MLHSelect. Using THE NEW MEDICAL PLAN

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1 Using THE NEW MEDICAL PLAN MLHSelect How is MLH Select different from PPO Core? What differentiates the two plans is cost savings and networks. With MLH Select, you pay little or nothing out-of-pocket for care you receive from Main Line Health and other top quality local doctors, specialists and facilities. Look inside to learn more about how to use this plan to get the best, most affordable care. This Newsletter serves as a Summary of Material Modifications to your Summary Plan Description, as required by the Employee Retirement Income Security Act of 1974 (ERISA), as amended. Please consider this Newsletter to be part of your Summary Plan Description, and keep it with your important benefits information. This Newsletter is intended to be an overview of key plan provisions of the Main Line Health Medical Plan. The plan is governed by formal plan documents, and, in the event of any conflict, the formal plan documents will govern. MLH reserves the right to amend or terminate any or all of the benefit plans, in whole or in part, at any time. Participation in these plans does not create any contractual or other right to receive any other benefits, nor does your participation constitute a condition or right of future employment. Main Line Health Human Resources 240 Radnor Chester Rd, Ste. 200 Radnor, PA 19087

2 Using MLHSelect The MLH Select plan, administered through the Independence Blue Cross Network, offers our employees and their families access to high quality health coverage, at an affordable cost, while encouraging healthier lifestyles. MLH Select is a Point of Service plan, which is a type of medical plan that combines the benefits of a PPO and HMO plan. What sets the MLH Select plan apart is the amount you can save while getting the highest quality care. Similar to the PPO Core, MLH Select lets you maintain freedom of choice by allowing you to select your own doctors and hospitals. And, similar to the HMO, you can minimize your out-of-pocket expenses when your care is provided or referred by your SelectPLUS Primary Care Physician (PCP). To receive the highest benefit, you ll need to pay attention to the way you seek care. 1 Choose a SelectPLUS Network Primary Care Provider (PCP): When you enroll in the MLH Select plan, you must choose a Primary Care Physician (PCP). Your PCP can be a family practitioner, general practitioner, internist, OB/GYN, or pediatrician. Each family member can have a different PCP. Your PCP will treat your basic health care needs. While enrolled in the MLH Select plan, you can change PCPs, for any reason, at any time during the year. If you change your PCP during the first part of a month, the change will become effective the first day of the following month. 2 Get PCP-referred specialist care: If you need the services of a specialist, diagnostic testing, hospitalization, or any other service your PCP does not routinely provide, your PCP can refer you to an appropriate provider or facility. When your PCP refers care, you can rest assured that you re getting the right care, at the right time, at the right place. You will pay less when you re referred to providers in the SelectPLUS Network. 3 Stay in the SelectPLUS Network to save the most: Remember, when you visit a SelectPLUS Network provider or facility, you receive a higher level of benefits and your out-of-pocket costs are lower. You always have flexibility to see any provider you wish, in any network you choose you ll just pay more and you may also need to obtain any required precertification or preapproval on your own, by calling ASK-BLUE. This is what is known as a self-referral. When your PCP coordinates your care, precertification and preapproval are managed by your PCP.

3 How Do the MLH Select and PPO Core Plans Networks Compare? The MLH Select plan provides access to best-in-class providers and facilities in Philadelphia and the five surrounding counties, as well as southern Delaware, southern New Jersey, and the Lehigh Valley. MLH Select offers two types of in-network coverage both with higher benefits than going outside the network but the SelectPLUS Network is preferred. By using our own providers and facilities, you will pay less out-of-pocket; and, you ll keep care within our health system, which helps control costs for you and the health system. MLH Select Medical Plan Network SelectPLUS Network Keystone Health Plan East Network Participating Physicians: All MLH and Jefferson-employed primary care physician practices (family practitioner, general practitioner, internist, or pediatrician) All specialists currently All pediatricians currently Select newly-added adult PCPs Participating Facilities: Bryn Mawr Hospital Bryn Mawr Rehabilitation Hospital Holy Redeemer Lankenau Medical Center Magee Rehabilitation Mirmont Treatment Center Nemours A.I. DuPont Hospital for Children Paoli Hospital Riddle Memorial Hospital Thomas Jefferson University Hospitals (including the Methodists Hospital Division) All other facilities and providers participating with Keystone Health Plan East Network *Not all JeffPLUS adult PCPs will participate in the SelectPLUS network. PPO Core Medical Plan Network IBC s Personal Choice PPO Participating Physicians: All current primary care practices (family practitioner, general practitioner, internist, or pediatrician). Note: Be sure to confirm your physician continues to be eligible to participate in the network. All specialists currently All pediatricians currently Home Facilities: Non-Home Facilities: Bryn Mawr Hospital Nemours A.I. Bryn Mawr DuPont Hospital Rehabilitation Hospital for Children Holy Redeemer Lankenau Medical Center Magee Rehabilitation Mirmont Treatment Center Paoli Hospital Riddle Memorial Hospital Thomas Jefferson University Hospitals (including the Methodists Hospital Division) All other facilities and providers participating with Personal Choice PPO Network You will pay the least out-of-pocket at a Home Facility. You will pay slightly more out-of-pocket at a Non-Home Facility. You will pay the most in the Personal Choice PPO Network.

4 Understand the Cost Difference When you enroll in the MLH Select plan, you must choose a Primary Care Physician (PCP) from either the SelectPLUS Network or Keystone Health Plan East (KHPE) Network. When you need care beyond a visit to your PCP, it s your choice whether you seek a referral from your PCP or get self-referred care. You can minimize your out-of-pocket costs by visiting your SelectPLUS Network PCP who will coordinate your health care needs. However, if you would prefer to self-refer to a physician or facility directly that is in-network or out-of-network, you have that choice. When you self-refer, you will be responsible for additional out-of-pocket expenses in comparison to referred care coordinated by your PCP. When you self-refer to an out-of-network provider, you are responsible for obtaining any required precertification or preapproval, by calling ASK-BLUE. Let s take a look at how certain services compare: Provider-Referred SelectPLUS Network Provider-Referred KHPE Network Self-Referred SelectPLUS or KHPE Network Self-Referred Out-of-Network Deductible $0 individual $0 family $0 individual $0 family $500 individual $1,500 family $1,000 individual $3,000 family Coinsurance N/A N/A 20% after deductible Out-of-Pocket Maximum $2,500 individual $4,500 family $2,500 individual $4,500 family $2,500 individual $4,500 family $5,000 individual $10,000 family Primary Care $0 copayment $20 copayment $35 copayment (no deductible) Specialist Care $10 copayment $30 copayment $40 copayment (no deductible) Inpatient Hospital $0 copayment $700 per admission $700 copayment per admission then 20% after deductible Inpatient Physician/Surgeon $0 copayment $0 copayment 20% after deductible Urgent Care Center $50 copayment $75 copayment $75 copayment (no deductible) Emergency Room (waived if admitted) $125 copayment $125 copayment $125 copayment $125 copayment Laboratory $0 copayment $0 copayment $0 copayment Complex Radiology (MRI/MRA/CAT/ PET Scan) $15 copayment $30 copayment 30% after deductible Outpatient Surgery (Facility) $0 copayment $300 copayment $300 copayment then 20% after deductible Outpatient Surgery (Professional) Physical Therapy (60 visits combined) $0 copayment $0 copayment 20% after deductible $15 copayment $30 copayment $30 copayment Occupational Therapy $15 copayment $30 copayment $30 copayment

5 How Do I Pay for MLH Select Coverage? Medical Plan Rates Your medical plan rates are based on your annual salary pay band, coverage level (e.g., employee only or family) and employment status (e.g., full-time or part-time time). Please note that your bi-weekly payroll deductions for the MLH Select plan will be less than the Core PPO plan. This is due to the greater cost efficiency from the improved care coordination the plan provides. Health and Productivity Rewards For 2015, by earning your Health and Productivity Rewards, you will receive discounts on your medical plan rates. Healthy Choices Annual Discount Available Are tobacco/nicotine free $520 For 2015, you will qualify for one of three rate structures based upon your efforts to actively work on improving your health status: Rate Structure Standard Non-Tobacco/ Nicotine Use How You Qualify You will qualify for this rate if you: Currently use tobacco/nicotine These rates are the highest rates that an employee will pay for medical coverage. You will qualify for this rate if you: Certify that you don t use tobacco/ nicotine during Open Enrollment Do not achieve Healthy and Productivity Program discounts Achieve 2014 Health and Productivity Rewards (you must certify you don t use tobacco/nicotine), based on annual salary pay band: Under $50,000 $50,000 to $89,999 $90,000 to $199,000 $200,000+ Note: medical contributions get higher as the pay band increases $200 $225 $250 $275 Healthy and Productivity Rewards You will qualify for this rate if you: Certify that you don t use tobacco/ nicotine during Open Enrollment Achieve Healthy and Productivity Program discounts These are the lowest rates that an employee will pay for medical coverage. ACCESS YOUR MEDICAL PLAN PERSONAL RATE SHEET During Open Enrollment check out your Medical Plan Personal Rate Sheet on MLH Self Service. Based upon your actual annual salary as of September 1st and employment status, the page outlines your specific 2015 medical plan options and their associated biweekly contribution rates. It also shows the specific rewards you can earn for actively working to improve your health in You see how the rate for each plan is impacted by whether or not you use tobacco/nicotine products and whether you achieve Health and Productivity Rewards. Login to MLH Self Service, click My MLH Medical Plan Rates, read the Welcome Statement and click View Report. NEW! MEDICAL PLAN PROVIDER WEBSITE Beginning mid-october, you can visit for a complete list of the providers and facilities available through the SelectPLUS and s in You ll be able to search for providers for each medical plan option. We encourage you to review your current provider status within both provider networks as you consider your medical plan election for 2015.

6 Frequently Asked Questions Do other health systems offer this type of plan? This type of plan is common among other health systems, and it s proven to be a superior way to deliver care. The MLH Select plan is based on an Accountable Care Organization (ACO), which is a group of doctors, hospitals and health care providers working together to provide you with coordinated high quality care. What if I need to see a specialist? How does the referral process work? Your PCP can provide a referral before you see a specialist. All referrals are done electronically. You may be able to get a referral simply by calling your PCP s office. Your PCP will decide if he or she needs to see you before providing a referral. If you have any questions about the status of a referral, call Member Services at ASK-BLUE. Or, access the information via IBC s benefits portal at ibxpress.com. How do I self-refer for care with a specialist? Self-referral is easy. Simply make an appointment with the specialist physician to receive care. You do not need to notify either your PCP or Independence Blue Cross. If your physician s office staff has questions about a self-referral, please have them contact Independence Blue Cross at ASK-BLUE. Remember that your out-of-pocket cost will be higher when you self-refer for care without getting a referral from your PCP. What if I need laboratory or routine/complex radiology? All laboratory services in either the SelectPLUS or KHPE Network are covered at 100% ($0 copayment). For routine and complex radiology, your PCP will assign you to a designated facility (sometimes called capitation). Your benefit will depend on the designated facility s network participation. For more information on your facility assignment, please refer to your member identification card. What if I need care for an emergency or life-threatening situation? If you need emergency care (i.e., treatment for onset of sudden, severe and persistent pain, or uncontrolled bleeding), go to the nearest Emergency Room (ER) or Urgent Care Center. Notify your PCP as soon as possible when care is provided by a physician other than your PCP. You would be responsible for an ER copayment, which would be waived if you are admitted to the hospital. What if I need care for a possible emergency or unexpected illness or injury? If you need urgent care (i.e., treatment for severe vomiting or severe eye pain with redness), call your PCP immediately. Your PCP will decide if he or she needs to see you, or refer you to an Urgent Care Center or the Emergency Room (ER) for further care. If your PCP is unavailable, you can always self-refer to an Urgent Care Center or the ER. You would be responsible for an Urgent Care Center copayment or an ER copayment, which would be waived if you are admitted to the hospital. My child attends college out of state. How will he/she be covered by the plan? Your child can enroll in a Guest Membership and receive comprehensive medical benefits, including routine and preventative services, while away from home. A Guest Member remains a member of his/her home plan, but is enrolled to receive benefits of the host plan while in their service area. To enroll, call Member Services at least 30 days prior to leaving the service area. What if I need emergency care while outside the service area on vacation? For emergency care, go to the nearest hospital to receive the appropriate care. If you are treated in the Emergency Room (ER), you will be responsible for the plan s ER copayment. If you are admitted to the hospital through the ER, you will be covered at the Home Hospital level of benefit. If you have any questions about your coverage, call Member Services at the number listed on the back of your identification card. Be sure to use this information in this newsletter to help make your decision between the MLH Select or PPO Core options easier and watch your mail for two more newsletters about the MLH Select plan!