for
                                                             new applications is as follows:
                                    STEP       ACTION
                                      1.       Application is submitted to CareFirst.

                                      2.       Underwriter may request additional medical information, based
                                               on the information on the application and the applicant’s CareFirst
                                               claim’s history.

                                      3.       Upon receipt of the medical information, a decision is reached about
                                               whether or not to accept the application for health coverage.


                                                     Results - The underwriting process can result
                                                                in one of the following:
                                   RESULT – Application for coverage is…

                                    • Accepted or
                                    • Denied or
                                    • Accepted excluding certain individuals or
                                    • Counter-offered with a higher premium rate.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            1-10
I. COMMISSIONED PRODUCTS                                                      Personal Comp – Maryland



Sample                            • Results can vary depending on the severity of conditions
Decision                          • Shown below is a sample of decision results
Results




          ICD 9      Diagnosis                     Criteria                                                 Decision
          401-4019   Hypertension, essential       If essential and well controlled                         Approve


                                                   If not well controlled (readings between 140/90 and
          401-4019   Hypertension, essential       160/100) or on 2 medications                             Approve


                                                   If not well controlled (readings over 160/100) or on
          401-4020   Hypertension, essential       more than 2 medications                                  Approve with 25% Rate Increase
          402-4029   Hypertensive heart disease    If well controlled                                       Approve
          402-4029   Hypertensive heart disease    If not well controlled                                   Decline
          403-4039   Hypertensive renal disease                                                             Decline

          278-2780   Overweight                    Based upon BMI of 25-29.9                                Approve
          278-2780   Obesity                       Based upon BMI of 30-35                                  Approve with 25% Rate Increase
          278-2780   Morbid Obesity                Based upon BMI of over 35                                Decline




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            1-11
I. COMMISSIONED PRODUCTS                                              Personal Comp – Maryland


Medical                        All decisions regarding acceptance, counter offer or rejection of an application are made
Underwriting                   in Central Medical Review.
Guidelines
                               All medical conditions are closely reviewed and a decision is based on the history and
                               treatment of given conditions.

                               Maryland applicants, who receive either an exclusion or a denial, or have any of the
                               conditions listed on the next page may be eligible for health coverage under the
                               Maryland Health Insurance Plan (MHIP). MHIP is a high-risk pool for Maryland residents
                               who are medically uninsurable.

                               Applicants will not be eligible for MHIP if they are eligible for any of the following
                               coverages:

                               1.        Medicare;
                               2.        Maryland Medical Assistance;
                               3.        Maryland Children’s Health Program; or
                               4.        An employer sponsored health plan that provides benefits comparable to MHIP,
                                         unless you are considered an eligible individual under the Trade Act of 2002.
                                         Eligible individuals under the Trade Act of 2002 include individuals who qualify
                                         for a tax credit under §35 of the Internal Revenue Code. Generally, this
                                         includes displaced workers harmed by foreign trade and retirees receiving
                                         payments from the Pension Benefit Guaranty Corporation.

                               MHIP also offers products to Maryland resident individuals and their dependents that
                               meet HIPAA eligibility criteria. You may obtain information regarding MHIP from the
                               Maryland Health Insurance Plan:

                                                                  Maryland Health Insurance Plan
                                                                         P.O. Box 47160
                                                                   Baltimore, MD 21244-7160
                                                                          866-780-7105

                               Information regarding MHIP also may be obtained from the website at
                               www.marylandhealthinsuranceplan.state.md.us




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            1-12
I. COMMISSIONED PRODUCTS                                                   Personal Comp – Maryland




MHIP                           Maryland applicants with any of the conditions listed below may be eligible for health
Conditions for                 coverage under the Maryland Health Insurance Plan (MHIP).
Eligibility

                               Behavioral Health (Psychiatric)
                               Bipolar Disorder, Chemical Dependency, Dementia, Psychotic Disorders

                               Blood/Blood Forming
                               Aplastic Anemia, Hemocromatosis, Hemophilia, Sickle Cell Disease

                               Cardiovascular
                               Angina Pectoris, Cardiomyopathy, Congestive Heart Failure, Coronary Artery Disease, Coronary
                               Insufficiency, Coronary Occlusion

                               Endocrine (Hormonal)
                               Addison’s Disease, Cystic Fibrosis, Diabetes (Type I and II), Porphyria, Wilson’s Disease

                               Gastrointestinal
                               Ascites, Banti’s Disease or Syndrome, Cirrhosis of the Liver, Crohn’s Disease, Esophageal
                               Varicies, Hepatitis B & C, Ulcerative Colitis

                               Infectious
                               AIDS, HIV Positivity

                               Musculoskeletal/Connective
                               Ankylosing Spondylitis, Lupus Erythematosus Disseminate, Rheumatoid Arthritis, Scleroderma

                               Pulmonary (Lung)
                               Chronic Obstructive Pulmonary Disease, Emphysema

                               Neoplasm (Cancers)
                               Cancer (except skin cancer) treated or diagnosed within the past 5 years, Hodgkin’s Disease,
                               Leukemia, Multiple Myeloma, Non-Hodgkin’s Lymphoma, Wilm’s Tumor

                               Neurologic
                               Alzheimer’s Disease, Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease), Friederich’s Ataxia,
                               Guillain Barre Syndrome, Huntington’s Disease, Hydrocephalus, Multiple Sclerosis, Muscular
                               Dystrophy, Myasthenia Gravis, Myotonia, Palsy, Paraplegia, Parkinson’s Disease, Quadraplegia,
                               Stroke, Tay-Sachs Disease

                               Other:
                               Kidney Disease requiring Dialysis, Major Organ Transplant, Pregnancy




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            1-13
I. COMMISSIONED PRODUCTS                                                   Personal Comp – Maryland



Rating Up                      •    Depending on the level of severity of certain conditions within the past five years
                                    may result in the counter-offer of a rated-up premium rate by 25% or 50%.

                               •    If a rated-up coverage is offered, the customer will receive a letter indicating the
                                    increase in the premium and a counteroffer form which will need to be signed and
                                    returned to CareFirst.




Exclusionary                   •    An Exclusionary Amendment is a legal document that may be added to a medically
Amendments                          underwritten policy to exclude a family member from health care coverage.

                               •    Excluded Family Member - A family member may be excluded from the policy if his
                                    or her medical risk is determined to be too great. An Exclusionary Amendment is
                                    added to the contract and the individual is not covered.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            1-14
I. COMMISSIONED PRODUCTS                                                   Personal Comp – Maryland




How the                        Shown below is how the Plan works.
Plan Works



       HSA COMPATIBLE PERSONAL COMP                                                              PERSONAL COMP
          HSA Compatible                        HSA Compatible                    $100, $200, $500,                  $400 & $800
              $1,700                                $2,500                         $1,000, $2,500,                deductible options
                                                                                  $5,000 & $10,000                       only
                                                                                 deductible options
                   Member chooses deductible level                                          Member chooses deductible level

   Member meets the deductible                  Member meets the                                Member meets the deductible
                                                   deductible
  (Two Party/Family need to meet                                                (The deductible is part of the out-of-pocket maximum.
         family deductible                  (Two Party/Family need to             The Family deductible is two times the individual
        $3,400 for Family)                    meet family deductible                                 deductible.)
                                               $5,000 for Family)
 • Plan pays 80% of AB                    • Plan pays 100% of AB              • Plan pays 80% of AB             • Plan pays 75% of AB


 • Member pays the co-                    • Member pays 0%                    • Member pays the co-             • Member pays the co-
   insurance (20% of AB)                                                        insurance (20% of AB)             insurance (25% of AB)
      •    Member meets out-of-pocket maximum                                       •    Member meets out-of-pocket maximum

                   • Personal Comp pays 100% of AB                                          •     Personal Comp pays 100% of AB
                       for the remainder of the year.                                               for the remainder of the year.
             •   Benefits are based on a calendar year.                                 •       Benefits are based on a calendar year.
AB = Allowed Benefit




Rate Increases                 •    Rates are not guaranteed and can be 25% or 50% higher than quoted depending
                                    on the severity of medical conditions.
                               •    Rates can be changed with 45 days prior notice



Payment Options                •    Quarterly
                               •    Monthly (only available through EasyPay)




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            1-15
I. COMMISSIONED PRODUCTS                                         Personal Comp – Maryland


Termination of                It is the policyholder’s responsibility to notify CareFirst of the terminating event, except
Insured’s                     in the case of the policyholder’s death.
Coverage                       An insured will no longer be eligible for coverage at the end of the period for which
                               CareFirst has accepted premiums during which:

                               A child or grandchild:
                                   - reaches the age of 19;
                                   - is married; OR
                                   - enters the military.

                               •    A full time student:
                                    - reaches the age of 25;
                                    - no longer meets the definition of a full-time student;
                                    - is married; OR
                                    - enters the military.

                               •    A spouse;
                                    - dies;
                                    - enters military service;    OR
                                    - is divorced.

                               •    A policyholder;
                                    - dies;
                                    - enters military service; OR
                                    - an insured reaches the policy maximum.

                               •    Unless this policy is terminated as a result of the policyholder’s failure to pay the required
                                    premium, a child subject to a medical child support order may not be terminated unless
                                    written evidence is provided to CareFirst that:
                                    - The medical child support order is no longer in effect; OR
                                    - The child has been or will be enrolled under other reasonable health insurance
                                      that will take effect no later than the effective date of the disenrollment.

                               •    In the case of the death of a policyholder:
                                    - Remaining insureds will continue to be covered under this policy;
                                    - The oldest insured who remains covered under the policy will become
                                       the policyholder; AND
                                    - If necessary, any adjustment in premium will be made for the period beginning
                                       on the first of the month following the death.



Provider                       Participating Providers
Networks                       For services and supplies provided by Participating Providers, the Plan Allowance is
                               based on the Participating Provider Allowances. Providers cannot bill members for any
                               balance above the Plan Allowance.

                               Non-Participating Providers
                               For services and supplies provided by a non-participating provider, the Plan Allowance
                               is based on the Participating Provider Allowances. Non-Participating Providers may bill
                               you for any balance above the Plan Allowance.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            1-16
I. COMMISSIONED PRODUCTS                                                            BluePreferred



Overview                      •    A medically underwritten health plan that uses a Preferred Provider Organization
                                   (PPO) to help keep premium payments reasonable.
                              •    Allows members to select from a number of deductible and coinsurance options to
                                   tailor a plan that best suits their needs and budget. The higher the deductible and
                                   coinsurance selected, the lower the premium rate.
                              •    Customers have the flexibility to go in or out of the PPO network, giving them
                                   complete freedom to choose any doctor. If a member elects to go out-of-network, a
                                   higher deductible and lower coinsurance applies. In addition, the member may be
                                   balanced billed if the out-of-network provider does not participate in the provider
                                   network.


Key Selling                   •    Competitive rates
Features                      •    Provides preventive care for adults and children with no deductible
                              •    Up to $2,000,000 of lifetime benefits per member in Maryland
                                   and an unlimited lifetime maximum per member in Virginia and D.C.
                              •    Freedom to choose any doctor in the PPO network
                              •    No balance billing when members visit preferred providers
                                   (see Provider Information section for explanation)
                              •    Little, if any, paperwork if a preferred or participating provider is used
                              •    Prescription drug benefits
                              •    Maternity benefit rider
                              •    Discounts on a variety of alternative therapies and wellness services through the
                                   Options Discount Program.
                              •    Easy access to benefits while traveling, through the BlueCard® program
                              •    Child-only rates available (age 1-17)

Calendar or                   •    Calendar Year
Contract Year

Membership                    •    There is a four tier rate structure:
Types                              • Individual (Age 1and older) Applicants 65 and over must not be
                                      eligible for Medicare benefits and must submit, with their application,
                                      a letter indicating such from the Social Security Administration.
                                   •    Individual & Child(ren)
                                   •    Individual & Adult
                                   •    Family
                              •    Applicant may choose any membership type regardless of marital status.
                              •    Rates for multiple member policies are determined based on the age of the
                                   person listed on the application as the applicant.
                              •    Applicants over 64 may apply if not eligible for Medicare.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 1
I. COMMISSIONED PRODUCTS                                                            BluePreferred



Membership                    Enrollment of other new dependents (other than a newborn, newly adopted child or newly
Type                          eligible grandchild):
Changes                       •    The member must submit an enrollment information form, including a medical
                                   questionnaire. Based on our review of applicant’s health status, applicant may be
                                   approved or disapproved for coverage.
                              •    Enrollment will be effective on the first day of month following the month in which
                                   CareFirst:
                                   a. gives final approval to the application
                                   b. receives the premium payments and
                                   c. receives and approves all requested and completed forms and information

                              Coverage of a Newborn child newly adopted child or newly eligible grandchild:
                              •    Enrollment requirements for an eligible newborn child, newly adopted child, or newly
                                   eligible grandchild depend on the type of coverage that is in effect on the date of the
                                   child’s first eligibility date.
                              •    If member already has family coverage on the child’s first eligibility date, an eligible
                                   newborn child, newly adopted child or newly eligible grandchild will be covered
                                   automatically as of the child’s first eligibility date.

                              •
Effective Date                •    Enrollment will be effective on the first day of the month following the month in which
                                   the CareFirst gives final approval to the application.



Waiting Periods               •    There is a ten month waiting period for pre-existing conditions.
                                   (There is no coverage for maternity for the first ten (10) months after the maternity
                                   rider is added.)



Waiver of                     •    Waiting period of 10 months will be fully waived with evidence of certificate of
Waiting Period                     creditable coverage for 10 or more months.

                              •    Evidence of creditable coverage that is less than 10 months will reduce the waiting
                                   period by 1 full month for each full month of creditable coverage.

                              NOTE: See page 1-3 regarding HIPAA Eligibility Requirements for creditable coverage.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 2
I. COMMISSIONED PRODUCTS                                                            BluePreferred


 Deductibles                  Below are the four (4) deductibles, out-of-pocket maximums and co-insurance levels per
Out-of-Pocket                 individual for Maryland residents.
Maximums &
Co-Insurance                          DEDUCTIBLE                        OUT OF POCKET                          COVERAGE LEVEL
                                                                          MAXIMUM
(MD)
                               In-Network         Out-of-          In-Network          Out-of-           In-Network        Out-of- Network
                                                  Network                              Network
                                   $100              $300            $2,500             $5,000               90%                  70%
                                   $300              $500            $2,500             $5,000               90%                  70%
                                   $300              $500            $2,500             $5,000               80%                  60%
                                   $500              $750            $2,500             $4,000               80%                  60%




Deductibles                   Below are the six (6) deductibles, out-of-pocket maximums and co-insurance levels per
Out of Pocket                 individual for District of Columbia and Virginia residents
Maximums &
                                      DEDUCTIBLE                        OUT-OF-POCKET                          COVERAGE LEVEL
Co-Insurance                                                              MAXIMUM
(DC and VA)
                               In-Network         Out-of-          In-Network          Out-of-           In-Network        Out-of- Network
                                                  Network                              Network
                                   $100              $300            $2,500             $5,000               90%                  70%
                                   $300              $600            $2,500             $5,000               90%                  70%
                                   $300              $600            $2,500             $5,000               80%                  60%
                                   $500             $1,000           $2,500             $5,000               80%                  60%
                                   $750             $1,500           $3,500             $7,000               80%                  60%
                                  $2,500            $5,000           $5,000             $7,500               80%                  60%




Preventive                    Includes:
Benefits                      • Routine physicals, mammograms, immunizations and well childcare
                              •   Visits to the doctor for adults and children when using Participating
                                  Providers and the customer does not have to satisfy the deductible first.

Maternity                     •    Includes Optional Maternity and Prenatal Coverage.
Benefits                      •    Maternity and prenatal care coverage can be purchased during the initial
                                   enrollment for an additional $126 a month.
                              •    If maternity coverage is added at any time, there will be a 10-month waiting
                                   period for maternity benefits.
                              •    There is a $3,000 benefit limit in DC.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 3
 I. COMMISSIONED PRODUCTS                                                           BluePreferred


Other Benefits                    •    Oral contraceptives are covered.
                                  •    In-Vitro Fertilization and Artificial Insemination are not covered in DC or VA
                                  •    Freestanding dental may be purchased separately and is only available in MD & DC
                                  •    Vision is covered



Prescription                      A prescription drug card is issued separately from the medical card.
Drug Benefits –
3 Tier                            The chart below outlines the benefits of the 3-tier drug benefit design:


                                           CATEGORY                                                  BENEFIT
                               Deductible                                                      $100 per individual

                               Family Aggregate Deductible Max                                         None

                               Tier 1 Generic Co-pay                                                    $10

                               Tier 2 Preferred Brand Co-pay                                            $25

                               Tier 3 Non-Preferred Brand Co-pay                                        $45

                               Self-Injectable Drugs (including                     50% Coinsurance up to a $75 maximum
                               insulin, except infertility drugs &
                               agents in MD)*
                               Infertility Drugs and Agents                          MD                     DC                 VA
                                                                                50% of Plan            Not Covered        Not Covered
                                                                                 Allowance
                                                                               up to lifetime
                                                                           maximum for covered
                                                                           infertility services as
                                                                                in certificate
                               Generic Penalty:                                                       Applies
                               Member pays difference between
                               the cost of generic and brand name
                               drug when generic is available
                               Annual Benefit Maximum                                                 $1,500

                               Supply Per Co-pay                                                      30 Days

                               Contraceptive Drugs Covered?                                             Yes

                               Maintenance Drug Co-pay –                            MD                     DC                  VA
                               90 day supply
                                   Retail                                                    2X for 31 – 60 days
                                                                                             3X for 61 – 90 days
                                      Mail Order                           2X for 31 – 60 days 2X for                   2X for
                                                                           3X for 61 – 90 days 31 – 90 days             31 – 90 days




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 4
 I. COMMISSIONED PRODUCTS                                                             BluePreferred



Benefit Chart                 Below is the BluePreferred benefit chart for the Individual Market.




                                               Benefit                        Covered             Member Responsibility
                              Well-Child care, up to age 18                       X          $0 co-pay, no deductible – DC & VA
                                                                                               $25 co-pay, no deductible - MD

                              Mammograms, Pap Tests and PSAs                      X                      $0 (in-network)
                              (cancer screenings)

                              Physician Office Visits                             X                $25 co-pay, no deductible
                                                                                                         (in-network)

                              Allergy Shots                                       X                $5 co-pay, no deductible
                                                                                                         (in-network)

                              Adult Preventive Physical Exams                     X                $25 co-pay, no deductible
                                                                                                         (in-network)

                              OB/GYN Preventive Care                              X                $25 co-pay, no deductible
                                                                                                         (in-network)

                              Emergency Care – Emergency Room                     X                $50 co-pay, deductible &
                                                                                                         coinsurance

                              365 Days Hospitalization per year                   X              Coinsurance after deductible

                              Inpatient Physician Services                        X              Coinsurance after deductible

                              Inpatient/Outpatient Surgery                        X              Coinsurance after deductible

                              Diagnostic Tests and X-rays                         X              Coinsurance after deductible

                              Annual Routine Eye Exam                             X                $10 co-pay, no deductible
                                                                                                         (in-network)

                              Physical Therapy                                    X              Coinsurance after deductible

                              Radiation and Chemotherapy                          X              Coinsurance after deductible

                              Prescription Drugs**                                X                    $100 deductible
                                                                                                     $10 generic co-pay
                                                                                                 $25 Preferred Brand co-pay
                                                                                               $45 Non-Preferred Brand co-pay
                                                                                                  $1,500 annual benefit max

                              * See page 2-3 for Coinsurance and deductible amounts
                              **Generic drugs must be chosen when available or an additional expense will be incurred.
                              Self-injectable drugs are covered at a 50% coinsurance up to a maximum. Member payment
                              of $75 per covered injectable medication and are subject to the annual benefit maximum.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 5
I. COMMISSIONED PRODUCTS                                                            BluePreferred



Out-of-Area                   To make sure that CareFirst benefit plans travel easily; Blue Cross and Blue Shield
Coverage                      plans throughout the USA have developed a national electronic data delivery system
                              called BlueCard®.

                              BlueCard® advantages:

                              •    Speeds the payment of a member’s claim if treatment is received outside of the
                                   CareFirst service area
                              •    Helps members receive maximum benefits and savings
                              •    No claims have to be filed and the member cannot be billed for charges above the
                                   Plan’s approved amount when a CareFirst member receives care from a provider
                                   who participates with the local BCBS plan



Standard                      See Deductible and Co-Insurance Section
Option(s)



Other                         •    HIPAA - See HIPAA section of manual.
Options
                              •    Open Enrollment (Virginia and DC) - See BluePreferred Open Enrollment section

                              •    Group Conversion (Maryland) - See Group Conversion section of manual

                              •    Group Conversion (Virginia and DC) - See Group Conversion section of manual



Benefit Upgrades              The subscriber may be permitted to increase or decrease the amount of coverage under
& Downgrades                  his or her agreement. If the Subscriber is applying for an increase in coverage, he or
                              she may be required to complete medical questionnaire and/or submit additional
                              information to determine if he or she qualifies.



Jurisdictional                BluePreferred has 3 jurisdictions:
Issues
                                   1. MD (available throughout all of Maryland)
                                   2. DC and
                                   3. Northern VA

                              See Benefit Chart for details.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 6
 I. COMMISSIONED PRODUCTS                                                           BluePreferred


Eligibility &                 Many factors determine participant eligibility when enrolling for coverage. These factors
Enrollment                    may be mandated by State law or required by CareFirst.

                              The specific requirements are found in the direct pay contract.

Who is Eligible?              •    Applicant must be a Maryland, D.C. or Virginia resident in the CareFirst service area
                                   (i.e., a MD resident can only apply for a MD plan)
                              •    Applicant must be between the ages of 1-64 and not eligible for Medicare benefits.
                              •    Applicant must be in reasonably good health.
                              •    Applicants 65 and over must not be eligible for Medicare benefits and must submit,
                                   with their application, a letter indicating such from the Social Security Administration.

                              To be covered, the applicant must meet all of the following conditions:

                              The applicant must be eligible for coverage either as a Subscriber, as a Spouse or as a
                              Dependent Child. The applicant must apply for coverage by submitting an Enrollment
                              Information Form (Application) to CareFirst AND CareFirst must receive premium
                              payments.

                              •    Subscriber
                                   - under the age of 65;
                                   - over the age of 65 and not receiving Medicare benefits; OR
                                   - eligible for Medicare, but have a Dependent Child or children who are eligible under
                                   a family contract.
                                   – Resident of Maryland; the District of Columbia or (i) Arlington County, the City of
                                   Alexandria, the City of Fairfax and the Town of Vienna, Virginia; (ii) the part of Fairfax
                                   County lying within State Route 123 to the West and the Potomac River to the East;
                                   or (iii) the part of Prince William County lying within and to the North of State Route
                                   123, Virginia.
                              •    Anyone not enrolled under nor eligible for coverage by CareFirst in an existing group
                              •    Spouse
                              •    Dependent Children -To be covered as a Dependent Child, the child must be
                                   unmarried and under the age of 23; AND
                                   Related to the Subscriber in one of the following ways:
                                   - the Subscriber’s natural child;
                                   - the Subscriber’s legally adopted child or grandchild;
                                   - a child (including a grandchild) for whom the Subscriber is the legally recognized
                                   proposed adoptive parent and who is dependent upon and living with the Subscriber
                                   during the waiting period before the adoption becomes final;
                                   - a stepchild who permanently resides in the Subscriber’s household
                                   - a grandchild who is in the court ordered custody of and is dependent upon and
                                   residing with the Subscriber;
                                   - a child for whom the Subscriber has been court ordered or administratively ordered
                                   to provide coverage would otherwise terminate or within 31 days after the effective
                                   date of the child’s coverage under the Agreement, whichever is later.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 7
I. COMMISSIONED PRODUCTS                                                      BluePreferred


Who is Not                    •    Applicants who are currently enrolled in a group/FEP with CareFirst.
Eligible?                     •    New applicants who are eligible for and receiving Medicare benefits.
                              •    Existing members who are currently enrolled with our MediGap coverage.



Enrollment                     1. The Subscriber must complete an Enrollment Information Form (Application),
Guidelines                        including a medical questionnaire, for himself or herself and other eligible family
                                  members, if applicable. Based on the CareFirst’s review of the applicant’s health
                                  status, the applicant(s) may be approved OR disapproved for coverage.

                              2. The enrollment requirements for an eligible newborn child, a newly adopted child or
                                 a newly eligible grandchild depends on the type of coverage that is in effect on the
                                 date of the child’s First Eligibility Date. First Eligibility Date means:

                                   - for a newborn child, the child’s date of birth;
                                   - or a newly adopted child, the earlier of:
                                      - judicial decree of adoption; or
                                       - Date of assumption of custody, pending adoption of a prospective
                                          adoptive child by a proposed adoptive parent.
                                   - for the grandchild the, date of the court decree or the date the court decree
                                   becomes effective, whichever is later.

                              3. Dependent children will be covered automatically as of the child’s First Eligibility
                                 Date.

                               4. If the addition of the child results in a change of Type of Coverage, from Self Only to
                                   two-party, the child’s automatic coverage will end on the 31st day following the
                                   child’s First Eligibility Date. If the Subscriber wishes to continue coverage beyond
                                   this 31day period, he or she must enroll the child within 31 days following the
                                   child’s First Eligibility Date.
                                   - if the Subscriber already has Family Coverage on the child’s First Eligibility Date
                                   the child will be covered automatically as of the child’s First Eligibility Date.

                              5. For enrollments under Court or Administrative Order, coverage begins the date
                                 which the order was signed by a competent court or administrative agency.

                              6. If enrollment is not made within the 31day period, the child is subject to the same
                                 requirements for enrollment as all other new Dependents.

                              7. In the event of the Subscriber’s death:
                                 - Coverage of any Dependents will continue under the Subscriber’s enrollment until
                                 the last day of the month in which the Subscriber’s death occurs.
                                 - The enrolled spouse or, if there is no spouse, the covered Dependent Children of
                                 the Subscriber, may purchase a Conversion Contract (see information under Group
                                 Conversion)

                                                                                                                                   Continued



The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                            BluePreferred




Enrollment                    Primary Care Dependent (District of Columbia Applicant Only). To qualify for coverage as
Guidelines                    a Primary Care Dependent, the child must be the Subscriber’s grandchild, niece, or
                              nephew. The child must be under the Subscriber’s “Primary Care”*
continued

                              *Primary Care means that the Subscriber provides food, clothing and shelter for the child
                              on a regular and continuous basis during the time that the District of Columbia public
                              schools are in regular session.

                              The Subscriber must provide CareFirst with proof, upon application, that the child meets
                              the requirements for coverage as a Primary Care Dependent, including proof of the child’s
                              relationship and primary dependency on the Subscriber and certification that the child’s
                              legal guardian does not have other coverage. CareFirst has the right to verify whether the
                              child is and continues to qualify as a Primary Care Dependent.


                              Disabled Dependent -A dependent child who is age 23 or older will be eligible if he or she
                              meet the following:

                              •    The child is incapable of supporting himself or herself due to a mental or physical
                                   incapacity;
                              •    The incapacity occurred before the child reached age 23;
                              •    The child is chiefly dependent on the Subscriber for support and maintenance;

                              AND

                              •    The Subscriber provides CareFirst with proof of the child’s incapacity, including
                                   certification by a physician

                              Children whose relationship to the Subscriber is not listed above, including grandchildren
                              (except as provided above) foster children or children whose relationship is one of legal
                              guardianship are not covered under the Individual Enrollment Agreement. Even if the child
                              lives with the Subscriber and is dependent upon the Subscriber for support.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 9
I. COMMISSIONED PRODUCTS                                                            BluePreferred



Medical                       Medical Underwriting is a systematic process that insurers use to collect information
Underwriting                  about a health insurance applicant. Based on the medical information collected, an
                              insurer can accept or deny certain applicants for coverage, issue a counter-offer or deny
                              coverage completely for all applicants.

                              Medical Underwriting is used to help keep insurance affordable to everyone.
                              CareFirst uses medical information provided on the application, information provided by
                              the applicant’s health care providers (doctors, other healthcare providers and labs) and
                              a review of claims history.

                                   •    Generally, the Medical Underwriting process takes 4 – 6 weeks.


                              The underwriting process and results are listed below:




                                                       Process - The underwriting process for
                                                           new applications is as follows:
                                       STEP      ACTION
                                         1.      Application is submitted to CareFirst.

                                         2.      Underwriter may request additional medical information, based
                                                 on the information on the application and the applicant’s CareFirst
                                                 claim’s history.

                                         3.      Upon receipt of the medical information, a decision is reached
                                                 about whether or not to accept the application for health coverage.


                                                   Results - The underwriting process can result
                                                              in one of the following:
                                       RESULT – Application for coverage is…

                                       • Accepted or
                                       • Denied or
                                       • Accepted excluding certain individuals or
                                       • Counter-offered with a higher premium rate.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 10
I. COMMISSIONED PRODUCTS                                                                 BluePreferred



Medical                           • Medical Underwriting results can vary depending on the severity of conditions
Underwriting                      • Shown below is a sample of decision results

Sample
Decision
Results



          ICD 9      Diagnosis                    Criteria                                                Decision
          401-4019   Hypertension, essential      If essential and well controlled                        Approve


                                                  If not well controlled (readings between 140/90 and
          401-4019   Hypertension, essential      160/100) or on 2 medications                            Approve


                                                  If not well controlled (readings over 160/100) or on
          401-4020   Hypertension, essential      more than 2 medications                                 Approve with 25% Rate Increase
          402-4029   Hypertensive heart disease   If well controlled                                      Approve
          402-4029   Hypertensive heart disease   If not well controlled                                  Decline
          403-4039   Hypertensive renal disease                                                           Decline

          278-2780   Overweight                   Based upon BMI of 25-29.9                               Approve
          278-2780   Obesity                      Based upon BMI of 30-35                                 Approve with 25% Rate Increase
          278-2780   Morbid Obesity               Based upon BMI of over 35                               Decline




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 11
I. COMMISSIONED PRODUCTS                                                            BluePreferred


Medical                       All decisions regarding acceptance, counter offer or rejection of an application are made
Underwriting                  in Central Medical Review.
Guidelines
                              All medical conditions are closely reviewed and a decision is based on the history and
                              treatment of given conditions.

                              Maryland applicants, who receive either an exclusion or a denial, or have any of the
                              conditions listed on the next page may be eligible for health coverage under the Maryland
                              Health Insurance Plan (MHIP). MHIP is a high-risk pool for Maryland residents who are
                              medically uninsurable. Applicants will not be eligible for MHIP if they are eligible for any of
                              the following coverages:


                              1.        Medicare;
                              2.        Maryland Medical Assistance;
                              3.        Maryland Children’s Health Program; or
                              4.      An employer sponsored health plan that provides benefits comparable to MHIP,
                              unless you are considered an eligible individual under the Trade Act of 2002. Eligible
                              individuals under the Trade Act of 2002 include individuals who qualify for a tax credit
                              under §35 of the Internal Revenue Code. Generally, this includes displaced workers
                              harmed by foreign trade and retirees receiving payments from the Pension Benefit
                              Guaranty Corporation.


                              MHIP also offers products to Maryland resident individuals and their dependents that
                              meet HIPAA eligibility criteria. You may obtain information regarding MHIP from the
                              Maryland Health Insurance Plan:


                                                                  Maryland Health Insurance Plan
                                                                             P.O. Box 47160
                                                                     Baltimore, MD 21244-7160
                                                                              866-780-7105


                              Information regarding MHIP also may be obtained from the website at
                              www.marylandhealthinsuranceplan.state.md.us.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                            BluePreferred



MHIP                          Maryland applicants with any of the conditions listed below may be eligible for health
Conditions for                coverage under the Maryland Health Insurance Plan (MHIP).
Eligibility

                              Behavioral Health (Psychiatric)
                              Bipolar Disorder, Chemical Dependency, Dementia, Psychotic Disorders

                              Blood/Blood Forming
                              Aplastic Anemia, Hemocromatosis, Hemophilia, Sickle Cell Disease

                              Cardiovascular
                              Angina Pectoris, Cardiomyopathy, Congestive Heart Failure, Coronary Artery Disease, Coronary
                              Insufficiency, Coronary Occlusion

                              Endocrine (Hormonal)
                              Addison’s Disease, Cystic Fibrosis, Diabetes (Type I and II), Porphyria, Wilson’s Disease

                              Gastrointestinal
                              Ascites, Banti’s Disease or Syndrome, Cirrhosis of the Liver, Crohn’s Disease, Esophageal Varicies,
                              Hepatitis B & C, Ulcerative Colitis

                              Infectious
                              AIDS, HIV Positivity

                              Musculoskeletal/Connective
                              Ankylosing Spondylitis, Lupus Erythematosus Disseminate, Rheumatoid Arthritis, Scleroderma

                              Pulmonary (Lung)
                              Chronic Obstructive Pulmonary Disease, Emphysema

                              Neoplasm (Cancers)
                              Cancer (except skin cancer) treated or diagnosed within the past 5 years, Hodgkin’s Disease,
                              Leukemia, Multiple Myeloma, Non-Hodgkin’s Lymphoma, Wilm’s Tumor

                              Neurologic
                              Alzheimer’s Disease, Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease), Friederich’s Ataxia,
                              Guillain Barre Syndrome, Huntington’s Disease, Hydrocephalus, Multiple Sclerosis, Muscular
                              Dystrophy, Myasthenia Gravis, Myotonia, Palsy, Paraplegia, Parkinson’s Disease, Quadraplegia,
                              Stroke, Tay-Sachs Disease

                              Other:
                              Kidney Disease requiring Dialysis, Major Organ Transplant, Pregnancy




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 13
I. COMMISSIONED PRODUCTS                                                      BluePreferred



Rating Up                     Depending on the level of severity of certain conditions within the past seven years may
                              result in the counter-offer of a rated-up premium rate by 25% or 50%. If a rated-up
                              coverage is offered, the customer will receive a letter indicating the increase in the
                              premium and a counteroffer form which will need to be signed and returned to CareFirst.




Exclusionary                  An Exclusionary Amendment is a legal document that may be added to a
Amendments                    medically underwritten policy to exclude a family member from health care
                              coverage.


                              Excluded Family Member
                              A family member may be excluded from the policy if his or her medical risk is
                              determined to be too great. An Exclusionary Amendment is added to the contract
                              and the individual is not covered.




How the                       Shown below is how the plan works in-network and out-of-network.
Plan Works



                                                  IN-NETWORK                                          OUT-OF-NETWORK

                                                                   Member chooses deductible level

                                                                   Member meets deductible
                                                      The deductible is part of the out-of-pocket maximum.
                                                   The Family deductible is two times the individual deductible.

                                        •    The plan pays 80% or 90%                   •    The plan pays 60% or 70% (depending
                                             (depending on deductible)                                   on deductible)
                                               of the allowed benefit                                of the allowed benefit

                                                                  •     Member pays the co-insurance

                                                             •    Member meets out-of-pocket maximum

                                                           BluePreferred pays 100% of the allowed benefit
                                                                   for the remainder of the year.
                                                               Benefits are based on a calendar year.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 14
I. COMMISSIONED PRODUCTS                                                            BluePreferred



Rate Increases                •    30 day rate change notice is required for DC residence.
                              •    30 day rate change notice is required for MD residence.
                              •    30-60 day rate change notice is required for VA residence.



Payment Options               •    Blue Preferred is billed monthly only



Termination of                •    The Subscriber may terminate the coverage of an eligible member, at any time, by
Insured’s                          written request to CareFirst to either change his or her type of coverage to an
Coverage                           Individual or non-Family type of coverage; or remove an eligible dependent from his or
                                   her coverage.
                              •    All Unmarried Dependent Children are eligible up to age 23
                              •    In case of the death of the policyholder: Coverage of any Dependents will continue
                                   under the Subscriber’s enrollment until the last day of the month in which the
                                   Subscriber’s death occurs.
                              •    Coverage ends on the last day of the month in which eligibility terminates.
                              •    A Subscriber will no longer be eligible for coverage if he or she dies.



Provider Networks             Preferred Providers
                              For services and supplies provided by Preferred Providers, the benefit payments are
                              based on Preferred Provider Allowances.

                              Participating Providers
                              For services and supplies provided by Participating Providers, the Plan Allowance is
                              based on Preferred Provider Allowances. Participating Providers may bill you for the
                              difference between the Preferred Provider Allowance and the Participating Provider
                              Allowance.

                              Non-Participating Providers
                              When you use a Non-Participating Provider, the Plan Allowance is based on the
                              Participating Provider Allowances. Non-Participating Providers may bill you for any
                              balance above the Plan Allowance.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 15
I. COMMISSIONED PRODUCTS                                                            BluePreferred-Saver



Overview                      •    Three (3) new, low cost BluePreferred PPO deductible/coinsurance options are now
                                   offered in addition to the standard, individual BluePreferred product
                              •    Medically underwritten health plan that uses a Preferred Provider Organization (PPO)
                                   to help keep premium payments reasonable.
                              •    Offered to individuals in the CareFirst service area (MD, DC & VA)
                              •    Product options are not HSA (Health Savings Account) compatible.



Key Selling                   •    Competitive rates
Features
                              •    Allows members to select from a number of deductible and coinsurance options to
                                   tailor a plan that best suits their needs and budget. The higher the deductible and
                                   coinsurance selected, the lower the premium rate.
                              •    Provides preventive care for adults and children with no deductible (in-network)
                              •    Up to $3,000,000 of lifetime benefits per member
                              •    Customers have the flexibility to go in or out of the PPO network, giving them
                                   complete freedom to choose any doctor. If a member elects to go out-of-network, a
                                   higher deductible and coinsurance applies. In addition, the member may be balanced
                                   billed if the out-of-network provider does not participate in the provider network.
                              •    No balance billing when members visit preferred providers
                                   (see Provider Information section for explanation)
                              •    Little, if any, paperwork if a preferred or participating provider is used
                              •    Prescription drug benefits
                              •    Child-only coverage available (age 1-17)
                              •    Optional extended maternity benefit rider
                              •    Discounts on a variety of alternative therapies and wellness services through the
                                   Options discount program.
                              •    Easy access to benefits while traveling, through the Blue Card program
                              •    Core routine vision benefits including an annual eye exam and discounts on glasses,
                                   contact lenses and laser vision correction surgery
                              •    Optional Dental HMO coverage available



Calendar or                   •    Calendar Year
Contract Year




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 16
I. COMMISSIONED PRODUCTS                                                            BluePreferred-Saver



Membership                    Four-tier rate structure:
Types                         1. Individual (Age 1and older) Applicants 65 and over must not be eligible for Medicare
                                 benefits and must submit, with their application, a letter indicating such from the
                                 Social Security Administration.
                              2. Individual & Child(ren)
                              3. Individual & Adult
                              4. Family
                              Applicant may choose any membership type regardless of marital status.
                              Rates for multiple member policies are determined based on the age of the
                              oldest person listed on the application as the applicant.


                              Applicants over 64 may apply if not eligible for Medicare. Members may stay in the
                              product after turning 65; however, at that point Medicare becomes primary and this plan
                              will be secondary. Rates will decrease accordingly.


Membership                    Enrollment of other new dependents (other than a newborn, newly adopted child or newly
Type Changes                  eligible grandchild):
                              •    The member must submit an enrollment information form, including a medical
                                   questionnaire. Based on our review of applicant’s health status, applicant may be
                                   approved or disapproved for coverage.
                              •    Enrollment will be effective on the first day of month following the month in which
                                   CareFirst:
                                   a. gives final approval to the application
                                   b. receives the premium payments and
                                   c. receives and approves all requested and completed forms and information

                              Coverage of a Newborn child newly adopted child or newly eligible grandchild:
                              •    Enrollment requirements for an eligible newborn child, newly adopted child, or newly
                                   eligible grandchild depend on the type of coverage that is in effect on the date of the
                                   child’s first eligibility date.
                              •    If member already has family coverage on the child’s first eligibility date, an eligible
                                   newborn child, newly adopted child or newly eligible grandchild will be covered
                                   automatically as of the child’s first eligibility date.


Effective Date                Enrollment will be effective on the first day of the month following the month in which
                              CareFirst:
                              •    provides final approval to the application;
                              •    receives the premium payment.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 17
I. COMMISSIONED PRODUCTS                                                            BluePreferred-Saver



Waiting                       There is a ten month waiting period for pre-existing conditions.
Periods                       There is no coverage for maternity for the first ten (10) months after the maternity rider is
                              added.

Waiver of                     Waiting period of 10 months will be fully waived with evidence of certificate of creditable
Waiting Period                coverage for 10 or more months. Evidence of creditable coverage that is less than 10
                              months will reduce the waiting period by 1 full month for each full month of creditable
                              coverage.
                              Note: See page Section 1-3, regarding HIPAA Eligibility Requirements for creditable
                              coverage.


Deductibles                   Below are the three deductibles, out-of-pocket maximums and co-insurance options
Out-of-Pocket                 available:
Maximums &
Co-Insurance
(MD)


                                  DEDUCTIBLE                         OUT-OF-POCKET MAXIMUM                          COINSURANCE
                      In-Network          Out-of-Network            In-Network          Out-of- Network          In-            Out-of-
                                                                                                               Network          Network
                      $2,500 ind.           $5,000 ind.            $5,000 ind.            $10,000 ind.            30%             40%
                     $5,000 family         $10,000 family         $10,000 family         $20,000 family
                     $5,000 ind.            $10,000 ind.           $5,000 ind.            $12,500 ind.            0%              20%
                    $10,000 family         $20,000 family         $10,000 family         $22,500 family
                     $10,000 ind.           $12,500 ind.           $10,000 ind.           $15,000 ind.            0%              20%
                    $20,000 family         $25,000 family         $20,000 family         $27,500 family




Preventive                    Includes:
Benefits                      • Unique preventive care package of benefits and services
                              • Routine physicals, mammograms, immunizations and well childcare
                              • Visits to the doctor for adults and children when using Participating
                                  Providers and the customer does not have to satisfy the deductible first.


Vision                        •    BlueVision is core to the product
Benefits                      •    $10 annual routine eye exam and discounts on glasses, contact lenses
                              •    Benefits administered by Davis Vision




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 18
 I. COMMISSIONED PRODUCTS                                                           BluePreferred-Saver



Maternity Benefits            •      Includes Optional Extended Maternity Coverage
                              •      Maternity and prenatal care coverage can be purchased during the initial enrollment for an
                                     additional $126 a month.
                              •      If maternity coverage is added at any time following the member’s initial enrollment, there will
                                     be a 10-month waiting period for maternity benefits.


Prescription                  A prescription drug card is issued separately from the medical card. No outpatient drugs will be
Drug Benefits                 covered under medical for this product.


                              The chart below outlines the benefits of drug benefit design:



                                                   CATEGORY                                                 BENEFIT
                                  Deductible                                              $150 per member

                                  Family Aggregate Deductible Max                         None

                                  Generic Co-pay                                          $15

                                  Preferred Brand Co-pay                                  Discount

                                  Non-Preferred Brand Co-pay                              Discount

                                  Self-Administered Injectable Drugs (including           Discount
                                  insulin, except infertility drugs & agents in MD)* -
                                  both generic & brand
                                  Infertility Drugs and Agents (both generic &                  MD               DC                VA
                                  brand)
                                                                                          50% of Plan       Not Covered       Not Covered
                                                                                          Allowance*
                                  Generic Penalty:                                                         Not applicable
                                  Member pays difference between the cost of
                                  generic and brand name drug when generic is
                                  available
                                  Annual Maximum                                          $1,500 (generic drugs)

                                  Supply Per Co-pay                                       34 Days

                                  Contraceptive Drugs Covered?                            Yes
                              * up to lifetime max for covered infertility services as in certificate


                           Maintenance Drug Co-                       MD                         DC                          VA
                                    pay
                              (90-Day Supply)
                                     Retail                    2X for 35-60 days         2X for 35-60 days           2X for 35-60 days
                                                               3X for 61-90 days         3X for 61-90 days           3X for 61-90 days
                                     Mail Order                2X for 35-60 days         2X for 35-90 days           2X for 35-90 days
                                                               3X for 61-90 days

The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 19
 I. COMMISSIONED PRODUCTS                                                           BluePreferred-Saver



Other Benefits                •    Oral contraceptives are covered.
                              •    In-Vitro Fertilization and Artificial Insemination are not covered in DC or VA.
                              •    Freestanding dental may be purchased separately and is only available in MD & DC.

Benefit Chart                 Below is a benefit chart outlining some of the covered services:



 *If the member uses a provider who does not participate with CareFirst NCA, the member may be balanced billed
above the deductible and coinsurance.



                          Benefit                          Covered                          Member Responsibility
         Well-child care, up to age 18                         X           $30 co-pay in MD (no deductible) No charge in VA
                                                                           or DC
         Mammograms, Pap Test and PSAs                         X           No charge (no deductible)
         (cancer screenings)
         Physician Office Visits                               X           $30 per visit for the first 2 office visits
                                                                           excluding preventive care (no deductible) then,
                                                                           coinsurance and deductible.
         Allergy Shots                                         X           Coinsurance and deductible
         Adult Preventive                                      X           $30 co-pay (no deductible)
         OB/GYN Preventive Care                                X           $30 co-pay (no deductible)
         Emergency Care-                                       X           Deductible and Coinsurance
         Emergency Room
         365 Days Hospitalization per year                     X           Deductible and Coinsurance
         Inpatient Physician Services                          X           Deductible and Coinsurance
         Inpatient/Outpatient Surgery                          X           Deductible and Coinsurance (based on jurisdiction)
         Diagnostic Tests and X-rays                           X           Coinsurance and deductible
         Annual Routine Eye Exam                               X           $10 (administered by Davis Vision)
         Physical Therapy                                      X           $30 per visit for the first 2 office visits excluding
                                                                           preventive care (no deductible) then, coinsurance
                                                                           and deductible.
         Prescription Drugs                                    X           Prescription Drug Card $150 deductible, $15
                                                                           generic co-pay, Discount on brand, $1500 (generic
                                                                           drug) annual maximum per person




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 20
I. COMMISSIONED PRODUCTS                                                            BluePreferred-Saver


Out-of-Area                   To make sure that CareFirst benefit plans travel easily; Blue Cross and Blue Shield plans
Coverage                      throughout the USA have developed a national electronic data delivery system called
                              BlueCard®.

                              BlueCard® advantages:

                              •    Speeds the payment of a member’s claim if treatment is received outside of the
                                   CareFirst service area
                              •    Helps members receive maximum benefits and savings
                              •    No claims have to be filed and the member cannot be billed for charges above the
                                   Plan’s approved amount when a CareFirst member receives care from a provider who
                                   participates with the local BCBS plan



Other Options                 •    HIPAA – option added in VA only (refer to HIPAA Section)




Benefit                       The subscriber may be permitted to increase or decrease the amount of coverage under his or her
Upgrades &                    agreement. If the Subscriber is applying for an increase in coverage, he or she may be required to
                              complete medical questionnaire and/or submit additional information to determine if he or she
Downgrades                    qualifies.




Jurisdictional                See Benefit Chart for details. BluePreferred-Saver has 3 jurisdictions:
Issues
                                   1. MD (available throughout all of Maryland)
                                   2. DC and
                                   3. Northern VA.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 21
I. COMMISSIONED PRODUCTS                                                            BluePreferred-Saver


Who is Not                    •    Applicants who are currently enrolled in a group/FEP with CareFirst.
Eligible?                     •    New applicants who are eligible for and receiving Medicare benefits.
                              •    Existing members who are currently enrolled with our Medigap coverage.



Enrollment                    1. The Subscriber must complete an application, including a medical questionnaire, for
Guidelines                       himself or herself and other eligible family members, if applicable. Based on the
                                 CareFirst’s review of the applicant’s health status, the applicant(s) may be approved
                                 OR disapproved for coverage.

                              2. The enrollment requirements for an eligible newborn child, a newly adopted child or
                                 a newly eligible grandchild depends on the type of coverage that is in effect on the
                                 date of the child’s First Eligibility Date. First Eligibility Date means:

                                   - for a newborn child, the child’s date of birth;
                                   - or a newly adopted child, the earlier of:
                                      - judicial decree of adoption; or
                                       - Date of assumption of custody, pending adoption of a prospective
                                          adoptive child by a proposed adoptive parent.
                                   - for the grandchild the, date of the court decree or the date the court decree
                                   becomes effective, whichever is later.

                              3. Dependent children will be covered automatically as of the child’s First Eligibility
                                 Date.

                               4. If the addition of the child results in a change of Type of Coverage, from Self Only to
                                   two-party, the child’s automatic coverage will end on the 31st day following the
                                   child’s First Eligibility Date. If the Subscriber wishes to continue coverage beyond
                                   this 31day period, he or she must enroll the child within 31 days following the
                                   child’s First Eligibility Date.
                                   - if the Subscriber already has Family Coverage on the child’s First Eligibility Date
                                   the child will be covered automatically as of the child’s First Eligibility Date.

                              5. For enrollments under Court or Administrative Order, coverage begins the date
                                 which the order was signed by a competent court or administrative agency.

                              6. If enrollment is not made within the 31day period, the child is subject to the same
                                 requirements for enrollment as all other new Dependents.

                              7. In the event of the Subscriber’s death:
                                 - Coverage of any Dependents will continue under the Subscriber’s enrollment until
                                 the last day of the month in which the Subscriber’s death occurs.
                                 - The enrolled Spouse or, if there is no Spouse, the covered Dependent Children of
                                 the Subscriber, may purchase a Conversion Contract (see information under Group
                                 Conversion)




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 22
I. COMMISSIONED PRODUCTS                                                            BluePreferred-Saver




Enrollment                    Primary Care Dependent (District of Columbia Applicant Only). To qualify for coverage as
Guidelines                    a Primary Care Dependent, the child must be the Subscriber’s grandchild, niece, or
                              nephew. The child must be under the Subscriber’s “Primary Care”*
continued

                              *Primary Care means that the Subscriber provides food, clothing and shelter for the child
                              on a regular and continuous basis during the time that the District of Columbia public
                              schools are in regular session.

                              The Subscriber must provide CareFirst with proof, upon application, that the child meets
                              the requirements for coverage as a Primary Care Dependent, including proof of the child’s
                              relationship and primary dependency on the Subscriber and certification that the child’s
                              legal guardian does not have other coverage. CareFirst has the right to verify whether the
                              child is and continues to qualify as a Primary Care Dependent.

                              Disabled Dependent -A dependent child who is age 23 or older will be eligible if he or she
                              meet the following:

                              •    The child is incapable of supporting his or her mental or physical incapacity;
                              •    The incapacity occurred before the child reached age 23;
                              •    The child is chiefly dependent on the Subscriber for support and maintenance;

                              AND

                              •    The Subscriber provides CareFirst with proof of the child’s incapacity, including
                                   certification by a physician

                              Children whose relationship to the Subscriber is not listed above, including grandchildren
                              (except as provided above) foster children or children whose relationship is one of legal
                              guardianship are not covered under the Individual Enrollment Agreement. Even if the child
                              lives with the Subscriber and is dependent upon the Subscriber for support.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 23
I. COMMISSIONED PRODUCTS                                                            BluePreferred-Saver



Medical                       Medical Underwriting is a systematic process that insurers use to collect information
Underwriting                  about a health insurance applicant. Based on the medical information collected, an
                              insurer can accept or deny certain applicants for coverage, issue a counter-offer or deny
                              coverage completely for all applicants.

                              Medical Underwriting is used to help keep insurance affordable to everyone.
                              CareFirst uses medical information provided on the application, information provided by
                              the applicant’s health care providers (doctors, other healthcare providers and labs) and
                              a review of claims history.

                              Generally, this process can take 4 – 6 weeks.

                              The underwriting process and results are listed below:


                                                          Process - The underwriting process for
                                                              new applications is as follows:
                                      STEP       ACTION
                                         1.      Application is submitted to CareFirst.

                                         2.      Underwriter may request additional medical information, based
                                                 on the information on the application and the applicant’s CareFirst
                                                 claim’s history.

                                         3.      Upon receipt of the medical information, a decision is reached
                                                 about whether or not to accept the application for health coverage.


                                                      Results - The underwriting process can result
                                                                 in one of the following:
                                      RESULT – Application for coverage is…

                                       • Accepted or
                                       • Denied or
                                       • Accepted excluding certain individuals or
                                       • Counter-offered with a higher premium rate.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 24
I. COMMISSIONED PRODUCTS                                                                 BluePreferred-Saver



Medical                          • Medical Underwriting results can vary depending on the severity of conditions
Underwriting                     • Shown below is a sample of decision results

Sample
Decision
Results



         ICD 9      Diagnosis                    Criteria                                                Decision
         401-4019   Hypertension, essential      If essential and well controlled                        Approve


                                                 If not well controlled (readings between 140/90 and
         401-4019   Hypertension, essential      160/100) or on 2 medications                            Approve


                                                 If not well controlled (readings over 160/100) or on
         401-4020   Hypertension, essential      more than 2 medications                                 Approve with 25% Rate Increase
         402-4029   Hypertensive heart disease   If well controlled                                      Approve
         402-4029   Hypertensive heart disease   If not well controlled                                  Decline
         403-4039   Hypertensive renal disease                                                           Decline

         278-2780   Overweight                   Based upon BMI of 25-29.9                               Approve
         278-2780   Obesity                      Based upon BMI of 30-35                                 Approve with 25% Rate Increase
         278-2780   Morbid Obesity               Based upon BMI of over 35                               Decline




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 25
I. COMMISSIONED PRODUCTS                                                            BluePreferred-Saver


Medical                       All decisions regarding acceptance, counter offer or rejection of an application are made
Underwriting                  in Central Medical Review.
Guidelines
                              All medical conditions are closely reviewed and a decision is based on the history and
                              treatment of given conditions.

                              Maryland applicants, who receive either an exclusion or a denial, or have any of the
                              conditions listed on the next page may be eligible for health coverage under the Maryland
                              Health Insurance Plan (MHIP). MHIP is a high-risk pool for Maryland residents who are
                              medically uninsurable. Applicants will not be eligible for MHIP if they are eligible for any of
                              the following coverages:


                              1.        Medicare;
                              2.        Maryland Medical Assistance;
                              3.        Maryland Children’s Health Program; or
                              4.      An employer sponsored health plan that provides benefits comparable to MHIP,
                              unless you are considered an eligible individual under the Trade Act of 2002. Eligible
                              individuals under the Trade Act of 2002 include individuals who qualify for a tax credit
                              under §35 of the Internal Revenue Code. Generally, this includes displaced workers
                              harmed by foreign trade and retirees receiving payments from the Pension Benefit
                              Guaranty Corporation.


                              MHIP also offers products to Maryland resident individuals and their dependents that
                              meet HIPAA eligibility criteria. You may obtain information regarding MHIP from the
                              Maryland Health Insurance Plan:


                                                                  Maryland Health Insurance Plan
                                                                             P.O. Box 47160
                                                                     Baltimore, MD 21244-7160
                                                                              866-780-7105


                              Information regarding MHIP also may be obtained from the website at
                              www.marylandhealthinsuranceplan.state.md.us.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 26
I. COMMISSIONED PRODUCTS                                                            BluePreferred-Saver



MHIP                          Maryland applicants with any of the conditions listed below may be eligible for health
Conditions for                coverage under the Maryland Health Insurance Plan (MHIP).
Eligibility

                              Behavioral Health (Psychiatric)
                              Bipolar Disorder, Chemical Dependency, Dementia, Psychotic Disorders

                              Blood/Blood Forming
                              Aplastic Anemia, Hemocromatosis, Hemophilia, Sickle Cell Disease

                              Cardiovascular
                              Angina Pectoris, Cardiomyopathy, Congestive Heart Failure, Coronary Artery Disease, Coronary
                              Insufficiency, Coronary Occlusion

                              Endocrine (Hormonal)
                              Addison’s Disease, Cystic Fibrosis, Diabetes (Type I and II), Porphyria, Wilson’s Disease

                              Gastrointestinal
                              Ascites, Banti’s Disease or Syndrome, Cirrhosis of the Liver, Crohn’s Disease, Esophageal Varicies,
                              Hepatitis B & C, Ulcerative Colitis

                              Infectious
                              AIDS, HIV Positivity

                              Musculoskeletal/Connective
                              Ankylosing Spondylitis, Lupus Erythematosus Disseminate, Rheumatoid Arthritis, Scleroderma

                              Pulmonary (Lung)
                              Chronic Obstructive Pulmonary Disease, Emphysema

                              Neoplasm (Cancers)
                              Cancer (except skin cancer) treated or diagnosed within the past 5 years, Hodgkin’s Disease,
                              Leukemia, Multiple Myeloma, Non-Hodgkin’s Lymphoma, Wilm’s Tumor

                              Neurologic
                              Alzheimer’s Disease, Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease), Friederich’s Ataxia,
                              Guillain Barre Syndrome, Huntington’s Disease, Hydrocephalus, Multiple Sclerosis, Muscular
                              Dystrophy, Myasthenia Gravis, Myotonia, Palsy, Paraplegia, Parkinson’s Disease, Quadraplegia,
                              Stroke, Tay-Sachs Disease

                              Other:
                              Kidney Disease requiring Dialysis, Major Organ Transplant, Pregnancy




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 27
I. COMMISSIONED PRODUCTS                                                            BluePreferred-Saver



Rating Up                     Depending on the level of severity of certain conditions within the past seven years may
                              result in the counter-offer of a rated-up premium rate by 25% or 50%. If a rated-up
                              coverage is offered, the customer will receive a letter indicating the increase in the
                              premium and a counteroffer form which will need to be signed and returned to
                              CareFirst.




Exclusionary                  An Exclusionary Amendment is a legal document that may be added to a medically
Amendments                    underwritten policy to exclude a family member from health care coverage.


                              Excluded Family Member
                              A family member may be excluded from the policy if his or her medical risk is
                              determined to be too great. An Exclusionary Amendment is added to the contract and
                              the individual is not covered.




How the Plan                  Shown below is how the plan works in-network and out-of-network.
Works
                                             IN-NETWORK                                          OUT-OF-NETWORK
                                                                  Member chooses deductible level

                                                                    Member meets deductible
                                                       The deductible is part of the out-of-pocket maximum.
                                                    The Family deductible is two times the individual deductible.

                              • The plan pays 70% or 100% (depending on                • The plan pays 60% or 80% (depending on
                                  deductible) of the allowed benefit                       deductible) of the allowed benefit

                                                                  • Member pays the co-insurance

                                                             • Member meets out-of-pocket maximum

                                                       BluePreferred-Saver pays 100% of the allowed benefit
                                              for the remainder of the year. Benefits are based on a calendar year.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 28
I. COMMISSIONED PRODUCTS                                                            BluePreferred-Saver



Rate Increases                •    DC – 30 day rate change notice is required
                              •    VA – 30 day or 60 day rate change notice for increases over 35%
                              •    MD – 30 day rate change notice required



Payment                       •    Blue Preferred is billed monthly only
Options



Termination of                •    The Subscriber may terminate the coverage of an eligible member, at any time, by
Insured’s                          written request to CareFirst to either change his or her type of coverage to an
Coverage                           Individual or non-Family type of coverage; or remove an eligible dependent from his
                                   or her coverage.
                              •    All Unmarried Dependent Children are eligible up to age 23
                              •    In case of the death of the policyholder: Coverage of any Dependents will continue
                                   under the Subscriber’s enrollment until the last day of the month in which the
                                   Subscriber’s death occurs.
                              •    Coverage ends on the last day of the month in which eligibility terminates.
                              •    A Subscriber will no longer be eligible for coverage if he or she dies.

                              •


Provider                      Preferred Providers
Networks                      For services and supplies provided by Preferred Providers, the benefit payments are
                              based on Preferred Provider Allowances.

                              Participating Providers
                              For services and supplies provided by Participating Providers, the Plan Allowance is
                              based on Preferred Provider Allowances. Participating Providers may bill you for the
                              difference between the Preferred Provider Allowance and the Participating Provider
                              Allowance.

                              Non-Participating Providers
                              When you use a Non-Participating Provider, the Plan Allowance is based on the
                              Participating Provider Allowances. Non-Participating Providers may bill you for any
                              balance above the Plan Allowance.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 29
I. COMMISSIONED PRODUCTS                                               BluePreferred HSA

Overview                      •    Launched 2/1/06 for a 3/1/06 and later effective dates
                              •    Product is a high deductible PPO product that contains an integrated medical
                                   and prescription deductible, out of pocket maximum and lifetime maximum.
                              •    New and existing members may apply for this product
                              •    Existing members must complete a new BluePreferred HSA application
                                   subject to the existing medical underwriting process


Bancorp Bank                  •    Carefirst has partnered with The Bancorp Bank (other financial institutions that
Partner                            offer HSAs may be selected also).
                              •    The Bancorp Bank offers BluePreferred HSA account holders a range of
                                   financial investment options once account balance reaches $2,500.
                              •    Money may be used to pay smaller medical expenses, including deductible
                                   and co-payments.
                              •    Competitive interest rate is earned the moment the account is opened
                              •    Members in the BluePreferred HSA are not required to “use it or lose it” as with
                                   flexible spending accounts.
                              •    All money contributed is tax-deductible, all earnings on the money are tax free,
                                   and all deductions for qualified medical expenses are tax free.
                              •    Bancorp Bank will automatically send an Enrollment Kit and application when
                                   BluePreferred HSA application is processed (unless otherwise indicated).
                              •    Call Center Support – 866-435-1373
                              •    Online – www.myhsabankaccount.com
                              •    Customer Service – 800-377-5548

Key Selling                   •    Competitive rates
Features                      •    Provides preventive care for adults and children with no deductible
                              •    Up to $3,000,000 of lifetime benefits per member
                              •    Freedom to choose any doctor in the PPO network
                              •    No balance billing when members visit preferred providers
                                   (see Provider Information section for explanation)
                              •    Little, if any, paperwork if a preferred or participating provider is used
                              •    Prescription drug benefits
                              •    Maternity benefit rider
                              •    Vision benefit rider
                              •    Discounts on a variety of alternative therapies and wellness services through
                                   the Options Discount Program.
                              •    Easy access to benefits while traveling, through the BlueCard® program
                              •    Child-only rates available (age1-17), but individuals under 18 are not eligible to
                                   open a bank account.

Calendar or                   •    Calendar Year
Contract Year




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 30
I. COMMISSIONED PRODUCTS                                               BluePreferred HSA


Membership                    Four-tier rate structure:
Types                                        Individual (Age 1-64) (Applicants 65 and over must not be eligible for
                                             Medicare benefits and must submit, with their application, a letter
                                             indicating such from the Social Security Administration.)
                                             Individual & Child(ren)
                                             Individual & Adult
                                             Family


                              •    Applicant may choose any membership type regardless of marital status.
                              •    Rates for multiple member policies are determined based on the age of the
                                   oldest person listed on the application.
                              •    Applicants over 64 may apply if not eligible for Medicare.


Membership                    Enrollment of other new dependents (other than a newborn, newly adopted child or
Type                          newly eligible grandchild):
Changes                       •    The member must submit an enrollment information form, including a medical
                                   questionnaire. Based on our review of applicant’s health status, applicant may
                                   be approved or disapproved for coverage.
                              •    Enrollment will be effective on the first day of month following the month in
                                   which CareFirst:
                                   a. gives final approval to the application
                                   b. receives the premium payments and
                                   c. receives and approves all requested and completed forms and information

                              Coverage of a Newborn child, newly adopted child or newly eligible grandchild:
                              •    Enrollment requirements for an eligible newborn child, newly adopted child, or
                                   newly eligible grandchild depend on the type of coverage that is in effect on
                                   the date of the child’s first eligibility date.
                              •    If member already has family coverage on the child’s first eligibility date, an
                                   eligible newborn child, newly adopted child or newly eligible grandchild will be
                                   covered automatically as of the child’s first eligibility date.

Effective Date                •    Enrollment will be effective on the first day of the month following the month in
                                   which the CareFirst gives final approval to the application.

Waiting Periods               •    There is a ten month waiting period for pre-existing conditions.
                                   There is no coverage for maternity for the first ten (10) months after the
                                   maternity rider is added.)

Waiver of                     •    Subject to jurisdiction. Requirements may vary.
Waiting Period
                              Note: See page 1-3, Waiver of Waiting Period.
                              Please contact your Broker Representative for additional information.


The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 31
I. COMMISSIONED PRODUCTS                                               BluePreferred HSA


Deductibles                   Below are the two deductibles, out-of-pocket maximums and co-insurance levels for
Out-of-Pocket                 individual coverage for MD, DC, and VA residents.
Maximums &
                                      DEDUCTIBLE                        OUT OF POCKET                     COVERAGE LEVEL
Co-Insurance                                                              MAXIMUM
                               In-Network         Out-of-          In-Network         Out-of-         In-Network         Out-of-
                                                  Network                             Network                            Network

                                  $1,200           $2,400            $2,800            $5,000             80%               60%

                                  $2,700           $5,400            $3,200            $6,400            100%               80%




Preventive                    Includes:
Benefits                      • Routine physicals, mammograms, immunizations and well childcare
                              • Visits to the doctor for adults and children when using Participating
                                  Providers and the customer does not have to satisfy the deductible first


Maternity                     •    Includes Optional Maternity and Prenatal Coverage.
Benefits                      •    Maternity and prenatal care coverage can be purchased during the initial
                                   enrollment for an additional $126 a month.
                              •    If maternity coverage is added at any time, there will be a 10-month waiting
                                   period for maternity benefits.
                              •    There is a $3,000 benefit limit in DC.


Other                         •    Oral contraceptives are covered.
Benefits                      •    In-Vitro Fertilization and Artificial Insemination are not covered in DC or VA.
                              •    Dental may be purchased separately. Only available in MD or DC.
                              •    Vision may be purchased separately in MD, DC, or VA.
                              •    Freestanding dental may be purchased separately and is only available in MD
                                   & DC.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 32
 I. COMMISSIONED PRODUCTS                                              BluePreferred HSA


Prescription Drug                 A prescription drug card is issued separately from the medical card.
Benefits –
3 Tier                            The chart below outlines the benefits of the 3-tier drug benefit design:




                             CATEGORY                                                    BENEFIT
                   Deductible                                                Combined with medical deductible

                   Family Aggregate Deductible                Yes - Combined with medical deductible; there is no individual
                   Max                                        deductible to satisfy; any member on the policy may meet the
                                                             family deductible and benefits will be paid for the entire family.
                   Tier 1 Generic Co-pay                                                   $10

                   Tier 2 Preferred Brand Co---pay                                            $25

                   Tier 3 Non-Preferred Brand Co--                                            $45
                   pay
                   Self-Injectable Drugs (including                      50% Coinsurance up to a $75 maximum
                   insulin, except infertility drugs &
                   agents in MD)*
                   Infertility Drugs and Agents                       MD                         DC                      VA
                                                                 50% of Plan               Not Covered              Not Covered
                                                                  Allowance
                                                                up to lifetime
                                                            maximum for covered
                                                            infertility services as
                                                                 in certificate
                   Generic Penalty:                                                         Applies
                   Member pays difference between
                   the cost of generic and brand
                   name drug when generic is
                   available
                   Supply Per Co-pay                                                       30 Days

                   Contraceptive Drugs Covered?                                               Yes
                   Maintenance Drug Co-pay –                          MD                         DC                      VA
                   90 day supply
                       Retail                                                         2X for 31 – 60 days
                                                                                      3X for 61 – 90 days
                        Mail Order                         2X for 31 – 60 days          2X for 31 – 90 days      2X for 31 – 90
                                                           3X for 61 – 90 days                                   days




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 33
 I. COMMISSIONED PRODUCTS                                              BluePreferred HSA



Benefit Chart                 Below is the BluePreferred HSA benefit chart for the Individual Market.




                                               Benefit                        Covered             Member Responsibility
                                                                                                     (In-Network)
                              Well-Child care, up to age 18                       X          $0 co-pay, no deductible – DC & VA
                                                                                               $30 co-pay, no deductible – MD


                              Mammograms, Pap Tests and PSAs                      X                $0 co-pay, no deductible
                              (cancer screenings)

                              Physician Office Visits                             X              $30 co-pay, after deductible


                              Allergy Shots                                       X              Coinsurance after deductible


                              Adult Preventive Physical Exams                     X                $30 co-pay, no deductible


                              OB/GYN Preventive Care                              X                $30 co-pay, no deductible


                              Emergency Care – Emergency Room                     X              Coinsurance after deductible

                              365 Days Hospitalization per year                   X              Coinsurance after deductible

                              Inpatient Physician Services                        X              Coinsurance after deductible

                              Inpatient/Outpatient Surgery                        X              Coinsurance after deductible

                              Diagnostic Tests and X-rays                         X              Coinsurance after deductible

                              Physical Therapy                                    X              Coinsurance after deductible

                              Radiation and Chemotherapy                          X              Coinsurance after deductible

                              Prescription Drugs*                                 X          Deductible – combined with medical
                                                                                                     $10 generic co-pay
                                                                                                $25 Preferred Brand co-pay
                                                                                              $45 Non-Preferred Brand co-pay

                              * Generic drugs must be chosen when available or an additional expense will be incurred. Self-
                              injectable drugs are covered at a 50% coinsurance up to a maximum. Member payment of $75 per
                              covered injectable medication and are subject to the annual benefit maximum.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 34
I. COMMISSIONED PRODUCTS                                               BluePreferred HSA



Out-of-Area                   To make sure that CareFirst benefit plans travel easily; Blue Cross and Blue
Coverage                      Shield plans throughout the USA have developed a national electronic data
                              delivery system called BlueCard®.

                              BlueCard® advantages:

                              •    Speeds the payment of a member’s claim if treatment is received outside of
                                   the CareFirst service area
                              •    Helps members receive maximum benefits and savings
                              •    No claims have to be filed and the member cannot be billed for charges
                                   above the Plan’s approved amount when a CareFirst member receives care
                                   from a provider who participates with the local BCBS plan

Standard                      See Deductible and Co-Insurance Section
Option(s)

Other Options                 •    HIPAA - See HIPAA section of manual.

                              •    Open Enrollment (Virginia and DC) - See BluePreferred Open Enrollment
                                   section

                              •    Group Conversion (Maryland) - See Group Conversion section of manual

                              •    Group Conversion (Virginia and DC) - See Group Conversion section of
                                   manual

Benefit                       The subscriber may be permitted to increase or decrease the amount of coverage
Upgrades &                    under his or her agreement. If the Subscriber is applying for an increase in
Downgrades                    coverage, he or she may be required to complete medical questionnaire and/or
                              submit additional information to determine if he or she qualifies.


                              For more information, the Subscriber should contact CareFirst at the following
                              address:

                                                   CareFirst BlueCross BlueShield
                                                   550 12th Street, S.W.
                                                   Washington, D.C. 20065



Jurisdictional                BluePreferred HSA has 3 jurisdictions:
Issues                            1. MD
                                  2. DC and
                                  3. Northern VA.

                              See Benefit Chart for details.


The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 35
 I. COMMISSIONED PRODUCTS                                              BluePreferred HSA


Eligibility &                 Many factors determine participant eligibility when enrolling for coverage. These
Enrollment                    factors may be mandated by State law or required by CareFirst.

                              The specific requirements are found in the direct pay contract.

Who is Eligible?              •    Applicant must be a Maryland, D.C. or Virginia resident in the CareFirst service
                                   area (i.e., a MD resident can only apply for a MD plan)
                              •    Applicant must be between the ages of 1-64 and not eligible for Medicare
                                   benefits.
                              •    Applicant must be in reasonably good health

                              To be covered, the applicant must meet all of the following conditions:

                              The applicant must be eligible for coverage either as a Subscriber, as a Spouse or
                              as a Dependent Child. The applicant must apply for coverage by submitting an
                              Enrollment Information Form (Application) to CareFirst AND CareFirst must receive
                              premium payments.

                              •    Subscriber
                                   - under the age of 65;
                                   - over the age of 65 and not receiving Medicare benefits; OR
                                   - eligible for Medicare, but have a Dependent Child or children who are eligible
                                   under a family contract.
                                   - resident of Maryland, the District of Columbia or (i) Arlington County, the City
                                   of Alexandria, the City of Fairfax and the Town of Vienna, Virginia; (ii) the part
                                   of Fairfax County lying within State Route 123 to the West and the Potomac
                                   River to the East; or (iii) the part of Prince William County lying within and to the
                                   North of State Route 123, Virginia.
                              •    Anyone not enrolled under nor eligible for coverage by CareFirst in an existing
                                   group
                              •    Spouse
                              •    Dependent Children -To be covered as a Dependent Child, the child must be
                                   unmarried and under the age of 23; AND
                                   Related to the Subscriber in one of the following ways:
                                   - the Subscriber’s natural child;
                                   - the Subscriber’s legally adopted child or grandchild;
                                   - a child (including a grandchild) for whom the Subscriber is the legally
                                   recognized proposed adoptive parent and who is dependent upon and living
                                   with the Subscriber during the waiting period before the adoption becomes final;
                                   - a stepchild who permanently resides in the Subscriber’s household
                                   - a grandchild who is in the court ordered custody of and is dependent upon and
                                   residing with the Subscriber;
                                   - a child for whom the Subscriber has been court ordered or administratively
                                   ordered to provide coverage would otherwise terminate or within 31 days after
                                   the effective date of the child’s coverage under the Agreement, whichever is
                                   later.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 36
I. COMMISSIONED PRODUCTS                                               BluePreferred HSA


Who is Not                    •    Applicants who are currently enrolled in a group/FEP with CareFirst.
Eligible?                     •    New applicants who are eligible for and receiving Medicare benefits.
                              •    Existing members who are currently enrolled with our MediGap coverage.



Enrollment                    •    The Subscriber must complete an Enrollment Information Form (Application),
Guidelines                         including a medical questionnaire, for himself or herself and other eligible family
                                   members, if applicable. Based on the CareFirst’s review of the applicant’s health
                                   status, the applicant(s) may be approved OR disapproved for coverage.

                              •    The enrollment requirements for an eligible newborn child, a newly adopted child or a
                                   newly eligible grandchild depends on the type of coverage that is in effect on the date
                                   of the child’s First Eligibility Date. First Eligibility Date means:

                                   - for a newborn child, the child’s date of birth;
                                   - or a newly adopted child, the earlier of:
                                      - judicial decree of adoption; or
                              •    - Date of assumption of custody, pending adoption of a prospective
                                          adoptive child by a proposed adoptive parent.
                                   - for the grandchild the, date of the court decree or the date the court decree
                                   becomes effective, whichever is later.

                              •    Dependent children will be covered automatically as of the child’s First Eligibility Date.

                              •    If the addition of the child results in a change of Type of Coverage, from Self Only to
                                   two-party, the child’s automatic coverage will end on the 31st day following the child’s
                                   First Eligibility Date. If the Subscriber wishes to continue coverage beyond this 31day
                                   period, he or she must enroll the child within 31 days following the child’s First
                                   Eligibility Date.
                                   - if the Subscriber already has Family Coverage on the child’s First Eligibility Date the
                                   child will be covered automatically as of the child’s First Eligibility Date.

                              •    For enrollments under Court or Administrative Order, coverage begins the date which
                                   the order was signed by a competent court or administrative agency.

                              •    If enrollment is not made within the 31day period, the child is subject to the same
                                   requirements for enrollment as all other new Dependents.

                              •    In the event of the Subscriber’s death:
                                   - Coverage of any Dependents will continue under the Subscriber’s enrollment until
                                   the last day of the month in which the Subscriber’s death occurs.
                                   - The enrolled spouse or, if there is no spouse, the covered Dependent Children of
                                   the Subscriber, may purchase a Conversion Contract (see information under Group
                                   Conversion)

                                                                                                                        Continued




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 37
I. COMMISSIONED PRODUCTS                                               BluePreferred HSA




Enrollment                    Primary Care Dependent (District of Columbia Applicant Only). To qualify for
Guidelines                    coverage as a Primary Care Dependent, the child must be the Subscriber’s
                              grandchild, niece, or nephew. The child must be under the Subscriber’s “Primary
continued                     Care”*


                              *Primary Care means that the Subscriber provides food, clothing and shelter for
                              the child on a regular and continuous basis during the time that the District of
                              Columbia public schools are in regular session.

                              The Subscriber must provide CareFirst with proof, upon application, that the child
                              meets the requirements for coverage as a Primary Care Dependent, including
                              proof of the child’s relationship and primary dependency on the Subscriber and
                              certification that the child’s legal guardian does not have other coverage.
                              CareFirst has the right to verify whether the child is and continues to qualify as a
                              Primary Care Dependent.


                              Disabled Dependent -A dependent child who is age 23 or older will be eligible if
                              he or she meet the following:

                              •    The child is incapable of supporting himself or herself due to a mental or
                                   physical incapacity;
                              •    The incapacity occurred before the child reached age 23;
                              •    The child is chiefly dependent on the Subscriber for support and
                                   maintenance;

                              AND

                              •    The Subscriber provides CareFirst with proof of the child’s incapacity,
                                   including certification by a physician

                              Children whose relationship to the Subscriber is not listed above, including
                              grandchildren (except as provided above) foster children or children whose
                              relationship is one of legal guardianship are not covered under the Individual
                              Enrollment Agreement. Even if the child lives with the Subscriber and is
                              dependent upon the Subscriber for support.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 38
I. COMMISSIONED PRODUCTS                                               BluePreferred HSA



Medical                       Medical Underwriting is a systematic process that insurers use to collect
Underwriting                  information about a health insurance applicant. Based on the medical information
                              collected, an insurer can accept or deny certain applicants for coverage, issue a
                              counter-offer or deny coverage completely for all applicants.

                              Medical Underwriting is used to help keep insurance affordable to everyone.
                              CareFirst uses medical information provided on the application, information
                              provided by the applicant’s health care providers (doctors, other healthcare
                              providers and labs) and a review of claims history.

                                   •    The oldest applicant will be the policyholder at the time of initial
                                        enrollment.
                                   •    Generally, this process takes 4 – 6 weeks.


                              The underwriting process and results are listed below:




                                                       The Process - The underwriting process for
                                                             new applications is as follows:
                                       STEP      ACTION

                                         1.      Application is submitted to CareFirst.

                                         2.      Underwriter may request additional medical information, based
                                                 on the information on the application and the applicant’s CareFirst
                                                 claim’s history.

                                         3.      Upon receipt of the medical information, a decision is reached
                                                 about whether or not to accept the application for health coverage.




                                               The Results - The underwriting process can result
                                                            in one of the following:
                                       RESULT – Application for coverage is…

                                       • Accepted or
                                       • Denied.
                                       • Accepted excluding certain individuals or
                                       • Countered-offered with a higher premium rate.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 39
I. COMMISSIONED PRODUCTS                                                        BluePreferred HSA



Medical                          • Medical Underwriting results can vary depending on the severity of conditions
Underwriting                     • Shown below is a sample of decision results

Sample
Decision
Results




     ICD 9      Diagnosis                    Criteria                                                Decision
     401-4019   Hypertension, essential      If essential and well controlled                        Approve


                                             If not well controlled (readings between 140/90 and
     401-4019   Hypertension, essential      160/100) or on 2 medications                            Approve


                                             If not well controlled (readings over 160/100) or on
     401-4020   Hypertension, essential      more than 2 medications                                 Approve with 25% Rate Increase
     402-4029   Hypertensive heart disease   If well controlled                                      Approve
     402-4029   Hypertensive heart disease   If not well controlled                                  Decline
     403-4039   Hypertensive renal disease                                                           Decline

     278-2780   Overweight                   Based upon BMI of 25-29.9                               Approve
     278-2780   Obesity                      Based upon BMI of 30-35                                 Approve with 25% Rate Increase
     278-2780   Morbid Obesity               Based upon BMI of over 35                               Decline




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 40
I. COMMISSIONED PRODUCTS                                                  BluePreferred HSA


Medical                       All decisions regarding acceptance, counter offer or rejection of an application are
Underwriting                  made in Central Medical Review.
Guidelines
                              All medical conditions are closely reviewed and a decision is based on the history and
                              treatment of given conditions.

                              Maryland applicants, who receive either an exclusion or a denial, or have any of the
                              conditions listed on the next page may be eligible for health coverage under the
                              Maryland Health Insurance Plan (MHIP). MHIP is a high-risk pool for Maryland
                              residents who are medically uninsurable. Applicants will not be eligible for MHIP if
                              they are eligible for any of the following coverages:


                              1. Medicare;
                              2. Maryland Medical Assistance;
                              3. Maryland Children’s Health Program; or
                              4. An employer sponsored health plan that provides benefits comparable to MHIP,
                              unless you are considered an eligible individual under the Trade Act of 2002. Eligible
                              individuals under the Trade Act of 2002 include individuals who qualify for a tax credit
                              under §35 of the Internal Revenue Code. Generally, this includes displaced workers
                              harmed by foreign trade and retirees receiving payments from the Pension Benefit
                              Guaranty Corporation.


                              MHIP also offers products to Maryland resident individuals and their dependents that
                              meet HIPAA eligibility criteria. You may obtain information regarding MHIP from the
                              Maryland Health Insurance Plan:


                                                                Maryland Health Insurance Plan
                                                                          P.O. Box 47160
                                                                   Baltimore, MD 21244-7160
                                                                           866-780-7105


                              Information regarding MHIP also may be obtained from the website at
                              www.marylandhealthinsuranceplan.state.md.us.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 41
I. COMMISSIONED PRODUCTS                                                    BluePreferred HSA



MHIP                          Maryland applicants with any of the conditions listed below may be eligible for
                              health coverage under the Maryland Health Insurance Plan (MHIP).
Conditions for
Eligibility

                              Behavioral Health (Psychiatric)
                              Bipolar Disorder, Chemical Dependency, Dementia, Psychotic Disorders

                              Blood/Blood Forming
                              Aplastic Anemia, Hemocromatosis, Hemophilia, Sickle Cell Disease

                              Cardiovascular
                              Angina Pectoris, Cardiomyopathy, Congestive Heart Failure, Coronary Artery Disease,
                              Coronary Insufficiency, Coronary Occlusion

                              Endocrine (Hormonal)
                              Addison’s Disease, Cystic Fibrosis, Diabetes (Type I and II), Porphyria, Wilson’s Disease

                              Gastrointestinal
                              Ascites, Banti’s Disease or Syndrome, Cirrhosis of the Liver, Crohn’s Disease, Esophageal
                              Varicies, Hepatitis B & C, Ulcerative Colitis

                              Infectious
                              AIDS, HIV Positivity

                              Musculoskeletal/Connective
                              Ankylosing Spondylitis, Lupus Erythematosus Disseminate, Rheumatoid Arthritis,
                              Scleroderma

                              Pulmonary (Lung)
                              Chronic Obstructive Pulmonary Disease, Emphysema

                              Neoplasm (Cancers)
                              Cancer (except skin cancer) treated or diagnosed within the past 5 years, Hodgkin’s Disease,
                              Leukemia, Multiple Myeloma, Non-Hodgkin’s Lymphoma, Wilm’s Tumor

                              Neurologic
                              Alzheimer’s Disease, Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease), Friederich’s
                              Ataxia, Guillain Barre Syndrome, Huntington’s Disease, Hydrocephalus, Multiple Sclerosis,
                              Muscular Dystrophy, Myasthenia Gravis, Myotonia, Palsy, Paraplegia, Parkinson’s Disease,
                              Quadraplegia, Stroke, Tay-Sachs Disease

                              Other:
                              Kidney Disease requiring Dialysis, Major Organ Transplant, Pregnancy




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 42
I. COMMISSIONED PRODUCTS                                               BluePreferred HSA


Rating Up                     Depending on the level of severity of certain conditions within the past five years
                              may result in the counter-offer of a rated-up premium rate by 25% or 50%. If a
                              rated-up coverage is offered, the customer will receive a letter indicating the
                              increase in the premium and a counteroffer form which will need to be signed and
                              returned to Carefirst.

Exclusionary                  An Exclusionary Amendment is a legal document that may be added to a
Amendments                    medically underwritten policy to exclude a family member from health care
                              coverage.


                              Excluded Family Member
                              A family member may be excluded from the policy if his or her medical risk is
                              determined to be too great. An Exclusionary Amendment is added to the contract
                              and the individual is not covered.

How the                       Shown below is how the plan works in-network and out-of-network:
Plan Works



                                                  IN-NETWORK                                     OUT-OF-NETWORK

                                                              Member chooses deductible level

                                                             Member meets deductible
                                               The deductible is part of the out-of-pocket maximum.
                                      The Family deductible must be met before claims are paid. There is no
                                  individual deductible and any member of the family may meet the deductible to
                                                       have benefits paid for the entire family.

                                       •    The plan pays 80% or 100%                     •    The plan pays 60% or 80%
                                            (depending on deductible)                          (depending on deductible)
                                              of the allowed benefit                             of the allowed benefit

                                                             •    Member pays the co-insurance

                                                        •    Member meets out-of-pocket maximum

                                                  BluePreferred HSA pays 100% of the allowed benefit
                                                             for the remainder of the year.
                                                        Benefits are based on a calendar year.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 43
I. COMMISSIONED PRODUCTS                                               BluePreferred HSA



Rate                          •    30 day rate change notice is required for DC residence.
Increases                     •    30 day rate change notice is required for MD residence.
                              •    30-60 day rate change notice is required for VA residence.



Payment                       •    Blue Preferred HSA is billed monthly or subscriber may elect Automatic Debit
Options                            to have monthly premium withdrawn from checking account



Termination of                •    The Subscriber may terminate the coverage of an eligible member, at any
Insured’s                          time, by written request to CareFirst to either change his or her type of
Coverage                           coverage to an Individual or non-Family type of coverage; or remove an
                                   eligible dependent from his or her coverage.
                              •    All Unmarried Dependent Children are eligible up to age 23
                              •    In case of the death of the policyholder: Coverage of any Dependents will
                                   continue under the Subscriber’s enrollment until the last day of the month in
                                   which the Subscriber’s death occurs.
                              •    Coverage ends on the last day of the month in which eligibility terminates.
                              •    A Subscriber will no longer be eligible for coverage if he or she dies



Provider                      Preferred Providers
Networks                      For services and supplies provided by Preferred Providers, the benefit payments
                              are based on Preferred Provider Allowances.

                              Participating Providers
                              For services and supplies provided by Participating Providers, the Plan Allowance
                              is based on Preferred Provider Allowances. Participating Providers may bill you
                              for the difference between the Preferred Provider Allowance and the Participating
                              Provider Allowance.

                              Non-Participating Providers
                              When you use a Non-Participating Provider, the Plan Allowance is based on the
                              Participating Provider Allowances. Non-Participating Providers may bill you for
                              any balance above the Plan Allowance.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 44
I. COMMISSIONED PRODUCTS                                    BluePreferred–DC–Open Enrollment



Overview                       •     Offered all year
                               •     BluePreferred Open Enrollment is offered without medical underwriting.
                               •     No maternity benefit available



Eligibility                    •     Applicant must be a resident in the District of Columbia
Requirements                   •     Applicant cannot be eligible for Medicare benefits.
                               •     Dependents must be under the age of 23 years old.



Membership Types               •     There is a four tier rate structure:
                                     • Individual
                                     • Individual & Child(ren)
                                     • Individual & Adult
                                     • Family



Effective Date                 •     Coverage is made effective on the first of the month following the date of
                                     acceptance of the policy.



Waiting Period                 •     There is NO waiting period for pre-existing conditions.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                         2- 45
I. COMMISSIONED PRODUCTS                                                           BlueChoice



Overview                        •    Offers HMO coverage designed for individuals and their families who
                                     are seeking affordable, comprehensive health coverage without sacrificing quality
                                     care.
                                •    Choice of three co-payment levels for a Primary Care Physician (PCP)
                                     office visit: $10, $15 or $20.
                                •    All options offer coverage for hospitalization, medical/surgical services, preventive
                                     care, prescription drugs, maternity and emergency services.



Key Selling                     •    Available to individuals and families without employer-sponsored coverage
Features                        •    Regional provider network
                                •    Choice of three plan options
                                •    Low monthly premiums, small co-payments and few deductibles
                                •    No claim forms
                                •    Preventive services, including well-child care
                                •    Discounts on a variety of alternative therapies and wellness services through the
                                     Options Discount Program
                                •    Routine office visits with predictable co-pays
                                •    Medical and surgical services
                                •    365 days of hospitalization per year (after deductible) for one facility co-pay per
                                     admission
                                •    Mental illness and substance abuse benefits
                                •    Maternity care
                                     MD – core;
                                     DC only – optional for medically underwritten; core for HIPAA high option
                                     DC only
                                •    Prescription drugs (after deductible)
                                •    Diagnostic tests
                                •    Emergency care for one low co-pay
                                •    Eye exams and discounts on lenses and frames
                                •    Optional dental coverage
                                •    Child-only coverage available (age 1-17)


Calendar or                     •    Calendar year
Contract Year




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 1
I. COMMISSIONED PRODUCTS                                                           BlueChoice


Membership                      •    There is a four tier rate structure:
Types                                • Individual (Age 1and older) Applicants 65 and over must not be eligible for
                                        Medicare benefits and must submit, with their application, a letter indicating
                                        such from the Social Security Administration.
                                     • Individual & Child(ren)
                                     • Individual & Adult
                                     • Family

                                •    Applicant may choose any membership type regardless of marital status.
                                •    Rates for multiple member policies are based on the age of the oldest applicant.

Membership Type                 A subscriber may remove a dependent child or spouse at any time.
Changes                         • The subscriber must submit a written request. The coverage will end on the 1st of
                                   the month following the month in which the Corporation is notified, except for
(Individual,                       situations of death and divorce.
Individual and
                                Death or divorce:
Child(ren),
                                • If the contract is a two-party membership, the displaced member’s individual
Individual and                     coverage will be made effective the day following the date of death of the
Adult, and Family)                 spouse/dependent or,
                                • The first of the month following the date of divorce. The member must contact the
                                   Plan within 31 days of the event. Otherwise, coverage will become effective 1st of
                                   the month following approval of a medically underwritten application.

                                A subscriber may add a dependent child or spouse by submitting a medically
                                underwritten application:
                                • The family member(s) will be medically underwritten. Based on the information
                                   provided, the application to add dependent(s) may be accepted or rejected.
                                • Coverage will become effective 1st of the month following the date the application is
                                   approved by CareFirst.
                                A newborn child of the subscriber or covered spouse is automatically covered for the
                                first 31 days from birth, whether sick or well.
                                • The member must notify the Plan within 31 days of the date of birth to continue
                                     beyond the first 31 days.
                                • Continuing coverage beyond the 31 days will require the member to submit an
                                     application to add the dependent newborn.
                                • When due, the additional premium must be paid to cover the child since the
                                     effective date of coverage is the date of birth (premiums will be charged
                                     retroactively).
                                • If the member does not notify the Plan within the first 31 days of the date of birth,
                                     the child is considered a late enrollee.
                                • The child will be subject to medically underwriting.
                                • The effective date (if approved) will be the first of the month following approval by
                                     the Plan.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 2
I. COMMISSIONED PRODUCTS                                                           BlueChoice


Effective Date                  •    Coverage will become effective the first of the month following the date the
                                     application is approved.



Waiting Periods                 •    There is no waiting period for pre-existing conditions. Members are eligible for
                                     benefits immediately.

Deductibles                     •    See Benefit Chart starting on Page 3-6
Out-of-Pocket
Maximums &
Co-Insurance

Preventive                      Includes:
Benefits                        •    Adult routine preventive health
                                •    Well child exams and immunizations
                                •    Prostrate Screening Visits
                                •    Allergy Testing and Treatment
                                •    Annual Routine Eye Exam ( at designated Davis vision care centers)
                                •    Mammography Screening Visits - no co-pay



Maternity                       Members who live in Maryland:
Benefits                        • Maternity Services are included in the policy but are subject to policy co-pays.


                                Members who live in DC:
                                • You may choose to add maternity coverage to your policy (for yourself or your
                                  covered spouse). For an additional $126 a month, you will receive coverage for
                                  pre and postnatal care as well as covered services associated with delivery.
                                •    Maternity may only be added at the time of the initial enrollment of a female
                                     applicant. Female applicants will not be able to add maternity coverage at any
                                     time subsequent to the initial enrollment.



Dental Benefits                 •   Dental services are marketed by CareFirst and administered by The Dental
                                    Network. Please refer to the Dental Section of this manual for additional
                                    information.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 3
I. COMMISSIONED PRODUCTS                                                           BlueChoice


Drug                            In an effort to keep care costs steady, a three-tier benefit structure and lower
Benefits                        maximums were placed on drug coverage. The drug benefits are administered
                                through Advanced PCS. The three-tier drug program allows members to pay a
                                different co-payment depending on whether the member receives a generic drug, a
                                brand-name drug on the formulary, or a non-formulary drug. There are several
                                variations of deductibles, co-payments and annual maximums.

                                A prescription card is issued with the Medically Underwritten and DC HIPAA products.

                                MD — A 35-90-day supply of maintenance drugs is available through retail or
                                mail for 2 co-pays.

                                DC — A 90-day supply of maintenance drugs is available for 2 co-pays through mail
                                order only.

                                Listed below is a chart outlining the drug benefits:




                  Drug                                                   Low                   Medium                       High
                  MD & DC: 34 Day Supply
                  Deductible                                      $150 deductible          $100 deductible            $50 deductible
                  Generic Co-pay                                          $10                      $10                       $10
                  Preferred Brand Name Co-pay                             $25                      $25                       $25
                  Non-Preferred Brand Name Co-                            $40                      $40                       $40
                  pay
                  Maximum Annual Drug benefit                            $500                    $1000                     $1000
                  Contraceptive Drugs                                  Covered                  Covered                   Covered
                  Maintenance Drugs
                  MD: 35-90 day Supply—                         2 x Co-pays                2 x Co-pays            2 x Co-pays
                  Maintenance Drugs                             Retail or Mail             Retail or Mail         Retail or Mail
                  DC: 90 day supply—                            2 x Co-pays                2 x Co-pays            2 x Co-pays
                  Maintenance Drugs                             Mail order only            Mail order only        Mail order only
                  Artificial Insemination / IVF Drugs
                  MD                                                    50% up to $100,000 max not subject to Rx max
                  DC                                                                          Not covered




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                           BlueChoice



Vision Benefits                 The vision benefit (BlueVision) is managed by Davis Vision.

                                The benefit includes an annual comprehensive vision examination and discounts on
                                frames and contact lenses.




                                                               Benefits                                      Co-pay
                                    Annual Routine Eye Exam                                                    $10




Other Benefits –                •    Oral contraceptives are covered.
                                •    Artificial insemination and in vitro fertilization are covered for Maryland residents
                                     only.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                         BlueChoice


Benefit Chart                  Below is the BlueChoice benefit chart.



                                BLUECHOICE – Medically Underwritten Options
       Services                                 $20 / $30 Option              $15 / $25 Option                 $10 / $20 Option
       Preventive Services and Office Visits
       Well Child –                                            $20 PCP /                   $15 PCP /                     $10 PCP /
       Exams & Immunizations through age                     $30 Specialist              $25 Specialist                $20 Specialist
       17
       Adult Preventive                                        $20 PCP /                   $15 PCP /                     $10 PCP /
                                                             $30 Specialist              $25 Specialist                $20 Specialist
       Routine Gynecological Visits (Covered                   $20 PCP /                   $15 PCP /                     $10 PCP /
       in full for Pap Smear)                                $30 Specialist              $25 Specialist                $20 Specialist

       Cancer Screenings                                     Covered in full             Covered in full              Covered in full

       Allergy Testing & Treatment                             $20 PCP /                   $15 PCP /                     $10 PCP /
                                                             $30 Specialist              $25 Specialist                $20 Specialist

       Physician Office Visits                                 $20 PCP /                   $15 PCP /                     $10 PCP /
                                                             $30 Specialist              $25 Specialist                $20 Specialist

       Inpatient Hospital Services
       365 Days Room and Board (Semi-                     $700 facility co-     $500 facility co-pay per        $250 facility co-pay per
       Private Room)                                         pay per                  admission                       admission
                                                            admission

       Emergency or Urgent Care
       Plan-Affiliated Urgent Care Facility                        $30                         $25                          $20

       Hospital Emergency Room or Non-                             $50                         $50                          $50
       Plan Facility
       (Waived if Admitted)

       Ambulance (when medically                             Covered in full             Covered in full              Covered in full
       necessary)

       Prescription Drugs
       Annual Deductible                                          $150                        $100                          $50

       Generic co-pay                                              $10                         $10                          $10

       Formulary Brand co-pay                                      $25                         $25                          $25

       Non-formulary Brand co-pay                                  $40                         $40                          $40

       Annual Drug benefit maximum                                $500                       $1,000                        $1,000

      PCP=Primary Care Physician




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                         BlueChoice



Out-of-Area                    To make sure that CareFirst benefit plans travel easily, Blue Cross and Blue Shield
Coverage                       plans throughout the USA have developed a national electronic data delivery system
                               called BlueCard®.

                               BlueCard® advantages:

                               •     Speeds the payment of a member’s claim if they receive treatment outside
                                     of the CareFirst service area
                               •     Helps members receive maximum benefits and savings
                               •     No claims have to be filed and the member cannot be billed for charges
                                     above the Plan’s approved amount when a CareFirst member receives
                                     care from a provider who participates with the local BCBS plan



Standard                       BlueChoice HMO Medically Underwritten coverage (DC & MD jurisdictions only):
Options                            • Low Option
                                   • Medium Option and
                                   • High Option


                               BlueChoice HMO HIPAA coverage (DC only):
                                   • Low Option and
                                   • High Option



                               The Individual HMO product options vary by:

                               •     Primary Care Physician/Specialist co-pay
                               •     Inpatient deductible
                               •     Prescription drug benefits
                               •     Out-of-pocket limits




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted for
informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                           BlueChoice


Standard Options                The standard options by product are listed below:
continued


                                                     BlueChoice DB Options by Product
               Options             Primary Care                  Inpatient            Out-of-Pocket                        Drug
                                    Physician/                   Hospital              Maximum
                                 Specialist Co-pay              Deductible
                                                             Medically Underwritten
               Low                   $20/$30          $700 per         Ind         $3600                             $150 deductible
                                                      admission        Ind & Child(ren), Ind & Adult                 $10/$25/$40*
                                                                       $7200                                         $500 max
                                                                       FAM       $11000

               Medium                $15/$25          $500 per         Ind          $3000                            $100 deductible
                                                      admission        Ind & Child(ren), Ind & Adult                 $10/$25/$40*
                                                                       $6000                                         $1000 max
                                                                       FAM          $9000

               High                  $10/$20          $250 per         Ind         $2000                             $50 deductible
                                                      admission        Ind & Child(ren), Ind & Adult                 $10/$25/$40*
                                                                       $4000                                         $1000 max
                                                                       FAM         $6000

                                                                  HIPAA – DC Only
               Low                   $20/$30          $700 per         Ind         $3600                             $150 deductible
                                                      admission        Ind & Child(ren), Ind & Adult                 $10/$25/$40*
                                                                       $7200                                         $500 max
                                                                       FAM       $11000

               High                  $10/$20          $250 per         Ind         $2000                             $50 deductible
                                                      admission        Ind & Child(ren), Ind & Adult                 $10/$25/$40*
                                                                       $4000                                         $1000 max
                                                                       FAM         $6000
                  * Gen/Brand Formulary/Brand Non-Formulary. A 90-day supply of maintenance drugs is available at 2 times
                  the co-pays through mail order only for DC and through retail or mail order for MD. Oral contraceptives are
                  covered. Drug deductibles and co-pays are not applied to the out-of-pocket maximum.

                  Ind = Individual               FAM = Family




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                           BlueChoice



Other Options                   HIPAA - See HIPAA section of the manual
                                GROUP CONVERSION - See Group Conversion section of manual



Benefit Upgrades                •    All covered members will need to go through medical underwriting again.
                                •    If the covered member fails to pass medical underwriting, then the upgrade is not
                                     approved and the member can continue with existing coverage.
                                •    If the covered member passes, coverage is effective the first of the month after
                                     approval.
                                •    Out-of-pockets and benefit maximums are credited to the new coverage.
                                •    Allowed once in a 12 month period.




Benefit                         •    Medical underwriting is not required.
Downgrades                      •    Allowed once in a 12-month period.
                                •    Downgrades do not have to occur on the anniversary date.




Jurisdictional                  The Individual HMO product options differ across jurisdictions by:
Issues
                                •    Artificial insemination/invitro fertilization procedures
                                •    Extended maternity
                                •    Mental health and substance abuse
                                •    Artificial insemination/invitro fertilization drugs
                                •    Maintenance drug coverage




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                           BlueChoice


Eligibility &                   There are many factors that determine participant eligibility and may be mandated by state law
Enrollment                      or required by CareFirst. The specific requirements are found in the direct pay contract.


Who is Eligible?                The requirements include but are not limited to:
                                An applicant who has no coverage with CareFirst.
                                •    Members terminating group coverage.
                                •    Existing direct-pay members
                                •    Applicant must be in reasonably good health
                                •    Subscriber:

                                •    Age 1 and older (applicants 65 and over must not be eligible for Medicare benefits
                                     and must submit, with their application, a letter indicating such from the Social
                                     Security Administration.

                                •     Must be a resident of the District of Columbia or Maryland (does not have to be a
                                      US citizen)

                                •    Spouse.

                                •    Dependent children up to age 23. The child must be unmarried and be under age
                                     23
                                     • Biological child
                                     • Stepchildren permanently residing in the household
                                     • Legally adopted children – by means of judicial decree of adoption or legal
                                        custody pending adoption
                                     • Children for whom the court has ordered the subscriber to provide coverage
                                     • Grandchildren/nieces/nephews under Primary Care Dependent Provisions*

                                *The child must be under the Subscriber’s “Primary Care” (Primary Care means that
                                the Subscriber provides food, clothing and shelter for the child on a regular and
                                continuous basis during the time that the District of Columbia public schools are in
                                regular session). If the child’s legal guardian is someone other than the Subscriber,
                                the child’s legal guardian may not be covered under an accident or sickness policy.

                                •    Disabled Dependents. A child, who is mentally and/or physically impaired prior to
                                     the age of 23, is eligible to continue coverage under a family contract.
                                     • The dependent must be claimed as a dependent on the subscriber’s latest
                                         federal income tax return and receive 50% of their support for the subscriber.
                                     • Written proof of the incapacity must be submitted to the Plan within 31 days of
                                         when the child would otherwise lose coverage. Written proof MUST include a
                                         physician’s certification of incapacity.
Who is NOT                      •    Applicants who are currently enrolled in a group/FEP with CareFirst.
Eligible?                       •    New applicants who are eligible for and receiving Medicare benefits.
                                •    Existing members who are currently enrolled with our MediGap coverage.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                           BlueChoice



Medical                        Medical Underwriting is a systematic process that insurers use to collect information about
Underwriting                   a health insurance applicant. Based on the medical information collected, an insurer can
                               accept or deny certain applicants for coverage, issue a counter-offer or deny coverage
                               completely for all applicants.

                               Medical Underwriting is used to help keep insurance affordable to everyone.
                               CareFirst uses medical information provided on the application, information provided by
                               the applicant’s health care providers (doctors, other healthcare providers and labs) and a
                               review of claims history.

                                    •    The oldest applicant will be the policyholder at the time of initial enrollment.
                                    •    Generally, this process takes 4 – 6 weeks.


                               The underwriting process and results are listed below:



                                                           Process - The underwriting process for
                                                               new applications is as follows:
                                        STEP      ACTION
                                          1.      Application is submitted to CareFirst.

                                          2.      Underwriter may request additional medical information, based
                                                  on the information on the application and the applicant’s CareFirst
                                                  claim’s history.

                                          3.      Upon receipt of the medical information, a decision is reached
                                                  about whether or not to accept the application for health coverage.


                                                       Results - The underwriting process can result
                                                                  in one of the following:
                                        RESULT – Application for coverage is…

                                        • Accepted or
                                        • Denied or
                                        • Accepted excluding certain individuals or
                                        • Counter-offered with a higher premium rate.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                              BlueChoice



Medical                           • Medical Underwriting results can vary depending on the severity of conditions
Underwriting                      • Shown below is a sample of decision results

Sample
Decision
Results




          ICD 9      Diagnosis                     Criteria                                                 Decision
          401-4019   Hypertension, essential       If essential and well controlled                         Approve


                                                   If not well controlled (readings between 140/90 and
          401-4019   Hypertension, essential       160/100) or on 2 medications                             Approve


                                                   If not well controlled (readings over 160/100) or on
          401-4020   Hypertension, essential       more than 2 medications                                  Approve with 25% Rate Increase
          402-4029   Hypertensive heart disease    If well controlled                                       Approve
          402-4029   Hypertensive heart disease    If not well controlled                                   Decline
          403-4039   Hypertensive renal disease                                                             Decline

          278-2780   Overweight                    Based upon BMI of 25-29.9                                Approve
          278-2780   Obesity                       Based upon BMI of 30-35                                  Approve with 25% Rate Increase
          278-2780   Morbid Obesity                Based upon BMI of over 35                                Decline




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 12
I. COMMISSIONED PRODUCTS                                                           BlueChoice


                               All decisions regarding acceptance, counter offer or rejection of an application are made
Medical
                               in Central Medical Review.
Underwriting
Guidelines                     All medical conditions are closely reviewed and a decision is based on the history and
                               treatment of given conditions.

                               Maryland applicants, who receive either an exclusion or a denial, or have any of the
                               conditions listed on the next page may be eligible for health coverage under the
                               Maryland Health Insurance Plan (MHIP). MHIP is a high-risk pool for Maryland residents
                               who are medically uninsurable. Applicants will not be eligible for MHIP if they are
                               eligible for any of the following coverages:


                               1.        Medicare;
                               2.        Maryland Medical Assistance;
                               3.        Maryland Children’s Health Program; or
                               4.      An employer sponsored health plan that provides benefits comparable to MHIP,
                               unless you are considered an eligible individual under the Trade Act of 2002. Eligible
                               individuals under the Trade Act of 2002 include individuals who qualify for a tax credit
                               under §35 of the Internal Revenue Code. Generally, this includes displaced workers
                               harmed by foreign trade and retirees receiving payments from the Pension Benefit
                               Guaranty Corporation.


                               MHIP also offers products to Maryland resident individuals and their dependents that
                               meet HIPAA eligibility criteria. You may obtain information regarding MHIP from the
                               Maryland Health Insurance Plan:


                                                                  Maryland Health Insurance Plan
                                                                            P.O. Box 47160
                                                                     Baltimore, MD 21244-7160
                                                                              866-780-7105


                               Information regarding MHIP also may be obtained from the website at
                               www.marylandhealthinsuranceplan.state.md.us.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I . COMMISSIONED PRODUCTS                                                           BlueChoice



MHIP                           Maryland applicants with any of the conditions listed below may be eligible for health
Conditions for                 coverage under the Maryland Health Insurance Plan (MHIP).
Eligibility

                               Behavioral Health (Psychiatric)
                               Bipolar Disorder, Chemical Dependency, Dementia, Psychotic Disorders

                               Blood/Blood Forming
                               Aplastic Anemia, Hemocromatosis, Hemophilia, Sickle Cell Disease

                               Cardiovascular
                               Angina Pectoris, Cardiomyopathy, Congestive Heart Failure, Coronary Artery Disease, Coronary
                               Insufficiency, Coronary Occlusion

                               Endocrine (Hormonal)
                               Addison’s Disease, Cystic Fibrosis, Diabetes (Type I and II), Porphyria, Wilson’s Disease

                               Gastrointestinal
                               Ascites, Banti’s Disease or Syndrome, Cirrhosis of the Liver, Crohn’s Disease, Esophageal
                               Varicies, Hepatitis B & C, Ulcerative Colitis

                               Infectious
                               AIDS, HIV Positivity

                               Musculoskeletal/Connective
                               Ankylosing Spondylitis, Lupus Erythematosus Disseminate, Rheumatoid Arthritis, Scleroderma

                               Pulmonary (Lung)
                               Chronic Obstructive Pulmonary Disease, Emphysema

                               Neoplasm (Cancers)
                               Cancer (except skin cancer) treated or diagnosed within the past 5 years, Hodgkin’s Disease,
                               Leukemia, Multiple Myeloma, Non-Hodgkin’s Lymphoma, Wilm’s Tumor

                               Neurologic
                               Alzheimer’s Disease, Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease), Friederich’s Ataxia,
                               Guillain Barre Syndrome, Huntington’s Disease, Hydrocephalus, Multiple Sclerosis, Muscular
                               Dystrophy, Myasthenia Gravis, Myotonia, Palsy, Paraplegia, Parkinson’s Disease, Quadraplegia,
                               Stroke, Tay-Sachs Disease

                               Other:
                               Kidney Disease requiring Dialysis, Major Organ Transplant, Pregnancy




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 14
I. COMMISSIONED PRODUCTS                                                           BlueChoice


Rating Up                      Depending on the level of severity of certain conditions within the past seven years may
                               result in the counter-offer of a rated-up premium rate by 25% or 50%. If a rated-up
                               coverage is offered, the customer will receive a letter indicating the increase in the
                               premium and a counteroffer form which will need to be signed and returned to
                               CareFirst.




Exclusionary                   An Exclusionary Amendment is a legal document that may be added to a
Amendments                     medically underwritten policy to exclude a family member from health care
                               coverage.


                               Excluded Family Member
                               A family member may be excluded from the policy if his or her medical risk is
                               determined to be too great. An Exclusionary Amendment is added to the
                               contract and the individual is not covered.




How the                         BlueChoice is a fee-for-service HMO plan that provides complete care through a large
Plan Works                      network of Primary Care Physicians (PCPs). These physicians provide preventive
                                services and illness care and refer members to a specialist for services when medically
                                necessary.

                                Members select a PCP when they enroll and make appointments as needed for illness.
                                PCPs may refer the member to any specialist in the network. The member is eligible
                                for annual check-ups and other routine preventive services, which the PCP provides.
                                All care should be coordinated through the PCP. If members seek care outside of the
                                HMO or without a referral, benefits will not be paid.

                                Most care is covered by a low per visit co-payment. Inpatient hospital services have a
                                per admission co-pay. Outpatient prescription drugs require an annual deductible.
                                Once the prescription drug deductible is satisfied, care is covered in full or is subject to
                                a nominal co-payment.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                           BlueChoice



Rate Increases                       DC - Rates can be changed with 30 day notice
                                     MD - Rates can be changed with 45 days notice
                                     VA – Rates can be changed with 30 days notice; 60 day notification is required if
                                     rate increase is 35% or higher.



Payment Options                 •    The payment options are monthly.



Termination                     An insured will no longer be eligible for coverage up to the following age limits:
of Insured’s                    •    All Dependent Children are eligible up to age 23
Coverage
                                •    Coverage will be continued past the limiting age of 23 years old for an unmarried
                                     Dependent who is unable to work to support him or herself due to mental of
                                     physical incapacity. The incapacity must have started prior to the date that the
                                     covered Dependent reached the limiting age of 23 years old. Written proof of the
                                     mental of physical incapacity must be submitted to the Plan within 31 days of when
                                     the child would otherwise lose coverage. The written proof must include a
                                     physician’s certification of the incapacity.


                                An insured will no longer be eligible for coverage due to the following:
                                •    A child or grandchild is married
                                •    A spouse is divorced
                                •    Non-payment of the premium
                                •    Member commits an act that constitutes fraud
                                •    The Subscriber moves outside of the Service area



Provider                        •   Plan Provider is any physician, health care professional or health care facility that
Networks                            has been designated by the Plan to provide services to Members.
                                •   Primary Care Physician is a Plan physician selected by a Member that provides
                                    and arranges the Member’s health care.
                                •   If members seek care outside of the HMO or without a referral, benefits will not be
                                    paid.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 16
I. COMMISSIONED PRODUCTS                                                           BlueChoice-Saver



Overview                        •    A no deductible, higher PCP and specialist office visit co-pay product
                                •    Offered in addition to the standard, individual BlueChoice product
                                •    Offers HMO coverage designed for individuals and their families who
                                     are seeking affordable, comprehensive health coverage without sacrificing quality
                                     care.
                                •    One co-payment level for a Primary Care Physician (PCP)
                                     office visit: $30 PCP
                                •    All options offer coverage for hospitalization, medical/surgical services, preventive
                                     care, prescription drugs, maternity and emergency services.
                                •    Offered in Maryland and DC


Key Selling                     •    Competitive rates
Features                        •    Available to individuals and families without employer-sponsored coverage
                                •    Regional provider network
                                •    One plan option
                                •    Low monthly premiums, small co-payments and few deductibles
                                •    No claim forms
                                •    Preventive services, including well-child care
                                •    Discounts on a variety of alternative therapies and wellness services through the
                                     Options discount program
                                •    Routine office visits with predictable co-pays
                                •    Medical and surgical services
                                •    Mental illness and substance abuse benefits
                                •    Maternity care (MD – core; DC – optional for medically underwritten)
                                •    Prescription drugs (after deductible)
                                •    Diagnostic tests
                                •    Emergency care for one low co-pay
                                •    Core routine vision benefits including an annual eye exam and discounts frames
                                     and lenses and contact lenses
                                •    Option dental coverage available.
                                •    Child-only coverage available (age 1-17)



Calendar or                     •    Calendar year
Contract Year




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 17
I. COMMISSIONED PRODUCTS                                                           BlueChoice-Saver



Membership Types                  • There are four membership types:
                                       o Individual (Age 1and older) Applicants 65 and over must not be eligible for
                                            Medicare benefits and must submit, with their application, a letter
                                            indicating such from the Social Security Administration.
                                       o Individual and Child(ren)
                                       o Individual and Adult
                                       o Family
                                  • Applicant may choose any membership type regardless of marital status.
                                  • Rates for multiple member policies are based on the age of the oldest applicant.


Membership                      A subscriber may remove a dependent child or spouse at any time.
Type Changes                     • The subscriber must submit a written request. The coverage will end on the 1st
                                     of the month following the month in which the Corporation is notified, except for
(Self-Only,                          situations of death and divorce.
Individual and
                                Death or divorce:
Child(ren),
                                 • If the contract is a two-party membership, the displaced member’s individual
Individual and                       coverage will be made effective the day following the date of death of the
Adult and Family)                    spouse/dependent or,
                                 • The first of the month following the date of divorce. The member must contact
                                     the Plan within 31 days of the event. Otherwise, coverage will become effective
                                     1st of the month following approval of a medically underwritten application.

                                A subscriber may add a dependent child or spouse by submitting a medically
                                underwritten application:
                                  • The family member(s) will be medically underwritten. Based on the information
                                     provided, the application to add dependent(s) may be accepted or rejected.
                                  • Coverage will become effective 1st of the month following the date the application
                                     is approved by the Corporation.

                                A newborn child of the subscriber or covered spouse is automatically covered for the
                                first 31 days from birth, whether sick or well.
                                   • The member must notify the Plan within 31 days of the date of birth to continue
                                       beyond the first 31 days.
                                   • Continuing coverage beyond the 31 days will require the member to submit an
                                       application to add the dependent newborn.
                                   • When due, the additional premium must be paid to cover the child since the
                                       effective date of coverage is the date of birth (premiums will be charged
                                       retroactively).
                                   • If the member does not notify the Plan within the first 31 days of the date of birth,
                                       the child is considered a late enrollee.
                                   • The child will be subject to medically underwriting.
                                   • The effective date (if approved) will be the first of the month following approval by
                                       the Plan.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                           BlueChoice-Saver



Effective Date                  •    Coverage will become effective the first of the month following the date the
                                     application is approved.



Waiting Periods                 •    There is no waiting period for pre-existing conditions. Members are eligible for
                                     benefits immediately.



Deductibles
Out-of-Pocket                   •    There is no deductible on medical services but Rx does have a deductible.
Maximums and
                                •    See chart below for out-of-pocket maximums
Co-Insurance

                                                    DEDUCTIBLE                 OUT-OF-POCKET MAXIMUM
                                                      In-Network
                                                            $0                          $4,000 Individual

                                                                                $8,000 Individual & Child(ren)

                                                                                   $8,000 Individual & Adult

                                                                                         $12,000 Family



Preventive                      Includes:
Benefits                        •    Adult routine preventive health
                                •    Well child exams and immunizations
                                •    Cancer screenings require no co-pay
                                •    Allergy Testing and Treatment
                                •    Annual Routine Eye Exam (at designated Davis Vision care center)



Vision                          •    BlueVison is core to the product
Benefits                        •    $10 annual routine eye exam and discounts on frames, lenses and contacts
                                •    Benefits administered by Davis Vision




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                           BlueChoice-Saver



Maternity                       Members who live in Maryland:
Benefits
                                •    Maternity Services are included in the policy but are subject to policy co-pays.


                                Members who live in DC:

                                •    You may choose to add maternity coverage to your policy (for yourself or your
                                     covered spouse). For an additional $126 a month, you will receive coverage for
                                     pre and postnatal care as well as covered services associated with delivery.
                                •    Maternity may only be added at the time of the initial enrollment of a female
                                     applicant. Female applicants will not be able to add maternity coverage at any
                                     time subsequent to the initial enrollment.



Optional                        •    Dental HMO plan with dental care for predictable co-pays.
Dental Benefits
                                •    Coverage includes preventive, restorative and surgical services.
                                •    Orthodontia for adults and children included.
                                •    Dental services are marketed by CareFirst and administered by The Dental
                                     Network. The Dental HMO is an optional benefit that is billed with the medical
                                     product.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                           BlueChoice-Saver



Prescription                   A prescription drug card is issued separately from the medical card. No outpatient drugs will be
Drug Benefits –                covered under medical for this product.


                               The chart below outlines the benefits of drug benefit design:



                                           CATEGORY                                                         BENEFIT
                Deductible                                                                $150 per individual

                Family Aggregate Deductible Max                                           None

                Generic Co-pay                                                            $15

                Preferred Brand Co-pay                                                    Discount

                Non-Preferred Brand Co-pay                                                Discount

                Self-Administered Injectable Drugs (including insulin, except             Discount
                infertility drugs & agents in MD)* - both generic & brand
                                                                                                  MD                DC              VA

                Infertility Drugs and Agents (both generic & brand)                       50% of Plan             Not              Not
                                                                                          Allowance*            Covered          Covered
                Generic Penalty: Member pays difference between the cost                                   Not applicable
                of generic and brand name drug when generic is available
                Annual Maximum                                                            $1,500 (generic drugs)

                Supply Per Co-pay                                                         34 Days

                Contraceptive Drugs Covered?                                              Yes
                    * up to lifetime max for covered infertility services as in certificate

                  Maintenance Drug Co-pay                         MD                          DC                            VA
                      (90-Day Supply)
                           Retail                         2X for 35-60 days           2X for 35-60 days             2X for 35-60 days
                                                          3X for 61-90 days           3X for 61-90 days             3X for 61-90 days
                           Mail Order                     2X for 35-60 days           2X for 35-90 days             2X for 35-90 days
                                                          3X for 61-90 days



Other Benefits –                •    Oral contraceptives are covered.
Artificial                      •    Artificial insemination and in vitro fertilization are covered for Maryland residents.
Insemination,
In Vitro Fertilization




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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 I. COMMISSIONED PRODUCTS                                                           BlueChoice-Saver



Benefit Chart                   Below is the BlueChoice-Saver benefit chart.




                           BLUECHOICE SAVER – Medically Underwritten Option

                                                                                                  $30 / $40 Option
                        Preventive Services and Office Visits
                        Well Child –                                             $30 PCP / $40 Specialist
                        Exams & Immunizations
                        Adult                                                    $30 PCP / $40 Specialist
                        Routine Preventive Health
                        Routine Gynecological Visits (no charge for              $30 PCP / $40 Specialist
                        Pap Smear)
                        Cancer Screenings                                        No charge
                        Outpatient Medical and Surgical Services

                        Physician Office Visit for Illness                       $30 PCP / $40 Specialist

                        Outpatient surgery in Physician Office                   $30 PCP/ $40 Specialist

                        Outpatient surgery in Outpatient Hospital                $300 facility co-pay and $30 PCP/ $40 Specialist
                        Inpatient Hospital Services
                        Hospital Admissions                                      $600 facility co-pay per day
                        Emergency or Urgent Care
                        Plan-Affiliated Urgent Care Facility                     $60

                        Emergency Room (Waived if Admitted)                      $100
                        Prescription Drugs

                        Annual Deductible                                        $150 per member

                        Generic co-pay                                           $15

                        Preferred Brand Name co-pay                              Discount

                        Non-Preferred Brand Name co-pay                          Discount

                        Annual Drug benefit maximum                              $1,500 (generic drugs)




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                           BlueChoice-Saver



Out-of-Area                     To make sure that CareFirst benefit plans travel easily, Blue Cross and Blue Shield
Coverage                        plans throughout the USA have developed a national electronic data delivery system
                                called BlueCard®.

                                BlueCard® advantages:

                                •    Speeds the payment of a member’s claim if they receive treatment outside
                                     of the CareFirst service area
                                •    Helps members receive maximum benefits and savings
                                •    No claims have to be filed and the member cannot be billed for charges
                                     above the Plan’s approved amount when a CareFirst member receives
                                     care from a provider who participates with the local BCBS plan

Other Options                   •    HIPAA – no options will be added
                                •    Open Enrollment – no options will be added
                                •    Group Conversion – no options will be added

Benefit                         •    All covered members will need to go through medical underwriting again.
Upgrades                        •    If they fail to pass medical underwriting then the upgrade is not approved and the
                                     member can continue with existing coverage.
                                •    If they pass, coverage is effective the 1st of the month after approval.
                                •    Out-of-pockets and benefit maximums are credited to the new coverage.
                                •    Allowed once in a 12 month period.

Benefit                         •    Medical underwriting is not required.
Downgrades                      •    Allowed once in a 12-month period. Downgrades do not have to occur on the
                                     anniversary date.

Jurisdictional                  The Individual HMO product options differ across jurisdictions by:
Issues
                                •    Artificial insemination/invitro fertilization procedures
                                •    Extended maternity
                                •    Mental health and substance abuse
                                •    Artificial insemination/invitro fertilization drugs
                                •    Maintenance drug coverage


Who is NOT                      •     Applicants who are currently enrolled in a group/FEP with CareFirst.
Eligible?                       •     New applicants who are eligible for and receiving Medicare benefits.
                                •     Existing members who are currently enrolled with our Medigap coverage.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                           BlueChoice-Saver


Medical                        Medical Underwriting is a systematic process that insurers use to collect information about
Underwriting                   a health insurance applicant. Based on the medical information collected, an insurer can
                               accept or deny certain applicants for coverage, issue a counter-offer or deny coverage
                               completely for all applicants.

                               Medical Underwriting is used to help keep insurance affordable to everyone.
                               CareFirst uses medical information provided on the application, information provided by
                               the applicant’s health care providers (doctors, other healthcare providers and labs) and a
                               review of claims history.

                                    •    The oldest applicant will be the policyholder at the time of initial enrollment.
                                    •    Generally, this process takes 4 – 6 weeks.


                               The underwriting process and results are listed below:



                                                           Process - The underwriting process for
                                                               new applications is as follows:
                                        STEP      ACTION
                                          1.      Application is submitted to CareFirst.

                                          2.      Underwriter may request additional medical information, based
                                                  on the information on the application and the applicant’s CareFirst
                                                  claim’s history.

                                          3.      Upon receipt of the medical information, a decision is reached
                                                  about whether or not to accept the application for health coverage.


                                                       Results - The underwriting process can result
                                                                  in one of the following:
                                        RESULT – Application for coverage is…

                                        • Accepted or
                                        • Denied or
                                        • Accepted excluding certain individuals or
                                        • Counter-offered with a higher premium rate.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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 I. COMMISSIONED PRODUCTS                                                              BlueChoice-Saver


Medical                           • Medical Underwriting results can vary depending on the severity of conditions
Underwriting                      • Shown below is a sample of decision results

Sample
Decision
Results




          ICD 9      Diagnosis                     Criteria                                                 Decision
          401-4019   Hypertension, essential       If essential and well controlled                         Approve


                                                   If not well controlled (readings between 140/90 and
          401-4019   Hypertension, essential       160/100) or on 2 medications                             Approve


                                                   If not well controlled (readings over 160/100) or on
          401-4020   Hypertension, essential       more than 2 medications                                  Approve with 25% Rate Increase
          402-4029   Hypertensive heart disease    If well controlled                                       Approve
          402-4029   Hypertensive heart disease    If not well controlled                                   Decline
          403-4039   Hypertensive renal disease                                                             Decline

          278-2780   Overweight                    Based upon BMI of 25-29.9                                Approve
          278-2780   Obesity                       Based upon BMI of 30-35                                  Approve with 25% Rate Increase
          278-2780   Morbid Obesity                Based upon BMI of over 35                                Decline




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 25
I. COMMISSIONED PRODUCTS                                                           BlueChoice-Saver


Medical                        All decisions regarding acceptance, counter offer or rejection of an application are made
Underwriting                   in Central Medical Review.
Guidelines
                               All medical conditions are closely reviewed and a decision is based on the history and
                               treatment of given conditions.

                               Maryland applicants, who receive either an exclusion or a denial, or have any of the
                               conditions listed on the next page may be eligible for health coverage under the
                               Maryland Health Insurance Plan (MHIP). MHIP is a high-risk pool for Maryland residents
                               who are medically uninsurable. Applicants will not be eligible for MHIP if they are
                               eligible for any of the following coverages:


                               1.        Medicare;
                               2.        Maryland Medical Assistance;
                               3.        Maryland Children’s Health Program; or
                               4.      An employer sponsored health plan that provides benefits comparable to MHIP,
                               unless you are considered an eligible individual under the Trade Act of 2002. Eligible
                               individuals under the Trade Act of 2002 include individuals who qualify for a tax credit
                               under §35 of the Internal Revenue Code. Generally, this includes displaced workers
                               harmed by foreign trade and retirees receiving payments from the Pension Benefit
                               Guaranty Corporation.


                               MHIP also offers products to Maryland resident individuals and their dependents that
                               meet HIPAA eligibility criteria. You may obtain information regarding MHIP from the
                               Maryland Health Insurance Plan:


                                                                  Maryland Health Insurance Plan
                                                                            P.O. Box 47160
                                                                     Baltimore, MD 21244-7160
                                                                              866-780-7105


                               Information regarding MHIP also may be obtained from the website at
                               www.marylandhealthinsuranceplan.state.md.us.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
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I. COMMISSIONED PRODUCTS                                                           BlueChoice-Saver

                               Maryland applicants with any of the conditions listed below may be eligible for health
                               coverage under the Maryland Health Insurance Plan (MHIP).
MHIP
Conditions for
Eligibility

                               Behavioral Health (Psychiatric)
                               Bipolar Disorder, Chemical Dependency, Dementia, Psychotic Disorders

                               Blood/Blood Forming
                               Aplastic Anemia, Hemocromatosis, Hemophilia, Sickle Cell Disease

                               Cardiovascular
                               Angina Pectoris, Cardiomyopathy, Congestive Heart Failure, Coronary Artery Disease, Coronary
                               Insufficiency, Coronary Occlusion

                               Endocrine (Hormonal)
                               Addison’s Disease, Cystic Fibrosis, Diabetes (Type I and II), Porphyria, Wilson’s Disease

                               Gastrointestinal
                               Ascites, Banti’s Disease or Syndrome, Cirrhosis of the Liver, Crohn’s Disease, Esophageal
                               Varicies, Hepatitis B & C, Ulcerative Colitis

                               Infectious
                               AIDS, HIV Positivity

                               Musculoskeletal/Connective
                               Ankylosing Spondylitis, Lupus Erythematosus Disseminate, Rheumatoid Arthritis, Scleroderma

                               Pulmonary (Lung)
                               Chronic Obstructive Pulmonary Disease, Emphysema

                               Neoplasm (Cancers)
                               Cancer (except skin cancer) treated or diagnosed within the past 5 years, Hodgkin’s Disease,
                               Leukemia, Multiple Myeloma, Non-Hodgkin’s Lymphoma, Wilm’s Tumor

                               Neurologic
                               Alzheimer’s Disease, Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease), Friederich’s Ataxia,
                               Guillain Barre Syndrome, Huntington’s Disease, Hydrocephalus, Multiple Sclerosis, Muscular
                               Dystrophy, Myasthenia Gravis, Myotonia, Palsy, Paraplegia, Parkinson’s Disease, Quadraplegia,
                               Stroke, Tay-Sachs Disease

                               Other:
                               Kidney Disease requiring Dialysis, Major Organ Transplant, Pregnancy




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 27
I. COMMISSIONED PRODUCTS                                                           BlueChoice-Saver


Rating Up                      Depending on the level of severity of certain conditions within the past seven years may
                               result in the counter-offer of a rated-up premium rate by 25% or 50%. If a rated-up
                               coverage is offered, the customer will receive a letter indicating the increase in the
                               premium and a counteroffer form which will need to be signed and returned to
                               CareFirst.




Exclusionary                   An Exclusionary Amendment is a legal document that may be added to a
Amendments                     medically underwritten policy to exclude a family member from health care
                               coverage.


                               Excluded Family Member
                               A family member may be excluded from the policy if his or her medical risk is
                               determined to be too great. An Exclusionary Amendment is added to the contract
                               and the individual is not covered.




How the                         BlueChoice is a fee-for-service HMO plan that provides complete care through a large
Plan Works                      network of Primary Care Physicians (PCPs). These physicians provide preventive
                                services and illness care and refer members to a specialist for services when medically
                                necessary.

                                Members select a PCP when they enroll and make appointments as needed for illness.
                                PCPs may refer the member to any specialist in the network. The member is eligible
                                for annual check-ups and other routine preventive services, which the PCP provides.
                                All care should be coordinated through the PCP. If members seek care outside of the
                                HMO or without a referral, benefits will not be paid.

                                Most care is covered by a low per visit co-payment. Inpatient hospital services have a
                                per admission co-pay. Outpatient prescription drugs require an annual deductible.
                                Once the prescription drug deductible is satisfied, care is covered in full or is subject to
                                a nominal co-payment.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 28
I. COMMISSIONED PRODUCTS                                                           BlueChoice-Saver



Rate                            •    DC – 30 day rate increase notice
Increases                       •    VA – 30 day rate increase notice or 60 days for increases >35%
                                •    MD – 45 day rate increase notice



Payment                         •    The payment options are monthly.
Options


Termination                     An insured will no longer be eligible for coverage up to the following age limits:
of Insured’s                    •    All Dependent Children are eligible up to age 23
Coverage
                                •    Coverage will be continued past the limiting age of 23 years old for an unmarried
                                     Dependent who is unable to work to support him or herself due to mental of
                                     physical incapacity. The incapacity must have started prior to the date that the
                                     covered Dependent reached the limiting age of 23 years old. Written proof of the
                                     mental or physical incapacity must be submitted to the Plan within 31 days of
                                     when the child would otherwise lose coverage. The written proof must include a
                                     physician’s certification of the incapacity.


                                An insured will no longer be eligible for coverage due to the following:
                                •    A child or grandchild is married
                                •    A spouse is divorced
                                •    Non-payment of the premium
                                •    Member commits an act that constitutes fraud
                                •    The Subscriber moves outside of the Service area



Provider                        Plan Provider is any physician, health care professional or health care facility that
Networks                        has been designated by the Plan to provide services to Members.
                                Primary Care Physician is a Plan physician selected by a Member that provides and
                                arranges the Member’s health care.

                                If members seek care outside of the HMO or without a referral, benefits will not be
                                paid.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 29
I. COMMISSIONED PRODUCTS                                                                             BlueChoice HSA


Overview                     • Product is a high deductible HMO product that contains an integrated medical and
                               prescription deductible, out of pocket maximum and lifetime maximum.
                             • New and existing members may apply for this product
                             • Existing members must complete a new BlueChoice HSA application subject to the
                               existing medical underwriting process (unless they are in a richer benefit product
                               HMO currently, then no medical underwriting is necessary)


Bancorp                      • Carefirst has partnered with The Bancorp Bank (other financial institutions that offer
Bank                           HSAs may be selected also).
Partner                      • The Bancorp Bank offers BlueChoice HSA account holders a range of financial
                               investment options once account balance reaches $2,500.
                             • Money may be used to pay smaller medical expenses, including deductible and co-
                               payments.
                             • Competitive interest rate is earned the moment the account is opened
                             • Members in the BlueChoice HSA are not required to “use it or lose it” as with flexible
                               spending accounts.
                             • All money contributed is tax-deductible, all earnings on the money are tax free, and
                               all deductions for qualified medical expenses are tax free.
                             • Bancorp Bank will automatically send an Enrollment Kit and application when
                               BlueChoice HSA application is processed (unless otherwise indicated).
                             • Call Center Support – 866-435-1373
                                        • Online – www.myhsabankaccount.com
                                        • Customer Service – 800-377-5548

Key Selling                  • Competitive rates
Features                     • Provides preventive care for adults and children with no deductible
                             • Unlimited lifetime maximum
                             • Freedom to choose any doctor in the HMO network
                             • Little, if any, paperwork
                             • Prescription drug benefits
                             • Maternity benefit core (MD & VA only) Maternity offered as a rider in DC
                             • Dental & Vision benefit freestanding
                             • Discounts on a variety of alternative therapies and wellness services through
                               the Options Discount Program.
                             • Easy access to benefits while traveling, through the BlueCard® program
                             • Child-only rates available (age1-17), but individuals under 18 are not eligible to
                               open a bank account.

Calendar or                  Calendar Year
Contract Year




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 30
I. COMMISSIONED PRODUCTS                                                                             BlueChoice HSA


Membership                   Four-tier rate structure:
Types                        1. Individual (Age 1-64) (Applicants 65 and over must not be eligible for Medicare
                                benefits and must submit, with their application, a letter indicating such from the
                                Social Security Administration.)
                             2. Individual & Child(ren)
                             3. Individual & Adult
                             4. Family

                             •     Applicant may choose any membership type regardless of marital status.
                             •     Rates for multiple member policies are determined based on the age of the oldest
                                   person listed on the application.
                             •     Applicants over 64 may apply if not eligible for Medicare.



Membership                   •     Enrollment of other new dependents (other than a newborn, newly adopted child
Type Changes                       or newly eligible grandchild):
                             •     The member must submit an enrollment information form, including a medical
                                   questionnaire. Based on our review of applicant’s health status, applicant may be
                                   approved or disapproved for coverage.
                             •     Enrollment will be effective on the first day of month following the month in which
                                   CareFirst: a. gives final approval to the application b. receives the premium
                                   payments and c. receives and approves all requested and completed forms and
                                   information

                             Coverage of a Newborn child, newly adopted child or newly eligible grandchild:
                             •     Enrollment requirements for an eligible newborn child, newly adopted child, or
                                   newly eligible grandchild depend on the type of coverage that is in effect on the
                                   date of the child’s first eligibility date.
                             •     If member already has family coverage on the child’s first eligibility date, an eligible
                                   newborn child, newly adopted child or newly eligible grandchild will be covered
                                   automatically as of the child’s first eligibility date.



Effective Date               •     Enrollment will be effective on the first day of the month following the month in
                                   which the CareFirst gives final approval to the application.



Waiting Periods              •     There is no waiting period for pre-existing conditions. Members are eligible for
                                   benefits immediately.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 31
I. COMMISSIONED PRODUCTS                                                                             BlueChoice HSA



Deductibles,                 Below are the two deductibles and out-of-pocket maximums for individual coverage for MD,
Out-of-Pocket                DC, and VA residents.
Maximums and
Co-Insurance                                                DEDUCTIBLE                     OUT OF POCKET MAXIMUM
                                                              In-Network                               In-Network
                                                                 $1,200                                   $2,400

                                                                 $2,700                                   $5,250



Preventive                   Includes:
Benefits                     • Routine physicals, mammograms, immunizations and well childcare

                             • Visits to the doctor for adults and children when using Participating Providers and the
                               customer does not have to satisfy the deductible first.


Maternity                    •      Includes core Maternity and Prenatal Coverage for residents of Maryland and Virginia.
Benefits                     •     Includes Optional Maternity and Prenatal Coverage for District of Columbia residents
                                   can be purchased during the initial enrollment for an additional $126 per month.
                             •     If maternity coverage is added at any time, there will be a 10-month waiting period for
                                   maternity benefits.
                             •     There is a $3,000 benefit limit in DC.


Other Benefits               •    Oral contraceptives are covered.
                             •    In-Vitro Fertilization and Artificial Insemination are not covered in DC or VA
                             •    Vision may be purchased and added in MD, DC or VA
                             •    Dental may be purchased separately in MD or DC (not available in VA)




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 32
I. COMMISSIONED PRODUCTS                                                                             BlueChoice HSA


Prescription                 A prescription drug card is issued separately from the medical card.
Drug Benefits –              The chart below outlines the benefits of the 3-tier drug benefit design:
3 Tier


                                   CATEGORY                                                          BENEFIT
                   Deductible                                                        Combined with medical deductible

                   Family Aggregate Deductible Max                             Yes - Combined with medical deductible;
                                                                              there is no individual deductible to satisfy;
                                                                           any member on the policy may meet the family
                                                                        deductible and benefits will be paid for the entire family.

                   Tier 1 Generic Co-pay                                                      $5 (after deductible)

                   Tier 2 Preferred Brand Co-pay                                             $25 (after deductible)

                   Tier 3 Non-Preferred Brand Co-pay                                         $45 (after deductible)

                   Self-Injectable Drugs (including                              50% Coinsurance up to a $75 maximum
                   insulin, except infertility drugs &
                   agents in MD)*
                   Infertility Drugs and Agents                                        MD                           DC                VA
                                                                       50% of Plan Allowance up to                Not               Not
                                                                          lifetime maximum for                  Covered           Covered
                                                                        covered infertility services
                                                                              as in certificate
                   Generic Penalty: Member pays                                                       Applies
                   difference between the cost of generic
                   and brand name drug when generic is
                   available

                   Supply Per Co-pay                                                                  30 Days

                   Contraceptive Drugs Covered?                                                         Yes
                   Maintenance Drug Co-pay –                                           MD                           DC                VA
                   90 day supply
                        Retail                                                                 2X for 31 – 60 days
                                                                                               3X for 61 – 90 days
                        Mail Order                                     2X for 31 – 60 days                    2X for 31 –       2X for 31 –
                                                                       3X for 61 – 90 days                    90 days           90 days




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 33
I. COMMISSIONED PRODUCTS                                                                             BlueChoice HSA

Benefit Chart                Below is the BlueChoice HSA benefit chart for the Individual Market.



                                             Benefit                           Covered                 Member Responsibility
                                                                                                          (In-Network)
                        Well-Child care, up to age 18                               X                No Charge (no deductible)

                        Mammograms, Pap Tests and PSAs                              X                 No Charge (no deductible)
                        (cancer screenings)

                        Physician Office Visits                                     X         Per visit: $30 PCP/$40 Specialist (after
                                                                                                             deductible)

                        Allergy Shots                                               X         Per visit: $30 PCP/$40 Specialist (after
                                                                                                             deductible)

                        Adult Preventive Physical Exams                             X                 No charge (no deductible)

                        OB/GYN Preventive Care                                      X                 No charge (no deductible)

                        Emergency Care – Emergency Room                             X             Per Visit: $100 (after deductible);
                                                                                                         waived if admitted

                        365 Days Hospitalization per year –                         X         Per day: $600 (after deductible), up to
                        Inpatient Facility Services                                           out-of-pocket maximum, then covered
                                                                                                              in full

                        Inpatient Physician Services                                X                No charge (after deductible)

                        Inpatient/Outpatient Surgery                                X                No charge (after deductible)

                        Diagnostic Tests and X-rays                                 X                No charge (after deductible)

                        Prescription Drugs*                                         X           Deductible – combined with medical
                                                                                                        $5 generic co-pay
                                                                                                   $25 Preferred Brand co-pay
                                                                                                 $45 Non-Preferred Brand co-pay

                       * Generic drugs must be chosen when available or an additional expense will be incurred. Self-
                       injectable drugs are covered at a 50% coinsurance up to a maximum. Member payment of $75
                       per covered injectable medication and are subject to the annual benefit maximum.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 34
I. COMMISSIONED PRODUCTS                                                                             BlueChoice HSA


Out-of-Area                  To make sure that CareFirst benefit plans travel easily; Blue Cross and Blue Shield plans
Coverage                     throughout the USA have developed a national electronic data delivery system called
                             BlueCard®.

                             BlueCard® advantages:
                             • Speeds the payment of a member’s claim if treatment is received outside of the
                                CareFirst service area
                             • Helps members receive maximum benefits and savings
                             • No claims have to be filed and the member cannot be billed for charges above the
                                Plan’s approved amount when a CareFirst member receives care from a provider who
                                participates with the local BCBS plan



 Standard                    See Deductible and Co-Insurance Section
 Option(s)

Other                        • HIPAA - See HIPAA section of manual.
Options                      • Open Enrollment (Virginia and DC) - See BluePreferred Open Enrollment section
                             • Group Conversion (Maryland) - See Group Conversion section of manual
                             • Group Conversion (Virginia and DC) - See Group Conversion section of manual



 Benefit                     The subscriber may be permitted to increase or decrease the amount of coverage under
 Upgrades &                  his or her agreement. If the Subscriber is applying for an increase in coverage, he or she
 Downgrades                  will be required to complete medical questionnaire and/or submit additional information to
                             determine if he or she qualifies.
                             For more information, the Subscriber should contact CareFirst at the following address:
                                            CareFirst BlueCross BlueShield
                                            550 12th Street, S.W.
                                            Washington, D.C. 20065



 Jurisdictional                 BlueChoice HSA has 3 jurisdictions:
 Issues                             1. MD
                                    2. DC and
                                    3. Northern VA.

                                See Benefit Chart for details.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 35
 I. COMMISSIONED PRODUCTS                                                                             BlueChoice HSA



                                Many factors determine participant eligibility when enrolling for coverage. These
   Eligibility &
                                factors may be mandated by State law or required by CareFirst.
   Enrollment                   The specific requirements are found in the direct pay contract.

   Who is Eligible?             • Applicant must be a Maryland, D.C. or Virginia (see specific VA requirements
                                  below) resident in the CareFirst service area (i.e., a MD resident can only apply
                                  for a MD plan)
                                • Applicant must be in reasonably good health
                                • The applicant must be eligible for coverage either as a Subscriber, as a Spouse
                                  or as a Dependent Child. The applicant must apply for coverage by submitting
                                  an Enrollment Information Form (Application) to CareFirst AND CareFirst must
                                  receive premium payments.
                                • Applicant must be between the ages of 1-64 and not eligible for Medicare
                                  benefits.

                                To be covered, the applicant must meet all of the following conditions:
                                • Subscriber - under the age of 65; - over the age of 65 and not receiving
                                  Medicare benefits; OR - eligible for Medicare, but have a Dependent Child or
                                  children who are eligible under a family contract. - resident of Maryland, the
                                  District of Columbia or (i) Arlington County, the City of Alexandria, the City of
                                  Fairfax and the Town of Vienna, Virginia; (ii) the part of Fairfax County lying
                                  within State Route 123 to the West and the Potomac River to the East; or (iii) the
                                  part of Prince William County lying within and to the North of State Route 123,
                                  Virginia.
                                • Anyone not enrolled under nor eligible for coverage by CareFirst in an existing
                                  group
                                • Spouse
                                • • Dependent Children -To be covered as a Dependent Child, the child must be
                                  unmarried and under the age of 23; AND Related to the Subscriber in one of the
                                  following ways: - the Subscriber’s natural child; - the Subscriber’s legally
                                  adopted child or grandchild; - a child (including a grandchild) for whom the
                                  Subscriber is the legally recognized proposed adoptive parent and who is
                                  dependent upon and living with the Subscriber during the waiting period before
                                  the adoption becomes final; - a stepchild who permanently resides in the
                                  Subscriber’s household - a grandchild who is in the court ordered custody of and
                                  is dependent upon and residing with the Subscriber; - a child for whom the
                                  Subscriber has been court ordered or administratively ordered to provide
                                  coverage would otherwise terminate or within 31 days after the effective date of
                                  the child’s coverage under the Agreement, whichever is later.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 36
I. COMMISSIONED PRODUCTS                                                                             BlueChoice HSA



Who is Not                       •    Applicants who are currently enrolled in a group/FEP with CareFirst.
Eligible?                        •    New applicants who are eligible for and receiving Medicare benefits.
                                 •    Existing members who are currently enrolled with our MediGap coverage.



 Enrollment                      •    The Subscriber must complete an Enrollment Information Form (Application),
 Guidelines                           including a medical questionnaire, for himself or herself and other eligible family
                                      members, if applicable. Based on the CareFirst’s review of the applicant’s health
                                      status, the applicant(s) may be approved OR disapproved for coverage.
                                 •    The enrollment requirements for an eligible newborn child, a newly adopted child
                                      or a newly eligible grandchild depends on the type of coverage that is in effect on
                                      the date of the child’s First Eligibility Date. First Eligibility Date means: - for a
                                      newborn child, the child’s date of birth; - or a newly adopted child, the earlier of: -
                                      judicial decree of adoption; or
                                 •    Date of assumption of custody, pending adoption of a prospective adoptive child
                                      by a proposed adoptive parent. - for the grandchild the, date of the court decree or
                                      the date the court decree becomes effective, whichever is later.
                                 •    Dependent children will be covered automatically as of the child’s First Eligibility
                                      Date.
                                 •    If the addition of the child results in a change of Type of Coverage, from Self Only
                                      to two-party, the child’s automatic coverage will end on the 31st day following the
                                      child’s First Eligibility Date. If the Subscriber wishes to continue coverage beyond
                                      this 31day period, he or she must enroll the child within 31 days following the
                                      child’s First Eligibility Date. - if the Subscriber already has Family Coverage on the
                                      child’s First Eligibility Date the child will be covered automatically as of the child’s
                                      First Eligibility Date.
                                 •    For enrollments under Court or Administrative Order, coverage begins the date
                                      which the order was signed by a competent court or administrative agency.
                                 •    If enrollment is not made within the 31day period, the child is subject to the same
                                      requirements for enrollment as all other new Dependents.
                                 •    In the event of the Subscriber’s death: - Coverage of any Dependents will
                                      continue under the Subscriber’s enrollment until the last day of the month in which
                                      the Subscriber’s death occurs. - The enrolled spouse or, if there is no spouse, the
                                      covered Dependent Children of the Subscriber, may purchase a Conversion
                                      Contract (see information under Group Conversion)




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 37
I. COMMISSIONED PRODUCTS                                                                             BlueChoice HSA



 Enrollment                     Primary Care Dependent (District of Columbia Applicant Only)
 Guidelines                     To qualify for coverage as a Primary Care Dependent, the child must be the
                                Subscriber’s grandchild, niece, or nephew. The child must be under the Subscriber’s
 continued                      “Primary Care.”*

                                *Primary Care means that the Subscriber provides food, clothing and shelter for the
                                child on a regular and continuous basis during the time that the District of Columbia
                                public schools are in regular session.

                                The Subscriber must provide CareFirst with proof, upon application, that the child
                                meets the requirements for coverage as a Primary Care Dependent, including proof of
                                the child’s relationship and primary dependency on the Subscriber and certification that
                                the child’s legal guardian does not have other coverage. CareFirst has the right to
                                verify whether the child is and continues to qualify as a Primary Care Dependent.

                                Disabled Dependent -A dependent child who is age 23 or older will be eligible if he or
                                she meet the following:
                                       • The child is incapable of supporting himself or herself due to a mental or
                                         physical incapacity;
                                       • The incapacity occurred before the child reached age 23;
                                       • The child is chiefly dependent on the Subscriber for support and
                                         maintenance;

                                AND
                                          • The Subscriber provides CareFirst with proof of the child’s incapacity,
                                            including certification by a physician

                                Children whose relationship to the Subscriber is not listed above, including
                                grandchildren (except as provided above) foster children or children whose relationship
                                is one of legal guardianship are not covered under the Individual Enrollment
                                Agreement. Even if the child lives with the Subscriber and is dependent upon the
                                Subscriber for support.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 38
I. COMMISSIONED PRODUCTS                                                                             BlueChoice HSA


    Medical      Medical Underwriting is a systematic process that insurers use to collect information about
    Underwriting a health insurance applicant. Based on the medical information collected, an insurer can
                          accept or deny certain applicants for coverage, issue a counter-offer or deny coverage
                          completely for all applicants.
                          Medical Underwriting is used to help keep insurance affordable to everyone. CareFirst uses
                          medical information provided on the application, information provided by the applicant’s
                          health care providers (doctors, other healthcare providers and labs) and a review of claims
                          history.
                                   • The oldest applicant will be the policyholder at the time of initial enrollment.
                                   • Generally, this process takes 4 – 6 weeks.


                          The underwriting process and results are listed below:


                                                         The Process - The underwriting process for
                                                               new applications is as follows:
                                    STEP             ACTION

                                       1.            Application is submitted to CareFirst.

                                       2.            Underwriter may request additional medical information, based on the
                                                     information on the application and the applicant’s CareFirst claim’s
                                                     history.

                                       3.            Upon receipt of the medical information, a decision is reached about
                                                     whether or not to accept the application for health coverage.




                                                    The Results - The underwriting process can result
                                                                 in one of the following:
                                RESULT – Application for coverage is…

                                 • Accepted or
                                 • Denied.
                                 • Accepted excluding certain individuals or
                                 • Countered-offered with a higher premium rate.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 39
I. COMMISSIONED PRODUCTS                                                                             BlueChoice HSA



 Medical                        All decisions regarding acceptance, counter offer or rejection of an application are
 Underwriting                   made in Central Medical Review.
 Guidelines
                                All medical conditions are closely reviewed and a decision is based on the history and
                                treatment of given conditions.

                                Maryland applicants, who receive either an exclusion or a denial, or have any of the
                                conditions listed on the next page may be eligible for health coverage under the
                                Maryland Health Insurance Plan (MHIP). MHIP is a high-risk pool for Maryland
                                residents who are medically uninsurable. Applicants will not be eligible for MHIP if they
                                are eligible for any of the following coverages:


                                1. Medicare;
                                2. Maryland Medical Assistance;
                                3. Maryland Children’s Health Program; or
                                4. An employer sponsored health plan that provides benefits comparable to MHIP,
                                unless you are considered an eligible individual under the Trade Act of 2002. Eligible
                                individuals under the Trade Act of 2002 include individuals who qualify for a tax credit
                                under §35 of the Internal Revenue Code. Generally, this includes displaced workers
                                harmed by foreign trade and retirees receiving payments from the Pension Benefit
                                Guaranty Corporation.

                                MHIP also offers products to Maryland resident individuals and their dependents that
                                meet HIPAA eligibility criteria. You may obtain information regarding MHIP from the
                                Maryland Health Insurance Plan:
                                                                   Maryland Health Insurance Plan
                                                                             P.O. Box 47160
                                                                      Baltimore, MD 21244-7160
                                                                               866-780-7105

                                Information regarding MHIP also may be obtained from the website at
                                www.marylandhealthinsuranceplan.state.md.us.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 40
I. COMMISSIONED PRODUCTS                                                                             BlueChoice HSA


    MHIP                           Maryland applicants with any of the conditions listed below may be eligible for health
    Conditions for                 coverage under the Maryland Health Insurance Plan (MHIP).
    Eligibility
                                   Behavioral Health (Psychiatric)
                                   Bipolar Disorder, Chemical Dependency, Dementia, Psychotic Disorders

                                   Blood/Blood Forming
                                   Aplastic Anemia, Hemocromatosis, Hemophilia, Sickle Cell Disease

                                   Cardiovascular
                                   Angina Pectoris, Cardiomyopathy, Congestive Heart Failure, Coronary Artery Disease,
                                   Coronary Insufficiency, Coronary Occlusion

                                   Endocrine (Hormonal)
                                   Addison’s Disease, Cystic Fibrosis, Diabetes (Type I and II), Porphyria, Wilson’s Disease

                                   Gastrointestinal
                                   Ascites, Banti’s Disease or Syndrome, Cirrhosis of the Liver, Crohn’s Disease, Esophageal
                                   Varicies, Hepatitis B & C, Ulcerative Colitis
                                   Infectious

                                   AIDS, HIV Positivity
                                   Musculoskeletal/Connective
                                   Ankylosing Spondylitis, Lupus Erythematosus Disseminate, Rheumatoid Arthritis, Scleroderma

                                   Pulmonary (Lung)
                                   Chronic Obstructive Pulmonary Disease, Emphysema

                                   Neoplasm (Cancers)
                                   Cancer (except skin cancer) treated or diagnosed within the past 5 years, Hodgkin’s Disease,
                                   Leukemia, Multiple Myeloma, Non-Hodgkin’s Lymphoma, Wilm’s Tumor

                                   Neurologic
                                   Alzheimer’s Disease, Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease), Friederich’s
                                   Ataxia, Guillain Barre Syndrome, Huntington’s Disease, Hydrocephalus, Multiple Sclerosis,
                                   Muscular Dystrophy, Myasthenia Gravis, Myotonia, Palsy, Paraplegia, Parkinson’s Disease,
                                   Quadraplegia, Stroke, Tay-Sachs Disease

                                   Other:
                                   Kidney Disease requiring Dialysis, Major Organ Transplant, Pregnancy




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 41
I. COMMISSIONED PRODUCTS                                                                             BlueChoice HSA


Rating Up                    Depending on the level of severity of certain conditions within the past five years may
                             result in the counter-offer of a rated-up premium rate by 25% or 50%. If a rated-up
                             coverage is offered, the customer will receive a letter indicating the increase in the
                             premium and a counteroffer form which will need to be signed and returned to Carefirst.


Exclusionary                   An Exclusionary Amendment is a legal document that may be added to a medically
Amendments                     underwritten policy to exclude a family member from health care coverage.
                               Excluded Family Member
                               A family member may be excluded from the policy if his or her medical risk is
                               determined to be too great. An Exclusionary Amendment is added to the contract and
                               the individual is not covered.



 How the                        Shown below is how the plan works in-network and out-of-network.
 Plan Works

                                                IN-NETWORK                                        OUT-OF-NETWORK

                                                               Member chooses deductible level

                                 Member meets deductible The deductible is part of the out-of-pocket maximum.
                                 The Family deductible must be met before claims are paid. There is no individual
                                deductible and any member of the family may meet the deductible to have benefits
                                                            paid for the entire family.


                                                            Member meets out-of-pocket maximum


                                  BlueChoice HSA pays 100% of the allowed benefit for the remainder of the year.
                                                            Benefits are based on a calendar year.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 42
I. COMMISSIONED PRODUCTS                                                                             BlueChoice HSA



Rate                          •     30 day rate change notice is required for DC residence.
Increases                     •     30 day rate change notice is required for MD residence.
                              •     30-60 day rate change notice is required for VA residence.



Payment                       •     BlueChoice HSA is billed monthly or subscriber may elect Automatic Debit to have
Options                             monthly premium withdrawn from checking account



Termination of                •     The Subscriber may terminate the coverage of an eligible member, at any time, by
Insured’s                           written request to CareFirst to either change his or her type of coverage to an
Coverage                            Individual or non-Family type of coverage; or remove an eligible dependent from his
                                    or her coverage.
                              •     All Unmarried Dependent Children are eligible up to age 23
                              •     In case of the death of the policyholder: Coverage of any Dependents will continue
                                    under the Subscriber’s enrollment until the last day of the month in which the
                                    Subscriber’s death occurs.
                              •     Coverage ends on the last day of the month in which eligibility terminates.
                              •     A Subscriber will no longer be eligible for coverage if he or she dies




Provider                     Plan Provider is any physician, health care professional or health care facility that has
Networks                     been designated by the Plan to provide services to Members. Primary Care Physician is
                             a Plan physician selected by a Member that provides and arranges the Member’s health
                             care. If members seek care outside of the HMO or without a referral, benefits will not be
                             paid.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                   3- 43
I. COMMISSIONED PRODUCTS                                               Comprehensive Major Medical


Overview                        •    Program covers most medically necessary hospital and physician charges and other
                                     medical expenses.

                                •    Provides access to any covered provider or hospital of your choice. By choosing a
                                     participating provider, you’ll receive the maximum benefits under the plan and limit
                                     your out-of-pocket medical expenses.

                                •    Coverage is medically underwritten. Enrollment applications and health evaluation
                                     questionnaires must be completed. Qualified personnel will review the health history
                                     and related medical information. Based upon this review, the application can be
                                     approved or denied.

Key Selling                     •    Competitive rates
Features                        •    Provides preventive care for children
                                •    Provides mammograms and pap smears for adults
                                •    Up to $1,000,000 of lifetime benefits per member in Maryland (PG and Montgomery
                                     Counties), DC and Virginia
                                •    Freedom to choose any doctor
                                •    No balance billing when members visit a participating provider
                                •    Little, if any, paperwork if a participating provider is used
                                •    Prescription drug benefits (subject to deductible and co-insurance)
                                •    Discounts on a variety of alternative therapies and wellness services through the
                                     Options Discount Program.


Calendar or                     •    Calendar year
Contract Year


Membership                      •    There is a four tier rate structure:
Types                                • Individual (Age 1and older) Applicants 65 and over must not be eligible for
                                        Medicare benefits and must submit, with their application, a letter indicating such
                                        from the Social Security Administration.
                                     • Individual & Child(ren)
                                     • Individual & Adult
                                     • Family

                                •     Applicant may choose any membership type regardless of marital status.
                                •     Rates for multiple member policies are determined based on the age of the person
                                      listed on the application as the applicant.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           4- 1
I. COMMISSIONED PRODUCTS                                               Comprehensive Major Medical



Membership Type                 Age Limit for Coverage of Dependent Children:
Changes                         Unmarried dependent children may be covered up to the following age limits:
                                     •    All Dependent Children are eligible up to age 23;

                                Coverage of a Newborn Child, Newly Adopted Child or
                                Newly Eligible Grandchild:
                                Enrollment requirements Coverage of a Newborn Child, Newly adopted child or newly
                                eligible grandchild depend on the Type of Coverage that is in effect on the date of the
                                child’s First Eligibility Date, as defined below.
                                “First Eligibility Date” means:
                                     •    For a newborn child, the child’s date of birth;
                                     •    For a newly adopted child, the earlier of: a judicial decree of adoption; or date
                                          of the assumption of custody, pending adoption of a prospective adoptive child
                                          by a prospective adoptive parent.
                                     •    For a grandchild for whom you have been granted legal custody, the date of
                                          the court decree or the date the court decree becomes effective, whichever is
                                          later.

                                Coverage of Dependents:
                                (Other than a newborn, newly adopted child or newly eligible grandchild):
                                Subscribers may apply for coverage for your Dependents. This includes new family
                                members, such as a new spouse or stepchild or a subsequent enrollment of an already
                                eligible Dependent. Coverage of Dependent(s) will be subject to the requirements set
                                forth in the Eligibility Schedule.




Effective Date                  •    Enrollment will be effective on the first day of the month following the month in
                                     which CareFirst gives final approval to the application.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           4- 2
 I. COMMISSIONED PRODUCTS                                               Comprehensive Major Medical


Waiting                         •     There is a ten month waiting period for pre-existing conditions.
Period                          •     May be waived if HIPAA eligibility guidelines are met.



Waiver of                       •     See page 1-3, Waiver of Waiting Period.
Waiting Period                        Please contact your Broker Representative for additional information.
                                •     Requirements may vary.



Deductibles,                    Listed below are the deductibles, out-of-pocket maximums and co-insurance levels per
Out-of-Pocket                   individual. After the deductible is met, Comprehensive Major Medical pays 80% of the
Maximums and                    allowed benefit and the customer pays 20% up to the out-of-pocket amount associated
Co-Insurance                    with the deductible that was chosen.

                                With all Comprehensive Major Medical products, the deductible does not apply toward
                                the out of pocket maximum.




                                                   DEDUCTIBLE                     OUT OF POCKET MAXIMUM
                                                         $300                                     $500
                                                         $500                                     $500



Preventive                      •    Routine mammograms, immunizations and well child care
Benefits                        •    Visits to the doctor are paid at a 80/20 coinsurance
                                •    Member does not have to satisfy the deductible first for well child care

Maternity                       •    Maternity benefits are standard to this product
Benefits                        •    Deductibles and coinsurance apply
                                •    A 10 month waiting period applies to all pre-existing conditions

Other                           NOTE:
Benefits                        •    In-vitro Fertilization and Artificial Insemination are not covered in DC or VA.
                                •    Freestanding dental may be purchased separately and is only available in MD &
                                     DC.
                                •     Vision is not covered.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           4- 3
I. COMMISSIONED PRODUCTS                                               Comprehensive Major Medical



Benefit Chart                   Below is the Comprehensive Major Medical benefits chart for the individual market.




                                                                                        Member Responsibility
                       Benefits                Covered                     MD                        VA                         DC
              Medical and Surgical                    X                20% of AB                 20% of AB                  20% of AB
              Services

              Child Wellness                          X              Covered from              Covered from               Covered from
                                                                       age 0-18                  age 0-18                   age 0-18
                                                                     No deductible             No deductible              No deductible

              Mammograms and                          X                20% of AB                20% of AB              100% covered and
              Pap test only                                                                                              no deductible

              Non-Routine Office                      X                20% of AB                20% of AB                   20% of AB
              Visits

              Maternity Care                          X                20% of AB                 20% of AB                  20% of AB
              Pre/and Post natal visits &
              delivery

              Surgery, Laboratory                     X                20% of AB                20% of AB                   20% of AB
              Tests and X-rays

              Hospitalization                         X                20% of AB                20% of AB                   20% of AB
              (facility and Physician)

              Outpatient Medical                      X                20% of AB                20% of AB                   20% of AB

              Emergency                               X                20% of AB                20% of AB                   20% of AB

              Inpatient Facility                      X                20% of AB                20% of AB                   20% of AB

              Inpatient Physician                     X                20% of AB                 20% of AB                  20% of AB

              Prescription Drug                       X                20% of AB                20% of AB                   20% of AB

            AB = Allowed Benefit




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           4- 4
I. COMMISSIONED PRODUCTS                                               Comprehensive Major Medical



Out-of-Area                     To ensure that CareFirst benefit plans travel easily; Blue Cross and Blue Shield plans
Coverage                        throughout the USA have developed a national electronic data delivery system called
                                BlueCard®.

                                BlueCard® advantages:

                                •    Speeds payment of a member’s claim if care is received outside of the CareFirst
                                     service area
                                •    Helps members receive maximum benefits and savings
                                •    Members do not have to file claims and cannot be billed for charges above the
                                     Plan’s approved amount when care is received from a provider who participates
                                     with the local BCBS plan


Standard Options                See Deductible and Co-insurance information on page 4-3.



Other Options                   •     HIPAA Products – See HIPAA section of manual.
                                •     Group Conversion – See Group Conversion section of manual.



Benefit                         •     The subscriber may be permitted to increase or decrease the amount of coverage
Upgrades                              under his or her agreement.
& Downgrades
                                •     If the Subscriber is applying for an increase in coverage, he or she may be
                                      required to complete medical questionnaire and/or submit additional information to
                                      determine if he or she qualifies.




Jurisdictional                  •     Comprehensive Major Medical has 3 jurisdictions in MD, DC and
Issues                                Northern Virginia. See Benefits Chart for Details.



Eligibility &                   •     There are many factors that determine participant eligibility and may be mandated
Enrollment                            by state law or required by CareFirst.

                                •     The specific requirements are found in the direct pay contract.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           4- 5
I. COMMISSIONED PRODUCTS                                               Comprehensive Major Medical


Who is Eligible?                •    Subscriber
                                        •    under the age of 65;
                                        •    over the age of 65 and not receiving Medicare benefits; OR
                                             eligible for Medicare, but have a Dependent Child or children
                                             who are eligible under a family contract.
                                        •    Montgomery County Maryland or Prince George’s County Maryland resident; the
                                             District of Columbia or (i) Arlington County, the City of Alexandria, the City of
                                             Fairfax and the Town of Vienna, Virginia; (ii) the part of Fairfax County lying within
                                             State Route 123 to the West and the Potomac River to the East; or (iii) the part of
                                             Prince William County lying within and to the North of State Route 123, Virginia.

                                •    Anyone not enrolled under nor eligible for coverage by CareFirst in an
                                      existing group
                                •    Spouse
                                •    Dependent Children- To be covered as a Dependent Child, the child must be unmarried and
                                     under the age of 23; AND
                                •    Related to the Subscriber in one of the following ways:
                                          •    the Subscriber’s natural child;
                                          •    the Subscriber’s legally adopted child or grandchild;
                                          •    a child (including a grandchild) for whom the Subscriber is the legally recognized
                                               propose adoptive parent and who is dependent upon and living with the Subscriber
                                               during the waiting period before the adoption becomes final;
                                          •    a stepchild who permanently resides in the Subscriber’s household
                                          •    a grandchild who is in the court ordered custody of and is dependent upon and
                                               residing with the Subscriber;
                                          •    a child for whom the Subscriber has been court ordered or administratively ordered
                                               to provide coverage. (DC applicants only)
                                          •    Primary Care Dependents. To qualify for coverage as a Primary Care Dependent,
                                               the child must be the Subscriber’s grandchild, niece, or nephew. The child must be
                                               under the Subscriber’s “Primary Care”*
                                •    Disabled Dependent – A Dependent Child who is age 23 or older will be eligible if he or she
                                     meet the following:
                                     •    the Child is incapable of supporting himself or herself mental or physical incapacity;
                                     •    the incapacity occurred before the child reached age 23;
                                     •    the child is chiefly dependent on the Subscriber for support and maintenance; AND
                                     •    the Subscriber provides CareFirst with proof of the child’s incapacity, including
                                          certification by a physician

                                *Primary Care means that the Subscriber provides food, clothing and shelter for the child on a regular and
                                continuous basis during the time that the District of Columbia public schools are in regular session. The
                                Subscriber must provide CareFirst with proof, upon application, that the child meets the requirements for
                                coverage as a Primary Care Dependent, including proof of the child’s relationship and primary dependency
                                on the Subscriber and certification that the child’s legal guardian does not have other coverage. CareFirst
                                has the right to verify whether the child is and continues to qualify as a Primary Care Dependent

                                 Children whose relationship to the Subscriber is not listed above, including grandchildren (except as
                                provided above), foster children or children whose relationship is one of legal guardianship are not covered
                                under the Individual Enrollment Agreement. This rule applies even if the child lives with the Subscriber and
                                is dependent upon the Subscriber for support.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           4- 6
I. COMMISSIONED PRODUCTS                                               Comprehensive Major Medical



Who is NOT                      1. Applicants who are currently enrolled in a group/FEP with CareFirst
Eligible?
                                2. New applicants who are eligible for and receiving Medicare benefits.
                                3. Existing members who are currently enrolled with our MediGap coverage
                                4. Existing members covered through COBRA.



Enrollment                      •    First Eligibility Date
Guidelines                           • For a newborn child, the child’s date of birth;
                                     • For a newly adopted child, the earlier of:
                                              - A judicial decree of adoption; OR
                                              - Date of assumption of custody, pending adoption of a prospective
                                              adoptive child by a proposed adoptive parent.
                                     • For the grandchild, the date of the court decree or the date the court decree
                                         becomes effective, whichever is later.

                                •    The enrollment requirements for an eligible newborn child, a newly adopted child,
                                     or a newly eligible grandchild depend on the type of coverage that is in effect on
                                     the date of the child’s First Eligibility Date.

                                •    Dependent children will be covered automatically as of the Child’s First Eligibility
                                     Date.

                                •    If the addition of the child results in a change of Type of Coverage, from Self Only
                                     to Two-Party, the child’s automatic coverage will end on the 31st day following the
                                     child’s First Eligibility Date.

                                •    If the Subscriber wishes to continue coverage beyond this 31day period, he or she
                                     must enroll the child within 31 days following the child’s First Eligibility Date.

                                •    If the Subscriber already has Family Coverage on the child’s First Eligibility Date
                                     the child will be covered automatically as of the child’s First Eligibility Date.

                                •    For enrollments under Court or Administrative Order, coverage begins the date
                                     which the order was signed by a competent court or administrative agency.

                                •    If enrollment is not made within the 31day period, the child is subject to the same
                                     requirements for enrollment as all other new Dependents.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           4- 7
I. COMMISSIONED PRODUCTS                                               Comprehensive Major Medical



Medical                         Medical Underwriting is a systematic process that insurers use to collect information
Underwriting                    about a health insurance applicant. Based on the medical information collected, an
                                insurer can accept the applicant for coverage or deny coverage completely.

                                Medical Underwriting is used to help keep insurance affordable to everyone. CareFirst
                                uses medical information provided on the application, information provided by the
                                applicant’s health care providers (doctors, other healthcare providers and labs) and a
                                review of claims history.

                                     •     The oldest applicant will be the policyholder at the time of initial enrollment.
                                     •     Generally, this process takes 4 – 6 weeks.

                                The medical underwriting process and results are listed below:




                                                           Process - The underwriting process for
                                                               new applications is as follows:
                                         STEP     ACTION
                                          1.      Application is submitted to CareFirst.

                                          2.      Underwriter may request additional medical information, based
                                                  on the information on the application and the applicant’s CareFirst
                                                  claim’s history.

                                          3.      Upon receipt of the medical information, a decision is reached
                                                  about whether or not to accept the application for health coverage.


                                                       Results - The underwriting process can result
                                                                  in one of the following:


                                      RESULT

                                         • Application for coverage is accepted or
                                         • Application for coverage is denied.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           4- 8
 I. COMMISSIONED PRODUCTS                                               Comprehensive Major Medical



Medical Condition               •    Not Available
Guidelines

Automatic                       •    Not Available
Rating Up

Exclusionary                    •    Not Available
Amendments

How the                         •    Member pays the deductible when applicable.
Plan Works                      •    The Family deductible is two times the individual deductible.
                                •    All members can contribute toward the family deductible with no individual family
                                     member contributing more than one individual deductible.


Termination                     The Subscriber may terminate the coverage of an eligible Member, at any time, by
of Insured’s                    written request to CareFirst to either:
Coverage
                                     •    change his or her Type of Coverage to an Individual or
                                          non-Family Type of Coverage OR
                                     •    remove an eligible dependent from his or her coverage.

                                Coverage ends on the last day of the month in which eligibility terminates.

                                In the event of the Subscriber’s death:

                                     •    Coverage of any dependents will continue under the
                                          Subscriber’s enrollment until the last day of the month
                                          in which the Subscriber’s death occurs.
                                     •    Children of the Subscriber may purchase a Conversion Contract (see Group
                                          Conversions)

Provider                        Participating Providers
Networks                        For services and supplies provided by Participating Providers, the Plan Allowance is
                                based on the Participating Provider Allowances. Providers cannot bill members for
                                any balance above the Plan Allowance.

                                Non-Participating Providers
                                For services and supplies provided by a non-participating provider, the Plan
                                Allowance is based on the Participating Provider Allowances. Non-Participating
                                Providers may bill you for any balance above the Plan Allowance.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           4- 9
I. COMMISSIONED PRODUCTS                                                          HIPAA - Overview


Overview –                      In 1996, President Bill Clinton signed a ground breaking new health insurance act into
                                law. This law is known as the Health Insurance Portability & Accountability Act
What is HIPAA?                  (HIPAA) and it provides for the “portability” of insurance coverage when leaving a
                                group insurance plan. HIPAA provides Americans with “peace of mind” that they may
                                continue their health insurance coverage.

                                All insurance policyholders are entitled to receive a “certificate of creditable coverage”
                                when leaving one insurance plan for another. This certificate lists the amount of time a
                                policyholder has accumulated in their health insurance plan and can be used to reduce
                                a pre-existing waiting period (which could be up to 12 (or 18 months for late enrollee)
                                months) when signing up for a new group insurance plan.

                                Non-group or individual, insurance is handled differently. HIPAA specifies that under
                                certain situations, those applying for individual health insurance coverage may no
                                longer be required to complete a medical underwriting questionnaire to obtain health
                                insurance benefits and pre-existing conditions would be covered.

                                This legislation also specified that a person on an under-65 plan cannot be forced out
                                when he/she becomes Medicare eligible.

HIPAA Eligibility               HIPAA specifies that in order to qualify for coverage without medical underwriting and
Requirements                    a restriction for pre-existing conditions, all of the following criteria must be met.

                                Applicant and/or dependents must:
                                • Have 18 months of creditable coverage with the most recent coverage being
                                   group-based. (Certificates of creditable coverage must indicate at least 18 months
                                   of aggregate health insurance coverage.)
                                • Have no more than a 63-day break in coverage.
                                • Have elected and exhausted COBRA and or State Continuation.
                                • Be ineligible for Medicare A or B and Medicaid.
                                • Not be eligible for or be covered by any other health insurance plan.
                                • Not have had prior insurance plan coverage terminated because of non-payment
                                   by the applicant or a fraudulent act by the applicant.
                                • Virginia residents may have had their most recent coverage through an individual
                                   product.



Maryland                        Maryland residents can call the Maryland Health Insurance Plan (MHIP) toll free at 1-
Residents                       866-780-7105 or visit www.marylandhealthinsuranceplan.state.md.us for product
Only                            information, rates and an application for coverage. To be considered for eligibility for
                                Maryland Health Insurance Plan, applicants and/or dependents must meet ALL of the
                                criteria listed in the HIPAA Eligibility Requirements section.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           5- 1
 I. COMMISSIONED PRODUCTS                                          HIPAA Questions & Answers



Questions               Health Insurance Portability and Accountability Act Talking Points
and Answers


1.     What are the requirements to be HIPAA eligible?
       •  Have 18 months of creditable coverage with the most recent coverage being group-based.
          (Certificates of creditable coverage must indicate at least 18 months of aggregate health
          insurance coverage.)
       •  Have no more than a 63-day break in coverage
       •  Have elected and exhausted COBRA and or State Continuation coverage
       •  Be ineligible for Medicare part A and B or Medicaid
       •  Not be eligible for or be covered by any other health insurance plan
       •  Not have had prior insurance plan coverage terminated because of non-payment by the
          applicant or a fraudulent act by the applicant
       •  Virginia residents may have had their most recent coverage through an individual product.

2.     How is COBRA coverage credited under HIPAA?
       Under HIPAA, any period of time that you are receiving COBRA continuation coverage is counted
       as previous continuous health coverage as long as the coverage did not have a break in coverage
       of 63 days or more. For example, if you were covered for five months by a previous health plan and
       then received seven months of COBRA continuation coverage, you would receive credit for twelve
       months of coverage by your new group health plan. However, to be entitled for IMD HIPAA
       coverage, COBRA must be exhausted.

3.     Can an individual not elect COBRA benefits when they are offered?
       An eligible individual can refuse COBRA but would then be ineligible for an Individual HIPAA
       product. However, to be entitled for Individual Sales HIPAA coverage, COBRA must be exhausted.
       MHIP is the state HIPAA alternative for Maryland HIPAA eligible residents.

4.     Is there an age limit on HIPAA or to be eligible for HIPAA products?
       To be eligible for HIPAA, you must be under 65 to apply or, if over 65, you must
       provide proof from the Social Security Administration that you are not eligible for Medicare.

5.     Do we have to keep over 65’ers in under 65 products or can we use existing conversion
       strategy? (for people who age into IMD products)
       As of 7/1/97, insurers cannot cancel coverage for individuals attaining Medicare eligibility or
       eligibility in group and individual products. The existing process for those who turn 65 will remain in
       place. These individuals will be offered MediGap Plan C with an option to stay in the under 65
       product they currently have.

6.     Is there individual to individual portability?
       Yes - VA residences.
       No - MD or DC residence.

7.     Does the Individual HIPAA Products cover pre-existing medical conditions?
       Yes. Please note that the Virginia or DC applicant enrolling in a Carefirst HIPAA product and who
       has demonstrated creditable coverage will not have a pre-existing period on their policy.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           5- 2
I. COMMISSIONED PRODUCTS                                          HIPAA Questions & Answers


Questions
and Answers
continued

8.     What does the term “other” mean?
       In many cases the term “other” will be used to classify a particular group. The term “other” relates to the
       non-HIPAA eligible.

9.     Will individual business Dental products be impacted?
       No.

10.    Does Group Conversion go away?
       No, Group Conversion is a state law. However, if a HIPAA eligible person takes a group conversion
       product, they will disqualify themselves for HIPAA. Group Conversion is considered an Individual plan.

11.    Maryland Continuation is for groups with less than 20 employees. When an individual’s State
       Continuation Coverage is up, are they HIPAA eligible?
       They are HIPAA eligible if they meet the following criteria.
        • Must have 18 months of aggregate coverage with last coverage being group.
        • Elected and exhausted State Continuation (if offered).
        • Be ineligible for Medicare A or B and/or Medicaid
        • Not be eligible for or be covered by any other health insurance plan
        • Not have had prior insurance plan coverage terminated because of non-payment by the applicant or a
           fraudulent act by the applicant

12.    Will CareFirst calculate the 63-day break in coverage on a continuous basis or aggregate?
       CareFirst will count the 63-day break as continuous; however the 18 months creditable coverage is counted
       in the aggregate.

13.    Must a carrier accept a HIPAA applicant who is void of their certificate or unable to verify coverage?
       If an applicant does not have the Certificate of Creditable Coverage, other documentation (refer to the
       brochure in the packet) can be provided to show previous coverage. It is the employee’s responsibility to
       provide this information. If it is not provided, the applicant can be denied coverage. CareFirst will assist the
       member in trying to obtain proof of prior coverage.

14.    Where should questions about the Certificates of Creditable Coverage and
       Portability be transferred?

       Questions about Certificates of Creditable Coverage should be transferred to 1-800-510-6760.

15.    If I change jobs am I guaranteed the same benefits that I have under my
       current plan?

       No. When a person transfers from one plan to another, the benefits the person receives will be those
       provided under the new plan. Coverage under the new plan could be less or could be greater.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           5- 3
I. COMMISSIONED PRODUCTS                                          HIPAA Questions & Answers

Question and Answers
Continued

16.    I am pregnant. Am I eligible for HIPAA products?
       Yes. If all other federal requirements are met.

17.    What if I have trouble getting documentation from a prior employer?
       Under HIPAA, insurers and group health plans are required to provide documentation to individuals who certify any
       creditable coverage they have earned. CareFirst will assist the member in trying to obtain proof of prior coverage.

18.    What if my new employer does not provide health coverage?
       There is no requirement for any employer to offer health insurance coverage. If
       your new employer does not offer health insurance, you may, if qualified, continue coverage under your previous plan
       under COBRA.

19.    What if I am unable to obtain group coverage?
       You may have the option of obtaining coverage under an individual policy.
       HIPAA would guarantee access to individual insurance for those who meet HIPAA guidelines.

20.    Who will enforce HIPAA?
       The States have the primary enforcement responsibility for group and individual policy.

21.    Can I go from a Self-Employed product to a HIPAA product?
       Yes, Self-Employed products qualify as a group plan, as long as you meet all other HIPAA requirements. (Except for the
       exhaustion of COBRA). Effective 10/1/05, self employed individuals are no longer considered eligible to enroll in the
       Maryland Small Group Reform product. Members currently enrolled in a Small Employers Group Option product as a self
       employed individual who terminate their coverage will not be eligible for reinstatement as they will no longer meet the
       statutory/regulatory eligibility for enrollment.

22.    How are HIPAA customers billed?
       HIPAA customers will be billed the same as all other customers in the same product lines.

23.    If I am getting a divorce will I still qualify for HIPAA coverage?
       Yes, if you have a certificate of creditable coverage and meet all other HIPAA guidelines.

24.    Is Temporary Medical coverage considered a group product?
       No.

25.    Do widowed spouse/children have to exhaust 36 months of COBRA before
       they are eligible?
       Yes, HIPAA regulations state you must exhaust COBRA before you are eligible.

26.    Can one or two members of the family get on a HIPAA product while the other
       family members don’t?
       Yes, a family can split membership, but the member wanting the HIPAA product must have a certificate of
       creditable coverage.

27.    Is there self employed COBRA or Continuation?
       No. Therefore a person can go from a Self Employed product to an IMD product as long as
       they meet all other HIPAA requirements.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           5- 4
  I. COMMISSIONED PRODUCTS                                                  HIPAA Product Options-
                                                                               BluePreferred HIPAA



Overview                         •     BluePreferred HIPAA has the same benefits as the BluePreferred
                                       non-HIPAA product.
                                 •     See the BluePreferred section of the manual for additional product information.
                                 •     These plans do not require medical underwriting



Benefit Options                 •     This product is available to residents of DC and VA
                                •     Rates are higher for HIPAA policyholders.
                                •     The options for BluePreferred HIPAA are listed below.



                                        DEDUCTIBLE                     OUT OF POCKET                     COVERAGE LEVEL
                                                                         MAXIMUM
                                    In Network       Out of        In Network           Out of         In Network          Out of
                                                    Network                            Network                            Network
                                                                           DC OPTIONS
                                      $100            $300            $2,500            $5,000             90%              70%
                                      $300            $600            $2,500            $5,000             80%              60%
                                                                       VIRGINIA OPTIONS
                                      $100            $300            $2,500            $5,000             90%              70%
                                      $300            $600            $2,500            $5,000             90%              70%
                                      $300            $600            $2,500            $5,000             80%              60%
                                      $500           $1,000           $2,500            $5,000             80%              60%
                                      $750           $1,500           $3,500            $7,000             80%              60%
                                      $2,500         $5,000           $5,000            $7,500             80%              60%




Effective Dates                 •     First of the month following approval or
                                •     Members may request an effective date bridging prior coverage




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           5- 5
  I. COMMISSIONED PRODUCTS                                  HIPAA Product Options-
                                               BluePreferred Saver - HIPAA VA Only



Overview                         •    BluePreferred Saver HIPAA has the same benefits as the BluePreferred Saver
                                      non-HIPAA product.
                                 •    See the BluePreferred section of the manual for additional product information.
                                 •    These plans do not require medical underwriting



Benefit Options                 •    This product is available to residents in the Virginia service area VA, only.
                                •    Rates are higher for HIPAA policyholders.
                                •    The options for BluePreferred HIPAA are listed below.



             DEDUCTIBLE                              OUT-OF-POCKET MAXIMUM                                    COINSURANCE
  In-Network            Out-of-Network             In-Network           Out-of- Network             In-Network           Out-of- Network
  $2,500 ind.             $5,000 ind.             $5,000 ind.              $10,000 ind.                 30%                     40%
 $5,000 family           $10,000 family          $10,000 family           $20,000 family
  $5,000 ind.             $10,000 ind.            $5,000 ind.              $12,500 ind.                  0%                     20%
 $10,000 family          $20,000 family          $10,000 family           $22,500 family
  $10,000 ind.            $12,500 ind.            $10,000 ind.             $15,000 ind.                  0%                     20%
 $20,000 family          $25,000 family          $20,000 family           $27,500 family




Effective Dates                 •    First of the month following approval or
                                •    Members may request an effective date bridging prior coverage




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           5- 6
  I. COMMISSIONED PRODUCTS                                          HIPAA Product Options-
                                                         BluePreferred HSA - HIPAA VA Only



Overview                         •     BluePreferred HSA HIPAA has the same benefits as the BluePreferred HSA
                                       non-HIPAA product.
                                 •     See the BluePreferred HSA section of the manual for additional product
                                       information.
                                 •     These plans do not require medical underwriting

Benefit Options                 •     This product is available to residents in the Virginia service area , only.
                                •     Rates are higher for HIPAA policyholders.
                                •     The options for BluePreferred HSA HIPAA are listed below.




                         DEDUCTIBLE                          OUT-OF-POCKET MAXIMUM                          COINSURANCE
               In-Network            Out-of-Network          In-Network              Out-of-          In-Network          Out-of-
                                                                                     Network                              Network
               $1,200 ind.             $2,400 ind.           $2,800 ind.          $5,000 ind.             80%               60%
              $2,400 family           $4,800 family         $5,600 family        $10,000 family
               $2,700 ind.            $5,400 ind.            $3,200 ind.          $6,400 ind.             100%              80%
              $5,400 family          $10,800 family         $6,400 family        $12,800 family




Effective Dates                 •     First of the month following approval or
                                •     Members may request an effective date bridging prior coverage




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           5- 7
  I. COMMISSIONED PRODUCTS                                                  HIPAA Product Options-
                                                                                BlueChoice HIPAA




Overview                        •    See the BlueChoice section of the manual for additional product information.
                                •    These plans do not require medical underwriting



Benefit Options                 •    This product is available to DC residents only.
                                •    Rates are higher for HIPAA policyholders.
                                •    The two options for BlueChoice HIPAA are listed below.
                                •    The High Option includes maternity coverage.




                                                           BlueChoice HIPAA
           OPTION                Co-pay                         Co-pay                 Out-of-Pocket                Co-pay &
                           Preventive Services            Inpatient Hospital            Maximum                    Deductible
                            and Office Visits                 Services                                            Prescription
                                                                                                                     Drugs
           Low             $20 PCP                        $700 per admission          Ind        $3600         $150 deductible
                           $30 Specialist                                             2-Party    $7200         $10/$25/$40
                                                                                      FAM        $11000        $500 max


           High            $10 PCP                        $250                        Ind        $2000         $50 deductible
                           $20 Specialist                 per admission               2-Party    $4000         $10/$25/$40
                                                                                      FAM        $6000         $1000 max


             PCP = Primary Care Physician


          Ind = Individual               2-Party = Individual & Adult or Individual & Child(ren)                    FAM = Family




Effective Dates                 •    First of the month following approval or
                                •    Members may request an effective date bridging prior coverage




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           5- 8
I. COMMISSIONED PRODUCTS                                             HIPAA Product Options-
                                                             BlueChoice HSA - HIPAA (VA Only)



Overview                         •    BlueChoice HSA HIPAA has the same benefits as the BlueChoice HSA
                                      non-HIPAA product.
                                 •    See the BlueChoice HSA section of the manual for additional product information.
                                 •    These plans do not require medical underwriting

Benefit                          • This product is available to residents in the Virginia service area only.
Options                          • Rates are higher for HIPAA policyholders.
                                 • The options for BlueChoice HSA HIPAA are listed below.

How Does                        HIPAA specifies that under certain situations, those applying for individual (non-group)
HIPAA                           health insurance coverage for themselves or their family may no longer be subject to
Affect Me?                      waiting periods or be required to complete a medical underwriting questionnaire in
                                order to obtain health insurance benefits.



Qualifying for                  To enroll in HIPAA coverage, you must submit a completed application and Certificate
HIPAA Coverage                  of Creditable Coverage. You and your covered dependents may enroll without a
                                medical examination , waiting period or health evaluation questionnaire if all of the
                                following criteria are met:
                                • Have 18 or more months of creditable coverage with the most recent coverage
                                    under individual health insurance coverage, a group employer-sponsored plan,
                                    governmental plan, church plan, State Children’s Health Insurance Plan (S-CHIP) or
                                    benefit plan offered in conjunction with any of these plans. Certificates of creditable
                                    coverage must indicate at least 18 months of aggregate health insurance coverage.
                                • Have elected and exhausted health insurance benefits through a COBRA or similar
                                    group, state or federal continuation plan, including the Federal Employee Health
                                    Benefits Program (FEHBP), FEHBP Temporary Continuation of Coverage (TOC) or
                                    state continuation coverage, if available.
                                • Have no more than a 63-day break in coverage.
                                • Not be eligible for Medicare A or B, Medicaid, or any other employer-sponsored
                                    plan.
                                • Not be covered by any other health insurance plan.
                                • Not have had prior insurance coverage terminated because of the applicant’s failure
                                    to pay the required premium or fraudulent/intentional misrepresentations made by
                                    the applicant.

 Effective                      • First of the month following approval or
 Dates                          • Members may request an effective date bridging prior coverage




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           5- 9
I. COMMISSIONED PRODUCTS                                           HIPAA Product Options-
                                                            BlueChoice HSA - HIPAA (VA Only)


         SERVICES                                                                       $20 PCP / $30 Specialist Co-pays
         GENERAL INFORMATION
         Member Deductible                                                              $0
         Out-of-Pocket Maximum
         • Individual                                                                   $3,600
         • Individual & Child(ren)* / Individual & Adult**                              $7,200
                                                                                        $11,000
                                                                                        No lifetime maximum
         PREVENTIVE SERVICES & OFFICE VISITS
         Well-Child – Exams & Immunizations (through age 17)                            $20 PCP / $30 Specialist
         Adult Routine Preventive Health                                                $20 PCP / $30 Specialist
         Routine Gynecological Visits (No Charge for Pap Smears)                        $20 PCP / $30 Specialist
         Prostate Screening Visit (No Charge for PSA test)                              $20 PCP / $30 Specialist
         Colorectal Cancer Screening Test                                               $20 PCP / $30 Specialist
         Mammography Screening Visit (No Charge for test)                               No charge
         Allergy Testing and Treatment                                                  $20 PCP / $30 Specialist
         Annual Routine Eye Exam                                                        $10
         -at participating Davis Vision provider (optometrists and
         ophthalmologists)
         Hearing Screening                                                              $20 PCP / $30 Specialist
         OUTPATIENT MEDICAL AND SURGICAL SERVICES
         Physician Office Visit for illness                                             $20 PCP / $30 Specialist
         Rehabilitative Services (Physical, Occupational and Speech                     $20 PCP / $30 Specialist
         Therapy – each limited to 30 visits each per illness or injury
         per calendar year)
         Surgical Services – Professional                                               $20 PCP / $30 Specialist
         Surgical Services – Hospital or Other Facility                                 $50 facility co-pay plus $20 PCP / $30
                                                                                        Specialist co-pay
         Diagnostic Procedures                                                          $20 PCP / $30 Specialist
         X-Ray and lab Tests at Plan Facilities                                         No charge
         INPATIENT HOSPITAL SERVICES
         365 Days Rooms and Board (Semi-Private Room)                                   $700 facility co-pay per admission
         Medical and Surgical Services                                                  No charge
         Prescription Drug (Inpatient)                                                  No charge




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           5- 10
I. COMMISSIONED PRODUCTS                                            HIPAA Product Options-
                                                             BlueChoice HSA-HIPAA (VA Only)



         MATERNITY SERVICES
         Prenatal and Postnatal Care
         PCP                                                                            $20 per visit (up to $200 per pregnancy)
         Specialists                                                                    $30 per visit (up to $300 per pregnancy)
         Hospital Facility                                                              $700 facility co-pay per admission
         Delivery                                                                       No charge
         Birthing Center                                                                $30 per visit
         Nursery Care (for newborn)                                                     No charge
         EMERGENCY OR URGENT CARE
         Plan Affiliated Urgent Care Facility                                           $30
         Hospital Emergency Room or Non-Plan Urgent Care Facility                       $30
         (Waived if admitted)
         Ambulance (when medical necessary)                             No charge
       * A child is your unmarried, dependent child under the age of 23 or defined in the CareFirst BlueChoice
       Group Conversion/HIPAA contract.

       ** ”Adult” means the spouse of the subscriber who resides with the subscriber and satisfies the eligibility
       requirements defined in the BlueChoice Group Conversion/HIPAA contract.

*** Family Membership provides coverage for two adults and children or grandchildren or a single parent
with more than one child or grandchild. Each additional child can be added to the Family membership at
no extra cost.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           5- 11
I. COMMISSIONED PRODUCTS               HIPAA Product Options –
               Comprehensive Major Medical HIPAA – VA Residents Only



Overview                        •    Comprehensive Major Medical HIPAA has the same benefits as the
                                     Comprehensive Major Medical non-HIPAA product.
                                •    See the Comprehensive Major Medical section of the manual for additional product
                                     information.
                                •    These plans do not require medical underwriting




Benefit Options                 •    This product is available to Virginia residents in our service area only.
                                •    Rates are higher for HIPAA policyholders.
                                •    The options for the Comprehensive Major Medical HIPAA are listed below:



                                                   DEDUCTIBLE                     OUT OF POCKET MAXIMUM
                                                         $300                                     $500
                                                         $500                                     $500




Effective Dates                 •    First of the month following approval, or
                                •    Members may request an effective date bridging prior coverage




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                           5- 12
I. COMMISSIONED PRODUCTS                                             Medicare Supplemental Plans



Overview                        Medicare supplemental insurance is designed to supplement Medicare benefits and is
                                regulated by federal and state law.


                                As of 2006, there are twelve (12) standardized Medicare Supplemental Plans named
                                “A” through “L.” For Plans A through J, the higher the Plan letter, the more
                                comprehensive the coverage. Plans K and L are new lower cost plans effective
                                January 2006.
                                Medicare supplemental Plans A-J pay most, if not all, Medicare coinsurance amounts
                                (usually the 20% that Medicare does not pay). Plans K and L, plans new in the
                                marketplace, require higher member cost-sharing. Additionally some plans provide
                                coverage for the up-front deductibles for hospital (Part A) and or physician services
                                (Part B).


                                MD RESIDENTS ONLY
                                CareFirst offers MediGap Plans to Maryland residents.


                                DC AND VIRGINIA RESIDENTS ONLY
                                CareFirst offers the Supplement-65 to residents of DC and Virginia.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-1
I. COMMISSIONED PRODUCTS                                         Medigap Early Enrollment Discount



                               •    The Medigap early enrollment discount is a flat rate discount being offered on our
Overview                            Medigap plans (Medigap-65 in Maryland and Supplement-65 Medically
                                    Underwritten products in DC and VA).
                               •    Not all members are affected: Members must be age 65 or older and within 3 years
                                    of their Medicare Part B effective date (see Eligibility Section).



Key Selling                    •    15% flat discount off the standard premium for 3 years (discount does not decrease
Features                            during the 3 years)
                               •    15% flat discount applies to new and existing members* who meet the criteria
                               •    CareFirst will offer some of the most competitive rates in the marketplace
                               •    Existing members * receive price relief—will increase retention
                               •    Will give members getting discount an additional savings that can be used to buy
                                    other ancillary products offered by CareFirst.

                               *See Eligibility Section.


Effective Date                 •    The effective date of the discount began August 1, 2006.




Jurisdictional                 •    The discount applies to Maryland, District of Columbia and Northern Virginia.
Impact




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-2
I. COMMISSIONED PRODUCTS                                         Medigap Early Enrollment Discount


Eligibility &                  There are many factors that determine the participant’s eligibility for the discount. These
Enrollment                     factors may be mandated by State law or required by CareFirst.

Who is Eligible?               New members: This discount will apply as long as the applicant’s Medicare Part B
                               effective date is within three years of the CareFirst policy effective date PLUS:
                                • Discount only available to individuals 65+
                                • In DC and VA - only members in a medically underwritten product can receive the
                                    discount (Medigap Plans C and F)
                                • Since MD has no medically underwritten products the discount is available for all
                                    Medigap plans offered (Medigap Plans A, B, C, F and High Deductible F)


                                Existing members: This discount will apply only if the member enrolled with Medicare
                                Part B with an effective date of 8/1/03 or later as of 8/1/06.


                               MARYLAND
                               New Members:
                                  • Subscribers 65+
                                  • Within 3 years of Medicare Part B eligibility based on policy effective date

                               Existing Members:
                                   • Subscribers 65+
                                   • Enrolled as of 8/1/06
                                   • Part B effective date 8/1/03 or later


                               VIRGINIA/DC
                               New Members:
                               Option #1
                                   • Subscribers 65+
                                   • Within 6 months of Medicare Part B effective date based on policy effective date

                               OR
                               Option #2
                                   • Subscribers 65+ AND
                                   • 6 months to 3 years of their Medicare Part B eligibility based on policy effective
                                       date AND
                                   • Have passed Medical Underwriting

                               Existing Members:
                                   • Subscribers 65+
                                   • Enrolled as of 8/1/06 in a medically underwritten product
                                   • Part B effective date 8/1/03 or later




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-3
I. COMMISSIONED PRODUCTS                                         Medigap Early Enrollment Discount



Who Is NOT                      • Subscribers ineligible for Medicare Part B
Eligible?
                                • Subscribers whose Medicare Part B effective date is over 3 years in the past from
                                     the current date

                                • Subscribers who are in the non-underwritten product in DC or VA

                               Example: Person is 70 years of age and is applying 5 months AFTER their Part B open
                               enrollment period. Person must apply for medically underwritten product. If he/she
                               does NOT pass underwriting—he/she is eligible for non-medically underwritten product
                               but NOT eligible for discount.

                                • Subscribers who are under the age of 65

                                • Inactive subscribers




Notification                   •    There was a one-time notification to existing members who were with CareFirst as
to Existing                         of August 1, 2006.
Members
                               •    Existing members enrolled as of August 1, 2006 who were eligible for the discount
                                    were notified by a special letter of their eligibility for the discount and the fact that
                                    the discount began August 1, 2006.




                               •    Members will be notified about termination of the discount.
Termination
of the                         •    If the billed date is greater than 36 months from the benefit enrollment effective
Discount                            date; the discount will no longer be applied.

                               •    A discount termination letter will be automatically generated to the subscriber.

                               •    Easy-Pay letters will be generated 60 days prior to the discount ending so that the
                                    subscriber can notify their bank or credit card company.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-4
I. COMMISSIONED PRODUCTS                                        MediGap-65 Standard Plans - MD


Products Available              The “standard” plan offerings available to individuals age 65 and over are:
                                   • Plan A (also available to individuals under age 65)
                                   • Plan B
                                   • Plan C (also available to individuals under age 65)
                                   • Plan F
                                   • High-Deductible Plan F

Key Selling                     •    Fills the gaps in Medicare coverage
Features                        •    Lowers out-of-pocket costs
                                •    Protects against high costs of long-term hospital stays
                                •    Competitively priced
                                •    Provides choice of plans at multiple price points
                                •    Optional Dental program available through The Dental Network
                                •    Optional Vision program available through Davis Vision
                                •    Discounts on alternative therapies and wellness services through the Options
                                     Discount Program* which include discounts on: hearing care services, eldercare
                                     services, weight watchers online, acupuncture, massage therapy, chiropractic care,
                                     fitness centers, health-related magazines, cosmetic dentistry, contact lenses and
                                     laser vision correction.
                                •    An Argus Discount Drug Card providing drug discounts at over 60,000 pharmacies
                                     nationwide. Members are guaranteed the lowest price available in that pharmacy
                                     at the time of purchase. For members who have a Medicare Prescription Drug
                                     card, the discount drug can be used to pay for any drugs that their Medicare
                                     Prescription Drug program does not cover. Please note: Members should
                                     continue using their Medicare Prescription Drug card during the coverage gap
                                     because negotiated discounts continue from their Medicare Prescription Drug
                                     program during the gap.



Calendar or                     •    Calendar Year
Contract Year

Membership Types                •    Individual only



Services Not                    •    Long term care/custodial care
Covered                         •    Services excluded from coverage under Medicare




*Options Discount Program is not a covered benefit but a way for our members to tap into health and wellness practitioners at

The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-5
discounted rates. No referrals or paperwork are required to gain access to the discounts.
Additional information can be obtained at www.carefirst.com.




I. COMMISSIONED PRODUCTS                                        MediGap-65 Standard Plans - MD



Waiting Period                  •    There is a 90-day waiting period for pre-existing conditions.
                                •    Generally, the 90-day waiting period may be waived if:
                                     - the applicant is applying for MediGap coverage within 63 days from the
                                       termination of his/her prior coverage;
                                OR
                                      - the applicant is applying for MediGap coverage within 6 months of
                                        his/her Medicare eligibility date.
                                      - The applicant has at least 6 months of creditable coverage*.


                                *For applicants with fewer than 6 months of creditable coverage, CareFirst will reduce
                                the 90-day waiting period by the number of days the prior policy was in force. The
                                prior policy must have been in force within the past 63 days from receipt by CareFirst
                                of the Medicare supplemental application.




Termination of                  A member’s coverage may be terminated when:
Coverage                        • There is evidence of fraud or
                                • There is non-payment of premiums or
                                • The member becomes eligible for Medicaid coverage.




Who Is Eligible?                •    The applicant must be a resident of the state of Maryland.
                                •    The applicant must be enrolled in Medicare Parts A and B.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-6
I. COMMISSIONED PRODUCTS                                      MediGap-65 Standard Plans - MD


Plan Summary                    A brief Plan summary is provided below for each of the offerings:




                                    PLAN          SUMMARY
                                      A           • Covers Part A hospital co-pays for days 61-150
                                                  • Covers 20% Part B physician coinsurance
                                                  • Covers additional 365 lifetime reserve hospital days

                                      B           •   Covers Part A hospital deductible
                                                  •   Covers Part A hospital co-pays for days 61-150
                                                  •   Covers 20% Part B physician coinsurance
                                                  •   Covers additional 365 lifetime reserve hospital days

                                      C           •   Covers Part A hospital deductible
                                                  •   Covers Part A hospital co-pays for days 61-150
                                                  •   Covers Part B physician deductible
                                                  •   Covers 20% Part B physician coinsurance
                                                  •   Covers foreign emergency care after a separate deductible
                                                  •   Covers additional 365 lifetime reserve hospital days

                                       F          • Covers Part A hospital deductible
                                                  • Covers Part A hospital co-pays for days 61-150
                                                  • Covers Part B physician deductible
                                                  • Covers 20% Part B physician coinsurance
                                                  • Covers foreign emergency care after a separate deductible
                                                  • Covers Part B excess charges
                                                    NOTE: Excess charge is the amount above Medicare that
                                                    doctors are allowed to charge if they don’t accept Medicare
                                                    assignment and is capped at 15% above the Medicare allowed
                                                    amount.
                                                  • Covers additional 365 lifetime reserve hospital days

                                  High-           • Covers all Plan F benefits AFTER the member has paid a
                                Deductible          calendar year deductible of $1,790 (for 2006).
                                  Plan F          • The deductible increases annually.
                                                  • Foreign travel emergency deductible is separate.
                                                  • Medicare deductibles and coinsurance for Parts A & B apply to
                                                    the deductible.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-7
I. COMMISSIONED PRODUCTS                                        MediGap-65 Standard Plans - MD



Benefit Chart                   Listed below is a chart outlining some of the MediGap 65 – Maryland benefits.




                                                                                      MediGap-65 Plan Coverage
                         Medicare Does Not Pay                            Plan A       Plan B       Plan C        Plan F       High-Ded.
                            (for year 2007)                                Pays         Pays         Pays          Pays         Plan F*
              Part A Hospital Services
              [$992] inpatient hospital deductible first 60 days              -           X            X             X               X
              [$248] a day co-payment for days                               X            X            X             X               X
              61-90 in a hospital

              [$496] a day co-payment for days                               X            X            X             X               X
              91-150 (Lifetime Reserve)

              100% of Medicare allowable expenses for                        X            X            X             X               X
              additional 365 days after Medicare hospital
              benefits stop completely

              Calendar year blood deductible (first 3 pints of               X            X            X             X               X
              blood) if the deductible is not met by the
              replacement of the blood

              [$124] per day for days 21-100 in a skilled                -                -            X             X               X
              nursing facility
              Part B Physician and Medical Services
              [$131] Part B deductible                                        -           -            X             X               X


              20% of Medicare approved amount (Part B                        X            X            X             X               X
              coinsurance) after [$131] Part B deductible is
              met

              100% of Medicare Part B excess charges                          -           -            -             X               X
              Additional Expenses Not Covered By Medicare
              Benefits for medically necessary emergency care                 -           -            X             X               X
              received in a foreign country ($250 deductible
              with $50,000 lifetime maximum)



               *After the member pays a $1790 deductible in 2006 (2007 deductible not yet announced), High-Deductible Plan
               F pays for the benefits denoted with an “X.”

               [ ] Bracketed amounts subject to increase annually.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-8
I. COMMISSIONED PRODUCTS                                                 Supplement-65 (DC/VA)


Products Available              •    Plans A, C and F (non-medically underwritten) are available to individuals 65 and
                                     over.
                                •    Plans C and F (underwritten) are available to individuals 65 and over.
                                •    Plans A and C (non-medically underwritten) are available to individuals under 65
                                     for Virginia and DC residents.


Key Selling                     •    Fills the gaps in Medicare coverage
Features                        •    Lowers out-of-pocket costs
                                •    Protects against high costs of long-term hospital stays
                                •    Competitively priced
                                •    Provides choice of plans at multiple price points
                                •    Optional Dental program available through The Dental Network (DC only)
                                •    Optional Vision program available through Davis Vision
                                •    Discounts on alternative therapies and wellness services through the Options
                                     Discount Program* which include: hearing care services, eldercare services,
                                     weight watchers online, acupuncture, massage therapy, chiropractic care, fitness
                                     centers, health-related magazines, cosmetic dentistry, contact lenses and laser
                                     vision correction.
                                •    An Argus Discount Drug Card providing drug discounts at over 60,000 pharmacies
                                     nationwide. Members are guaranteed the lowest price available in that pharmacy
                                     at the time of purchase. For members who have a Medicare Prescription Drug
                                     card, the discount drug can be used to pay for any drugs that their Medicare
                                     Prescription Drug program does not cover. Please note: Members should
                                     continue using their Medicare Prescription Drug card during the coverage gap
                                     because negotiated discounts continue from their Medicare Prescription Drug
                                     program during the gap


Calendar or                     •    Calendar Year
Contract Year

Membership Types                •    Individual only

Services Not                    •    Long-term care/custodial care
Covered                         •    Services excluded from coverage under Medicare



*Options Discount Program is not a covered benefit but a way for our members to tap into health and wellness practitioners at
discounted rates. No referrals or paperwork are required to gain access to the discounts.
Additional information can be obtained at www.carefirst.com.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-9
I. COMMISSIONED PRODUCTS                                                 Supplement-65 (DC/VA)



Waiting Period                  •    There is a 90-day waiting period for pre-existing conditions.
                                •    Generally, the 90-day waiting period may be waived if:
                                     - The applicant is applying for Medigap coverage within 63 days from the
                                       termination of his/her prior coverage;
                                OR
                                      - The applicant is applying for Medigap coverage within 6 months of
                                        his/her Medicare eligibility date.
                                      - The applicant has at least 6 months of creditable coverage*.


                                *For applicants with less than 6 months of creditable coverage, CareFirst will reduce the
                                90-day waiting period by the number of days the prior policy was in force. The prior
                                policy must have been in force within the past 63 days from receipt by CareFirst of the
                                Medicare supplemental application.




Termination of                  A member’s coverage may be terminated when:
Coverage                        •    There is evidence of fraud or
                                •    There is non-payment of premiums or
                                •    The member becomes eligible for Medicaid coverage




Who Is Eligible?                •    The applicant must be a resident of the:
                                      - District of Columbia or
                                      - (i) Arlington County, the City of Alexandria, the City of Fairfax or the Town of
                                      Vienna, Virginia;
                                      - (ii) the part of Fairfax County lying within State Route 123 to the West of the
                                      Potomac River to the East; or
                                      - (iii) the part of Prince William County lying within and to the North of State Route
                                      123, Virginia.
                                •    The applicant must be enrolled in Medicare parts A and B.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-10
I. COMMISSIONED PRODUCTS                                                 Supplement-65 (DC/VA)


Plan Summary                    A brief Plan summary is provided below for each of the offerings:




                                   PLAN           SUMMARY
                                      A           • Covers Part A hospital co-pays for days 61-150
                                                  • Covers 20% Part B physician coinsurance
                                                  • Covers additional 365 lifetime reserve hospital days

                                      C           • Covers Part A hospital deductible
                                                  • Covers Part A hospital co-pays for days 61-150
                                                  • Covers Part B physician deductible
                                                  • Covers 20% Part B physician coinsurance
                                                  • Covers foreign emergency care after a separate deductible
                                                  • Covers additional 365 lifetime reserve hospital days

                                      F           • Covers Part A hospital deductible
                                                  • Covers Part A hospital co-pays for days 61-150
                                                  • Covers Part B physician deductible
                                                  • Covers 20% Part B physician coinsurance
                                                  • Covers foreign emergency care after a separate deductible
                                                  • Covers Part B excess charges
                                                    NOTE: Excess charge is the amount above Medicare that
                                                    doctors are allowed to charge if they don’t accept Medicare
                                                    assignment and is capped at 15% above the Medicare allowed
                                                    amount.
                                                  • Covers additional 365 lifetime reserve hospital days




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-11
I. COMMISSIONED PRODUCTS                                                 Supplement-65 (DC/VA)


Benefit Chart                   Listed below is a chart outlining some of Supplement-65 – DC/VA benefits.




                                                                                                        Supplement-65
                                              Medicare Does Not Pay                                Plan A Plan C Plan F
                                                 (for year 2007)                                    Pays    Pays     Pays
                                Part A Hospital Services
                                [$992] inpatient hospital deductible first 60 days                     -            X           X

                                [$248] a day co-payment for days 61-90 in a                            X            X           X
                                hospital
                                [$496 ] a day co-payment for days 91-150                               X            X           X
                                (Lifetime Reserve)
                                100% of Medicare allowable expenses for                                X            X           X
                                additional
                                365 days after Medicare hospital benefits stop
                                completely
                                Calendar year blood deductible (first 3 pints of                       X            X           X
                                blood) if the deductible is not met by the
                                replacement of the blood
                                [$124] per day for days 21-100 in a skilled nursing                    -            X           X
                                facility
                                Part B Physician and Medical Services
                                [$131] Part B deductible                                               -            X           X

                                Generally 20% of Medicare approved amount                              X            X           X
                                (Part B coinsurance after [$131] Part B deductible
                                is met)

                                100% of Medicare Part B excess charges                                 -            -           X

                                Additional Expenses Not Covered by Medicare
                                Benefits for medically necessary emergency care                        -            X           X
                                received in a foreign country
                                ($250 deductible with $50,000 lifetime maximum)

                              [ ] Bracketed amounts subject to increase annually.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-12
I. COMMISSIONED PRODUCTS                                  Medi–CareFirst BlueCross BlueShield



Program Overview –    •                Effective January 1, 2006, the Medicare Prescription Drug Program (also called
Medicare Prescription                  Medicare Part D) is insurance provided by private companies that have
Drug (Part D)                          contracted with Medicare.

                                  •    The Medicare Prescription Drug Program is not an entitlement plan.
                                       Most Medicare eligibles must choose and enroll in a plan.

                                  •    Individuals who want Medicare Drug coverage must choose to get it through
                                       stand-alone Prescription Drug Plans or through Medicare Advantage (MA) Plans
                                       such HMOs and PPOs or as an optional benefit with Medicare Advantage Private
                                       Fee-for–Service Plans, Medicare Advantage Medicare Savings Account Plans or
                                       1876 Cost Plans.


Product Overview –                •    Medi-CareFirst is offered by First Care Inc., doing business as Medi-CareFirst
                                       BlueCross BlueShield. It is a new subsidiary set up to market a Medicare
Medi-CareFirst                         Prescription Drug Plan in the District of Columbia, Maryland and Delaware.
                                       Medi-CareFirst BlueCross BlueShield is backed by the strength of CareFirst
                                       BlueCross BlueShield and Blue Cross Blue Shield of Delaware.

                                  •    For applicants who reside in Virginia, brokers must contact Anthem Blue Cross
                                       and Blue Shield at 1-800-551-1186 from 8am to 6pm, Monday through Friday.
                                       Virginia is outside the CareFirst service area for the Medi-CareFirst BlueCross
                                       BlueShield plan.


Products Available                Medi-CareFirst BlueCross BlueShield offers two levels of coverage:

                                             1. Blue Rx Standard Plan

                                             2. Blue Rx Enhanced Plan


Participating                     •      Medi-CareFirst has more than 1,400 pharmacies in its service area of Maryland,
Pharmacies                               the District of Columbia and Delaware and 60,000 network pharmacies
                                         nationwide.

                                  •     To find a participating pharmacy, use our Pharmacy Locator on www.medi-
                                        carefirst.com.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-13
I. COMMISSIONED PRODUCTS                                   Medi–CareFirst BlueCross BlueShield


Key Selling Features              •     Medi-CareFirst is a part of BlueCross and BlueShield —one of the most
                                        recognized names in health care
                                  •     Over 45 years of experience providing service to people with Medicare
                                  •     More than 1,400 regional pharmacies and 60,000 pharmacies nationwide
                                  •     Medi-CareFirst covers ALL of the prescription drugs that Medicare has
                                        approved for the Medicare Prescription Drug Program (Open Formulary)
                                  •     The Medi-CareFirst negotiated discount applies during the coverage gap period
                                        when the member is responsible for 100% of the cost
                                  •     Blue Rx Standard and Blue Rx Enhanced Benefit Advantages:
                                             •    no deductible
                                             •    a one month supply is 34 days vs. 30 days
                                             •    $7 co-pay on generic drugs for a one month supply.
                                             •    a three-month supply of drugs for only 2 co-pays.
                                            • Blue Rx Enhanced provides generic drug coverage in the coverage gap
                                  •    A free medication therapy management program (see Medication Therapy
                                       Management section)
                                  •    Discounts on alternative therapies and wellness services (CareFirst Options
                                       Program).


Calendar or Contract              •     Calendar Year
Year

Membership Types                  •    Individual only



Who Is Eligible?                  •     Individuals entitled to Medicare Part A and/or enrolled in Medicare Part B.

                                  •     Individuals enrolled in a Medicare Advantage Private Fee-for Service, Medicare
                                        Advantage Medical Savings Account Plan, or an 1876 Cost Plan who have NOT
                                        also taken the OPTIONAL Medicare prescription drug coverage with that plan.

                                  •     The individual must live in Maryland, the District of Columbia or Delaware. If the
                                        person lives in Virginia, residents can apply for coverage through Anthem Blue
                                        Cross Blue Shield.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-14
I. COMMISSIONED PRODUCTS                                   Medi–CareFirst BlueCross BlueShield


Who Is NOT                      •    Anyone who is currently enrolled in a Medicare Advantage HMO or PPO with drug.
Eligible?
                                •    Anyone who is currently enrolled in a Medicare Advantage Private Fee-for Service,
                                     Medicare Advantage Medical Savings Account Plan, or a 1876 Cost Plan in
                                     addition to being enrolled in the OPTIONAL Medicare prescription drug coverage
                                     with that plan.

                                •    Anyone who resides outside Medi-CareFirst’s service area (Maryland, DC and
                                     Delaware).

Medical                         •    There is no Medical Underwriting.
Underwriting
                                •    Everyone is accepted on a GUARANTEED ISSUE basis.

Initial Enrollment              •    For those enrolled in Medicare as of January 1, 2006, the Initial Enrollment Period
Period                               was November 15, 2005 through May 15, 2006. This extended Initial Enrollment
                                     Period was established for existing Medicare eligibles because these individuals
                                     were considered to be newly eligible to the Medicare Prescription Drug Program.

                                •    The Initial Enrollment Period is established for individuals newly eligible for
                                     Medicare based on age or disability. The Initial Enrollment Period is 7 months
                                     (three months before and three months after the time the person becomes
                                     eligible).

                                          o    Birthday example: For individuals turning 65, If the member’s birthday is
                                               July 10, the Initial Enrollment Period is April 1-October 31. This is three
                                               months prior to the person’s birth month (April, May and June), the month
                                               of the birthday (July) and the three months following the birth month
                                               (August, September and October).

                                          o    Disability example: Individuals also may enroll if newly eligible for
                                               Medicare, based on a disability (i.e., End Stage Renal disease or receipt of
                                               Social Security or Railroad Retirement Board disability benefits for 24
                                               months). The Initial Enrollment Period begins three months before and
                                               ends three months after the month that Medicare entitlement begins.

                                •    See the Initial Beneficiary Entitlement Period chart to assist in determining
                                     entitlement and enrollment periods.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-15
I. COMMISSIONED PRODUCTS                                   Medi–CareFirst BlueCross BlueShield




Annual                          •    The Annual Coordinated Election Period is from November 15 through December
Coordinated                          31 of each year. Coverage begins January 1 of the following year. The Annual
Election Period                      Election Period is when:
And Benefit                           o Existing Medicare Prescription drug members can make product or carrier
Changes                                      changes
                                      o Late enrollees (those who missed the Initial Enrollment period) can enroll
                                              Late enrollment will result in a higher premium (1% increase for every
                                              month the individual does not have coverage at least as good as
                                              Medicare Prescription Drug). The higher premium will continue as long
                                              as the individual has Medicare Prescription Drug coverage.

                                EXCEPTIONS:
                                • Penalties are waived if the member was previously enrolled in a drug plan with
                                   coverage at least as good as Medicare Prescription Drug Coverage. The member
                                   must enroll within 60 days of losing coverage to avoid a penalty.

                                •    There are special rules for those receiving extra help:
                                     Dual eligibles (Medicare and Medicaid) can change plans at any time.
                                     There also may be special rules for other low income subsidy members.
                                •
                                          o    If the member feels that they qualify for a Special Enrollment Period the
                                               member can call Membership Customer Service (1-888-857-6118 or TDD
                                               users should call 1-800-855-2880 from 8 am-8 pm seven days a week for
                                               assistance.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-16
I. COMMISSIONED PRODUCTS                                   Medi–CareFirst BlueCross BlueShield


                           INITIAL BENEFICIARY ENTITLEMENT PERIOD
                                     If,                                                         Then,
                        First Entitled to Part A or                                 The Initial Enrollment Period
                     Enrolls in Part B on This Date…                                        for Part D Is…
                                    October 1, 2006                                   July 1, 2006 to January 31, 2007

                                   November 1, 2006                                August 1, 2006 to February 28, 2007

                                   December 1, 2006                                September 1, 2006 to March 31, 2007

                                    January 1, 2007                                  October 1, 2006 to April 30, 2007

                                    February 1, 2007                                November 1, 2006 to May 31, 2007

                                      March 1, 2007                                 December 1, 2006 to June 30, 2007

                                       April 1, 2007                                  January 1, 2007 to July 31, 2007

                                       May 1, 2007                                 February 1, 2007 to August 31, 2007

                                       June 1, 2007                                March 1, 2007 to September 30, 2007

                                       July 1, 2007                                  April 1, 2007 to October 31, 2007

                                     August 1, 2007                                 May 1, 2007 to November 30, 2007

                                   September 1, 2007                                June 1, 2007 to December 31, 2007

                                    October 1, 2007                                   July 1, 2007 to January 31, 2008

                                   November 1, 2007                                August 1, 2007 to February 28, 2008

                                   December 1, 2007                                September 1, 2007 to March 31, 2008


                  NOTE: Individuals who missed their Initial Enrollment Period may enroll November 15 through
                  December 31st of each year but may be subject to a penalty.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-17
I. COMMISSIONED PRODUCTS                                    Medi–CareFirst BlueCross BlueShield


Special Enrollment              •    The Special Enrollment Period circumstances include:
Period                                • Moving out of service area
                                      • Member not informed that their previous drug coverage was not creditable
                                      • Member loses creditable drug coverage.
                                      • The Plan does not renew its contract with Medicare
                                      • Member becomes newly qualified as low-income subsidy eligible
                                        o Members should refer to Evidence of Coverage to find a listing of specific
                                            circumstances that will result in a Special Enrollment Period

                                •    If the member feels that they qualify for a Special Enrollment Period the member
                                     can call Membership Customer Service (1-888-857-6118 or TDD users should call
                                     1-800-855-2880 from 8 am-8 pm seven days a week for assistance.



Waiting Periods                 •    The applicant must enroll during the initial enrollment period.

                                •    If the applicant misses the initial enrollment period, (unless the applicant is eligible
                                     for a special enrollment period), the applicant must wait until the Annual
                                     Coordinated Election Period (November 15th through December 31st ) to enroll.

                                •    Late enrollees may be subject to the 1% monthly penalty.

                                     EXCEPTION: Penalties are waived if the member was previously enrolled
                                     in a drug plan with coverage at least as good as Medicare Prescription Drug
                                     Coverage. The member must enroll within 60 days of losing coverage to avoid a
                                     penalty.

                                •    See Section on Annual Coordinated Election Periods.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-18
I. COMMISSIONED PRODUCTS                                   Medi–CareFirst BlueCross BlueShield




How Medi-CareFirst              •    Medi-CareFirst BlueCross BlueShield offers two levels of Coverage:
Works
                                          1. Blue Rx Standard Plan and

                                          2. Blue Rx Enhanced Plan.

                                •    Step 1: Initial Coverage Limit.
                                     There is no deductible for either plan. The member pays a co-pay or co-insurance
                                     based on the type of drug, type of pharmacy and whether the member is getting a
                                     one-month (34 days) or 3-month (90 days) drug supply. Co-pays or coinsurance
                                     are paid until $2,400 in drug costs (the member’s out-of-pocket costs plus Blue
                                     Rx’s payments) are reached. This does not include the member’s premium.

                                •    Step 2: Coverage Gap:
                                     Once the member and Blue Rx have spent a total of $2,400 in drug costs,
                                     coverage changes as the member enters the coverage gap. While in the coverage
                                     gap, members still get the benefit of Medi-CareFirst’s negotiated discount pricing.

                                          o    With Blue Rx Standard, the member pays 100% of drug costs until an out-
                                               of-pocket maximum of $3,850 is reached.

                                          o    With Blue Rx Enhanced, the member pays for drug coverage until an out-
                                               of-pocket maximum of $3,850 is reached. The member pays only a $7
                                               co-pay for Generic drugs while in the Gap. The member pays 100% of
                                               drug costs for all other drugs.

                                •    Step 3: Catastrophic Coverage:
                                     If $3,850 in out-of-pocket is reached, the member pays no more than 5% of drug
                                     costs. Specifically, the member pays $2.15 for generic or brand-name drugs
                                     treated as Generic and $5.35 for all other drugs or 5%, whichever is greater.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-19
I. COMMISSIONED PRODUCTS                                   Medi–CareFirst BlueCross BlueShield




Plan Summary                    Listed below is a summary of the benefits:




                                                                     Blue Rx                                       Blue Rx
                                                                    STANDARD                                      ENHANCED
                                                                       Plan                                          Plan
                                                                                     You Pay In-Network*
         Monthly Premium                                                $34.20**                                      $42.20**
         Annual Deductible                                                                       $0
                                                                                         34-day Supply
                                                                                     $7 for Generic (Tier 1)
                                                                           $25 for Preferred Brand-Name (Tier 2)
         Regular Coverage –                                             $69 for Non-Preferred Brand-Name (Tier 3)
         Amount you pay In-Network for                      25% for Non-Self Administered Medical Injectables (Tier 4)***
         the first $2,400 in total drug
         costs                                                                    90-day Supply
                                                                              $14 for Generic (Tier 1)
                                                                      $50 for Preferred Brand-Name (Tier 2)
                                                                    $138 for Non-Preferred Brand-Name (Tier 3)
                                                            25% for Non-Self Administered Medical Injectables (Tier 4)***
                                                                  34-Day Supply                                 34-Day Supply
         “Coverage Gap” –                                    Generic: 100% of all costs                          Generic: $7
         Amount you pay until your out-                       Brand: 100% of all costs                      Brand: 100% of all costs
         of-pocket expenses reach                                 90-Day Supply                                 90-Day Supply
         $3,850
                                                             Generic: 100% of all costs                          Generic: $14
                                                              Brand: 100% of all costs                      Brand: 100% of all costs
         Catastrophic Coverage –                                     $2.15 for Generic Drugs or Brand-Name Drugs
         Amount you pay once your                                                    treated as Generic
         out-of-pocket expenses                                    $5.35 for all other drugs or 5% whichever is greater
         reach $3,850

       NOTES:
       *The co-pays listed above are for in-network pharmacies. You must use in-network pharmacies, except
       under non-routine circumstances.

       **If you missed your Initial Enrollment Period you will likely pay an additional 1% for each month that you
       did not have coverage that was at least as good as the Medicare Prescription Drug Program.

       ***Self-administered medical injectables are covered in Tiers 2 and 3.


The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-20
I. COMMISSIONED PRODUCTS                                   Medi–CareFirst BlueCross BlueShield



Out-of-Area                     •    If a member is out of the area and requires a prescription, in-network benefits are
                                     available through Medi-CareFirst BlueCross BlueShield’s nationwide network of
Emergencies
                                     over 60,000 pharmacies.

                                •    Members can only use out-of-network pharmacies in a medical emergency or
                                     urgent care situation.

                                     Example: if a member is traveling within the United States or territories and
                                     becomes ill, loses or runs out of prescription drugs, Medi-CareFirst BlueCross
                                     BlueShield will cover prescriptions filled at an out-of-network pharmacy.

                                •    When a member uses an out-of-network pharmacy, the member pays for the
                                     prescription out-of-pocket and then files a claim. The member is responsible for the
                                     co-pay plus the difference between Medi-CareFirst’s negotiated in-network price
                                     and the out-of-network price.

Payment Options                 •    The Member can have their monthly premium deducted from their Social Security
                                     check. Do to computer administrative issues at this time, Medicare is suggesting
                                     that people not select this form of payment.
                                     NOTE: Members who enroll in the MD Senior Prescription Drug Assistance or DE
                                     Prescription Drug Assistance Programs should NOT have their premiums
                                     deducted from their Social Security check. This is to avoid too much money being
                                     taken out of their check since the State will be subsidizing a portion of the
                                     member’s premium).

                                •    The member can have Medi-CareFirst send them a monthly bill

                                •    The member can sign up for EasyPay which automatically debits the member’s
                                     checking or credit card account.

Product and Rate                •    All benefit and rate changes are made annually effective January 1 of each year.
Changes
                                     •  Medicare may change the standard plan structure annually. This change may
                                        impact the deductibles, co-pays, thresholds and/or out-of-pocket amounts.
                                      • Any Medicare changes will result in changes to the Blue Rx plan options as
                                        well.

                                 •    Plans are required by Medicare to notify members of any benefit and/or rate
                                      changes in an Annual Notice of Change to be received prior to October 31st of
                                      each year

Jurisdictional                  •    Any Blue Rx plan member who moves out of the service area must disenroll. They
Changes                              will receive a special enrollment period to join another prescription drug plan
                                     without a penalty.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-21
I. COMMISSIONED PRODUCTS                                   Medi–CareFirst BlueCross BlueShield



Termination                     •    If the member disenrolls, generally they can only re-enroll during the Annual
of Insured’s                         Coordinated Election Period which is November 15- December 31 of every year
Coverage                             unless eligible for a special enrollment period. Those enrolling during the Annual
                                     Coordinated Election Period may be subject to a late enrollment penalty.

                                •    Medi-CareFirst BlueCross BlueShield can disenroll the member if:

                                              •    the member is no longer eligible for Medicare Prescription Drug
                                                   Coverage

                                              •    Medi-CareFirst is no longer contracting with Medicare or leaves the
                                                   member’s service area

                                              •    the member moves out of the Medi-CareFirst service area

                                              •    the member materially misrepresents a third-party reimbursement

                                              •    the member fails to pay the Blue Rx plan premium

                                              •    the member engages in disruptive behavior, provides fraudulent
                                                   information when they enrolled, or abuses their enrollment card




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-22
I. COMMISSIONED PRODUCTS                                   Medi–CareFirst BlueCross BlueShield



Low-Income                      •    If the member has limited income and resources, they can apply to Medicare for
Subsidy                              assistance with their drug coverage. The amount of extra help will be based on
Information                          income and resources.

                                •    To qualify the member must have:
                                            • An annual income below $14,700 (or $19,800 if married) and
                                            • Resources (excluding home and car) not to exceed $11,500 (or
                                                 $23,000 if married). Resource limits include a $1,500 burial allowance
                                                 per individual.

                                •    The following individuals automatically qualify for extra help and do not have to
                                     apply:
                                             • Dual Eligibles (enrolled in both Medicare and Medicaid),
                                             • Individuals who receive Supplemental Security Income (SSI) and
                                             • Individuals who belong to a Medicare Savings Program (QMB, SLMB
                                                or QI)

                                •    Individuals who believe that they qualify for extra help and are not automatically
                                     enrolled in a plan may:
                                             • Call 1-800-MEDICARE, 24 hours a day/7 days a week
                                             • Call Social Security: 1-800-772-1213 between 7 am and 7 pm, Monday
                                                 through Friday (TTY number-1-800-325-0778)
                                             • Visit www.socialsecurity.gov
                                             • Visit the State Medicaid Office

                                •    Members receiving extra help who enroll in a Blue Rx plan will have to pay the
                                     difference between our premium and the regional benchmark or about $4.55 more
                                     per month for the Blue Rx Standard plan and $12.55 more per month for the Blue
                                     Rx Enhanced Plan.

                                •    After enrollment, Medicare will advise Medi-CareFirst how much assistance you
                                     the individual will receive and we will send the member information on their
                                     premium and co-pays




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-23
I. COMMISSIONED PRODUCTS                                   Medi–CareFirst BlueCross BlueShield



MD State                        •     The Maryland State Prescription Drug Assistance Program (SPDAP) will reduce
Prescription Drug                     out-of-pocket expenses (up to $25 toward monthly premium) for Maryland
Assistance                            residents enrolled in a Medicare Prescription Drug Program with incomes
Program                               between 135% and 300% of the Federal Poverty Level
                                •     Individuals seeking further information should call the Senior Prescription Drug
                                      Assistance Program Call Center at 1-800-215-8038 (Monday through Friday 9am
                                      to 6 pm)
                                •     Individuals who are enrolled in the SPDAD should NOT have premiums deducted
                                      from their Social Security payment as this State program will not coordinate that
                                      deduction with the Federal government.

DE State                        Delaware Prescription Drug Assistance Program
Prescription Drug               •    All Delaware Prescription Assistance Program (DPAP) clients must enroll in a
Assistance                           Medicare Prescription Drug Program and apply for the Federal Low Income
Program and                          Subsidy Program to continue to get their DPAP benefits.
Chronic Renal                   •    DPAP will continue to offer a $2500 calendar year benefit.
Disease Program                 •    DPAP will pay the premium for the standard equivalent program offered by Medi-
                                     CareFirst. Therefore DPAP will pay the entire Blue Rx Standard premium but will
                                     only pay $12.55 toward the Blue Rx Enhanced plans. The premium will be
                                     deducted from the $2500 annual DPAP subsidy.
                                •    The member is responsible for the Blue Rx co-pays/coinsurance for all of the Part
                                     D covered drugs.
                                •    DPAP will cover some of the drugs that are not covered under the Part D program.
                                     These include over-the counter drugs, benzodiazepines, and barbiturates.
                                     Members will pay the standard DPAP co-payment of $5 or 25%, whichever is
                                     greater ONLY for the DPAP covered drugs.
                                •    Client questions about DPAP coverage should be directed to DPAP Customer
                                     Service at 1-800-996-9969.
                                •    Client questions about their Blue Rx plan benefits should be directed to Claims
                                     Customer Service at 1-800-693-1434 24 hours, 7 days a week.

                                Chronic Renal Disease Program
                                •    All Chronic Renal Disease Program (CRDP) clients must enroll in a Medicare
                                     Prescription Drug Program and apply for the Federal Low Income Subsidy
                                     Program to continue to get their CRDP benefits.
                                •    CRDP will cover any Medicare cost sharing (co-payment/coinsurance or coverage
                                     gap) and will pay the Part D premium that is authorized by CRDP




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-24
I. COMMISSIONED PRODUCTS                                   Medi–CareFirst BlueCross BlueShield



Maintenance                     •    The member can get a three-month prescription filled and pay only a two-month
                                      co-pay at retail pharmacies in the Medi-CareFirst BlueCross BlueShield network.
Medications


Medication                      •    All Medi-CareFirst members can take advantage of the free Medication Therapy
Therapy                              Management program.
Management                      •    MTM uses specially trained Personal Medication Management Pharmacists to help
                                     make sure that the member is taking the most effective combination of drugs for
                                     his/her condition and help the member save money.
                                •    MTM is most beneficial to people who take several drugs or have long-term health
                                     problems



Utilization                     •    Prior Authorization: Members need to receive approval from Medi-CareFirst before
Management                           getting certain drugs filled. If approval is not obtained, the drug may not be
                                     covered.

                                •    Quantity Limits: Quantity limits apply to certain drugs. Limits are set to ensure
                                     these drug are used appropriately




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-25
I. COMMISSIONED PRODUCTS                                   Medi–CareFirst BlueCross BlueShield




Broker Part D                   All independent brokers who are marketing the Medi-CareFirst BlueCross BlueShield
                                Prescription Drug Plans are required to follow the Medicare Part D Marketing
Marketing
                                Guidelines established by the Centers for Medicare and Medicaid Services (CMS).
Requirements
                                Specifically, all agents must become familiar with and follow the guidelines set forth in
                                Chapter 11 (Guidelines for Promotional Activities) in the CMS document revised as of
                                July 25, 2006.

                                (http://www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/FinalMarketingGuidel
                                ines.pdf)

                                CMS has reported receiving complaints about improper marketing practices in violation
                                of its guidelines. The Maryland Insurance Administration and the Washington, DC
                                Department of Insurance each have distributed warnings to insurance agents
                                regarding the Medicare Part D benefit marketing activities.

                                CareFirst BlueCross BlueShield expects brokers marketing the Medi-CareFirst
                                BlueCross BlueShield product to know that the following types of marketing activities
                                are PROHIBITED:

                                •    Offering beneficiaries a cash payment as an inducement to enroll in Part D
                                •    Soliciting sales door-to-door
                                •    Stating that you work for, or contract with, the Social Security Administration or
                                     CMS
                                •    Misrepresenting a Medigap policy or non-Medicare drug plan as an approved Part
                                     D Plan
                                •    Misrepresenting the Prescription Drug Plan you are marketing
                                •    Requesting beneficiary information or check numbers, which may be a prelude to
                                     identity theft
                                •    Suggesting or implying that an individual must drop an existing Medicare
                                     Supplement plan or must buy a particular Medicare Supplement plan in order to
                                     qualify for the Part D benefit




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            6-26
II. NON-COMMISSIONED PRODUCTS                                                   Catastrophic




Overview                        •    Provides up to one million dollars in extra benefits. This policy is designed to be
                                     used in conjunction with any other basic major medical coverage and not to
                                     replace that coverage.
                                •    Benefits are available when members meet a $50,000 deductible for each 24
                                     month period. Once the deductible is satisfied, the plan pays up to $250,000 for all
                                     covered medical expenses not covered by basic or Major Medical plans.
                                •    Expenses incurred under the basic or Major Medical plan in each 12-month period
                                     may be applied to the Catastrophic deductible.

Eligibility                     •    Resident of the State of Maryland
Requirement                     •    Has basic coverage through a commercial carrier
                                •    Not a Medicare recipient



Membership Types                •    There is a four tier rate structure:
                                     •    Individual (Age 18-64)
                                     •    Individual & Child(ren)
                                     •    Individual & Adult
                                     •    Family



Effective Date                  •    If the applicant answers no to all four (4) of the medical question on the
                                     application, the coverage is made effective upon receipt and acceptance of the
                                     application.



Waiting Period                  •    There is a twelve month waiting period for pre-existing conditions.



Who to Contact                  •    Applicants may obtain marketing materials and product information by calling 410-
                                     356-8000 or 1-800-544-8703.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            7-1
 II. NON-COMMISSIONED PRODUCTS                                                 Student Health Plan



Overview                        •    Available to applicants who attend college in Maryland or a Maryland
                                     resident attending an out-of-state school.

                                •    Picks up where college health centers and clinics stop. The applicant
                                     is free to choose any doctor or hospital. The claims are automatically filed if the
                                     doctor or hospital is a Blue Cross and Blue Shield Participating provider.

                                •    Dental and Vision benefits can be added at any time.



Eligibility                     •    A student, enrolled as a full-time student at an accredited school,
Requirement                          carrying at least six (6) credit hours per semester
                                •    Age 19-29
                                •    Resident of the State of Maryland or attending a Maryland school




Membership Types                •    Individual only



Effective Date                  •    This plan is not medically underwritten. The coverage becomes effective when the
                                     signed application is received.




Waiting Period                  •    There is a nine month waiting period for pre-existing conditions.




Who to Contact                  •    Applicants may obtain marketing materials and product information
                                     by calling 410-356-8000 or 1-800-544-8703.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            7-2
II. NON-COMMISSIONED PRODUCTS
                                                        BluePreferred – VA – Open Enrollment



Overview                        •    Offered all year round.
                                •    BluePreferred Open Enrollment is offered without medical underwriting.
                                •    No maternity coverage is available



Eligibility                     •    Applicant must be a resident in Virginia (east of route 123).
Requirement                     •    Applicant cannot be eligible for Medicare benefits.
                                •    Dependents must be under the age of 23 years old.



Membership Types                •    There is a four tier rate structure:
                                     •    Individual (Age 18-64)
                                     •    Individual & Child(ren)
                                     •    Individual & Adult
                                     •    Family



Effective Date                  •    Coverage is made effective on the first of the month following the date of
                                     acceptance of the policy.



Waiting Period                  •    There is a ten month waiting period for pre-existing conditions.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            7-3
II. NON-COMMISSIONED PRODUCTS
                                                                      Indemnity Group Conversion-MD


Overview                        •    Offered to employees terminating employment with a CareFirst group.
                                •    Allows the employee to have continuous coverage on a group conversion product.



Eligibility                     •    The Group Administrator will determine whether or not the policyholder will be
Requirements                         offered continuous coverage.



Membership                      •    There is a four tier rate structure:
Types                                •    Individual (Age 18-64)
                                     •    Individual & Child(ren)
                                     •    Individual & Adult
                                     •    Family



Effective Date                  •    Since there are no medical restrictions on this plan, coverage is made
                                     effective the date the employee is terminated from group.



Who to Contact                  •    Group Conversion is handled through the Customer Service area.
                                     Members should be directed to call 410-581-3414 or 1-800-458-1981.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            7-4
II. NON-COMMISSIONED PRODUCTS
                                                                     BluePreferred Group Conversion



Overview                        •    Offered to employees terminating employment with a CareFirst group.
                                •    Allows the employee to have continuous coverage on a group conversion product.



                                •    The Group Administrator will determine whether or not the policyholder will be
Eligibility                          offered continuous coverage
Requirements



Membership Types                •    There is a four tier rate structure:
                                     •    Individual (Age 18-64)
                                     •    Individual & Child(ren)
                                     •    Individual & Adult
                                     •    Family



Effective Date                  •    Since there are no medical restrictions on this plan, coverage is made effective the
                                     date the employee is terminated from group.



Who to Contact                  •    Member inquiries should be directed to Customer Service at
                                     1(800) 321-3497.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            7-5
II. NON-COMMISSIONED PRODUCTS
                                                                           BlueChoice Group Conversion


Overview                        •    Offered to employees terminating employment with a CareFirst group.
                                •    Allows the employee to have continuous coverage on a group conversion product.



Eligibility                     •    The group administrator will determine whether or not the policyholder will be
Requirements                         offered continuous coverage.



Effective Date                  •    Since there are no medical restrictions on this plan, coverage is made effective the
                                     date the employee is terminated from group.



Membership Types                •    There is a four tier rate structure:
                                     •    Individual (Age 18-64)
                                     •    Individual & Child(ren)
                                     •    Individual & Adult
                                     •    Family



Who to Contact                  •    Group Conversion is handled through the Customer Service area.
                                     Member inquiries should be directed to Customer Service at
                                     1(866) 520-6099.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            7-6
II. NON-COMMISSIONED PRODUCTS                                                                   Dental


Overview                        •    Dental services are marketed by CareFirst and administered by The Dental
                                     Network (TDN).

                                •    TDN, a network of quality dental providers, is a dental HMO with offices throughout
                                     Maryland and DC. Members must select a provider from the list of Participating
                                     Dental Network providers.

                                •    Similar to a medical HMO model, a dental HMO is restricted to dentists who are
                                     part of the dental HMO network. Each member must choose a primary dentist.
                                     The primary care dentist renders all general dental care and refers members to a
                                     dental specialist within the network for specialty care. Members are responsible
                                     for a set co-payment dollar amount for each procedure, when using a network
                                     dentist. If members receive care from a dentist who does not participate with TDN,
                                     benefits will not be paid.

                                •    The customer may change providers at any time by calling The Dental Network at
                                     1-888-833-8464.

Key Selling                     •    Comprehensive dental care for predictable co-pays
Features                        •    No deductibles
                                •    No claim forms
                                •    No annual benefit maximums
                                •    Orthodontia coverage for children and adults
                                •    Full scale, quality assurance program
                                •    No pre-existing condition limitations (except orthodontia in progress)
                                •    Extensive provider credentialing
                                •    Ability for each member to select a different dentist
                                •    Can add dental benefits to a policy at any time



Eligibility                     •    Applicant must be a resident of Maryland or District of Columbia.
Requirements                    •    This product can be added to Personal Comp, BlueChoice and
                                     MediGap policies in Maryland
                                •    BluePreferred and MediGap members in DC can purchase dental through
                                     CareFirst only.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            7-7
II. NON-COMMISSIONED PRODUCTS                                                                 Dental



Membership Types                •    There is a four tier rate structure:
                                     •    Individual (Age 18-64)
                                     •    Individual & Child(ren)
                                     •    Individual & Adult
                                     •    Family

                                NOTE: The dental membership type must match the medical membership type
                                (e.g., if the medical plan membership type is husband/wife, then the dental
                                membership type must also be husband/wife).



Effective Date                  •    Coverage is effective the first of the month following receipt of the application.



Waiting Period                  •    There is no waiting period for pre-existing conditions.



Who to Contact                  •    Inquiries regarding the addition of dental benefits should be directed to Customer
                                     Service at 410-581-3414 or 1-800-458-1981.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            7-8
II. NON-COMMISSIONED PRODUCTS                                                                    Vision



Overview                        •    All BlueChoice and BluePreferred products have BlueVision core to their medical
                                     product. There is no additional product to sell them.
                                •    Offers other CareFirst Individual policyholders the opportunity to add Blue Vision
                                     benefits to existing coverage.
                                •    Vision services are marketed by CareFirst and administered by Davis Vision.
                                •    This is not a stand-alone policy. If a member cancels medical coverage, vision
                                     coverage will be cancelled as well.

                                Davis Vision, an experienced vision plan administrator, provides these vision services
                                for CareFirst. Members must select a provider from the list of participating Davis
                                Vision providers. See www.carefirst.com for a link to the provider directory.



Key Selling Feature             •    One vision exam per year for $10
                                •    Product offers measurable discounts on lenses and frames, rather than arbitrary
                                     discounts on retail pricing
                                •    Retail up to $70 = member pays $40
                                     Retail over $70 = member pays $40 + 10% off amount over $70
                                     Example: $100 lenses = $67
                                •    One regional network across Maryland, Northern Virginia and Washington D.C.
                                •    One national network available to all members
                                •    Unified portfolio offers one core vision benefit to BlueChoice and BluePreferred
                                •    Same vision benefit now available to Personal Comp and Medigap members
                                •    Proven customer service and claims payment through Davis Vision
                                •    No claim forms for members to file when using in-network services



Eligibility                     •    Applicant must be enrolled in a CareFirst medical product.
Requirements


Membership Types                •    There is a four tier rate structure:
                                     •    Individual (Age 18-64)
                                     •    Individual & Child(ren)
                                     •    Individual & Adult
                                     •    Family




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            7-9
II. NON-COMMISSIONED PRODUCTS                                                                   Vision



Effective Date                  •    Coverage is effective the first of the month following receipt of the application.




Waiting Period                  •    There is no waiting period for pre-existing conditions.




Who to Contact                  •    Members should be directed to Customer Service at 800-843-4280 for MediGap
                                     and Personal Comp, BluePreferred 202-484-9100, BlueChoice 866-520-6099.




The material contained in this manual is the property of CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and is submitted
for informational purposes only. No rights to said material are hereby transferred to any other person or entity. This material may not be
duplicated or copied in whole or in part, without prior written consent of CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
V3-100106                                                                                                                            7-10

								
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