ASO. BlueCross BlueShield of Oregon. Core Offerings SELF-FUNDED GROUPS, SIZED 100+ Crater Lake

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1 BlueCross BlueShield of Oregon ASO Core Offerings SELF-FUNDED GROUPS, SIZED 100+ Regence BlueCross BlueShield of Oregon is an Independent Licensee of the Blue Cross and Blue Shield Association Crater Lake

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3 Regence ASO Core Offerings Under an ASO self-funded arrangement, you define the ideal balance between control and risk. With Regence ASO, you can rely on professional eligibility and claims administration, along with highquality clinical services and a solid provider network that offers savings through deep discounts. The following products and services are available as Regence ASO Core Offerings. Network Advantage Regence preferred network Regence is local, has a long history of doing business in our communities, and brings a high volume of business to our network. This volume drives deeper discounts, and employers can rest assured that our providers are dedicated to caring for their employees. Our traditional Regence preferred network provides discounted access to care almost anywhere, which is crucial for international companies and those with employees who travel or work in rural locations. NATIONWIDE ACCESS: 96% of hospitals and 92% of physicians BlueCard Program advantage: BlueCard gives your employees seamless access to physicians and hospitals that participate in Blue Plan networks across the country. That s 92% of all physicians and 96% of all hospitals nationwide. The program links these providers with all the independent Blue Cross and/or Blue Shield Plans through a single electronic network for claims processing and reimbursement. So no matter where they live, work or travel, your employees will be covered at your plan s benefit levels. Blue Cross Blue Shield Global is a medical assistance program that connects employees traveling or living outside the United States, Puerto Rico and the U.S. Virgin Islands to a network of more than 9,000 hospitals and 21,000 health care professionals and outpatient care centers around the world. The program also provides claims support, referrals to providers, translation services and medical monitoring 24 hours a day, 365 days a year. It may provide other services, such as medical evacuation coordination, depending on your plan benefits and our payment guarantee.

4 Regence BlueCross BlueShield of Oregon ranks among the top 10 of all Blue Plans in the nation in Member Touchpoints Measures. The Member Touchpoint Measures (MTM) Program is used by the Blue Cross and Blue Shield Association to assess service performance by monitoring enrollment processing, claims adjudication, inquiry resolution and first call resolution to determine responsiveness to customers. Member Services Your dedicated Member Services Department has a toll-free number and no IVR. Our Voice Response Unit is available 24/7; employees can check claim status, request claim forms, order member ID cards and hear benefit information at any time. Benefit coordinators have direct phone and access to dedicated team leads. Our secure member web portal provides benefit information and allows your employees to: Order or print member ID cards View claims status and print EOBs Review eligibility and check authorization status Submit Other Health Insurance questionnaires Member Services Use our live chat feature Monday through Friday between 5 a.m. and 8 p.m. Access provider cost and quality information, a Personal Health Record, online provider directory, a wellness library, their prescription drug history, helpful information on prescription options, cost comparisons, generic drug information, and details about pharmacy benefits ASO escalation process We use a first-class escalation process for cases that require special handling. A highly skilled escalations team is accessible through any time an issue is escalated due to its sensitivity, complexity or visibility. This team performs a comprehensive review, adheres to a 24-hour response time and is accountable for achieving resolution including payment decisions. You will provide us with a list of those individuals who have authority to the escalations team. If a sender is not on that list, we will let them know that they are not on the list of authorized users. s to authorized users will include the name of your Regence sales executive to keep them informed every step of the way.

5 Medical Management Utilization management ensures medical necessity, avoiding unnecessary costs and directing employees to high-quality services. We guide your workforce toward safe, effective and evidence-based treatment options. Our goal: to connect employees with the right care at the right time, and to empower them to return to health as quickly as possible. Our approach supports prevention and evidence-based, member-specific interventions, providing the lowest level of health plan involvement possible. These philosophies minimize future treatment costs and foster in your employees a sense of independence and well-being. Services include: Core utilization management Uses evidence-based guidelines to ensure that procedures, medications and devices are supported by research, demonstrate effective outcomes and deliver value. Our three-stage review process includes: Pre-authorization Concurrent review on certain services Post-service review Case management Coordinates and evaluates options and services to support employees with catastrophic medical needs. Behavioral health management Provides utilization management for certain services. Additional medical management, and health and productivity services are available at additional costs. Please see ASO Optional Program Offerings for an overview of programs dedicated to advanced imaging, disease and pain management, and sleep medicine. Utilization management processes comply with turnaround times required by state and federal regulations. We are accredited by the National Committee for Quality Assurance (NCQA) and follow NCQA standards.

6 Claims We process claims in our ASO Service Center in Burlington, Washington, between 6 a.m. and 7 p.m. (Pacific time). Team structure Our Claims team is led by a supervisor and includes an operations lead and several claims analysts. Claims analysts have tenures ranging from one year to more than 20. Analysts and supervisors have been specifically trained to serve our self-funded accounts. In addition to in-house workers, we also allow claims analysts to work from secured environments in their homes. This popular program increases productivity and enables teams to adjust work hours based on claims volume. Home-based workers productivity isn t affected when inclement weather forces our offices to close. Training and auditing Our six-week new-hire training program provides claims trainees with the system and processing knowledge they need to process medical, hospital and vision claims. Trainers review all trainee claims before releasing the trainee to the Claims unit. The unit reviews claims for accuracy for the first two weeks; after that, the new employee goes through the Quality Assurance and Reporting area s monthly audit process. Claims are audited regularly by our Quality Audit Department to ensure processing and financial accuracy. Quality improvement activities are ongoing.

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8 Underwriting and Billing Services include: Stop loss integrated quotation Calculation of COBRA rates Claims projections Cost/benefit analysis of plan design 50% of specific stop loss level reports Monthly aggregate report Audit of stop loss claim above specific level Custom claims invoice options (available by request) ERISA Form 5500 services Schedule A and C filings Billing file format options Online administrative fee billing is available through our secure website. We create invoices in both PDF and Excel. You may elect to receive only the PDF, or both the PDF and Excel versions. You can choose to receive a hard copy in the mail or have that hard copy suppressed. You and your producer may also elect to receive a.csv version of the raw data contained in the invoice. This version is provided only upon request. Billing level details You will select from one of five statement options with varying levels of detail. Once a billing has been generated, it cannot be reissued in a different format. However, you can request that future bills be displayed differently. Information Included Option 1 Short Statement Option 2 Subgroup Summary Option 3 Class Summary Option 4 Subgroup Detail Option 5 Class Detail Claims Activity and Fees Included Included Included Included Included Claims per Billing and Subgroup Included Included Included Included Claims per Employee Class Included Included Claims per Benefit Plan Included Included Included Included Detailed Claims per Member Included Included More detail on these reports is available; please ask your account/ sales representative.

9 Weekly claims invoicing standard process Weekly billing is standard. Oregon groups: Weekly invoices generate each Wednesday, are available for delivery on Thursday and include all claims paid from Wednesday through Tuesday. Washington groups: Weekly invoices generate each Saturday, are available for delivery on Monday and will include all claims paid from Saturday through Friday. Monthly claims invoicing (requires approval) Monthly invoicing requires a credit review and advance approval from our Underwriting Department. An advance deposit (calculated by your underwriter) is also required and must be received prior to your effective date. Monthly invoices generate on the first day of each month and are available for delivery on the second day of each month. Monthly invoices include all claims paid from the first day through the last day of the previous month. Example: Claims paid May 1 through May 31 generate on June 1.

10 Benefits, Simplified We ve made it easier to enroll in and administer your Regence benefits. We have three kinds of solutions that offer a continuum of resources that make doing business with us faster and easier. You can choose the one that best meets your needs. Digital Basic A limited offering for groups currently set up with ANSI 834 capability Digital Enhanced A basic solution for employer groups Digital Premium : Regence Marketplace A solution that does even more, with additional features to simplify administration and enrich your employees shopping experience What you re looking for Digital Basic (ANSI 834) Digital Enhanced Digital Premium: Regence Marketplace SM No added cost Reporting Limited Defined contribution Greater choice for employees Decision support during benefit election HSA integration with HealthEquity Simplified benefit offerings Online access for employees Online messaging tailored to employees Suite of educational tools Employees paying greater share of premium More than one medical plan offered Payroll solution integrated with technology Limited Limited

11 Reporting Services include: Our online Employer-Based Reporting (EBR) system provides reporting for claims and utilization data. EBR training is available for groups and producers. Employer Center is our online employer access point. It allows you to: Get instant access to eligibility information Access claims and eligibility summary data Additional reporting is available: Your population s participation in medical management programs Quarterly or annual operations (groups of 500+) Year in review renewal packet (groups of 2,000+); annual utilization and cost review (your complete experience report will include claims/ medical management) Ad hoc reporting may be available for an additional charge in alignment with the resources required to produce it.

12 We re here to help you choose the programs that are right for your employees needs. For more information, please contact your producer or Regence Sales. Regence BlueCross BlueShield of Oregon 100 SW Market Street Portland, OR REG /05-ORrep Regence BlueCross BlueShield of Oregon