Virginia | Effective April 1, 2016 Small Group product guide · We put the same passion into our health plans, that you put into your business. Virginia | Effective April 1, 2016

We put the same passion into our health plans, that you put into your business

Virginia | Effective April 1, 2016

Small Group product guide

53744VAEENBVA-April2016 Rev 2/16 effective 4/1/2016

Welcome to Anthem and HealthKeepers, Inc. for small businessesRunning a small business takes courage and a lot of hard work. You make

important decisions every day. And choosing the right health plan is

definitely one of them.

That’s why we’ve made it easy, with plan designs that speak to who you

are, how you run your business and your bottom line. And because you’re

choosing a plan from Anthem Blue Cross and Blue Shield and/or its

affiliate HealthKeepers, Inc. (Anthem),1 you can count on the quality and

stability our customers have come to know for over 75 years.

Today, we want you to know, it’s your purpose that’s at the heart of our

promise: To build the ultimate benefits package for every single type of

small business and make it more accessible, more affordable and

more personal.

Now let’s find you the perfect plan.

Tell us about you Your size, your people, your budget

�Do you like your current plan, but need to lower costs? Check.

�Would your employees like incentives to stay healthy? Got them.

�Want a high-deductible plan that offers more ways to save? Done.

�Are you a big fan of lots of bells and whistles? Ring.

We’re ready to give you that special something you won’t find anywhere else. And like

any great relationship, when you’re happy, we’re happy. And that’s pretty healthy.

So let’s get to it!

affordable

personal

accessible

1 An

them

Hea

lthKe

eper

s pro

duct

s are

off

ered

by

Heal

thKe

eper

s, In

c. a

nd a

ll ot

her p

rodu

cts r

efer

red

to in

this

piec

e ar

e of

fere

d th

roug

h An

them

Blu

e Cr

oss a

nd B

lue

Shie

ld.

1

Welcome to a new kind of doctor-patient relationship created just for our members

It’s called Enhanced Personal Health Care and it’s the kind of care everybody wants

Our new model puts patients in a unique circle of care, making them the central focus on a team approach

to their overall health. We do this by:

�Paying doctors for value over volume when they improve patient health, meet quality standards and

lower costs.

�Giving doctors added support with the right tools and strategies to help strengthen the doctor-patient

relationship so they can spend more time with patients and coordinate their care with other doctors.

�Improving the patient experience with better access to a primary care physician (PCP) who cares for the

“whole person” and becomes their health care champion and helps them navigate the health care system.

Fewer inpatient and emergency

room visits

Reduced re-admission rates

Significant increase in referrals to

preferred labs

Increased provider follow-up visits

after a patient is discharged

More weekend hours for members

Improved quality and utilization scores

Enhanced Personal Health Care: a physician’s perspective“This partnership is truly refreshing. It’s a practice that’s centered on the patient. That’s why

we have extended hours and systems in place to try and help the patients receive the care

that they require. It’s a win for everybody. The more doctors we can get involved in the

process, I think the better the health care system in general will be.”– Frank Maselli, M.D., Family Practitioner, Riverdale Family Practice

46%of network providers

already participate in EPHC

21%of members are already

attributed to an EPHC provider

54,639 network providers participate in Enhanced Personal Health Care (EPHC)

Those providers care for approximately

4.0 million membersTota

l In-N

etwo

rk PC

P num

bers

are d

ata

colle

cted

as of

July

2015

.

Accessible

Accessible

Patients benefit from

More doctor- patient time

Proactive health and wellness

More convenient access

Providers benefit from

Better coordinated care

A stronger doctor-patient relationship

A personalized care team

Quality-driven care

Value over volume

Detailed patient reports

Tools and resources Rewards for meeting quality standards The advantages are undeniable

Enhanced Personal Health Care value is built into many of our new plans, with lower copays when members visit these providers.

2 3

97% U.S. Hospitals are in the

BlueCard® program1

1 in 3 Americans is covered by a Blue Cross and Blue Shield plan

381 Fortune 500 companies have a Blue Cross and Blue Shield plan

600K new members for 2014, plus 250,000 for 2015

2x total membership than our largest competition

Toris ute quibus volupit plibust. Abor si iliscius raessitatur? Rum idus et eribusam reic tese dolupita sum lacitaquam aut pratur abo.

HIGHEST MEMBER SATISFACTION

RATINGS

SIGNIFICANT SAVINGS =

DEEP NETWORK DISCOUNTS

LARGEST NETWORKS+ +

The power behind a Blue Cross and Blue Shield plan

Our strength is backed by some serious numbers

Providing health coverage for more than 100 million members is pretty powerful, but we’re also about creating healthier

communities and investing in the future for our people and our businesses.

That means you, our small business employers. When you choose Anthem and HealthKeepers, Inc., you’ll enjoy

unparalleled network discounts, innovative health and wellness programs and access to the highest quality of care.

92% U.S. Doctors are in the BlueCard® program1

Accessible

1 B

lue

Cros

s an

d Bl

ue S

hiel

d As

soci

atio

n, 2

013

stat

istic

s.

2 In

tern

al d

ata,

July

201

5.

SOUR

CE:

Blue

Cro

ss B

lue

Shie

ld A

ssoc

iatio

n, 2

013

stat

istic

s.

Employees have access to care, anytime, anywhere with LiveHealth Online — all it takes is an Internet connection

LiveHealth Online delivers high member satisfaction2

With LiveHealth Online, your employees can have face-to-face

conversations with board-certified doctors right from their

computer or mobile device, 24/7. In just seconds, they can connect

to a doctor to address nonemergency health issues right away.

No driving, no waiting, in no time!

LiveHealth Online employee benefits

�No appointments, no waiting rooms

�Easy to use

�Board-certified doctors

�Available for nonmembers

�Doctors diagnose health issues and may

prescribe medicine1

�Cost effective (average fee of $49)

LiveHealth Online employer benefits

�Innovative solution — a quick and easy way for your

employees to see a doctor

�Increased productivity — employees will spend less time

traveling to, and waiting at, other sites of care

To learn more, watch the videos at livehealthonline.com

92% 85% 90%

1 Pr

escr

iptio

n av

aila

bilit

y is

defi

ned

by p

hysi

cian

judg

men

t and

sta

te re

gula

tions

. Liv

eHea

lth

Onlin

e is

ava

ilabl

e in

mos

t sta

tes

and

is e

xpec

ted

to e

xpan

d to

mor

e in

the

near

futu

re. V

isit

the

hom

e pa

ge o

f liv

ehea

lthon

line.

com

to v

iew

the

serv

ice

map

by

stat

e.

2 Li

veHe

alth

Onl

ine

Cons

umer

Pos

t Vis

it Su

rvey

resu

lts.

85%

ACCESSIBLE DOCTORS AT THE SPEED OF

LIGHT

INNOVATIONS IN CARE

=

had a positive experience

resolved their issue

avoided extra costs

reported saving time

Accessible

100% VA Acute care hospitals

are in-network2

4 5

Affordable

If you’re looking for a new option with savings potential, then shared funding could be right for you

With a fully insured plan, you pay a set

premium each month (varies only by

enrollment) and no matter how much or

how little your employees use the plan,

you pay the same amount. With Anthem

Shared Funding, you get the same

predictability of a fully insured plan with

fixed monthly payments, but when your

group’s claims are better than expected,

you could get money back. You can also

save on some of the premium and health

care reform taxes!

Predictable monthly payments with a limit on financial responsibility

Unlike fully insured plans, if you have a healthier than expected year,

you could get money back

You make a fixed monthly payment that covers all of

your health care costs

How does shared funding work?

ENJOY COVERAGE FOR

EXCESS CLAIMS

SAVE ON premium tax and

health care reform taxes

Medical plans to fit every type of business need

With unbeatable health and wellness extras that deliver superior long-term value

Get ready to meet your match! No matter what the size of your business and your unique needs and

preferences, you’ll find the right health plan, right here. We offer a full range of high-quality plans for every

budget. Our commitment to you is to get it exactly right.

Here’s a brief explanation of the types of health plans we offer. For specific information, you can refer to the

product grids at the back of this brochure.

PPO A preferred provider organization allows members to see providers in network or out of network. Members

pay substantially less out of pocket when they use a provider in the PPO network. There’s no need to get a

referral to see a specialist.

POS Point of service allows members to see providers in the network or outside of the network. Members pay

substantially less out of pocket when they use a provider in the POS network. To see a specialist, members must

get a referral from their PCP.

OA POS

Open access point of service allows members to see providers in the network or outside the network.

Members pay substantially less out-of-pocket when they use a provider in the OAPOS network. No referrals

are needed to see specialist.

HDHP High-deductible health plans feature higher deductibles than traditional insurance plans. They can

be paired with a health savings account or a health reimbursement account allowing members to pay for

qualified out-of-pocket medical expenses.

HSA Health savings account is a savings account members can fund with pretax dollars and

apply toward qualified health care expenses, including prescriptions.

HRA Health reimbursement accounts are funded by a yearly allocation from employers and are used for

first-dollar coverage.

Shared funding is a new funding solution for Small Group employers with 15 to 50 or more employees.

It’s similar to a fully insured plan where employers pay a fixed payment based on enrollment each month, but if

employees are healthy and have low usage of benefits, then employers could get money back at the end of the year.

.... Affordable

6 7

Pharmacy benefits Together with medical — better and easier than ever

You may not know it, but pharmacy benefits are the most widely used benefits. That’s why we’re

not just pricing a bottle of pills, or focusing on pharmacy costs alone — we’re looking at the

bigger picture — the value of better health.

And we make it easy. You can offer your employees access to the care they need and you get

one seamless, simple experience: one website, one contact, one account team, one contract

and one invoice. Our pharmacy and medical experts are at the same table, have the same

resources and work together to help your employees live healthier.

The results speak for themselves

Outc

omes

for M

yHea

lth A

dvan

tage

using

our p

harm

acy d

ata w

hen c

ompa

red t

o ca

rve-o

ut ph

arm

acy d

ata.

Resu

lts ba

sed o

n mos

t rec

ent,

mea

sura

ble 1

2 m

onth

s of d

ata

avail

able

for c

linica

l and

cost-

of-ca

re pr

ogra

ms f

or en

terp

rise c

omm

ercia

l bus

iness

.Better health and lower costs of care begin with better medication management

With our pharmacy, clinical and cost-of-care programs, we are helping your employees live healthier.

Helping manage chronic conditions

Addressing medication gaps

Improving adherence to taking medications as prescribed

Saving money with generics, home delivery and a broad network of pharmacies

.... Affordable

By combining medical and pharmacy and coordinating these benefits systemwide, we are writing a prescription for more effective and more affordable health care for you and your employees.

MORE accurate

communications sent to members

37%

MORE gaps in care closed within 12 months

26%

MORE gaps in care

identified

28%

Medication ReviewA confidential pharmacy summary for

Here’s how we do it

When pharmacy and medical are combined, we can target members with specific

messaging such as cost savings for generics and therapeutic equivalents. And we can coordinate

that messaging between the member and the physician to identify and close gaps in care, switch

members to more effective and less expensive drugs and communicate safety concerns.

Medication Review

A monthly member mailing that

includes recent pharmacy claims,

information about current drugs

they’re taking, safety concerns and

ways to save money.

MyHealth Note

By combining members’ medical,

pharmacy and lab data with benefit

information, we can make

recommendations, coordinate with

doctors and notify members.

MyHealth NoteA confidential health care summary for

Let’s get technical with pharmacy

It’s easy to fill prescriptions, check copays or

coinsurance and more by going to anthem.com or downloading our mobile app.

We are closing the gap between giving members

information and getting them to act on it.

Medical Pharmacy More effective and affordable health care

8 9

For all your health care needs, Anthem is your total health solution

See how our medical, dental, vision, life and disability plans work together for your employees health and

your bottom line.

Meet your one carrier, one solution: Anthem Whole Health ConnectionSM

We believe health care should serve the whole person — head to toe,

at each stage of life. It should also be easy to administer, so you don’t

get bogged down in paperwork.

Let us tell you about how you can have one solution for all your

health benefits needs.

Through electronic health records, we get claims and clinical data

from network dentists, eye doctors, primary care physicians and

care coordinators, which allows us to create more complete health

profiles for our members.

The advantages can’t be matched by even the best stand-alone carriers.

Strong alone, better together

�Clinically coordinated care

through our connected

health plan portfolio

�Benefits from one source,

so you spend less energy

managing multiple plans

�Strong local and

national networks

�Competitive pricing

�A brand you can trust

.... Affordable

Anthem Whole Health Connection

Real choice. Quality care. Lower costs.

of employers say increased provider communications improves care

of employees believe they’d get better service with connected plans

88% 89% 82%

of employers understand that integration saves money

Medical

Vision Life

Disability

Dental

Anthem dental

Our Dental Prime and Dental Complete plans are built for greater choices, better oral health

and ultimate business value.

We’re helping change the face of health care by

simplifying how our medical and dental plans

work together — delivering more complete care

at an affordable cost with less hassle.

Good dental health and early detection can play an important role in helping your employees stay healthy.

In fact, 90% of the body’s diseases show signs and symptoms in the mouth.2

Dentists often have the first opportunity to notice early signs of a chronic disease. Our Dental Prime and Dental

Complete plans offer these benefits for optimal oral and overall health.

That’s why many of our plans have 100% coverage for preventive services, such as exams, cleanings and X-rays.

In addition, we have automatic enrollment for an additional cleaning or periodontal treatment for pregnant and

diabetic members engaged in one of our diabetic or maternal health care management programs.

For product details, see the grid at back of this brochure.

Extra cleaning or periodontal treatmentfor pregnant and diabetic members

100% in-network coverage

for cleanings, exams and X-rays

30% to 32% average savings on covered services1

Medical Dental Better overall health

“Ask a hygienist”Email questions to licensed dental professionals and get quick, private personalized advice at no extra cost

Brush biopsybenefit to help detect oral cancer

Access to one of the largest dental networks in the nation,

with 98,000+ unique dentists and 251,000

access points

International emergencyDental program for emergency services while traveling or working abroad

A huge network

1 Av

erag

e in-n

etwo

rk cl

aims s

aving

s for

Den

tal C

omple

te pl

ans.

2 A

cade

my o

f Gen

eral

Dent

istry

Kno

w Yo

ur Te

eth w

ebsit

e: W

arnin

g Sign

s in t

he M

outh

Can S

ave L

ives.

(Rev

. Jan

uary

201

2).

SOUR

CE: I

nter

nal s

urve

y dat

a

10 11

Anthem vision

More doctors, better discounts and

a clear path to overall health with Blue View VisionSM

Vision care plays a powerful role in early detection and more

effective management of chronic conditions. In fact, eye exams

are an important avenue to identify high-risk conditions like

diabetes, high blood pressure and high cholesterol.

When we connect Blue View Vision with our medical plans

through electronic health records, providers can see the

total health of the member which helps them deliver better,

more informed care. It also leads to lower costs and simplified

plan management.

Connection of care2

� Claims and clinical data go into members’ electronic health files

� Vision providers can see information quickly

� Automatic referrals go to our ConditionCare program if a health issue is found

For a list of Blue View Vision plans, see the grid at the back of this brochure.

At the heart of Anthem’s more personalized approach to health care is building better connections between employers and employees, patients and doctors, people and better health.

People are 3x more likely to get an annual eye exam than an annual physical1

3X

Members can use in-network

benefits and get savings from:

.... Affordable

Let’s protect your employees against the unexpected

It’s time to talk about life and disability coverage that goes way beyond a check.

When a life-changing event happens, you can count on Anthem to be there with superior service

from a caring staff, quick payment of claims and support services for employees and their families.

We offer a wide variety of options, so you can tailor a benefits program to your employees’ needs

and your budget, all from one single point of contact.

Anthem life and disability features

�Timely payments and support services

�Benefits employees can use before and after a loss

�Simplified benefit administration and dedicated customer service

�Support services that help employees get back to work and back to life

�Personalized service from Claims Management team

Anthem life and disability

comprehensive plans with special features

Long-term disability

VoluntaryShort-term disability

Accidental death and

dismembermentLife

Resource Advisor

Travel assistance

Beneficiary Companion

VA

L

UE

- A D D E D E N H A N C E M

EN

TS

�We can help you with Social Security

disability filings and approvals

�You get a designated service team with

industry-leading claims turnaround

times with 99.9% accuracy*

�Identity theft recovery services

�All customer service calls are

answered live

*Internal data 2014

Bigger discountsThe industry’s best discounts including

35% to 40% off extra glasses3

More doctorsOver 33,000 doctors at more than

26,000 locations nationwide

Less hassleSimplified administration from

enrollment through claims processing

Medical Vision Total health view

1 Ce

nter

s for

Dise

ase

Cont

rol a

nd P

reve

ntio

n, C

hron

ic D

iseas

e Pr

even

tion

and

Heal

th P

rom

otio

n.

2 An

y m

embe

r inf

orm

atio

n, c

laim

s dat

a an

d he

alth

hist

ory

shar

ed is

rele

vant

and

HIP

AA-c

ompl

iant

.3

Laws

in so

me

stat

es m

ay p

rohi

bit n

etwo

rk p

rovid

ers f

rom

disc

ount

ing

prod

ucts

and

serv

ices

that

are

not

cov

ered

ben

efits

und

er th

e pl

an.

12 13

.... Affordable

When you package disability with one of our medical plans ... your employees are connected with teams of

clinical, behavioral health, vocational rehabilitation

and counseling specialists who can help them get

back to life and back to work.

Medical Disability Improved outcomes

Life and disability

A new way of looking at it

When it comes to life and disability insurance, we do more than just send a check.

We give employees and their families valuable extras.

90%

of disabilities are caused by illness, not accidents1

Travel assistanceMembers with life coverage have a safety net if an emergency arises while they’re more than 100 miles away from home

Beneficiary CompanionHelp for families after a death, dealing with death

certificates, creditors and more for members with life and disability coverage

Resource AdvisorEmotional, legal and financial support for members with life and disability coverage

Newborn Parenting Resources

Provides eight weeks of personal life coaching services to help new mothers transition back to

work and work-life balance2

You get Guaranteed Issue! That means some of our life and disability

coverage options are available without your

employees having to go through health

underwriting — and there are no health

questionnaires to fill out.

1 C

ounc

il fo

r Dis

abili

ty A

war

enes

s, C

hanc

es o

f a D

isab

ility

, 201

2.2

Avai

labl

e w

ith s

hort

-term

dis

abili

ty.

14 15

.... Affordable

You want to offer dental, vision, life and disability coverage, but you just can’t cover the cost.

That’s ok. We’ve got another way.

We understand it can be a tough balancing act. You want to

offer a competitive benefits package that helps attract and

retain the best employees, but your dollars only go so far.

That’s why we offer a voluntary portfolio for dental, vision, life

and disability plans at no extra cost to you. You pick the plan

designs and your employees choose the coverage at affordable

group rates. And because the employee pays 100% of these

costs, there is no negative impact on your bottom line.

Voluntary plans offer you a way to strengthen the value of your benefits plan and improve employee satisfaction, at no extra cost to you.

paid by the employee

100%

No extra cost

16 17

Take your employees’ health (and yours) to the next level

With our Total Population Health solution It’s time to get personal. Everyone has their own unique set of health issues and goals. So we built our

wellness programs to speak to everyone on the wellness spectrum — from the super healthy to those

needing immediate support. Our programs are managed by a team of experts who connect members

to the right programs for their specific needs. This way, no one falls through the cracks.

Personal P

ersonal

Clinical programs

�Medical management

�Health coaching/advocacy

�Disease management

�Behavioral health

�Maternity

�Gaps in care

Wellness programs

�Lifestyle improvement programs

(Healthy Lifestyles)

�Preventive alerts

�24/7 NurseLine

Online resources

�Well-being Assessment

�Discounts

�Provider cost/quality information

�Online wellness coaching

�Communication campaigns

Doctor and member connections

Care management nurses Disease managementMedical directors

Total Population Health connects

primary care providers and our health

management teams for better results.

Find a whole world of health and wellness programs right here with your Anthem plan.

MyHealth Advantage is an outreach

program that helps members stay current

with their health care and save money. By

analyzing member health data and history,

the program identifies possible health risks,

care gaps and savings options. Care gaps are

sent to providers as well to ensure the best

care possible.

Healthy Lifestyles is an online health

resource that helps members transform

their behaviors and improve their health

in a variety of areas including weight,

nutrition, physical activity, tobacco use,

stress and depression. Some plans may

include incentives.

The ConditionCare program teams up

members with nurse coaches and other

health professionals who give them

holistic, integrated and seamless health

management for chronic conditions

including asthma, chronic obstructive

pulmonary disease (COPD) and heart disease.

Of those members in the program, 90% were

satisfied with their ConditionCare nurse

interactions and felt the tools and materials

were easy to understand.1

\\\|

Future Moms helps moms-to-be have a

healthy pregnancy. Experienced nurses

provide individualized care for pregnant

members to help ensure a full-term, healthy

baby. Of those members in the program,

90% said the information and tools helped

them have a healthy pregnancy.2

24/7 NurseLine is staffed with registered

nurses who are just a phone call away at any

time. Nurses can answer questions about a

medical concern or help members choose the

right level of care. Members can call the same

phone line and listen to hundreds of health

topics in the AudioHealth Library. The recordings

are available in English and Spanish.

LiveHealth Online gives members 24/7

access to doctors through a mobile device or

a computer with a webcam. Board-certified

doctors can evaluate nonemergency illnesses

or conditions and prescribe basic

medications, if needed,3 for $49 or less,

depending on health plan benefits.4

Case Management nurses help members

deal with complex health issues and

navigate the health care system. Backed by

a team of physicians, pharmacists, exercise

physiologists and others — our nurses have

the latest information on treatment options.

The Cancer Care Quality Program is

a new innovative initiative that allows

oncologists to compare planned cancer

treatments against evidence-based clinical

criteria and potentially receive enhanced

reimbursement. A goal of the program is to

promote access to quality, evidence-based,

affordable health care for our members and

to provide the framework to begin changing

the cancer care paradigm. This program also

allows our members to be identified earlier

for our Case Management program.

1 Voice of the Customer 2014 Year-End Annual Wellness Report for ConditionCare.

2 Internal Health and Wellness Solutions Member Satisfaction Study, 2014.

3 Prescription availability is defined by physician judgment and state regulations. LiveHealth Online is available in most states and is expected to expand to more in the near future. Visit the home page of livehealthonline.com to view the service map by state. 4 Doctors using the LiveHealth Online tool charge an average fee of $49.

Pharmacy Behavioral health Specialty

LiveHealth Online

18 19

So what else can we do for you?

A lot! We’ve got great tools and resources to make managing health care easier than ever.

Like any great relationship, we’ll always be right by your side so your employees can find the help they’re

looking for, whatever their health needs and goals. And we’ve made it easy for you to get started.

Here’s what we’re talking about:

A wellness toolkit to help you create a culture of health, right at work

Time Well Spent® is our online health and wellness resource that has all kinds of ways to communicate

important health information to your employees about specific health issues (like diabetes and asthma)

and overall health improvement. It comes at no extra cost to you and has information on dental, vision,

life and disability — and even some in Spanish. Here’s just a sample:

Start your company’s journey to wellness!

Go to timewellspent.anthem.com

Easier plan administration

EmployerAccess at anthem.com has everything you need for more efficient benefits administration.

Our quick, easy-to-access online tool makes it simple to enroll members, check eligibility, view your

contract, check on coverage and more — in one spot. It’s our job to help you save time and make doing

business with us easier than ever before.

With EmployerAccess, you can:

Personal

Vince, IT

Future Moms

Vince is the go-to guy for computer issues and

almost everything else technical. Always in

control, no one thought he’d be such a

nervous wreck when he found out his wife,

Mary, was expecting. He’s been hounding

everyone with questions, even the mail lady.

Michelle, the office manager tells him about

Anthem’s Future Moms program and gives

him the number. As soon as he gets home,

Vince and Mary call Future Moms and are

connected to Mandie, a registered

nurse who talks to them about risk

factors, screenings and healthy choices

for safe deliveries. Mandie is going to

send them books and more resources

and tells them to call anytime because

Future Moms nurses are available 24/7.

Mary called back twice, that night.

Devon, Operations

Healthy Lifestyles

When the office elevator went out, Devon had to

walk up two flights of stairs. By the time he got

to his desk, he looked like he was caught in a

downpour. Unfettered, he grabbed his usual

breakfast doughnut and opened his first email.

It was from Anthem’s Healthy Lifestyles program

and it was about weight management! He

double checked to see if maybe it was actually

from his wife. But then he remembered

doing an online health survey at

anthem.com where he answered questions

about his weight concerns. Maybe it was

a sign. He logged in to Healthy Lifestyles,

completed his personalized well-being plan

and made a commitment to start working

toward his health goals. Now he has access to

resources for weight management, online tools

for fitness and nutrition and support from online

coaches and communities.

SB OFFICE SUPPLIES

A story of health and

wellness benefits in action

Meet SB Office Supplies

Testimonials

Process enrollment changes View and pay billsView your group’s benefits Add new subscribers

Health kits Promotional materialsHealth articles Wellness Calendar Employer guide to wellness

PAY BILL

Register online todayJust go to anthem.com, select Employer and then your state. It’s that easy.

Mark, Sales

LiveHealth Online

Mark is a Sales rep who loves to chat, but lately

his coughing and sneezing is making everyone

run and hide. He’s got no time to see a doctor,

so Michelle, the office manager, is brave

enough to pull him into a conference room

and show him how to use LiveHealth Online to

visit a doctor with an app on his smartphone.

Mark can’t believe he’s connected with a

board-certified doctor in seconds who gives

him a diagnosis: “You have a virus. Go home,

get some rest and if you don’t feel better in a

few days, follow up with your primary care

doctor.” Mark follows the doctor’s directions

and the whole office feels better.

Georgi, Accounting

24/7 NurseLine

Georgi’s daughter, Tina, is an 8-year-old

soccer fiend who never stops running and

rarely gets sick. So when Georgi hears her

crying at 1 a.m., she knows something’s

definitely wrong. Georgi calls 24/7 NurseLine

and tells the nurse Tina’s symptoms. The nurse

says Tina’s temperature is a bit too high and

suggests that Georgi take her to an urgent care

center. The nurse finds several in-network

urgent care centers near Georgi. One of them is

right around the corner. Soon Tina is back up to

speed and Georgi feels like the best mom in the

world because she had these great resources at

her fingertips to help her child get better quickly.

Raja, Warehouse

ConditionCare

Raja has dealt with loud warehouse workers

for years. Nothing surprises or scares her,

except when she feels an asthma attack

coming on. Because she has Anthem, her

medical claims were flagged and sent to a

ConditionCare nurse, Kacey, who called Raja

right away. After yelling at her crew to pipe

down, Raja talked with Kacey about taking her

medication, using an inhaler and avoiding

triggers. Kacey promised to follow up with Raja

soon, but in the meantime, she plans to send

her information and helpful resources and

maybe she’ll even throw in some earplugs.

20 21

Personal

We’ve also got all this for your employees ...

Connect to care anywhere with our mobile app

Our Anthem mobile app can make it easier than ever for your employees

to manage their health care. They can just download the free app and always be prepared.

Download todayAvailable for free from Google PlayTM or the App StoreSM.

Visit anthem.com for 24/7 information

� Get tools and resources on topics like nutrition, weight loss and tobacco use

� Join online communities for added support from people with similar experiences

� Find a doctor or hospital in the network and nearby

� Compare and evaluate different hospitals for quality and cost

� Get discounts on healthy living products and services

� Order a new ID card or print a temporary one

� View benefits or check on a claim

� Submit benefit questions

Getting more social

We’re bringing health and wellness to the forefront of daily living by sharing the health with our

members and the entire social stratosphere. So while you’re posting, sharing, tweeting or just

plain emailing, why not add a little health into the mix?

Just search “Health. Join in.”Follow us for motivation, inspiration, recipes, workouts and some great healthy fun.

Find a doctor Compare provider costs and quality

Get a virtual ID card Manage prescription benefits

View claims

Anthem.com is now available in Spanish: es.anthem.com

anthem.com

Visit a doctor with our LiveHealth Online app

Employees can connect to a doctor anytime, anywhere. They can sign up for

LiveHealth Online and have a face-to-face conversation on their computer or

mobile device.

22 23

What’s new for 2016?

See what upcoming Affordable Care Act changes could mean for your group

Rating methods

In 2016, Anthem will be offering composite and member rating for small group employers

with 2 to 50 employees on ACA-compliant plans.

2015/2016 member rating

This is the process of calculating health

insurance premium costs separately for each

employee and enrolled dependents based on

their age. For example:

Employee rate = employee premium

Employee rate +

spouse/dependent rate =

family premium*

* Rates capped at three dependents under the age of 21.

2016 ACA-composite rating

The cost of coverage is averaged over the

entire group, so everybody pays the same

regardless of age. Rates are broken out by

contract types, for example:

Employee

Employee + spouse

Employee + child(ren)

Family

More resources to help you

Learn more about ACA, also known as health care reform, by going to our blog at

blog.makinghealthcarereformwork.com. Here you can stay up to date with the impacts

and changes that may affect your business. See what leading industry experts have to say

about ACA, wellness in the workplace and the best ways to manage costs.

Pediatric vision EHB

All of our Small Group medical plans include pediatric vision

essential health benefits for covered children up to age 19,

which includes coverage for vision exams and glasses or

contacts. Members can see any provider in the Blue View VisionSM network, which includes retailers such

as 1-800 CONTACTS®, LensCrafters®, Pearle Vision®, Sears OpticalSM, Target Optical® and JCPenney® Optical.

Covered children can choose from a selection of frames and contact lenses.

Pediatric vision EHB benefit grid In-network Out-of-network1

Routine eye exam (once every calendar year) $0 copay $30 reimbursement

Lenses — single, bifocal, trifocal (once every calendar year)Lens treatments

UV coatingStandard factory scratch coatingStandard polycarbonate lensesStandard Transitions® lensesStandard progressive lenses

$0 copay Covered in full Covered in fullCovered in fullCovered in fullCovered in full

$25, $40, $55 reimbursement N/AN/AN/AN/A$40 reimbursement

Frames (once every calendar year) $0 copay, Formulary $45 reimbursement

Elective contact lenses (once every calendar year — in lieu of eyeglasses)

$0 copay, Formulary $60 reimbursement

Nonelective contact lenses (once every calendar year) Covered in Full $210 reimbursement

1 Out-of-network usage will follow medical. PPO medical plans will have OON and HMO medical plans will not have OON.

Pediatric dental EHB

All of our small group medical plans include pediatric dental EHBs, which provide important coverage

for kids up to age 19, including preventive care, fillings and more extensive services like medically

necessary orthodontia. Members can see any provider in the Dental Prime network.

Pediatric dental EHB benefit grid In-network Out-of-network

Diagnostic and preventive services (cleanings, exams and X-rays) — not subject to deductible

90% 70%

Basic services (fillings) 60% 50%

Endodontic, periodontal, oral surgery and major services 50% 50%

Medically necessary orthodontia (12-month waiting period) 50% 50%

Because these benefits are part of a medical plan, they share a combined deductible and

out-of-pocket maximum. Diagnostic and preventive services like cleanings, exams and X-rays are

not subject to the deductible, so members can take advantage of them right away. These benefits

have no annual maximum.

New products for April 1, 2016 You asked, we listened. We’ve added seven new products

to our portfolio. Just look for the “New!” notation next to

the product names in the charts beginning on page 28.

24 25

It’s time to meet your matchYou’ll find it here, in one of the most comprehensive product portfolios in the market

We know each employer has a unique mix of employees and needs. So we designed

a great portfolio of plan options that allows you to create the ultimate benefits

package that’s perfect for your group. It’s a simple but strong strategy that gets right

to the heart of the matter: the health of your business.

So let’s get started. See which type of plan speaks to what’s most important to you.

Basic plan design

For employers who want to keep the type of

plan they have, but need to lower costs

If you like your current plan, but the cost has got

you worried, this can be a great option. Do you

like predictable costs (like knowing copay amounts

for office visits)? You can still offer that, but save

money by increasing the cost share when an

employee uses a benefit, for example, with higher

copays and deductibles:

� Same great products and benefit structure

� Same great network

� Higher copays and deductibles

� Lower premiums

� In-network preventive care covered 100%

In the product grids that follow, start with our silver

and bronze plans.

Healthy Support

If your employees have healthy living down

to a science, you can actually bank on that

There’s value in healthier employees, and here’s a

good way to make that work for everyone. These plans

are like our basic plans, but offer some additional ways

to bring the price down. It also gives employees

incentives for getting healthy and staying healthy:

� Anthem Select Drug List designed for more

savings, like using more generics

� Wellness package provides up to $700 in

incentives for employees who take healthy actions


In the product grids that follow, look for plus in the

plan name.

High-deductible health plans

An alternative benefit option that offers

savings for you and your employees

When employees have a greater stake in the game,

they’ll most likely make smarter health care

decisions and use their benefits more wisely. With

this plan option, employees have more control over

how they spend their health care dollars, and could

save on premiums. These plans, also known as

consumer-driven health plans (CDHP)s, can be paired

with a health savings account (HSA), which offers tax

savings to employees, or an employer-funded health

reimbursement account (HRA):

� Higher deductibles

� Lower premiums

� HSA-qualified plan options


In the product grids that follow, look for HSA or HRA

in the plan name.

A richer plan design

The one with all the bells and whistles

These are the plans that your employees may be

most familiar with. They have predictable costs, like

offering lower copays and deductibles. And

employees have access to a strong network of

doctors and hospitals, so there’s a great chance they

can stick with the doctors they know and love:

� Rich benefits

� Large networks

� Most inclusive list of covered drugs


In the product grids that follow, start with our

platinum and gold plans.

Like what you have, but need lower costs?

Employees have healthy

living down to a science?

Want savings for you and your

employees?

How about a health plan with all the

bells and whistles?

26 27

Product details

Platinum plans

Plan type Plan name

EPHC Network name

Contract code1 (CY/PY)

Embedded/ nonembedded2

Deductible (individual/family) Coinsurance

Out-of-pocket maximum (individual/family)

Office visit (PCP3/specialist) Urgent care

Emergency room facility

Outpatient surgery facility

Hospital inpatientfacility

Retail pharmacy:4 30-day supply (tier 1/tier 2/tier 3/tier4)

Drug list

Healthy Support

PPO

Anthem Platinum PPO 10/10%/2500 KeyCare 1NBP/1N5D Embedded N/A 10% $2,500/$5,000 $10/$20 $20 $2005 $250 $250 per day for 3 days $10/$35/$70/25% up to $250 N N/A

Anthem Platinum PPO 15/10%/4000 KeyCare 1P55/1P57 Embedded N/A 10% $4,000/$8,000 $15/$30 ($10 EPHC PCP) $30 $2005 $250 $500 per day for 3 days $10/$35/$70/25% up to $250 N N/A

Anthem Platinum PPO 10/20%/3000 KeyCare 1NBM/1N72 Embedded N/A 20% $3,000/$6,000 $10/$35 $35 $2005 $2505 $500 per day for 3 days $5/$35/$60/25% up to $250 N N/A

New! Anthem Platinum PPO 35/0%/4000 (available 4/1/2016) KeyCare 20V5/2OV7 Embedded N/A 0% $4,000/$8,000 $35/$60 ($25 EPHC PCP) $60 copay $3005 copay $300 copay $500 copay for 3 days $10/$35/$70/25% up to $250 N N/A

POS

Anthem HealthKeepers Platinum OAPOS 10/10%/2500 HealthKeepers 1NBR/1N5H Embedded N/A 10% $2,500/$5,000 $10/$20 $20 $2005 $250 $250 per day for 3 days plus 10% $10/$35/$70/25% up to $250 N N/A

Anthem HealthKeepers Platinum OAPOS 15/10%/4000 HealthKeepers 1P43/1P45 Embedded N/A 10% $4,000/$8,000 $15/$30 ($10 EPHC PCP) $30 $2005 $250 $500 per day for 3 days plus 10% $10/$35/$70/25% up to $250 N N/A

Anthem HealthKeepers Platinum OAPOS 10/20%/3000 HealthKeepers 1NBH/1N75 Embedded N/A 20% $3,000/$6,000 $10/$35 $35 $2005 $250 $500 per day for 3 days plus 20% $5/$35/$60/25% up to $250 N N/A

New! Anthem HealthKeepers Platinum OAPOS 35/0%/4000 (available 4/1/2016)

HealthKeepers 20UF/2OUH Embedded N/A 0% $4,000/$8,000 $35/$60 ($25 EPHC PCP) $60 copay $3005 copay $300 copay $500 copay for 3 days $10/$35/$70/25% up to $250 N N/A

Gold plans

PPO

Anthem Gold PPO 35/20%/6350 KeyCare 1P6G/1P6J Embedded N/A 20% $6,350/$12,700 $35/$65 $65 $2505 Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

Anthem Gold PPO 25/30%/5000 KeyCare 1P6L/1P6N Embedded N/A 30% $5,000/$10,000 $25/$50 $50 $2505 Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

Anthem Gold PPO 35/30%/5500 KeyCare 1NB6/1N77 Embedded N/A 30% $5,500/$11,000 $35/$60 ($25 EPHC PCP) $60 $2005 $250 $750 per day for 3 days plus 30% $15/$40/$80/25% up to $250 N N/A

Anthem Gold PPO 500/20%/4500 KeyCare 1NE0/1N6P Embedded $500/$1,500 20% $4,500/$9,000 $25/$50 ($15 EPHC PCP) $50 $3005 Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

Anthem Gold PPO 500/30%/5000 KeyCare 1P6U/1P6W Embedded $500/$1,500 30% $5,000/$10,000 $25/$50 ($15 EPHC PCP) $50 $2005 Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

Anthem Gold PPO 750/20%/4000 KeyCare 1NDF/1NAK Embedded $750/$2,250 20% $4,000/$8,000 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

Anthem Gold PPO 1000/20%/3000 KeyCare 1ND6/1NA9 Embedded $1,000/$3,000 20% $3,000/$6,000 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance N N/A

Anthem Gold PPO 1000/20%/3500 KeyCare 1N85/1N6G Embedded $1,000/$3,000 20% $3,500/$7,000 $25/$50 ($15 EPHC PCP) $50 $2505 Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

Anthem Gold PPO 1000/30%/2500 KeyCare 1NCX/1NAW Embedded $1,000/$3,000 30% $2,500/$5,000 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance N N/A

Anthem Gold PPO 1500/20%/3500 KeyCare 1NDR/1NB1 Embedded $1,500/$3,000 20% $3,500/$7,000 $25/$50 ($15 EPHC PCP) $50 $2005 Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

Anthem Gold PPO 1500/30%/4250 KeyCare 1N88/1N6V Embedded $1,500/$3,000 30% $4,250/$8,500 $20/$60 ($10 EPHC PCP) $60 $2005 Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

Anthem Gold PPO 2000/20%/3500 KeyCare 1NDD/1N70 Embedded $2,000/$4,000 20% $3,500/$7,000 $30/$50 ($20 EPHC PCP) $50 $2005 Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

1 CY = Calendar Year, PY = Plan Year. Our SHOP plans are only available as calendar year. Please see benefit proposal for final contract code.

2 Here’s a reminder of nonembedded versus embedded deductible products: Nonembedded Accumulation: All family members have a shared deductible and out-of-pocket (OOP) maximum, regardless of the number of family members. The entire deductible must be satisfied before any one member of the family can begin receiving benefits. The entire OOP must be satisfied before the family has satisfied the OOP maximum. Embedded Accumulation: Each member has an individual deductible/OOP amount. Any deductible amount contributed by an individual family member will apply to the family deductible amount, but no individual family member is required to contribute more to the family deductible than their individual deductible amount. The OOP accumulates on an embedded basis also.

3 Some plans may include a reduced cost share when seeing an Enhanced Personal Health Care provider. If so, it is noted in parentheses.

4 Pharmacy deductible, when applicable, does not apply to tier 1 drugs. Retail pharmacy is a 30-day supply limit. In-network and out-of-network benefits are combined. Home Delivery pharmacy is a 90-day supply limit. Specialty drug benefits are covered at a 30-day supply limit combined for in-network and out-of-network. If there is a generic drug available and members buy a brand name drug instead, members will be responsible for paying the brand-name copay plus the difference in cost between the generic drug and the brand-name drug. For benefit plans that contain a separate deductible for pharmacy, the deductible is combined for retail and home delivery and for both in-network and out-of-network benefits. The pharmacy cost shares noted apply to retail prescription drug purchases only. Members will pay more for Home Delivery services. Any plan that has a Rx copay in tiers 1, 2 and 3 will have a per script maximum in tier 4. Rx plans that are structured with a deductible and coinsurance for tiers 1, 2 and 3 will not have a per script max as part of the tier 4 benefit.

5 If a member’s plan includes emergency room facility copay and the member is directly admitted to the hospital, the emergency room facility copay is waived.

The below overview represents in-network benefits and is intended to only be a high level overview. Other

cost shares may apply, based on product and service utilized. For more plan information, please refer to the

Summary of Benefits (SOB). To find a specific SOB for any of these plans, visit sgplans.anthem.com.

All product offerings are subject to regulatory review and approval and are subject to change.

The plan naming structure includes these elements:brand + metal tier + product type + copay or deductible/coinsurance/out-of-pocket maximum

Enhanced Personal Health Care (EPHC) plans feature lower copays when members visit these providers.

28 29

Product details

Gold plans (continued)

Plan type Plan name

EPHC Network name








Hospital inpatient facility


Drug list

Healthy Support

POS

Anthem HealthKeepers Gold OAPOS 35/20%/6350 HealthKeepers 1P68/1P6A Embedded N/A 20% $6,350/$12,700 $35/$65 $65 $2505 Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

Anthem HealthKeepers Gold OAPOS 25/30%/5000 HealthKeepers 1P6C/1P6E Embedded N/A 30% $5,000/$10,000 $25/$50 $50 $2505 Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

Anthem HealthKeepers Gold OAPOS 35/30%/5500 HealthKeepers 1NCN/1N6W Embedded N/A 30% $5,500/$11,000 $35/$60 ($25 EPHC PCP) $60 $2005 $250 $750 per day for 3 days plus 30% $15/$40/$80/25% up to $250 N N/A

Anthem HealthKeepers Gold POS 500/20%/4000 Plus HealthKeepers 1P6Y/1P70 Embedded $500/$1,500 20% $4,000/$8,000 $25 — 3 visits before Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible, then

tier 1: 20% tier 2: 40%Deductible, then tier 1: 20% tier 2: 40% $15/$40/$80/30% up to $500 S Get Active

Anthem HealthKeepers Gold OAPOS 500/20%/4500 HealthKeepers 1ND4/1N6R Embedded $500/$1,500 20% $4,500/$9,000 $25/$50 ($15 EPHC PCP) $50 $3005 Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

Anthem HealthKeepers Gold OAPOS 500/30%/5000 HealthKeepers 1P6Q/1P6S Embedded $500/$1,500 30% $5,000/$10,000 $25/$50 ($15 EPHC PCP) $50 $2005 Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

Anthem HealthKeepers Gold OAPOS 750/20%/4000 HealthKeepers 1NDK/1N95 Embedded $750/$2,250 20% $4,000/$8,000 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

Anthem HealthKeepers Gold POS 1000/0%/4000 HealthKeepers 1P76/1P78 Embedded $1,000/$3,000 0% $4,000/$8,000 $20/deductible then $40 Deductible, then $40 Deductible, then $2005 Deductible, then $250 Deductible, then $500 per day

Deductible, then $15/$40/$80/25% up to $250 S N/A

Anthem HealthKeepers Gold OAPOS 1000/20%/3000 HealthKeepers 1N8G/1NAJ Embedded $1,000/$3,000 20% $3,000/$6,000 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance N N/A

Anthem HealthKeepers Gold POS 1000/20%/3000 Plus HealthKeepers 1ZEK/1ZE8 Embedded $1,000/$3,000 20% $3,000/$6,000 $20 — 3 visits before Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance $15/$40/$80/30% up to $500 S Get Active

Anthem HealthKeepers Gold OAPOS 1000/20%/3500 HealthKeepers 1NDA/1N74 Embedded $1,000/$3,000 20% $3,500/$7,000 $25/$50 ($15 EPHC PCP) $50 $2505 Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

Anthem HealthKeepers Gold OAPOS 1000/30%/2500 HealthKeepers 1NDP/1N99 Embedded $1,000/$3,000 30% $2,500/$5,000 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance N N/A

Anthem HealthKeepers Gold OAPOS 1500/20%/3500 HealthKeepers 1NDW/1NB9 Embedded $1,500/$3,000 20% $3,500/$7,000 $25/$50 ($15 EPHC PCP) $50 $2005 Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

Anthem HealthKeepers Gold OAPOS 1500/30%/4250 HealthKeepers 1NBG/1N6T Embedded $1,500/$3,000 30% $4,250/$8,500 $20/$60 ($10 EPHC PCP) $60 $2005 Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

Anthem HealthKeepers Gold OAPOS 2000/20%/3500 HealthKeepers 1ND7/1N6X Embedded $2,000/$4,000 20% $3,500/$7,000 $30/$50 ($20 EPHC PCP) $50 $2005 Deductible/coinsurance Deductible/coinsurance $10/$35/$70/25% up to $250 N N/A

PPO

CDHP

Anthem Gold PPO 1500E/20%/5000 w/ HRA (Employer contribution $500) KeyCare 1N8A/1NA8 Embedded $1,500/$3,000 20% $5,000/$10,000 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance N N/A

Anthem Gold PPO 2000/0%/2000 w/ HSA KeyCare 1NCZ/1NAU Nonembedded $2,000/$4,000 0% $2,000/$4,000 Deductible Deductible Deductible Deductible Deductible Deductible N N/A

Anthem Gold PPO 2000E/20%/5000 w/ HRA (Employer contribution $750) KeyCare 1NE1/1N9D Embedded $2,000/$4,000 20% $5,000/$10,000 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance N N/A

Anthem Gold PPO 2600E/30%/4750 w/ HSA (Employer contribution $1,000) KeyCare 1NCU/1NAY Embedded $2,600/$5,200 30% $4,750/$9,500 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance N N/A

Anthem Gold PPO 3425/0%/3425 w/ HRA (Employer contribution $750) KeyCare 1NDU/1N9F Nonembedded $3,425/$6,850 0% $3,425/$6,850 Deductible Deductible Deductible Deductible Deductible Deductible N N/A

POS

CDHP

Anthem HealthKeepers Gold OAPOS 1500E/20%/5000 w/ HRA (Employer contribution $500) HealthKeepers 1ND1/1N97 Embedded $1,500/$3,000 20% $5,000/$10,000 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance N N/A

Anthem HealthKeepers Gold OAPOS 2000/0%/2000 w/ HSA HealthKeepers 1ND2/1NAS Nonembedded $2,000/$4,000 0% $2,000/$4,000 Deductible Deductible Deductible Deductible Deductible Deductible N N/A

Anthem HealthKeepers Gold OAPOS 2000E/20%/5000 w/ HRA (Employer contribution $750) HealthKeepers 1NE5/1N9B Embedded $2,000/$4,000 20% $5,000/$10,000 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance N N/A

Anthem HealthKeepers Gold OAPOS 2600E/30%/4750 w/ HSA (Employer contribution $1,000) HealthKeepers 1NDH/1NAM Embedded $2,600/$5,200 30% $4,750/$9,500 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance N N/A

Anthem HealthKeepers Gold POS 3250/0%/3250 Plus w/ HRA (Employer contribution $750) HealthKeepers 2063/1ZDU Nonembedded $3,250/$6,500 0% $3,250/$6,500 Deductible Deductible Deductible Deductible Deductible Deductible S Get Active

Anthem HealthKeepers Gold OAPOS 3425/0%/3425 w/ HRA (Employer contribution $750) HealthKeepers 1NDQ/1N9H Nonembedded $3,425/$6,850 0% $3,425/$6,850 Deductible Deductible Deductible Deductible Deductible Deductible N N/A












30 31

Product details

Silver plans

Plan type Plan name

EPHC Network name










Drug list

Healthy Support

PPO

Anthem Silver PPO 2000/30%/4750 KeyCare 1P7S/1P7U Embedded $2,000/$4,000 30% $4,750/$9,500 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance N N/A

Anthem Silver PPO 2000/50%/6350 KeyCare 1N7E/1N6C Embedded $2,000/$4,000 50% $6,350/$12,700 $50/$75 ($35 EPHC PCP) $75 $3005 Deductible/coinsurance Deductible/coinsurance $15/$40/$80/25% up to $250 N N/A

Anthem Silver PPO 4000/20%/6850 KeyCare 1N7J/1N5V Embedded $4,000/$8,000 20% $6,850/$13,700 $40/$60 ($25 EPHC PCP) $60 $3005 Deductible/coinsurance Deductible/coinsurance $15/$250 Deductible then $40/$80/25% up to $250 N N/A

POS

Anthem HealthKeepers Silver POS 1250/40%/5500 Plus HealthKeepers 1P72/1P74 Embedded $1,250/$2,500 40% $5,500/$11,000 $25 — 3 visits before Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible, then

tier 1: 40% tier 2: 50%Deductible, then tier 1: 40% tier 2: 50% $15/$40/$80/30% up to $500 S Get Active

Anthem HealthKeepers Silver POS 1500/35%/5500 Plus HealthKeepers 1ZEM/206A Embedded $1,500/$3,000 35% $5,500/$11,000 $35 — 3 visits before Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance $15/$500 Deductible then

$40/$80/30% up to $500 S Get Active

Anthem HealthKeepers Silver POS 2000E/0%/6000 HealthKeepers 1P7F/1P7H Embedded $2,000/$4,000 0% $6,000/$12,000 Deductible, then $30/$60 Deductible, then $60 Deductible, then $4005 Deductible, then $500 Deductible, then $750

per day for 3 daysDeductible, then $15/$50/$90/30% S N/A

Anthem HealthKeepers Silver OAPOS 2000/30%/4750 HealthKeepers 1P7N/1P7Q Embedded $2,000/$4,000 30% $4,750/$9,500 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance N N/A

Anthem HealthKeepers Silver OAPOS 2000/50%/6350 HealthKeepers 1N8M/1N6E Embedded $2,000/$4,000 50% $6,350/$12,700 $50/$75 ($35 EPHC PCP) $75 $3005 Deductible/coinsurance Deductible/coinsurance $15/$40/$80/25% up to $250 N N/A

Anthem HealthKeepers Silver POS 2500/30%/5000 Plus HealthKeepers 1ZEF/1ZEB Embedded $2,500/$5,000 30% $5,000/$10,000 $25 — 3 visits before Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance $15/$250 Deductible then


Anthem HealthKeepers Silver POS 3000/0%/6500 HealthKeepers 1P7A/1P7C Embedded $3,000/$6,000 0% $6,500/$13,000 $20/deductible then $40 Deductible, then $40 Deductible, then $2505 Deductible, then $300 Deductible, then $500 per day

$15/Deductible then $15/$40/$80/25% up top $250 S N/A

Anthem HealthKeepers Silver POS 3000/20%/4500 Plus HealthKeepers 1ZE9/205U Embedded $3,000/$6,000 20% $4,500/$9,000 $30 — 3 visits before Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance $15/$250 Deductible then


Anthem HealthKeepers Silver OAPOS 4000/20%/6850 HealthKeepers 1NC2/1N6J Embedded $4,000/$8,000 20% $6,850/$13,700 $40/$60 ($25 EPHC PCP) $60 $3005 Deductible/coinsurance Deductible/coinsurance $15/$250 Deductible then $40/$80/25% up to $250 N N/A

PPO

CDHP

Anthem Silver PPO 2600E/20%/4500 w/ HSA KeyCare 1NBU/1N9M Embedded $2,600/$5,200 20% $4,500/$9,000 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance N N/A

New! Anthem Silver PPO 2600E/20%/4500 w/ HSA V2 (available 4/1/2016) KeyCare 20UK/2OUM Embedded $2,600/$5,200 20% $4,500/$9,000 20% coinsurance after

deductible20% coinsurance after deductible

20% coinsurance after deductible



Deductible, then $15/$40/$80/25% N N/A

New! Anthem Silver PPO 2600E/30%/4750 w/ HSA (available 4/1/2016) KeyCare 20UX/2OUZ Embedded $2,600/$5,200 30% $4,750/$9,500 30% coinsurance after






Anthem Silver PPO 2800E/20%/4000 w/ HSA KeyCare 1N9Y/1NDM Embedded $2,800/$5,600 20% $4,000/$8,000 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance N N/A

Anthem Silver PPO 3400/0%/3400 w/ HSA KeyCare 1N9T/1NE6 Nonembedded $3,400/$6,800 0% $3,400/$6,800 Deductible Deductible Deductible Deductible Deductible Deductible N N/A

Anthem Silver PPO 3500E/0%/3500 w/ HSA KeyCare 1NAC/1NAZ Embedded $3,500/$7,000 0% $3,500/$7,000 Deductible Deductible Deductible Deductible Deductible Deductible N N/A

Anthem Silver PPO 5500E/0%/5500 w/ HRA (Employer contribution $750) KeyCare 1NA3/1N8D Embedded $5,500/$11,000 0% $5,500/$11,000 Deductible Deductible Deductible Deductible Deductible Deductible N N/A

POS

CDHP

New! Anthem HealthKeepers Silver POS 2600E/10%/6550 Plus w/ HSA (available 4/1/2016) HealthKeepers 20UT/2OUV Embedded $2,600/$5,200 10% $6,550/$13,100 $25/$50 copay after

deductible$50 copay after deductible

$3005 copay after deductible




New! Anthem HealthKeepers Silver OAPOS 2600E/20%/4500 w/ HSA V2 (available 4/1/2016) HealthKeepers 20V1/2OV3 Embedded $2,600/$5,200 20% $4,500/$9,000 20% coinsurance after






New! Anthem HealthKeepers Silver OAPOS 2600E/30%/4750 w/ HSA (available 4/1/2016) HealthKeepers 20UP/2OUR Embedded $2,600/$5,200 30% $4,750/$9,500 30% coinsurance after

















32 33

Silver plans (continued)

Plan type Plan name

EPHC Network name










Drug list

Healthy Support

POS

CDHP

Anthem HealthKeepers Silver OAPOS 2600E/20%/4500 w/ HSA HealthKeepers 1NBF/1N9P Embedded $2,600/$5,200 20% $4,500/$9,000 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance N N/A

Anthem HealthKeepers Silver POS 2600E/30%/4500 Plus w/ HSA HealthKeepers 205W/1ZE0 Embedded $2,600/$5,200 30% $4,500/$9,000 Deductible, then

$20/$35 Deductible, then $35 Deductible, then $3005 Deductible/coinsurance Deductible/coinsurance Deductible, then $15/$40/$80/30% S Get Active

Anthem HealthKeepers Silver OAPOS 2800E/20%/4000 w/ HSA HealthKeepers 1N7P/1N8N Embedded $2,800/$5,600 20% $4,000/$8,000 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance N N/A

Anthem HealthKeepers Silver OAPOS 3400/0%/3400 w/ HSA HealthKeepers 1N8X/1N80 Nonembedded $3,400/$6,800 0% $3,400/$6,800 Deductible Deductible Deductible Deductible Deductible Deductible N N/A

Anthem HealthKeepers Silver OAPOS 3500E/0%/3500 w/ HSA HealthKeepers 1NAA/1NAF Embedded $3,500/$7,000 0% $3,500/$7,000 Deductible Deductible Deductible Deductible Deductible Deductible N N/A

Anthem HealthKeepers Silver OAPOS 5500E/0%/5500 w/ HRA (Employer contribution $750) HealthKeepers 1N7L/1N93 Embedded $5,500/$11,000 0% $5,500/$11,000 Deductible Deductible Deductible Deductible Deductible Deductible N N/A

Bronze plans

POS

Anthem HealthKeepers Bronze POS 5900/0%/6850 Plus HealthKeepers 1ZE4/1ZE5 Embedded $5,900/$11,800 0% $6,850/$13,700 $35 — 3 visits before deductible Deductible Deductible Deductible Deductible $15/$500 Deductible then


PPO

CDHP Anthem Bronze PPO 6000E/0%/6000 w/ HSA KeyCare 1N7T/1N6L Embedded $6,000/$12,000 0% $6,000/$12,000 Deductible Deductible Deductible Deductible Deductible Deductible N N/A

POS

CDHP

Anthem HealthKeepers Bronze POS 4250E/30%/6550 Plus w/ HSA HealthKeepers 205T/1ZDY Embedded $4,250/$8,500 30% $6,550/$13,100 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance S Get Active

Anthem HealthKeepers Bronze POS 4500E/40%/6550 Plus w/ HSA HealthKeepers 205V/2061 Embedded $4,500/$9,000 40% $6,550/$13,100 Deductible, then 40% Deductible, then $50 Deductible, then $3005 Deductible, then 40% Deductible, then 40% Deductible, then

$15/$50/$90/40% S Get Active

Anthem HealthKeepers Bronze POS 4750E/20%/6550 Plus w/ HSA HealthKeepers 1ZEJ/1ZE1 Embedded $4,750/$9,500 20% $6,550/$13,100 Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance S Get Active

Anthem HealthKeepers Bronze OAPOS 6000E/0%/6000 w/ HSA HealthKeepers 1NA7/1N5T Embedded $6,000/$12,000 0% $6,000/$12,000 Deductible Deductible Deductible Deductible Deductible Deductible N N/A

Anthem HealthKeepers Bronze POS 6300E/0%/6300 Plus w/ HSA HealthKeepers 1ZEN/1ZDW Embedded $6,300/$12,600 0% $6,300/$12,600 Deductible Deductible Deductible Deductible Deductible Deductible S Get Active

SHOP plans

POS

Anthem HealthKeepers Gold X OAPOS 3000/0%/4000 HealthKeepers 1P7K Embedded $3,000/$6,000 0% $4,000/$8,000 $15/$35 ($10 EPHC PCP) Deductible, then $35 $2005 Deductible Deductible $15/$250 Deductible then $40/$80/25% up to $250 N N/A

Anthem HealthKeepers Gold Pathway X POS 500/20%/5000 Plus

Pathway X tiered Hospital 2064 Embedded $500/$1,500 20% $5,000/$10,000 $20 — 3 visits before

Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance Deductible/coinsurance $15/$40/$80/30% up to $500 S Get Active

Anthem HealthKeepers Gold Pathway X POS 1000/20%/2900 Plus

Pathway X tiered Hospital 1P7L Embedded $1,000/$3,000 20% $2,900/$5,800 $20 — 3 visits before


Anthem HealthKeepers Silver X POS 2500/0%/5000 HealthKeepers 1P7D Embedded $2,500/$5,000 0% $5,000/$10,000 Deductible, then $30/$60 Deductible, then $60 Deductible, then $4005 Deductible, then $500 Deductible, then $750 Deductible, then

$15/$50/$90/30% S N/A

Anthem HealthKeepers Silver X OAPOS 4500E/0%/6000 HealthKeepers 1P7J Embedded $4,500/$9,000 0% $6,000/$12,000 Deductible Deductible Deductible Deductible Deductible $15/$40/$80/25% up to $250 N N/A

Anthem HealthKeepers Silver Pathway X POS 2000/30%/5500 Plus

Pathway X tiered Hospital 2060 Embedded $2,000/$4,000 30% $5,500/$11,000 $30 — 3 visits before


POS

CDHP

Anthem HealthKeepers Bronze Pathway X POS 5000E/20%/6550 Plus w/ HSA

Pathway X tiered Hospital 1P66 Embedded $5,000/$10,000 20% $6,550/$13,100 Deductible, then

$30/$60 Deductible, then $60 Deductible, then $3005 Deductible/coinsurance Deductible/coinsurance Deductible, then $15/$40/$80/25% S Get Active

Anthem HealthKeepers Bronze Pathway X POS 6000E/0%/6000 Plus w/ HSA

Pathway X tiered Hospital 2062 Embedded $6,000/$12,000 0% $6,000/$12,000 Deductible Deductible Deductible Deductible Deductible Deductible S Get Active






Product details







34 35

Plans with more coverage choices

When we created the Dental Prime and Dental Complete

plans, we made sure they could be custom fit. That means

lots of choices in coverage, including options for:

�Dental implants.

�Composite (tooth-colored) fillings on any tooth, not

just the front teeth.

�Orthodontic benefits for kids and adults, or kids only.

�Annual maximum carryover, which lets members carry over

some unused benefits to the next year.

Pediatric dental EHB benefits are included with your

medical plan. You can also add adult dental coverage or

supplement the pediatric dental EHB to a higher level of

coverage by purchasing one of our stand-alone Dental Prime

and Dental Complete plans. See the grid that follows for

more information.

Value, Classic and Enhanced dental plans

For groups of 2 to 50, we offer a choice of dental plans

that use our Dental Complete and the deeper discounted

Dental Prime networks. You can choose from our Value,

Classic and Enhanced levels. So you can select the level

that fits your needs and budget:

� Value dental plans cover the basics like cleanings,

exams, X-rays and fillings.

� Classic dental plans cover basic dental services, as well

as most major services.

� Enhanced dental plans have the most coverage, with

choices for higher levels of coverage/annual maximums

and lower coinsurance for members.

Value Classic Enhanced Voluntary

Passive Passive Active Passive Active Passive Active

Diagnostic and preventive services 100%/100% 100%/100% 100%/80% 100%/100% 100%/80% 100%/100% 100%/80%

Basic services 80%/80% 80%/80% 80%/60% 90%/90%/90% 90%/80%/70% 80%/80% 80%/60%

Major services Not covered 50%/50% 50%/50% 60%/60% 60%/50% 50%/50%

Endodontic, periodontal and oral surgery services

Not covered, 80%/80% 80%/80%/50% 80%/60%/50% 90%/90%/90% 90%/80%/70% 50%/50%

Implants Not covered Not covered or covered Covered Not covered or covered

Posterior composites Benefit as amalgam or covered Covered Covered Covered

Orthodontia Not coveredNot covered,

50% children only, 50% adults and childrenNot covered, 50% children only Not covered, 50% children only

Annual deductible (per person/family)

$50/$150 $50/150 $25/$75, $50/$150 $50/$150

Annual benefit maximum and orthodontia maximum

$1,000 $1,000 $1,250, $1,500 or $2,000 $1,500, $2,000 $1,000, $1,250, $1,500 or $2,000

Waiting periods (major and orthodontia)

No waiting period No waiting period No waiting periodMajor: 12 months

Orthodontia: None or 12 months

Annual maximum carryover Not included Not included or included Not included or included Optional

Out-of-network reimbursement MAC, 90th, 80th MAC, 90th, 80th 80th, 90th MAC, 90th, 80th

Dental network Prime or Complete Prime or Complete Complete Complete

In 2016, we will be offering the below dental plans. These dental plans allow for streamlined administration providing groups that have Anthem medical and Anthem dental with the convenience of one bill, one payment.

Product details

2016 Dental Prime and Dental Complete plans (new business only)

Dental Prime and Dental Complete

The above is a summary. See the Certificate of Coverage with the Schedule of Benefits and any riders associated with the plan for complete coverage details and related terms and conditions.

For renewing business, please contact your Anthem representative for a complete copy of the plan options available.

36 37

Blue View Vision stand-alone plans (2 to 50 employees)

Plan

Copay1 for Frequency

Eye exam/ Eyeglass lenses

Frames/Contact lenses allowance2 Eye exam Eyeglass lenses Frames Contact lenses

Full s

ervic

e

A1 $10/$0 $130/$130 Once per calendar year Once per calendar year Once per calendar year Once per calendar year






B1 $10/$0 $130/$130 Once per calendar year Once per calendar year Once every other calendar year Once per calendar year






C1 $10/$0 $130/$130 Once per calendar year Once every other calendar year Once every other calendar year Once every other calendar year









Mat

eria

l onl

y

MO1 Not covered/$10 $130/$130 Not covered Once per calendar year Once per calendar year Once per calendar year

MO2 Not covered/$10 $130/$130 Not covered Once per calendar year Once every other calendar year Once per calendar year





Exam

onl

y3

E01 $0/Not covered Not covered Once per calendar year Not covered Not covered Not covered





Get vision coverage and see increased productivity

Product details

1 Above amounts reflect in-network copays and allowances.

2 Benefits include coverage for member’s choice of eyeglass lenses or contact lenses, but not both. Nonelective contacts covered in full.

3 Retention plans only.

Pediatric vision is included in all of our

Small Group medical plans. Some plans

may also include adult vision benefits.

For more information, contact your broker

or Anthem Sales representative.

38 39

Request a copy of the Combined Evidence of Coverage/Member Booklet for comprehensive details on covered services,

limitations and exclusions. These exclusions and limitations will apply to all members enrolled in any of the products

described in this brochure unless otherwise noted.

All exclusions and limitations are subject to regulatory review and approval.

1. Abortion Services, supplies, prescription drugs, and other care for elective (voluntary) abortions and/or fetal reduction surgery (applies to Anthem HealthKeepers SHOP plans):

a) This exclusion does not apply to therapeutic abortions, which are abortions performed to save the life of the mother or as a result of incest or rape.

2. Acts of war, disasters or nuclear accidents In the event of a major disaster, epidemic, war, or other event beyond our control, we will make a good faith effort to give you covered services. We will not be responsible for any delay or failure to give services due to lack of available facilities or staff:

a) Benefits will not be given for any illness or injury that is a result of war, service in the armed forces, a nuclear explosion, nuclear accident, release of nuclear energy, a riot or civil disobedience.

3. Administrative charges:a) Charges to complete claim forms.b) Charges to get medical records or reports.c) Membership, administrative, or access fees charged by doctors or other

providers. Examples include, but are not limited to, fees for educational brochures or calling you to give you test results.

4. Alternative/complementary medicine Services or supplies for alternative or complementary medicine. This includes, but is not limited to:

a) Acupunctureb) Holistic medicine c) Homeopathic medicine d) Hypnosise) Aroma therapyf) Massage and massage therapy g) Reiki therapy h) Herbal, vitamin or dietary products or therapies i) Naturopathyj) Thermography k) Orthomolecular therapy l) Contact reflex analysis m) Bioenergetic synchronization technique (BEST) n) Iridology — study of the iris o) Auditory integration therapy (AIT) p) Colonic irrigation q) Magnetic innervation therapy r) Electromagnetic therapy s) Neurofeedback/biofeedback

5. Before effective date or after termination date Charges for care you get before your effective date or after your coverage ends, except as written in this plan.

6. Certain providers Services you get from providers that are not licensed by law to provide covered services as defined in this booklet. Examples include, but are not limited to, masseurs or masseuses (massage therapists), physical therapist technicians, and athletic trainers.

7. Charges over the maximum allowed amount Charges over the maximum allowed amount for covered services.

8. Charges not supported by medical records Charges for services not described in your medical records.

9. Chiropractic/manipulation therapy Any manipulation therapy or chiropractic service not authorized by ASHG (applies to HealthKeepers plans).

10. Complications of noncovered services Care for problems directly related to a service that is not covered by this plan. Directly related means that the care took place as a direct result of the noncovered service and would not have taken place without the noncovered service.

11. Contraceptives Contraceptive devices including diaphragms, intra uterine devices (IUDs), and implants (this exclusion only applies if employer group has qualified to opt out of this coverage).

12. Cosmetic services Treatments, services, prescription drugs, equipment, or supplies given for cosmetic services. Cosmetic services are meant to preserve, change, or improve how you look or are given for psychiatric, psychological, or social reasons. No benefits are available for surgery or treatments to change the texture or look of your skin or to change the size, shape or look of facial or body features (such as your nose, eyes, ears, cheeks, chin, chest or breasts).This exclusion does not apply to:

a) Surgery or procedures to correct deformity caused by disease, trauma, or previous therapeutic process.

b) Surgery or procedures to correct congenital abnormalities that cause functional impairment.

c) Surgery or procedures on newborn children to correct congenital abnormalities.

The plan will not consider the patient’s mental state in deciding if surgery is cosmetic.

13. Court-ordered testing Court-ordered testing or care unless medically necessary.

14. Custodial care Custodial care, convalescent care or rest cures. This exclusion does not apply to hospice services.

15. Dental services:a) Dental care for members age 19 or older.b) Dental services not listed as covered in this booklet.c) Services of anesthesiologists, unless required by law.

d) Intravenous and non-intravenous conscious sedation, analgesia, and general anesthesia when given separate from a covered oral surgery services and given by a dentist or by an employee of the dentist when the service is performed in his or her office who is certified in their profession to provide anesthesia services.

e) Dental services, appliances or restorations that are necessary to alter, restore or maintain occlusion, including, but not limited to: increasing vertical dimension, replacing or stabilizing tooth structure lost by attrition, realignment of teeth, periodontal splinting and gnathologic recordings.

f) Canal prep and fitting of preformed dowel and post. g) Occlusal procedures.h) Onlays or permanent crowns when the tooth does not have decay,

fracture or has been endodontically treated.i) Services or supplies that have the primary purpose of improving the

appearance of your teeth. This includes, but is not limited to, tooth-whitening agents or tooth bonding.

j) Case presentations.k) Athletic mouth guards, enamel microabrasion and odontoplasty.l) Retreatment or additional treatment necessary to correct or relieve the

results of treatment previously covered under the plan.m) Bacteriologic tests for determination of periodontal disease or

pathologic agents. n) The controlled release of therapeutic agents or biologic modifiers used

to aid in soft tissue and osseous tissue regeneration.o) Collection of oral cytology sample via scraping of the oral mucosa.p) Separate services billed when they are an inherent component of

another covered service.q) Pin retention is not covered when billed separately from

restoration procedure.r) Services for the replacement of an existing partial denture

with a bridge. s) Incomplete, interim or temporary services, including, but not limited to,

fixed prosthetic appliances (dentures, partials or bridges). t) Additional, elective or enhanced prosthodontic procedures including,

but not limited to, connector bar(s), stress breakers and precision attachments.

u) Placement or removal of sedative filling, base or liner used under a restoration when it is billed separately from a restoration procedure.

v) Pulp vitality tests.w) Adjunctive diagnostic tests.x) Analgesia, analgesia agents, anxiolysis nitrous oxide, medicines, or

drugs for nonsurgical or surgical dental care. y) Incomplete root canals.z) Cone beam images.aa) Anatomical crown exposure.bb) Temporary anchorage devices.cc) Sinus augmentation.dd) Oral hygiene instructions. ee) Repair or replacement of lost/broken appliances.ff) Removal of pulpal debridement, pulp cap, post, pin(s), resorbable or

nonresorbable filling material(s) and the procedures used to prepare and place material(s) in the canals (root).

gg) Root canal obstruction, internal root repair of perforation defects, incomplete endodontic treatment and bleaching of discolored teeth.

16. Educational services Services or supplies for teaching, vocational, or self-training purposes, except as listed in this booklet.

17. Experimental or investigational services Services or supplies that we find are experimental or investigational. This also applies to services related to experimental or investigational services, whether you get them before, during, or after you get the experimental or investigational service or supply:

a) The fact that a service or supply is the only available treatment will not make it a covered service if we conclude it is experimental or investigational.

18. Eyeglasses and contact lenses Eyeglasses and contact lenses to correct your eyesight unless listed as covered in this booklet. This exclusion does not apply to lenses needed after a covered eye surgery or accidental injury.

19. Eye exercises Orthoptics and vision therapy.

20. Eye surgery Eye surgery to fix errors of refraction, such as near-sightedness. This includes, but is not limited to, LASIK, radial keratotomy or keratomileusis, and excimer laser refractive keratectomy.

21. Family members Services prescribed, ordered, referred by or given by a member of your immediate family, including your spouse, child, brother, sister, parent, in-law or self.

22. Foot care Routine foot care unless medically necessary. This exclusion applies to cutting or removing corns and calluses; trimming nails; cleaning and preventive foot care, including, but not limited to:

a) Cleaning and soaking the feet. b) Applying skin creams to care for skin tone.c) Other services that are given when there is not an illness, injury or

symptom involving the foot.This exclusion does not apply to the treatment of corns, calluses, and care of toenails for patients with diabetes or vascular disease.

23. Foot orthotics Foot orthotics, orthopedic shoes or footwear or support items unless used for an illness affecting the lower limbs, such as severe diabetes.

24. Foot surgery Surgical treatment of flat feet; subluxation of the foot; weak, strained, unstable feet; tarsalgia; metatarsalgia; hyperkeratoses.

25. Free care Services you would not have to pay for if you didn’t have this plan. This includes, but is not limited to, government programs, services during a jail or prison sentence, services you get from Workers’ Compensation, and services from free clinics.If Workers’ Compensation benefits are not available to you, this exclusion does not apply. This exclusion will apply if you get the benefits in whole or in part. This exclusion also applies whether or not you claim the benefits or compensation, and whether or not you get payments from any third party.

26. Hearing aids Hearing aids or exams to prescribe or fit hearing aids, unless listed as covered in this booklet. This exclusion does not apply to cochlear implants.

Exclusions and limitations

40 41

27. Health club memberships and fitness services Health club memberships, workout equipment, charges from a physical fitness or personal trainer, or any other charges for activities, equipment, or facilities used for physical fitness, even if ordered by a Doctor. This exclusion also applies to health spas.

28. Home care:a) Services given by registered nurses and other health workers who are

not employees of or working under an approved arrangement with a home health care provider.

b) Food, housing, homemaker services and home delivered meals.

29. Infertility treatment Treatment related to infertility.

30. Maintenance therapy Treatment given when no further gains are clear or likely to occur. Maintenance therapy includes care that helps you keep your current level of function and prevents loss of that function, but does not result in any change for the better.

31. Medical equipment and supplies:a) Replacement or repair of purchased or rental equipment because of

misuse, abuse, or loss/theft.b) Surgical supports, corsets, or articles of clothing unless needed to

recover from surgery or injury.c) Nonmedically necessary enhancements to standard equipment and devices.

32. Medicare Services for which benefits are payable under Medicare Parts A, and/or B, or would have been payable if you had applied for Parts A and/or B, except as required by federal law. If you do not enroll in Medicare Part B, we will calculate benefits as if you had enrolled. You should sign up for Medicare Part B as soon as possible to avoid large out-of-pocket costs.

33. Missed or canceled appointments Charges for missed or canceled appointments.

34. Nonmedically necessary services Services we conclude are not medically necessary. This includes services that do not meet our medical policy, clinical coverage, or benefit policy guidelines.

35. Nutritional or dietary supplements Nutritional and/or dietary supplements, except as described in this booklet or that we must cover by law. This exclusion includes, but is not limited to, nutritional formulas and dietary supplements that you can buy over the counter and those you can get without a written prescription or from a licensed pharmacist.

36. Oral surgery Extraction of teeth, surgery for impacted teeth and other oral surgeries for to treat the teeth or bones and gums directly supporting the teeth, except as listed in this booklet.

37. Personal care and convenience: a) Items for personal comfort, convenience, protection, cleanliness such

as air conditioners, humidifiers, water purifiers, sports helmets, raised toilet seats, and shower chairs

b) First aid supplies and other items kept in the home for general use (bandages, cotton-tipped applicators, thermometers, petroleum jelly, tape, nonsterile gloves, heating pads)

c) Home workout or therapy equipment, including treadmills and home gymsd) Pools, whirlpools, spas, or hydrotherapy equipmente) Hypoallergenic pillows, mattresses, or waterbeds

f) Residential, auto, or place of business structural changes (ramps, lifts, elevator chairs, escalators, elevators, stair glides, emergency alert equipment, handrails).

38. Prescription benefit exclusionsCertain items are not covered under the prescription drug Retail or Home Delivery (Mail Order) Pharmacy benefit:

a) Administration charges Charges for the administration of any drug except for covered immunizations as approved by us or the Pharmacy Benefit Manager (PBM).

b) Compound drugs Compound drugs unless all of the ingredients are FDA-approved and require a prescription to dispense, and the compound medication is not essentially the same as an FDA-approved product from a drug manufacturer. Exceptions to non-FDA approved compound ingredients may include multisource, nonproprietary vehicles and/or pharmaceutical adjuvants.

c) Contraceptives Contraceptive drugs, injectable contraceptive drugs and patches unless we must cover them by law (this exclusion only applies if employer group has qualified to opt out of this coverage).

d) Contrary to approved medical and professional standards Drugs given to you or prescribed in a way that is against approved medical and professional standards of practice.

e) Delivery charges Charges for delivery of prescription drugs.

f) Drugs given at the provider’s office/facility Drugs you take at the time and place where you are given them or where the prescription Order is issued. This includes samples given by a doctor. This exclusion does not apply to drugs used with a diagnostic service, drugs given during chemotherapy in the office or drugs covered under the medical and surgical supplies benefit — they are covered services.

g) Drugs not on the Anthem prescription drug list (a formulary) You can get a copy of the list by calling us or visiting our website at anthem.com.

h) Drugs that do not need a prescription Drugs that do not need a prescription by federal law (including drugs that need a prescription by state law, but not by federal law), except for injectable insulin.

This exclusion does not apply to over-the-counter drugs that we must cover under federal law when recommended by the U.S. Preventive Services Task Force and prescribed by a physician.

i) Drugs over quantity or age limits Drugs in quantities which are over the limits set by the plan, or which are over any age limits set by us.

j) Drugs over the quantity prescribed or refills after one year Drugs in amounts over the quantity prescribed, or for any refill given more than one year after the date of the original prescription order.

k) Infertility drugs Drugs used in assisted reproductive technology procedures to achieve conception (e.g., IVF, ZIFT, GIFT.)

l) Items covered as durable medical equipment (DME) Therapeutic DME, devices and supplies except peak flow meters, spacers, and blood glucose monitors. Items not covered under the prescription drug benefit at a retail or home delivery (mail order) pharmacy benefit may be covered under the durable medical equipment and medical devices benefit.

m) Items covered under the allergy services benefit Allergy desensitization products or allergy serum. While not covered under the prescription drug benefit at a retail or home delivery (mail order) pharmacy” benefit, these items may be covered under the allergy services benefit.

n) Home delivery providers other than the PBM’s home delivery provider Prescription drugs dispensed by any home delivery provider other than the PBM’s home delivery provider, unless we must cover them by law.

o) Nonapproved drugs Drugs not approved by the FDA.

p) Off-label use Off-label use, unless we must cover the use by law or if we, or the PBM, approve it.

q) Onychomycosis drugs Drugs for onychomycosis (toenail fungus) except when we allow it to treat Members who are immuno-compromised or diabetic.

r) Over-the-counter items Drugs, devices and products, or prescription legend drugs with over-the -counter equivalents and any drugs, devices or products that are therapeutically comparable to an over-the-counter drug, device, or product. This includes prescription legend drugs when any version or strength becomes available over the counter.

This exclusion does not apply to over-the-counter products that we must cover as a preventive care benefit under federal law with a prescription.

s) Sex-change drugs Drugs for sex-change surgery.

t) Sexual-dysfunction drugs Drugs to treat sexual or erectile problems.

u) Syringes Hypodermic syringes except when given for use with insulin and other covered self-injectable drugs and medicine.

v) Weight-loss drugs Any drug mainly used for weight loss

39. Private-duty nursing Private-duty nursing services, unless listed as covered in this booklet. Your coverage does not include benefits for private-duty nurses in the inpatient setting.

40. Prosthetics Prosthetics for sports or cosmetic purposes. This includes wigs and scalp hair prosthetics.

41. Sex change Services and supplies for a sex change and/or the reversal of a sex change.

42. Sexual dysfunction Services or supplies for male or female sexual problems.

43. Stand-by charges Stand-by charges of a doctor or other provider.

44. Sterilization Services to reverse elective sterilization (this exclusion applies to all except for those employer groups who qualify to out of this coverage).

45. Sterilization For female sterilization or reversal of sterilization (this exclusion only applies if the employer group has qualified to opt out of this coverage).

46. Surrogate mother services Services or supplies for a person not covered under this plan for a surrogate pregnancy (including, but not limited to, the bearing of a child by another woman for an infertile couple).

47. Telemedicine Noninteractive telemedicine services, such as audio-only telephone conversations, electronic mail message, fax transmissions or online questionnaire.

48. Temporomandibular joint treatment Fixed or removable appliances which move or reposition the teeth, fillings, or prosthetics (crowns, bridges, dentures).

49. Travel costs Mileage, lodging, meals, and other member-related travel costs except as described in this plan.

50. Vein treatment Treatment of varicose veins or telangiectatic dermal veins (spider veins) by any method (including sclerotherapy or other surgeries) for cosmetic purposes.

51. Vision services: a) Eyeglass lenses, frames, or contact lenses for members age 19 and

older, unless listed as covered in this booklet.b) Safety glasses and accompanying frames.c) For two pairs of glasses in lieu of bifocals.d) Plano lenses (lenses that have no refractive power).e) Lost or broken lenses or frames if the member has already received

benefits during a benefit period.f) Vision services not listed as covered in this booklet.g) Cosmetic lenses or options.h) Blended lenses.i) Oversize lenses.j) Sunglasses and accompanying frames. k) For services or supplies combined with any other offer, coupon or

in-store advertisement.l) For members to age 19, no benefits are available for frames or contact

lenses not on the Anthem formulary.m) Certain frames in which the manufacturer imposes a no-discount policy.

52. Vision services Vision services not described as covered services in this booklet.

53. Waived cost-shares out of network For any service for which you are responsible under the terms of this plan to pay a copayment, coinsurance or deductible, and the copayment, coinsurance or deductible is waived by an out-of-network provider.

54. Weight-loss programs Programs, whether or not under medical supervision, unless listed as covered in this booklet.This exclusion includes, but is not limited to, commercial weight-loss programs (Weight Watchers®, Jenny Craig®, LA Weight Loss®) and fasting programs.

55. Weight-loss surgery Bariatric surgery. This includes, but is not limited to, Roux-en-Y (RNY), Laparoscopic gastric bypass surgery or other gastric bypass surgery (surgeries that lower stomach capacity and divert partly digested food from the duodenum to the jejunum, the section of the small intestine extending from the duodenum), or gastroplasty, (surgeries that reduce stomach size), or gastric banding procedures.

Exclusions and Limitations

42 43

Notes

44 45

This is not a contract or policy. This brochure is not a contract with Anthem Blue Cross and Blue Shield or its affiliate HealthKeepers, Inc. If there is any difference between this brochure and the Evidence of Coverage, Member Booklet, Summaries of Benefits, and related Amendments, the provisions of the Evidence of Coverage, Member Booklet, Summaries of Benefits and related Amendments will govern. For more information, please call Member Services.

LiveHealth Online is the trade name of Health Management Corporation, a separate company, providing telehealth services on behalf of Anthem Blue Cross and Blue Shield. Life and Disability products underwritten by Anthem Life Insurance Company. Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc. are independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

These policies have exclusions and limitations to benefits and terms under which the policies may be continued in force or discontinued. For costs and complete details of the coverage, contact your insurance agent or contact us.

The most detailed description of benefits, exclusions and restrictions can be found in the following group policies and Certificate Booklets which can be requested by calling Member Services.

AHK-VA-HMOPOS-SOB-T1P101 (4/16)ABCBS-VA-PPO-SOB-T3S2-HSA-rxC (4/16) AHK-VA-HMOPO-SBOB-T3S3-HSA-rxC (4/16)AHK-VA-HMOPOS-SOB-R3bS8-HSA (4/16)ABCBS-VA-PPO-SOB-T3S3-HSA-rxC (4/16)AHK-VA-HMOPOS-SOB-T3S2-HSA-rxC (4/16)ABCBS-VA-PPO-SOB-T1P101 (4/16) AHK-VA-HMOPOS-EOC (1/16) AHK-VA-HMOPOS-SOB-R2fG11 (1/16)AHK-VA-HMOPOS-SOB-R2fG2 (1/16)AHK-VA-HMOPOS-SOB-R2fS1 (1/16)AHK-VA-HMOPOS-SOB-R2fG4 (1/16)AHK-VA-HMOPOS-SOB-R2fS4 (1/16)AHK-VA-HMOPOS-SOB-R2fS6 (1/16)AHK-VA-HMOPOS-SOB-R2fS7 (1/16)AHK-VA-HMOPOS-SOB-RVA-2gG1 (1/16)AHK-VA-HMOPOS-SOB-RVA-2gS1 (1/16) AHK-VA-HMOPOS-SOB-T1dG7 (1/16)AHK-VA-HMOPOS-SOB-T1dG8 (1/16) AHK-VA-HMOPOS-SOB-T1G17 (1/16)AHK-VA-HMOPOS-SOB-T1P3 (1/16)AHK-VA-HMOPOS-SOB-T1P5 (1/16)AHK-VA-HMOPOS-SOB-T2G11R-VA (1/16)AHK-VA-HMOPOS-SOB-T2G38R-VA (1/16)AHK-VA-HMOPOS-SOB-T2G63R-VA (1/16)AHK-VA-HMOPOS-SOB-T2G64R-VA (1/16)AHK-VA-HMOPOS-SOB-T2G65R-VA (1/16)AHK-VA-HMOPOS-SOB-T2G66R-VA (1/16)AHK-VA-HMOPOS-SOB-T2IG1-VA-rxA (1/16)AHK-VA-HMOPOS-SOB-T2IS2-VA-rxA (1/16) AHK-VA-HMOPOS-SOB-T2S15R (1/16)AHK-VA-HMOPOS-SOB-T2S5R-VA (1/16)AHK-VA-HMOPOS-SOB-R3B2-HSA (1/16)AHK-VA-HMOPOS-SOB-R3B3-HSA (1/16)AHK-VA-HMOPOS-SOB-R3B4-HSA (1/16) AHK-VA-HMOPOS-SOB-R3B5-HSA (1/16)AHK-VA-HMOPOS-SOB-R3bB1-HSA (1/16)AHK-VA-HMOPOS-SOB-R3bB25-HSA (1/16)AHK-VA-HMOPOS-SOB-R3bS1-VA-rxA (1/16)AHK-VA-HMOPOS-SOB-R3bS2-VA-rxA (1/16)

AHK-VA-HMOPOS-SOB-R3bS6-HSA (1/16)AHK-VA-HMOPOS-SOB-RVA2gG1 (1/16)AHK-VA-HMOPOS-SOB-RVA2gS1 (1/16)AHK-VA-HMOPOS-SOB-T1P100 (1/16)AHK-VA-HMOPOS-SOB-T2G56-R-VA (1/16)AHK-VA-HMOPOS-SOB-T3S204-rxF (1/16) ABCBS-VA-PPO-SOB-T1P100 (1/16)AHK-VA-HMOPOS-SOB-R3G28-HRA (1/16)AHK-VA-HMOPOS-SOB-T3B13-HSA (1/16)AHK-VA-HMOPOS-SOB-T3G11-HSA (1/16)AHK-VA-HMOPOS-SOB-T3G27-HRA (1/16)AHK-VA-HMOPOS-SOB-T3G28-HRA (1/16)AHK-VA-HMOPOS-SOB-T3G31-HRA (1/16)AHK-VA-HMOPOS-SOB-T3G4 (1/16)AHK-VA-HMOPOS-SOB-T3G5 (1/16)AHK-VA-HMOPOS-SOB-T3G7-HSA (1/16)AHK-VA-HMOPOS-SOB-T3S15-HSA (1/16)AHK-VA-HMOPOS-SOB-T3S221 (1/16) AHK-VA-HMOPOS-SOB-T3S28-HRA (1/16)AHK-VA-HMOPOS-SOB-T3S30-HSA (1/16)AHK-VA-HMOPOS-SOB-T3S31-HSA (1/16)AHK-VA-HMOPOS-SOB-T3S6-HSA (1/16)AHK-VA-HMOPOS-SOB-T3G-VA1 (1/16)AHK-VA-HMOPOS-SOB-R2fB1 (1/16)ABCBS-VA-PPO-SOB-T1dG7 (1/16)ABCBS-VA-PPO-SOB-T1dG8 (1/16) ABCBS-VA-PPO-COC (1/16)ABCBS-VA-PPO-SOB-T1dG7 (1/16)

ABCBS-VA-PPO-SOB-T1dG8 (1/16) ABCBS-VA-PPO-SOB-T1G17 (1/16)ABCBS-VA-PPO-SOB-T1P3 (1/16)ABCBS-VA-PPO-SOB-T1P5 (1/16)ABCBS-VA-PPO-SOB-T2G11R-VA (1/16)ABCBS-VA-PPO-SOB-T2G38R-VA (1/16)ABCBS-VA-PPO-SOB-T2G63R-VA (1/16)ABCBS-VA-PPO-SOB-T2G64R-VA (1/16)ABCBS-VA-PPO-SOB-T2G65R-VA (1/16)ABCBS-VA-PPO-SOB-T2G66R-VA (1/16) AHK-VA-HMOPOS-SOB-T2S15-R-VA (1/16)AHK-VA-HMOPOS-SOB-T2S5-R-VA (1/16) ABCBS-VA-PPO-SOB-T3B13 HSA (1/16)ABCBS-VA-PPO-SOB-T3G11-HSA (1/16)ABCBS-VA-PPO-SOB-T3G27-HRA (1/16)ABCBS-VA-PPO-SOB-T3G28-HRA (1/16)ABCBS-VA-PPO-SOB-T3G31-HRA (1/16)ABCBS-VA-PPO-SOB-T3G4 (1/16)ABCBS-VA-PPO-SOB-T3G5 (1/16)ABCBS-VA-PPO-SOB-T3G7-HSA (1/16)ABCBS-VA-PPO-SOB-T3S15-HSA (1/16)ABCBS-VA-PPO-SOB-T3S221 (1/16) ABCBS-VA-PPO-SOB-T3S28-HRA (1/16)ABCBS-VA-PPO-SOB-T3S30-HSA (1/16)ABCBS-VA-PPO-SOB-T3S31-HSA (1/16)ABCBS-VA-PPO-SOB-T3S6-HSA (1/16)ABCBS-VA-PPO-SOB-T3G-VA1 (1/16)

Documents

Virginia | Effective April 1, 2016 Small Group product guide · We put the same passion into our health plans, that you put into your business. Virginia | Effective April 1, 2016