BE READY FOR ANYTHING

BE READY FOR ANYTHING Learn What You Need to Know About Your 2019 Highmark Blue Cross Blue Shield Delaware Coverage Options Benefit Period: January 1 to December 31, 2019 2019 HEALTH INSURANCE

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CONNECTING CARE AND COVERAGE You want to be ready for 2019 with the right health insurance coverage in place. At Highmark Blue Cross Blue Shield Delaware (Highmark Delaware), we re here to help. That s why we ve been working on new solutions that offer high quality, easy-to-access care. This guide contains the information you need to understand your health insurance options before you enroll in a 2019 plan. That helps avoid surprises when you see your doctor, receive care at a hospital, or fill a prescription. So you can feel confident that you are choosing the right plan to fit your real life and your budget. We understand that there is a lot to consider and that change can feel overwhelming at times. We hope you will use this guide to review details about our 2019 plans and contact us with any questions you have. Whatever 2019 has in store for you and your family, or whatever your health demands, we want you to feel ready for anything. That s why we re offering you a range of plan options with easier access to care by: Teaming up with doctors and hospitals in your community so you don t have to travel for care Providing access to thousands of participating physicians and hospitals across the country Bringing care to you on your terms with virtual medicine and direct access to a Blues on Call SM health coach who is a specially trained registered nurse IMPORTANT DETAILS TO CONSIDER BEFORE CHOOSING A PLAN: The open enrollment period lasts just 6 weeks Prescription drug coverage check to see if your drugs are covered Doctors and hospitals included in the Highmark Delaware network CHOOSE HIGHMARK DELAWARE FOR YOUR COVERAGE IN 2019 AND YOU LL HAVE: Peace of mind knowing your health plan is from a name trusted by generations. A network that includes top-rated providers right in your own community. Benefits including $0 copays for preventive care, such as checkups, immunizations, and much more. Free tools and resources to help you better manage your health and get the most from your health coverage. We re here for you if you have questions or need help along the way: Call 1-855-822-6925 (TTY/TDD 711) Visit DiscoverHighmark.com Talk to your local insurance agent We can also help you enroll through the Health Insurance Marketplace ( the Marketplace ). Or you can contact the Marketplace at: HealthCare.gov 1-800-318-2596 (TTY: 1-855-889-4325) 3

BE READY FOR ANYTHING BE ON TIME for Open Enrollment P. 5 BE WELL-INFORMED About Your Health Plan Options P. 6 BE PREPARED Before You Choose P. 10 BE KNOWLEDGEABLE with Base Plan Options & Monthly Rates Base Plans P. 12 Base Rates P. 25 YOUR HEALTH INSURANCE GLOSSARY P. 28 4

BE ON TIME for Open Enrollment OPEN ENROLLMENT PERIOD: NOVEMBER 1 TO DECEMBER 15, 2018 Mark your calendar for this year s Open Enrollment Period. Enroll by December 15, 2018 for coverage beginning January 1, 2019. 15 DEC Open Enrollment is the time when you can enroll in health insurance coverage. Enroll by December 15 or you won t have coverage on January 1 unless you qualify for a Special Enrollment Period. SPECIAL ENROLLMENT PERIOD Most people will enroll during Open Enrollment. But you can also change or enroll in coverage through a Special Enrollment Period if you have a qualifying life event. Some examples are: A NEW BABY GETTING MARRIED LOSING MINIMAL ESSENTIAL COVERAGE, SUCH AS COVERAGE THROUGH AN EMPLOYER MOVING TO A NEW, PERMANENT RESIDENCE WHERE YOU CAN T HAVE ACCESS TO THE SAME HEALTH PLANS If you think a Special Enrollment Period may apply to you, you can learn more by visiting HealthCare.gov. You may be asked to submit documents to show that you re eligible for a Special Enrollment Period. 5

BE WELL-INFORMED About Your Health Plan Options This year s plan options are designed with you in mind. Our 2019 plans focus on offering you high-quality care, right in your community. It s easier than ever to prepare Highmark Delaware has a variety of 2019 plan options. To bring you top-quality care, we work with your local hospitals and providers. This helps to lower the rising costs of health care, and keeps your copays and other out-of-pocket costs lower. Highmark Delaware has plans where you ll have access to a network of community providers for low or no cost services with one plan offering two free Primary Care Provider (PCP) office visits plus national access to thousands of providers. Along with providing access to care close to home, finding a provider isn t complicated. Doctors, facilities, and other providers are either in-network, or out-of-network it s that simple. HIGHMARK DELAWARE PLAN OPTIONS A Highmark Delaware Exclusive Provider Organization (EPO) plan makes it easy to get the care you need with network providers. Highmark Delaware offers plan options with: $0 copay for your first two PCP office visits* $0 copay for your first two mental health office visits* $0 copay for your first two substance abuse disorder office visits* Services at NO COST when you choose in-network health care providers for: > > $0 preventive screens and routine wellness exams > > $0 immunizations and vaccinations > > $0 contraceptives Lower-cost Silver plan options for members who qualify for financial help from the Marketplace Nationwide access to care with BlueCard No referrals for seeing specialists *The availability of $0 copay visits and the type of visits (PCP, mental health, and/or substance abuse) are dependent upon the plan selected. 6

BE WELL-INFORMED About Your Health Plan Options Major Events/Catastrophic Coverage If you are under 30 or meet financial hardship requirements, the low-cost Major Events Blue EPO plan was designed to provide you with basic coverage at an affordable cost. You get the protection you need in case of an emergency, serious illness, or accident, and your first three visits to your primary care doctor and certain preventive services are covered at no cost. Shared Cost Blue EPO Plans have copays with coverage for some services right from the start. For other services, you need to meet your deductible before we pay for your care. These plans are offered at three ACA metal levels Bronze, Silver, and Gold to give you a wide range of deductible levels from which to choose. See page 10 for a description of metal levels. Health Savings Embedded Blue EPO Plans are qualified high deductible health plans and may be coupled with a Health Savings Account (HSA) that offers tax and savings advantages. Other than preventive care, you will pay most costs until your deductible is met. After that, Highmark Delaware pays most of the plan allowance for covered in-network care for the remainder of the benefit period. Please note: Certain cost-sharing reductions (CSR) or plan variations of this plan that are offered through the Health Insurance Marketplace are not intended to be used with an HSA. If you have questions, please check with your financial advisor. HIGHMARK BLUE EDGE DENTAL Do you need adult dental insurance? Visit HighmarkBlueEdgeDental.com to find out more. 7

BE WELL-INFORMED Choose a Network Primary Care Provider GET MORE FROM YOUR HIGHMARK DELAWARE PLAN CHOOSE AN IN-NETWORK PRIMARY CARE PROVIDER (PCP) Even when you re healthy, having an in-network PCP feels great. A PCP is the doctor, medical professional, or practice that you visit for your primary and routine health care services, such as physicals and immunizations. The Journal of Health Affairs has found that people with PCPs enjoy lower overall health care costs and higher satisfaction with their care. A PCP CAN HELP YOU: Get the most value from your health care dollar Achieve health goals Monitor chronic health conditions Make sure you receive preventive care, like annual exams Coordinate the care you receive from other providers, such as specialists, labs, and imaging centers, to prevent gaps or overlaps in service Improve your patient experience NATIONWIDE ACCESS TO CARE WITH BLUECARD Wherever you go nationwide as a Highmark Delaware member, you have access to in-network providers. Just show your Highmark Delaware ID card at the thousands of participating physicians and hospitals across the country and you ll receive in-network access away from home. How to Find Out if Your Provider is In-Network: 3 Easy Ways Doctors, hospitals, and pharmacies in-networks often change. That s why it is very important to make sure your provider and/or facility are in-network before choosing an insurance plan or going for services. That way, you ll avoid surprises and unexpected costs. If you go to an out-of-network doctor, pharmacy, hospital, or other provider, you will have to pay 100% of the cost, except in the case of emergency care. Your services may not be covered by Highmark Delaware. Find a Doctor or Rx It s quick and easy to find an in-network provider or facility. Search online by plan type to make sure your doctor, specialist, or hospital is in-network. See maps, office hours, quality ratings, member reviews, and more. Visit HighmarkBCBSDE.com and click Find a Doctor or Rx to get started. It s easy to check which prescribed drugs are covered under your 2019 insurance plan. View Highmark Delaware s online Rx drug listing (or formulary) at HighmarkBCBSDE.com and click Find a Doctor or Rx. 8

BE WELL-INFORMED Review Your Prescription Drug List My Care Navigator Is your doctor in-network? My Care Navigator health advocates make it easy for you to find or change to an in-network doctor or facility, schedule an appointment, and transfer your medical records. Call 1-888-BLUE-428 or visit MyCareNavigator.com. Highmark Delaware Member Service Already a Highmark Delaware member? You probably know the value of great customer service from our Member Service area. By calling the number on the back of your Highmark Delaware ID card, our dedicated team can also help find you an in-network doctor or facility. IMPORTANT: 2019 Changes to the Prescription Drug List Prescription drugs are an important part of your coverage. The list of the drugs that your plan covers is called a formulary. As you choose a plan for 2019, be well-informed and avoid surprises. Be sure to check to see if your prescription drugs will be covered. Highmark plans use the Essential Formulary which groups drugs into four levels or tiers. Each tier may include generic, brand-name and/or specialty drugs. If your doctor prescribes a drug that is not included in the Essential Formulary, you may have to pay 100% out of pocket, unless an exception is granted. It s easy to check how your prescription drugs are covered visit HighmarkEssentialFormulary.com. Essential Formulary - 4 Tiers of Drugs Tier 1 Tier 2 Tier 3 Tier 4 Low-Cost Generics Medium-Cost Generics & Low-Cost Brands High-Cost Generics & Medium/High-Cost Brands High-Cost Generics & High-Cost Brands 9

BE PREPARED Before You Choose Ask yourself these important questions before choosing a plan! Is my doctor in-network? Is my hospital in-network? At what tier are my prescription drugs covered and how much will they cost? Can I get financial help through the Marketplace? Would I rather have lower monthly premiums or lower copays? Should I open a Health Savings Account (HSA) to manage out-of-pocket costs? Highmark Delaware offers you the support you need to answer these questions and more. We want you to have the plan that works best for your needs so you can be ready for anything. Metal Levels and Essential Health Benefits When you are shopping for one of Highmark Delaware s Affordable Care Act (ACA) health insurance plans, it s important to know about metal levels and essential health benefits. Metal Levels Highmark Delaware s Affordable Care Act health plans are grouped in metal categories: Bronze, Silver, and Gold. These levels are based on how you and your health plan split the costs of your health care. They are simply ways to categorize plan payment levels. They do not describe the quality of care you receive. Essential Health Benefits All Highmark Delaware plans include these essential health benefits: Ambulatory services, such as primary care and specialist visits Maternity and newborn care Emergency services Prescription drugs, including retail and mail order Pediatric services, including dental and vision care Mental health and substance abuse services Rehabilitative and habilitative services and devices Hospitalization Laboratory services Preventive and wellness services, and chronic disease management 10

BE PREPARED Before You Choose You May Qualify for Financial Help. It s Easy to Check. Many people who buy insurance through the Marketplace are pleased to learn they can get help paying for insurance. Before you enroll, you should find out if you can get this help to lower the cost of your monthly premium. To start, check the 2019 Household Income Chart below. You may qualify for one or both kinds of financial help: Advanced Premium Tax Credits (APTC), which may be applied in advance to lower what you pay each month for your premium on any Marketplace metal-level plan. Cost-Sharing Reductions (CSR)* will lower out-of-pocket costs that you may pay at the time of service for doctor visits, lab tests, drugs, and other covered services. You can only get these savings if you enroll in a Marketplace Silver metallevel plan. Eligibility for financial help can only be determined through the Marketplace at HealthCare.gov. 2019 Household Income Persons In Family / Household 1 2 3 4 5 6 7 8 Cost-Sharing Reductions (CSR) $12,140 - $30,350 $16,460 - $41,150 $20,780 - $51,950 $25,100 - $62,750 $29,420 - $73,550 $33,740 - $84,350 $38,060 - $95,150 $42,380 - $105,950 Advanced Premium Tax Credits (APTC) $12,140 - $48,560 $16,460 - $65,840 $20,780 - $83,120 $25,100 - $100,400 $29,420 - $117,680 $33,740 - $134,960 $38,060 - $152,240 $42,380 - $169,520 Medicaid Eligible Range (100-138% or less FPL) $12,140 - $16,753 $16,460 - $22,715 $20,780 - $28,676 $25,100 - $34,638 $29,420 - $40,600 $33,740 - $46,561 $38,060 - $52,523 $42,380 - $58,484 This chart is only applicable for coverage in 2019 and in the 48 contiguous states and the District of Columbia. For families/households with more than 8 persons, add $4,180 for each additional person. HHS Poverty Guidelines for 2018 (January 31, 2018). Retrieved from https://aspe.hhs.gov/poverty-guidelines 10-25-18 *American Indians and Alaska Natives who are members of federally recognized tribes are eligible for cost-sharing reductions at alternative dollar thresholds. You ll need these documents for yourself and every family member you want to enroll: Social Security numbers (or documents for legal immigrants) Birth dates Pay stubs, W-2 forms, or wage and tax statements to determine your income Policy numbers for any current health insurance Information about any health insurance you or your family could get from your job 11

BE KNOWLEDGEABLE With Base Plan Options by County 2019 PLAN BENEFIT GRIDS There's a lot to know and do when it comes to picking the right plan for you and your family. If you are looking for more medical plan details, visit Highmark-SBC2019.com to find each plan s Summary of Benefits and Coverage. If you do not have online access, you can get a paper copy of any Summary of Benefits free of charge by calling Highmark Delaware toll-free at 1-855-822-6925 (TTY/TDD 711). 12

Available in the following counties: Kent, New Castle, Sussex MAJOR EVENTS BLUE EPO 7900 CATASTROPHIC On-Exchange Base Plan ID: 76168DE0400001-01 Off-Exchange Base Plan ID: 76168DE0400001-00 The chart below shows in-network and out-of-network costs for all categories as a member. Benefit In-Network Out-of-Network Preventive Testing & Screenings Covered in full* Preventive care includes services such as childhood immunizations, annual wellness exams, mammography screenings, and flu shots. Office visit copay may apply for some screenings. Deductible and Out-of-Pocket Costs Deductible (Individual) $7,900 Deductible-Aggregate (Family) $15,800 Out of Pocket Maximum (Individual) $7,900 Out of Pocket Maximum- Aggregate (Family) $15,800 Office/Clinic/Telemedicine Visits Primary Care or Retail Clinic Office Visits 0% first 3 visits then Specialist Office & Virtual Visits Outpatient Mental Health Visits Telemedicine Service Hospital and Medical/Surgical Expenses (including maternity) Hospital Inpatient Hospital Outpatient Inpatient Hospital Maternity Medical Care and Surgical Expenses Emergency Services Urgent Care Center Visits Emergency Room Services Therapy, Rehabilitative and Habilitative Services Physical Therapy (Rehabilitative and Habilitative) Speech & Occupational Therapy (Rehabilitative and Habilitative) Chiropractor Services Diagnostic Services Basic Diagnostic Services (standard imaging, diagnostic medical, allergy testing) Advanced Imaging (MRI, CAT, PET scan, etc.) Lab/Pathology Prescription Drugs Formulary- Essential (Drug List) Tiers Tier 1 Tier 2 Tier 3 Tier 4 Retail (31 days supply) Mail (90 days supply) 13

Available in the following counties: Kent, New Castle, Sussex SHARED COST BLUE EPO BRONZE 7900 BRONZE On-Exchange Base Plan ID: 76168DE0410018-01 Off-Exchange Base Plan ID: 76168DE0410018-00 The chart below shows in-network and out-of-network costs for all categories as a member. Benefit In-Network Out-of-Network Preventive Testing & Screenings Covered in full* Preventive care includes services such as childhood immunizations, annual wellness exams, mammography screenings, and flu shots. Office visit copay may apply for some screenings. Deductible and Out-of-Pocket Costs Deductible (Individual) $7,900 Deductible-Aggregate (Family) $15,800 Out of Pocket Maximum (Individual) $7,900 Out of Pocket Maximum- Aggregate (Family) $15,800 Office/Clinic/Telemedicine Visits Primary Care or Retail Clinic Office Visits Specialist Office & Virtual Visits 0% first 2 visits then Outpatient Mental Health Visits then 0% after deductible Telemedicine Service Hospital and Medical/Surgical Expenses (including maternity) Hospital Inpatient Hospital Outpatient Inpatient Hospital Maternity Medical Care and Surgical Expenses Emergency Services Urgent Care Center Visits Emergency Room Services Therapy, Rehabilitative and Habilitative Services Physical Therapy (Rehabilitative and Habilitative) Speech & Occupational Therapy (Rehabilitative and Habilitative) Chiropractor Services Diagnostic Services Basic Diagnostic Services (standard imaging, diagnostic medical, allergy testing) Advanced Imaging (MRI, CAT, PET scan, etc.) Lab/Pathology Prescription Drugs Formulary- Essential (Drug List) Tiers Tier 1 Tier 2 Tier 3 Tier 4 Retail (31 days supply) Mail (90 days supply) 14

Available in the following counties: Kent, New Castle, Sussex SHARED COST BLUE EPO BRONZE 4000 BRONZE On Exchange Base Plan ID: 76168DE0410010-01 Off Exchange Base Plan ID: 76168DE0410010-00 The chart below shows in-network and out-of-network costs for all categories as a member. Benefit In-Network Out-of-Network Preventive Testing & Screenings Covered in full* Preventive care includes services such as childhood immunizations, annual wellness exams, mammography screenings, and flu shots. Office visit copay may apply for some screenings. Deductible and Out-of-Pocket Costs Deductible (Individual) $4,000 Deductible-Aggregate (Family) $8,000 Out of Pocket Maximum (Individual) $7,900 Out of Pocket Maximum- Aggregate (Family) $15,800 Office/Clinic/Telemedicine Visits Primary Care or Retail Clinic Office Visits $60 copay Specialist Office & Virtual Visits 3 Outpatient Mental Health Visits 0% first 2 visits then 3 Telemedicine Service $25 copay Hospital and Medical/Surgical Expenses (including maternity) Hospital Inpatient 3 Hospital Outpatient 3 Inpatient Hospital Maternity 3 Medical Care and Surgical Expenses 3 Emergency Services Urgent Care Center Visits 3 Emergency Room Services 3 3 Therapy, Rehabilitative and Habilitative Services Physical Therapy (Rehabilitative and Habilitative) 3 Speech & Occupational Therapy (Rehabilitative and Habilitative) 3 Chiropractor Services 25% after deductible Diagnostic Services Basic Diagnostic Services (standard imaging, diagnostic medical, allergy 3 testing) Advanced Imaging (MRI, CAT, PET scan, etc.) 3 Lab/Pathology 3 Prescription Drugs Formulary- Essential (Drug List) Tiers Tier 1 Tier 2 Tier 3 Tier 4 Retail (31 days supply) 3 3 3 3 Mail (90 days supply) 3 3 3 3 15

Available in the following counties: Kent, New Castle, Sussex HEALTH SAVINGS EMBEDDED BLUE EPO SILVER 4450 HSA SILVER On-Exchange Base Plan ID: 76168DE0420004-01 Off-Exchange Base Plan ID: 76168DE0420004-00 The chart below shows in-network and out-of-network costs for all categories as a member. Benefit In-Network Out-of-Network Preventive Testing & Screenings Covered in full* Preventive care includes services such as childhood immunizations, annual wellness exams, mammography screenings, and flu shots. Office visit copay may apply for some screenings. Deductible and Out-of-Pocket Costs Deductible (Individual) $4,450 Deductible-Embedded (Family) $8,900 Out of Pocket Maximum (Individual) $6,650 Out of Pocket Maximum- Embedded (Family) $13,300 Office/Clinic/Telemedicine Visits Primary Care or Retail Clinic Office Visits 1 Specialist Office & Virtual Visits 1 Outpatient Mental Health Visits 1 Telemedicine Service 1 Hospital and Medical/Surgical Expenses (including maternity) Hospital Inpatient 1 Hospital Outpatient 1 Inpatient Hospital Maternity 1 Medical Care and Surgical Expenses 1 Emergency Services Urgent Care Center Visits 1 Emergency Room Services 1 1 Therapy, Rehabilitative and Habilitative Services Physical Therapy (Rehabilitative and Habilitative) 1 Speech & Occupational Therapy (Rehabilitative and Habilitative) 1 Chiropractor Services 1 Diagnostic Services Basic Diagnostic Services (standard imaging, diagnostic medical, allergy 1 testing) Advanced Imaging (MRI, CAT, PET scan, etc.) 1 Lab/Pathology 1 Prescription Drugs Formulary- Essential (Drug List) Tiers Tier 1 Tier 2 Tier 3 Tier 4 Retail (31 days supply) 1 1 1 1 Mail (90 days supply) 1 1 1 1 16

Available in the following counties: Kent, New Castle, Sussex SHARED COST BLUE EPO SILVER 2400-2 FREE PCP VISITS SILVER On-Exchange Base Plan ID: 76168DE0410013-01 Off-Exchange Base Plan ID: 76168DE0410013-00 The chart below shows in-network and out-of-network costs for all categories as a member. Benefit In-Network Out-of-Network Preventive Testing & Screenings Covered in full* Preventive care includes services such as childhood immunizations, annual wellness exams, mammography screenings, and flu shots. Office visit copay may apply for some screenings. Deductible and Out-of-Pocket Costs Deductible (Individual) $2,400 Deductible-Aggregate (Family) $4,800 Out of Pocket Maximum (Individual) $7,800 Out of Pocket Maximum- Aggregate (Family) $15,600 Office/Clinic/Telemedicine Visits Primary Care or Retail Clinic Office Visits $0 first 2 visits then $40 copay Specialist Office & Virtual Visits $90 copay $0 first 2 visits Outpatient Mental Health Visits then $90 copay Telemedicine Service $20 copay Hospital and Medical/Surgical Expenses (including maternity) Hospital Inpatient 3 Hospital Outpatient 3 Inpatient Hospital Maternity 3 Medical Care and Surgical Expenses 3 Emergency Services Urgent Care Center Visits $90 copay Emergency Room Services (Copay Waived if Admitted) $750 copay after $750 copay after deductible deductible Therapy, Rehabilitative and Habilitative Services Physical Therapy (Rehabilitative and Habilitative) $90 copay Speech & Occupational Therapy (Rehabilitative and Habilitative) $90 copay Chiropractor Services 25% after deductible Diagnostic Services Basic Diagnostic Services (standard imaging, diagnostic medical, allergy testing) $90 copay Advanced Imaging (MRI, CAT, PET scan, etc.) 3 Lab/Pathology 3 Prescription Drugs Formulary- Essential (Drug List) Tiers Tier 1 Tier 2 Tier 3 Tier 4 Retail (31 days supply) 15% 25% 35% 50% Mail (90 days supply) 15% 25% 35% 50% 17

Available in the following counties: Kent, New Castle, Sussex SHARED COST BLUE EPO SILVER 0 SILVER On-Exchange Base Plan ID: 76168DE0410020-01 Off-Exchange Base Plan ID: 76168DE0410020-00 The chart below shows in-network and out-of-network costs for all categories as a member. Benefit In-Network Out-of-Network Preventive Testing & Screenings Covered in full* Preventive care includes services such as childhood immunizations, annual wellness exams, mammography screenings, and flu shots. Office visit copay may apply for some screenings. Deductible and Out-of-Pocket Costs Deductible (Individual) $0 Deductible-Aggregate (Family) $0 Out of Pocket Maximum (Individual) $7,800 Out of Pocket Maximum- Aggregate (Family) $15,600 Office/Clinic/Telemedicine Visits Primary Care or Retail Clinic Office Visits $40 copay Specialist Office & Virtual Visits $90 copay Outpatient Mental Health Visits $0 first 2 visits then $90 copay Telemedicine Service $20 copay Hospital and Medical/Surgical Expenses (including maternity) Hospital Inpatient $3,900 copay per day (Two Day Max) Hospital Outpatient 40% $3,900 copay per day Inpatient Hospital Maternity (Two Day Max) Medical Care and Surgical Expenses 40% Emergency Services Urgent Care Center Visits $90 copay Emergency Room Services (Copay Waived if Admitted) $1,400 copay $1,400 copay Therapy, Rehabilitative and Habilitative Services Physical Therapy (Rehabilitative and Habilitative) $90 copay Speech & Occupational Therapy (Rehabilitative and Habilitative) $90 copay Chiropractor Services 25% Diagnostic Services Basic Diagnostic Services (standard imaging, diagnostic medical, allergy testing) $90 copay Advanced Imaging (MRI, CAT, PET scan, etc.) 40% Lab/Pathology 40% Prescription Drugs Formulary- Essential (Drug List) Tiers Tier 1 Tier 2 Tier 3 Tier 4 Retail (31 days supply) 15% 25% 35% 50% Mail (90 days supply) 15% 25% 35% 50% 18

Available in the following counties: Kent, New Castle, Sussex SHARED COST BLUE EPO GOLD 1000-2 FREE PCP VISITS GOLD On Exchange Base Plan ID: 76168DE0410012-01 Off Exchange Base Plan ID: 76168DE0410012-00 The chart below shows in-network and out-of-network costs for all categories as a member. Benefit In-Network Out-of-Network Preventive Testing & Screenings Covered in full* Preventive care includes services such as childhood immunizations, annual wellness exams, mammography screenings, and flu shots. Office visit copay may apply for some screenings. Deductible and Out-of-Pocket Costs Deductible (Individual) $1,000 Deductible-Aggregate (Family) $2,000 Out of Pocket Maximum (Individual) $7,000 Out of Pocket Maximum- Aggregate (Family) $14,000 Office/Clinic/Telemedicine Visits Primary Care or Retail Clinic Office Visits $0 copay first 2 visits then $20 copay Specialist Office & Virtual Visits $45 copay $0 copay first 2 visits Outpatient Mental Health Visits then $45 copay Telemedicine Service $15 copay Hospital and Medical/Surgical Expenses (including maternity) Hospital Inpatient 2 Hospital Outpatient 2 Inpatient Hospital Maternity 2 Medical Care and Surgical Expenses 2 Emergency Services Urgent Care Center Visits $45 copay Emergency Room Services (Copay Waived if Admitted) $500 copay after $500 copay after deductible deductible Therapy, Rehabilitative and Habilitative Services Physical Therapy (Rehabilitative and Habilitative) $45 copay Speech & Occupational Therapy (Rehabilitative and Habilitative) $45 copay Chiropractor Services 2 Diagnostic Services Basic Diagnostic Services (standard imaging, diagnostic medical, allergy testing) $50 copay Advanced Imaging (MRI, CAT, PET scan, etc.) 2 Lab/Pathology 2 Prescription Drugs Formulary- Essential (Drug List) Tiers Tier 1 Tier 2 Tier 3 Tier 4 Retail (31 days supply) 15% 25% 35% 50% Mail (90 days supply) 15% 25% 35% 50% 19

Available in the following counties: Kent, New Castle, Sussex SHARED COST BLUE EPO PLATINUM 200-2 FREE PCP VISITS PLATINUM On-Exchange Base Plan ID: 76168DE0410021-01 Off-Exchange Base Plan ID: 76168DE0410021-00 The chart below shows in-network and out-of-network costs for all categories as a member. Benefit In-Network Out-of-Network Preventive Testing & Screenings Covered in full* Preventive care includes services such as childhood immunizations, annual wellness exams, mammography screenings, and flu shots. Office visit copay may apply for some screenings. Deductible and Out-of-Pocket Costs Deductible (Individual) $200 Deductible-Aggregate (Family) $400 Out of Pocket Maximum (Individual) $6,000 Out of Pocket Maximum- Aggregate (Family) $12,000 Office/Clinic/Telemedicine Visits Primary Care or Retail Clinic Office Visits $0 first 2 visits Then $5 copay Specialist Office & Virtual Visits $10 copay $0 first 2 visits then Outpatient Mental Health Visits $10 copay Telemedicine Service $5 copay Hospital and Medical/Surgical Expenses (including maternity) Hospital Inpatient 1 Hospital Outpatient 1 Inpatient Hospital Maternity 1 Medical Care and Surgical Expenses 1 Emergency Services Urgent Care Center Visits $10 copay Emergency Room Services (Copay Waived if Admitted) $300 copay $300 copay Therapy, Rehabilitative and Habilitative Services Physical Therapy (Rehabilitative and Habilitative) $10 copay Speech & Occupational Therapy (Rehabilitative and Habilitative) $10 copay Chiropractor Services 1 Diagnostic Services Basic Diagnostic Services (standard imaging, diagnostic medical, allergy testing) $20 copay Advanced Imaging (MRI, CAT, PET scan, etc.) 1 Lab/Pathology 1 Prescription Drugs Formulary- Essential (Drug List) Tiers Tier 1 Tier 2 Tier 3 Tier 4 Retail (31 days supply) 15% 25% 35% 50% Mail (90 days supply) 15% 25% 35% 50% 20

The following Highmark plan options are not available on the Marketplace and may be purchased directly through Highmark without financial help in Delaware: Shared Cost Blue EPO Silver 3500-2 Free PCP Visits Health Savings Embedded Blue EPO Silver 2750 HSA 21

Available in the following Counties: Kent, New Castle, Sussex SHARED COST BLUE EPO SILVER 3500 2 FREE PCP VISITS SILVER Off Exchange Base Plan ID: 76168DE0410019 00 The chart below shows in network and out of network costs for all categories as a member. Benefit In Network Out of Network Preventive Testing & Screenings Covered in full* Preventive care includes services such as childhood immunizations, annual wellness exams, mammography screenings, and flu shots. Office visit copay may apply for some screenings. Deductible and Out of Pocket Costs Deductible (Individual) $3,500 Deductible Aggregate (Family) $7,000 Out of Pocket Maximum (Individual) $7,700 Out of Pocket Maximum (Family) $15,400 Office/Clinic/Telemedicine Visits Primary Care or Retail Clinic Office Visits $0 first 2 visits then $50 copay Specialist Office & Virtual Visits $100 copay $0 first 2 visits Outpatient Mental Health Visits then $100 copay Telemedicine Service $20 copay Hospital and Medical/Surgical Expenses (including maternity) Hospital Inpatient 3 Hospital Outpatient 3 Inpatient Hospital Maternity 3 Medical Care and Surgical Expenses 3 Emergency Services Urgent Care Center Visits $100 copay Emergency Room Services (Copay Waived if Admitted $700 copay after $700 copay after deductible deductible Therapy, Rehabilitative and Habilitative Services Physical & Occupational Therapy (Rehabilitative and Habilitative) $100 copay Speech Therapy (Rehabilitative and Habilitative) $100 copay Chiropractor Services 25% after deductible Diagnostic Services Basic Diagnostic Services (standard imaging, diagnostic medical, allergy testing) $110 copay Advanced Imaging (MRI, CAT, PET scan, etc.) 3 Lab/Pathology 3 Prescription Drugs Formulary Essential (Drug List) Tiers Tier 1 Tier 2 Tier 3 Tier 4 Retail (31 days supply) 15% 25% 35% 50% Mail (90 days supply) 15% 25% 35% 50% 22

Available in the following counties: Kent, New Castle, Sussex HEALTH SAVINGS EMBEDDED BLUE EPO SILVER 2750 HSA SILVER Off Exchange Base Plan ID: 76168DE0420005 00 The chart below shows in network and out of network costs for all categories as a member. Benefit In Network Out of Network Preventive Testing & Screenings Covered in full* Preventive care includes services such as childhood immunizations, annual wellness exams, mammography screenings, and flu shots. Office visit copay may apply for some screenings. Deductible and Out of Pocket Costs Deductible (Individual) $2,750 Deductible Embedded (Family) $5,500 Out of Pocket Maximum (Individual) $6,650 Out of Pocket Maximum (Family) $13,300 Office/Clinic/Telemedicine Visits Primary Care or Retail Clinic Office Visits 2 Specialist Office & Virtual Visits 2 Outpatient Mental Health Visits 2 Telemedicine Service 2 Hospital and Medical/Surgical Expenses (including maternity) Hospital Inpatient 2 Hospital Outpatient 2 Inpatient Hospital Maternity 2 Medical Care and Surgical Expenses 2 Emergency Services Urgent Care Center Visits 2 Emergency Room Services 2 2 Therapy, Rehabilitative and Habilitative Services Physical & Occupational Therapy (Rehabilitative and Habilitative) 2 Speech Therapy (Rehabilitative and Habilitative) 2 Chiropractor Services 2 Diagnostic Services Basic Diagnostic Services (standard imaging, diagnostic medical, allergy testing) 2 Advanced Imaging (MRI, CAT, PET scan, etc.) 2 Lab/Pathology Prescription Drugs Formulary Essential (Drug List) Tiers Tier 1 Tier 2 Tier 3 Tier 4 Retail (31 days supply) 20% after deductible 20% after deductible 20% after deductible 20% after deductible Mail (90 days supply) 20% after deductible 20% after deductible 20% after deductible 20% after deductible 23

BE KNOWLEDGEABLE with Monthly Premiums Understand How Your Monthly Premium Is Calculated At Highmark Delaware, we want you to trust in the value of your health care coverage. To help you understand how we calculate the price you pay, we have included a guide to rates on pages 25-27. The premium rate listed is the most a person* will pay for their premium each month. Find Your Premium By: The Highmark Delaware plan you wish to purchase Your age and the age of each dependent on your plan Your tobacco use and the tobacco use of each dependent on your plan If You Have More Than Three Children Under Age 21: Only include rates for you, your spouse/domestic partner, children between ages 21 and 26, and the three oldest children under age 21. Your policy will also cover your remaining children. Please include them as eligible dependents when you enroll. *If you are also enrolling family members, you will need to get the base rate for each member of your family. Add these base rates together to get the rate that covers the family members on your plan. 24

BE KNOWLEDGEABLE with Monthly Premiums PREMIUM RATE PLANS (Use the Plan ID to find your plan on the Marketplace.) Catastrophic Bronze Bronze Silver Major Events Blue EPO 7900 Shared Cost Blue EPO Bronze 7900 Shared Cost Blue EPO Bronze 4000 Health Savings Embedded Blue EPO Silver 4450 HSA Plan ID 76168DE0400001 76168DE0410018 76168DE0410010 76168DE0420004 Age No Tobacco Tobacco No Tobacco Tobacco No Tobacco Tobacco No Tobacco Tobacco 0-14 $ 233.25 $ 233.25 $ 268.91 $ 268.91 $ 286.45 $ 286.45 $ 395.02 $ 395.02 15 $ 253.98 $ 253.98 $ 292.82 $ 292.82 $ 311.91 $ 311.91 $ 430.13 $ 430.13 16 $ 261.91 $ 261.91 $ 301.96 $ 301.96 $ 321.64 $ 321.64 $ 443.55 $ 443.55 17 $ 269.84 $ 269.84 $ 311.10 $ 311.10 $ 331.38 $ 331.38 $ 456.98 $ 456.98 18 $ 278.37 $ 278.37 $ 320.94 $ 320.94 $ 341.86 $ 341.86 $ 471.44 $ 471.44 19 $ 286.91 $ 286.91 $ 330.78 $ 330.78 $ 352.35 $ 352.35 $ 485.89 $ 485.89 20 $ 295.75 $ 295.75 $ 340.97 $ 340.97 $ 363.21 $ 363.21 $ 500.87 $ 500.87 21 $ 304.90 $ 312.52 $ 351.52 $ 360.31 $ 374.44 $ 383.80 $ 516.36 $ 529.27 22 $ 304.90 $ 312.52 $ 351.52 $ 360.31 $ 374.44 $ 383.80 $ 516.36 $ 529.27 23 $ 304.90 $ 312.52 $ 351.52 $ 360.31 $ 374.44 $ 383.80 $ 516.36 $ 529.27 24 $ 304.90 $ 312.52 $ 351.52 $ 360.31 $ 374.44 $ 383.80 $ 516.36 $ 529.27 25 $ 306.12 $ 313.77 $ 352.93 $ 361.75 $ 375.94 $ 385.34 $ 518.43 $ 531.39 26 $ 312.22 $ 320.03 $ 359.96 $ 368.96 $ 383.43 $ 393.02 $ 528.75 $ 541.97 27 $ 319.54 $ 327.53 $ 368.39 $ 377.60 $ 392.41 $ 402.22 $ 541.15 $ 554.68 28 $ 331.43 $ 339.72 $ 382.10 $ 391.65 $ 407.02 $ 417.20 $ 561.28 $ 575.31 29 $ 341.18 $ 349.71 $ 393.35 $ 403.18 $ 419.00 $ 429.48 $ 577.81 $ 592.26 30 $ 346.06 $ 354.71 $ 398.98 $ 408.95 $ 424.99 $ 435.61 $ 586.07 $ 600.72 31 $ 353.38 $ 362.21 $ 407.41 $ 417.60 $ 433.98 $ 444.83 $ 598.46 $ 613.42 32 $ 360.70 $ 369.72 $ 415.85 $ 426.25 $ 442.96 $ 454.03 $ 610.85 $ 626.12 33 $ 365.27 $ 374.40 $ 421.12 $ 431.65 $ 448.58 $ 459.79 $ 618.60 $ 634.07 34 $ 370.15 $ 379.40 $ 426.75 $ 437.42 $ 454.57 $ 465.93 $ 626.86 $ 642.53 35 $ 372.59 $ 381.90 $ 429.56 $ 440.30 $ 457.57 $ 469.01 $ 630.99 $ 646.76 36 $ 375.03 $ 384.41 $ 432.37 $ 443.18 $ 460.56 $ 472.07 $ 635.12 $ 651.00 37 $ 377.47 $ 386.91 $ 435.18 $ 446.06 $ 463.56 $ 475.15 $ 639.25 $ 655.23 38 $ 379.91 $ 389.41 $ 437.99 $ 448.94 $ 466.55 $ 478.21 $ 643.38 $ 659.46 39 $ 384.78 $ 394.40 $ 443.62 $ 454.71 $ 472.54 $ 484.35 $ 651.65 $ 667.94 40 $ 389.66 $ 428.63 $ 449.24 $ 494.16 $ 478.53 $ 526.38 $ 659.91 $ 725.90 41 $ 396.98 $ 438.66 $ 457.68 $ 505.74 $ 487.52 $ 538.71 $ 672.30 $ 742.89 42 $ 403.99 $ 449.24 $ 465.76 $ 517.93 $ 496.13 $ 551.70 $ 684.18 $ 760.81 43 $ 413.75 $ 463.81 $ 477.01 $ 534.73 $ 508.12 $ 569.60 $ 700.70 $ 785.48 44 $ 425.95 $ 482.18 $ 491.07 $ 555.89 $ 523.09 $ 592.14 $ 721.35 $ 816.57 45 $ 440.28 $ 504.12 $ 507.59 $ 581.19 $ 540.69 $ 619.09 $ 745.62 $ 853.73 46 $ 457.35 $ 530.53 $ 527.28 $ 611.64 $ 561.66 $ 651.53 $ 774.54 $ 898.47 47 $ 476.56 $ 560.91 $ 549.43 $ 646.68 $ 585.25 $ 688.84 $ 807.07 $ 949.92 48 $ 498.51 $ 596.22 $ 574.74 $ 687.39 $ 612.21 $ 732.20 $ 844.25 $ 1,009.72 49 $ 520.16 $ 633.03 $ 599.69 $ 729.82 $ 638.79 $ 777.41 $ 880.91 $ 1,072.07 50 $ 544.55 $ 667.07 $ 627.81 $ 769.07 $ 668.75 $ 819.22 $ 922.22 $ 1,129.72 51 $ 568.64 $ 696.58 $ 655.58 $ 803.09 $ 698.33 $ 855.45 $ 963.01 $ 1,179.69 52 $ 595.16 $ 729.07 $ 686.17 $ 840.56 $ 730.91 $ 895.36 $ 1,007.93 $ 1,234.71 53 $ 622.00 $ 761.95 $ 717.10 $ 878.45 $ 763.86 $ 935.73 $ 1,053.37 $ 1,290.38 54 $ 650.96 $ 797.43 $ 750.50 $ 919.36 $ 799.43 $ 979.30 $ 1,102.43 $ 1,350.48 55 $ 679.93 $ 832.91 $ 783.89 $ 960.27 $ 835.00 $ 1,022.88 $ 1,151.48 $ 1,410.56 56 $ 711.33 $ 871.38 $ 820.10 $ 1,004.62 $ 873.57 $ 1,070.12 $ 1,204.67 $ 1,475.72 57 $ 743.04 $ 910.22 $ 856.65 $ 1,049.40 $ 912.51 $ 1,117.82 $ 1,258.37 $ 1,541.50 58 $ 776.89 $ 951.69 $ 895.67 $ 1,097.20 $ 954.07 $ 1,168.74 $ 1,315.69 $ 1,611.72 59 $ 793.65 $ 972.22 $ 915.01 $ 1,120.89 $ 974.67 $ 1,193.97 $ 1,344.09 $ 1,646.51 60 $ 827.50 $ 1,013.69 $ 954.03 $ 1,168.69 $ 1,016.23 $ 1,244.88 $ 1,401.40 $ 1,716.72 61 $ 856.77 $ 1,049.54 $ 987.77 $ 1,210.02 $ 1,052.18 $ 1,288.92 $ 1,450.97 $ 1,777.44 62 $ 875.98 $ 1,073.08 $ 1,009.92 $ 1,237.15 $ 1,075.77 $ 1,317.82 $ 1,483.50 $ 1,817.29 63 $ 900.06 $ 1,102.57 $ 1,037.69 $ 1,271.17 $ 1,105.35 $ 1,354.05 $ 1,524.29 $ 1,867.26 64 $ 914.70 $ 1,120.51 $ 1,054.56 $ 1,291.84 $ 1,123.32 $ 1,376.07 $ 1,549.08 $ 1,897.62 65+ $ 914.70 $ 1,120.51 $ 1,054.56 $ 1,291.84 $ 1,123.32 $ 1,376.07 $ 1,549.08 $ 1,897.62 25

BE KNOWLEDGEABLE with Monthly Premiums PREMIUM RATE PLANS (Use the Plan ID to find your plan on the Marketplace.) Silver Shared Cost Blue EPO Silver 2400-2 Free PCP Visits Silver Gold Platinum Shared Cost Blue EPO Silver 0 Shared Cost Blue EPO Gold 1000-2 Free PCP Visits Shared Cost Blue EPO Platinum 200-2 Free PCP Visits Plan ID 76168DE0410013 76168DE0410020 76168DE0410012 76168DE0410021 Age No Tobacco Tobacco No Tobacco Tobacco No Tobacco Tobacco No Tobacco Tobacco 0-14 $ 409.80 $ 409.80 $ 427.86 $ 427.86 $ 402.29 $ 402.29 $ 467.02 $ 467.02 15 $ 446.22 $ 446.22 $ 465.89 $ 465.89 $ 438.05 $ 438.05 $ 508.53 $ 508.53 16 $ 460.15 $ 460.15 $ 480.43 $ 480.43 $ 451.72 $ 451.72 $ 524.40 $ 524.40 17 $ 474.08 $ 474.08 $ 494.97 $ 494.97 $ 465.39 $ 465.39 $ 540.27 $ 540.27 18 $ 489.08 $ 489.08 $ 510.63 $ 510.63 $ 480.12 $ 480.12 $ 557.37 $ 557.37 19 $ 504.07 $ 504.07 $ 526.29 $ 526.29 $ 494.84 $ 494.84 $ 574.46 $ 574.46 20 $ 519.61 $ 519.61 $ 542.51 $ 542.51 $ 510.09 $ 510.09 $ 592.17 $ 592.17 21 $ 535.68 $ 549.07 $ 559.29 $ 573.27 $ 525.87 $ 539.02 $ 610.48 $ 625.74 22 $ 535.68 $ 549.07 $ 559.29 $ 573.27 $ 525.87 $ 539.02 $ 610.48 $ 625.74 23 $ 535.68 $ 549.07 $ 559.29 $ 573.27 $ 525.87 $ 539.02 $ 610.48 $ 625.74 24 $ 535.68 $ 549.07 $ 559.29 $ 573.27 $ 525.87 $ 539.02 $ 610.48 $ 625.74 25 $ 537.82 $ 551.27 $ 561.53 $ 575.57 $ 527.97 $ 541.17 $ 612.92 $ 628.24 26 $ 548.54 $ 562.25 $ 572.71 $ 587.03 $ 538.49 $ 551.95 $ 625.13 $ 640.76 27 $ 561.39 $ 575.42 $ 586.14 $ 600.79 $ 551.11 $ 564.89 $ 639.78 $ 655.77 28 $ 582.28 $ 596.84 $ 607.95 $ 623.15 $ 571.62 $ 585.91 $ 663.59 $ 680.18 29 $ 599.43 $ 614.42 $ 625.85 $ 641.50 $ 588.45 $ 603.16 $ 683.13 $ 700.21 30 $ 608.00 $ 623.20 $ 634.79 $ 650.66 $ 596.86 $ 611.78 $ 692.89 $ 710.21 31 $ 620.85 $ 636.37 $ 648.22 $ 664.43 $ 609.48 $ 624.72 $ 707.55 $ 725.24 32 $ 633.71 $ 649.55 $ 661.64 $ 678.18 $ 622.10 $ 637.65 $ 722.20 $ 740.26 33 $ 641.74 $ 657.78 $ 670.03 $ 686.78 $ 629.99 $ 645.74 $ 731.36 $ 749.64 34 $ 650.32 $ 666.58 $ 678.98 $ 695.95 $ 638.41 $ 654.37 $ 741.12 $ 759.65 35 $ 654.60 $ 670.97 $ 683.45 $ 700.54 $ 642.61 $ 658.68 $ 746.01 $ 764.66 36 $ 658.89 $ 675.36 $ 687.93 $ 705.13 $ 646.82 $ 662.99 $ 750.89 $ 769.66 37 $ 663.17 $ 679.75 $ 692.40 $ 709.71 $ 651.03 $ 667.31 $ 755.77 $ 774.66 38 $ 667.46 $ 684.15 $ 696.88 $ 714.30 $ 655.23 $ 671.61 $ 760.66 $ 779.68 39 $ 676.03 $ 692.93 $ 705.82 $ 723.47 $ 663.65 $ 680.24 $ 770.43 $ 789.69 40 $ 684.60 $ 753.06 $ 714.77 $ 786.25 $ 672.06 $ 739.27 $ 780.19 $ 858.21 41 $ 697.46 $ 770.69 $ 728.20 $ 804.66 $ 684.68 $ 756.57 $ 794.84 $ 878.30 42 $ 709.78 $ 789.28 $ 741.06 $ 824.06 $ 696.78 $ 774.82 $ 808.89 $ 899.49 43 $ 726.92 $ 814.88 $ 758.96 $ 850.79 $ 713.61 $ 799.96 $ 828.42 $ 928.66 44 $ 748.34 $ 847.12 $ 781.33 $ 884.47 $ 734.64 $ 831.61 $ 852.84 $ 965.41 45 $ 773.52 $ 885.68 $ 807.61 $ 924.71 $ 759.36 $ 869.47 $ 881.53 $ 1,009.35 46 $ 803.52 $ 932.08 $ 838.94 $ 973.17 $ 788.81 $ 915.02 $ 915.72 $ 1,062.24 47 $ 837.27 $ 985.47 $ 874.17 $ 1,028.90 $ 821.93 $ 967.41 $ 954.18 $ 1,123.07 48 $ 875.84 $ 1,047.50 $ 914.44 $ 1,093.67 $ 859.80 $ 1,028.32 $ 998.13 $ 1,193.76 49 $ 913.87 $ 1,112.18 $ 954.15 $ 1,161.20 $ 897.13 $ 1,091.81 $ 1,041.48 $ 1,267.48 50 $ 956.72 $ 1,171.98 $ 998.89 $ 1,223.64 $ 939.20 $ 1,150.52 $ 1,090.32 $ 1,335.64 51 $ 999.04 $ 1,223.82 $ 1,043.08 $ 1,277.77 $ 980.75 $ 1,201.42 $ 1,138.55 $ 1,394.72 52 $ 1,045.65 $ 1,280.92 $ 1,091.73 $ 1,337.37 $ 1,026.50 $ 1,257.46 $ 1,191.66 $ 1,459.78 53 $ 1,092.79 $ 1,338.67 $ 1,140.95 $ 1,397.66 $ 1,072.77 $ 1,314.14 $ 1,245.38 $ 1,525.59 54 $ 1,143.68 $ 1,401.01 $ 1,194.08 $ 1,462.75 $ 1,122.73 $ 1,375.34 $ 1,303.37 $ 1,596.63 55 $ 1,194.57 $ 1,463.35 $ 1,247.22 $ 1,527.84 $ 1,172.69 $ 1,436.55 $ 1,361.37 $ 1,667.68 56 $ 1,249.74 $ 1,530.93 $ 1,304.82 $ 1,598.40 $ 1,226.85 $ 1,502.89 $ 1,424.25 $ 1,744.71 57 $ 1,305.45 $ 1,599.18 $ 1,362.99 $ 1,669.66 $ 1,281.55 $ 1,569.90 $ 1,487.74 $ 1,822.48 58 $ 1,364.91 $ 1,672.01 $ 1,425.07 $ 1,745.71 $ 1,339.92 $ 1,641.40 $ 1,555.50 $ 1,905.49 59 $ 1,394.38 $ 1,708.12 $ 1,455.83 $ 1,783.39 $ 1,368.84 $ 1,676.83 $ 1,589.08 $ 1,946.62 60 $ 1,453.84 $ 1,780.95 $ 1,517.91 $ 1,859.44 $ 1,427.21 $ 1,748.33 $ 1,656.84 $ 2,029.63 61 $ 1,505.26 $ 1,843.94 $ 1,571.60 $ 1,925.21 $ 1,477.69 $ 1,810.17 $ 1,715.45 $ 2,101.43 62 $ 1,539.01 $ 1,885.29 $ 1,606.84 $ 1,968.38 $ 1,510.82 $ 1,850.75 $ 1,753.91 $ 2,148.54 63 $ 1,581.33 $ 1,937.13 $ 1,651.02 $ 2,022.50 $ 1,552.37 $ 1,901.65 $ 1,802.14 $ 2,207.62 64 $ 1,607.04 $ 1,968.62 $ 1,677.87 $ 2,055.39 $ 1,577.61 $ 1,932.57 $ 1,831.44 $ 2,243.51 65+ $ 1,607.04 $ 1,968.62 $ 1,677.87 $ 2,055.39 $ 1,577.61 $ 1,932.57 $ 1,831.44 $ 2,243.51 26

PREMIUM RATES FOR YOUR COUNTY These plans are only available directly through Highmark in Delaware. They are not available on the Marketplace. Silver Shared Cost Blue EPO Silver 3500-2 Free PCP Visits Silver Health Savings Embedded Blue EPO silver 2750 HSA Plan ID 76168DE0410019 76168DE0420005 Age No Tobacco Tobacco No Tobacco Tobacco 0-14 $ 335.80 $ 335.80 $ 341.28 $ 341.28 15 $ 365.65 $ 365.65 $ 371.62 $ 371.62 16 $ 377.07 $ 377.07 $ 383.22 $ 383.22 17 $ 388.48 $ 388.48 $ 394.82 $ 394.82 18 $ 400.77 $ 400.77 $ 407.31 $ 407.31 19 $ 413.06 $ 413.06 $ 419.80 $ 419.80 20 $ 425.79 $ 425.79 $ 432.74 $ 432.74 21 $ 438.96 $ 449.93 $ 446.12 $ 457.27 22 $ 438.96 $ 449.93 $ 446.12 $ 457.27 23 $ 438.96 $ 449.93 $ 446.12 $ 457.27 24 $ 438.96 $ 449.93 $ 446.12 $ 457.27 25 $ 440.72 $ 451.74 $ 447.90 $ 459.10 26 $ 449.50 $ 460.74 $ 456.83 $ 468.25 27 $ 460.03 $ 471.53 $ 467.53 $ 479.22 28 $ 477.15 $ 489.08 $ 484.93 $ 497.05 29 $ 491.20 $ 503.48 $ 499.21 $ 511.69 30 $ 498.22 $ 510.68 $ 506.35 $ 519.01 31 $ 508.75 $ 521.47 $ 517.05 $ 529.98 32 $ 519.29 $ 532.27 $ 527.76 $ 540.95 33 $ 525.87 $ 539.02 $ 534.45 $ 547.81 34 $ 532.90 $ 546.22 $ 541.59 $ 555.13 35 $ 536.41 $ 549.82 $ 545.16 $ 558.79 36 $ 539.92 $ 553.42 $ 548.73 $ 562.45 37 $ 543.43 $ 557.02 $ 552.30 $ 566.11 38 $ 546.94 $ 560.61 $ 555.87 $ 569.77 39 $ 553.97 $ 567.82 $ 563.00 $ 577.08 40 $ 560.99 $ 617.09 $ 570.14 $ 627.15 41 $ 571.53 $ 631.54 $ 580.85 $ 641.84 42 $ 581.62 $ 646.76 $ 591.11 $ 657.31 43 $ 595.67 $ 667.75 $ 605.38 $ 678.63 44 $ 613.23 $ 694.18 $ 623.23 $ 705.50 45 $ 633.86 $ 725.77 $ 644.20 $ 737.61 46 $ 658.44 $ 763.79 $ 669.18 $ 776.25 47 $ 686.09 $ 807.53 $ 697.29 $ 820.71 48 $ 717.70 $ 858.37 $ 729.41 $ 872.37 49 $ 748.87 $ 911.37 $ 761.08 $ 926.23 50 $ 783.98 $ 960.38 $ 796.77 $ 976.04 51 $ 818.66 $ 1,002.86 $ 832.01 $ 1,019.21 52 $ 856.85 $ 1,049.64 $ 870.83 $ 1,066.77 53 $ 895.48 $ 1,096.96 $ 910.08 $ 1,114.85 54 $ 937.18 $ 1,148.05 $ 952.47 $ 1,166.78 55 $ 978.88 $ 1,199.13 $ 994.85 $ 1,218.69 56 $ 1,024.09 $ 1,254.51 $ 1,040.80 $ 1,274.98 57 $ 1,069.75 $ 1,310.44 $ 1,087.19 $ 1,331.81 58 $ 1,118.47 $ 1,370.13 $ 1,136.71 $ 1,392.47 59 $ 1,142.61 $ 1,399.70 $ 1,161.25 $ 1,422.53 60 $ 1,191.34 $ 1,459.39 $ 1,210.77 $ 1,483.19 61 $ 1,233.48 $ 1,511.01 $ 1,253.60 $ 1,535.66 62 $ 1,261.13 $ 1,544.88 $ 1,281.70 $ 1,570.08 63 $ 1,295.81 $ 1,587.37 $ 1,316.95 $ 1,613.26 64 $ 1,316.88 $ 1,613.18 $ 1,338.36 $ 1,639.49 65+ $ 1,316.88 $ 1,613.18 $ 1,338.36 $ 1,639.49 27

YOUR HEALTH INSURANCE GLOSSARY Here are some commonly used health insurance plan terms to help you. BlueCard A national program that enables Blue Plan members to obtain healthcare services while traveling or living in another Blue Plan s service area. The program links participating healthcare providers with independent Blue Plans across the country and in more than 200 countries and territories worldwide. The level of BlueCard access is dependent upon your plan s details. Refer to your plan documents for additional information. Coinsurance The costs of your care are shared between you and the insurance company. Coinsurance is the part of your medical bill that you pay after reaching your deductible. So if your medical bill for covered, in-network services is $100 and your coinsurance is 20%, you pay $20. The insurance company pays $80. Copay or Copayment A fixed dollar amount (like $25) that you pay each time you receive certain covered health care services. Deductible The amount of money you must pay for health care services before your health plan starts to pay. An embedded or aggregate deductible has two parts: an individual deductible and a family deductible. Each family member can meet but not exceed his/her own deductible before the family deductible is met. (Individual deductibles add up to meet the family deductible.) Emergency Medical Condition An illness, injury, symptom, or condition so serious that a reasonable person would seek care right away to avoid severe harm. Emergency Room Care Emergency services you receive in an emergency room. Emergency Services Evaluation of an emergency medical condition and treatment to keep the condition from getting worse. EPO (Exclusive Provider Organization) A health plan that provides benefits when care is received from network providers. Out-of-network care is not covered (except in an emergency). Formulary A list of prescription drugs covered by your health plan. In a tiered drug formulary, drugs are assigned a level or tier. Each tier has a different copay or coinsurance. You usually pay less when your doctor prescribes drugs in the lower tiers. Habilitative Services- Health care services that help you keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who isn t walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology, and other services for people with disabilities in a variety of inpatient and/or outpatient settings. High Deductible Health Plan (HDHP) These plans have higher deductibles than traditional health plans. Qualified HDHPs may be combined with a health savings account (HSA) that you can fund with tax-deductible contributions up to annual limits published by the IRS. You can use the HSA to pay for unreimbursed qualified medical expenses. Please note that not all HDHP plans are Qualified HDHPs. Certain Cost-Sharing Reductions (CSR) or plan variations of this plan that are offered through the Health Insurance Marketplace are not intended to be used with an HSA. In-Network/Network Providers A doctor, hospital, or other provider in the plan s network. In-network providers have agreed to accept a certain rate for people with that plan. You pay less when you use an in-network provider instead of an out-of-network provider. (In certain circumstances, a plan may have a contract with an out-of-network provider.) Highmark Delaware EPO plans cover services performed by in-network providers. Out-of-Network Provider A doctor, hospital, or other provider who does not have a contract with your health insurer to provide services to you at a discount. You will generally pay more to see an out-of-network provider. Out-of-Pocket Costs The copayments, coinsurance, and deductible amounts you have to pay. Out-of-Pocket Maximum The most you have to pay out of your own pocket each benefit period (usually a year). After that, your health insurance company pays 100% of the cost for covered services. Premium The amount of money you pay each month for your health insurance. You must pay this amount every month, even if you don t use services that month. Preventive Care Services Routine health care, like screenings, well visits, and checkups, to help prevent illnesses, disease, or other health problems. Primary Care Provider (PCP) The doctor or medical professional who provides most of your basic care, such as yearly preventive visits and screenings. In most cases your PCP will coordinate your care with specialists, health care facilities, and other providers. Qualified Health Plan (QHP) An insurance plan certified by the Marketplace. It must provide the 10 essential health benefits, follow established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meet other requirements. Rehabilitative Services Health care services that help you keep, get back, or improve skills and functioning for daily living that have been lost or impaired because you were sick, hurt, or disabled. These services may include physical and occupational therapy, speech-language pathology, and psychiatric rehabilitation services in a variety of inpatient and/or outpatient settings. Retail Clinic Convenient walk-in centers for quick and less complex health needs that can be served outside the doctor s office. Generally open in the evening and on weekends. Services include treatment of uncomplicated illness or preventative care. Telemedicine/Virtual Medicine Contacting and receiving health care guidance from a doctor in real time by using a smartphone, tablet, or computer. Urgent Care Center A walk-in center you can use when your doctor is unavailable, such as evenings or weekends, or when you have an illness or injury serious enough that you need care right away, but not serious enough for a trip to the emergency room. Urgent care visits are usually less costly than going to the emergency room, but more costly than a PCP visit. 28