ASO. BlueShield. Core Offerings SELF-FUNDED GROUPS, SIZED Shi Shi Beach

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1 BlueShield ASO Core Offerings SELF-FUNDED GROUPS, SIZED Regence BlueShield serves select counties in the state of Washington and is an Independent Licensee of the Blue Cross and Blue Shield Association Shi Shi Beach

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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 high-quality 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. 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 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. 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

4 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 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. 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. 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. High-risk maternity management Uses data mining and outreach to identify high-risk pregnancies, and support full-term deliveries and healthier babies. Core disease management Identifies and educates employees who would benefit from outreach and support from health coaches; available upon request. Radiology Quality Initiative (RQI) Promotes the use of advanced diagnostic imaging services based on widely accepted clinical judgment. 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.

5 Use our live chat feature Monday through Friday between 5 a.m. and 8 p.m. 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 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

6 Claims We process claims 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 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 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. Billing level details: You will select from one of three 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 Claims Activity and Fees Included Included Included Claims per Billing and Subgroup Included Included Claims per Employee Class Included Claims per Benefit Plan Included Included Detailed Claims per Member Weekly claims invoicing: Weekly invoices generate each Saturday, are available for delivery on Monday and will include all claims paid from Saturday through Friday.

9 BLUE PLAN NETWORK: 92% of all physicians and 96% of all hospitals nationwide participate. Network Advantage BlueCard Program advantage: BlueCard gives your employees seamless access to physicians and hospitals that participate in Blue Plan networks across the country. 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.

10 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: See your population s participation in medical management programs Ad hoc reporting may be available for an additional charge in alignment with the resources required to produce it.

11 Pharmacy Services include: Fully integrated Pharmacy Services Real-time pharmacy claims processing integrated with the medical plan; no separate eligibility feed required Pharmacy data incorporated into online reporting system A single member ID card, with one customer service number and a single website for both medical and pharmacy benefits Pharmacy Services has several programs that offer valuable information, cost savings and new ways to manage prescription dollars. Programs include: Blood Glucose Monitor Program Walgreens Specialty Drug Services Half-Tablet Program Information on other patient assistance programs Site of Care Program

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 BlueShield 1800 Ninth Avenue Seattle, WA REG /05-WArep Regence BlueShield