RE: Your Massachusetts State & Federal Medical Loss Ratio Rebate Important Information

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Group Name Address 1 Address 2 City State Zip August 2018 RE: Your Massachusetts State & Federal Medical Loss Ratio Rebate Important Information Group Name: <Group Name> Group Number: <Group Number> Dear Employer: At Tufts Health Plan our top priority is to provide your employees with high-quality, affordable coverage. To achieve this, we continuously monitor and manage ways to reduce costs. We are letting you know that you will be receiving a Medical Loss Ratio (MLR) rebate check for 2017 from Tufts Associated Health Maintenance Organization, Inc. (Tufts Health Plan). It will be noted on your applicable rebate whether it is a result of Massachusetts state and/or Federal MLR requirements. We have also enclosed a federally mandated communication titled Notice of Health Insurance Premium Rebate. This letter will provide you with the information you need to assist you in appropriately distributing the MLR rebate to your employees who are members of Tufts Health Plan. We are required to send this rebate to you by August 30, 2018, or apply this rebate to the health insurance premium that is due on or after August 30, 2018. Your eligible employees who were active Tufts Health Plan members through December 31, 2017 (or, if applicable, the date your group plan terminated the coverage), will receive a letter to help explain the MLR rebate. If you or your employees have questions about MLR, please see our Frequently Asked Questions (FAQs). We also recommend the following websites: https://tuftshealthplan.com/mlr (FAQs) www.healthcare.gov/glossary/medical-loss-ratio-mlr/ https://www.irs.gov/newsroom/medical-loss-ratio-mlr-faqs www.cms.gov/cciio/programs-and- Initiatives/Health-Insurance-Market-Reforms/Medical-Loss-Ratio.html Ways in Which You Can Distribute the Rebate As an employer, you may have fiduciary responsibilities regarding use of the Medical Loss Ratio rebates. Some or all of the rebate may be an asset of the plan, which must be used for the benefit of the employees covered by the policy. For general information about your responsibilities regarding the rebate, you may contact the Department of Labor s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or review the Department s technical guidance on this issue on its website at https://www.dol.gov/agencies/ebsa/employers-and-advisers/guidance/technical-releases/11-04. For more information about MLR please contact your Account Manager. Sincerely, Tufts Health Plan

Notice of Health Insurance Premium Rebate August 2018 Name Address 1 Address 2 City State Zip Re: Health Insurance Premium Rebate for Year 2017; Policy #<Group Number> Dear Policyholder: This letter is to inform you that Tufts Associated Health Maintenance Organization, Inc. (Tufts Health Plan) will be rebating a portion of your health insurance premiums through your employer or group policy holder. This rebate is required by the Affordable Care Act the health reform law. The Affordable Care Act requires Tufts Health Plan to rebate part of the premiums it received if it does not spend at least 80 percent of the premiums Tufts Health Plan receives on health care services, such as doctors and hospital bills, and activities to improve health care quality, such as efforts to improve patient safety. No more than 20 percent of premiums may be spent on administrative costs such as salaries, sales, and advertising. This is referred to as the Medical Loss Ratio standard or the 80/20 rule. The 80/20 rule in the Affordable Care Act is intended to ensure that consumers get value for their health care dollars. You can learn more about the 80/20 rule and other provisions of the health reform law at: https://www.healthcare.gov/health-carelaw-protections/rate-review/. The Affordable Care Act allows States to require health insurers to meet a higher ratio. Massachusetts sets a higher Medical Loss Ratio standard, so Tufts Health Plan must meet an 88% Medical Loss Ratio, meaning that 88% of premiums must be spent on medical services and activities to improve health care quality, and no more than 12% of premiums can be spent on administrative costs. What the Medical Loss Ratio Rule Means to You The Medical Loss Ratio rule is calculated on a State by State basis. In Massachusetts, Tufts Health Plan did not meet the 88/20 Federal standard. In 2018, Tufts Health Plan spent only 86.5% of a total of $401.3 million in premium dollars on health care and activities to improve health care quality. Since it missed the 88 percent target by 1.5% of premium it receives, Tufts Health Plan must rebate 1.5% of the total health insurance premiums paid by the employer and employees in your group health plan. We are required to send this rebate to your employer or group policyholder by August 30, 2018, or apply this rebate to the health insurance premium that is due on or after August 30, 2018. Employers or group policyholders must follow certain rules for distributing the rebate to you. (Please turn over)

Ways in Which an Employer Can Distribute the Rebate If your group health plan is a non-federal governmental plan, the employer or group policyholder must distribute the rebate in one of two ways: Reducing premium for the upcoming year; or Providing a cash rebate to employees or subscribers that were covered by the health insurance on which the rebate is based. If your group health plan is a church plan, the employer or group policyholder has agreed to distribute the portion of the rebate that is based on the total amount all of the employees contributed to the health insurance premium in one of the ways discussed in the prior paragraph. If your group health plan is not a governmental plan or a church plan, it likely is subject to the Federal Employee Retirement Income Security Act of 1974 (ERISA). Under ERISA, the employer or the administrator of the group health plan may have fiduciary responsibilities regarding use of the Medical Loss Ratio rebates. Some or all of the rebate may be an asset of the plan, which must be used for the benefit of the employees covered by the policy. Employees or subscribers should contact the employer or group policyholder directly for information on how the rebate will be used. For general information about your rights regarding the rebate, you may contact the Department of Labor s Employee Benefits Security Administration at 1-866-444- EBSA (3272) or review the Department s technical guidance on this issue on its web site at https://www.dol.gov/agencies/ebsa/employers-and-advisers/guidance/technical-releases/11-04. Need more information? If you have any questions about the Medical Loss Ratio and your health insurance coverage, please contact Tufts Health Plan toll-free at 1-800-462-0224 or www.tuftshealthplan.com. Contact your employer or Administrator directly for information on how the rebate will be distributed. For general information about your rights regarding the rebate if your group health plan is subject to ERISA, you may contact the Department of Labor s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or review the Department s technical guidance on this issue on its web site at https://www.dol.gov/agencies/ebsa/employers-andadvisers/guidance/technical-releases/11-04. Sincerely, Thomas Croswell President & Chief Executive Officer Tufts Health Plan

DISCRIMINATION IS AGAINST THE LAW Tufts Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Tufts Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Tufts Health Plan: Provides free aids and services to people with disabilities to communicate effectively with us, such as: Written information in other formats (large print, audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages If you need these services, contact Tufts Health Plan at 800.462.0224. If you believe that Tufts Health Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Tufts Health Plan, Attention: Civil Rights Coordinator Legal Dept. 705 Mount Auburn St. Watertown, MA 02472 Phone: 888.880.8699 ext. 48000, [TTY number 800.439.2370 or 711] Fax: 617.972.9048 Email: OCRCoordinator@tufts-health.com. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Tufts Health Plan Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 800.368.1019, 800.537.7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. tuftshealthplan.com 800.462.0224

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