Federal Employees Health Benefits Program. HMSA s Federal Plan 87

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1 Federal Employees Health Benefits Program HMSA s Federal Plan 87

2 We ve got you covered Freedom to choose your own doctors Access to a large provider network of doctors and hospitals Convenient care at any time

3 Quality care anytime, anywhere Convenient after-hours care HMSA s Online Care ($0 copayment) CVS/minuteclinics Urgent care clinics hmsa.com/federalplan AmericanWell is an independent company providing the hosting and software services for HMSA s Online Care platform on behalf of HMSA. CVS Health is an independent company providing pharmacy benefit management services through CVS Caremark on behalf of HMSA. 3

4 Top-rated hospitals and clinics 4

5 Travel with ease On the Mainland and 170 countries and territories For more information on the Blue Cross Blue Shield network, go to bcbs.com.

6 2019 Federal Plan Benefit Changes Advance care planning Tuberculosis test Tobacco cessation Earn a $50 debit card when you complete the RealAge Test RealAge is a registered mark of Sharecare, Inc. Sharecare, Inc., is an independent company that provides health and well-being programs to engage members on behalf of HMSA.

7 HMSA s Federal Plan 87 Your Plan Benefits Services From participating providers You pay Out-of-pocket maximum Deductible Office visit $15 Lab services $0 Hospital inpatient Outpatient facility Surgery Emergency room $3,000 per person $6,000 self plus one $9,000 family of three or more Not applicable $200 copayment per admission 20% of eligible charges $0 copayment 20% of eligible charges

8 HMSA s Federal Plan 87 Pharmacy Retail You pay Mail-order You pay Tier 1 Preferred generic $7 $0 Tier 2 Non-preferred generic Preferred brand $35 $35 $0 $75 Tier 3 Other brand $70 $185 Tier 4 Non-preferred specialty Tier 5 Non-preferred specialty $80 N/A $200 N/A

9 Meet the healthier you Register for Sharecare, enter your HMSA membership ID, take the RealAge Test, and enter to win a $50 debit card* Earn green days for staying healthy Lower your RealAge hmsa.com/sharecare RealAge is a registered mark of Sharecare, Inc. Sharecare, Inc., is an independent company that provides health and well-being programs to engage members on behalf of HMSA. * Participation is limited to you and your covered dependents age 18 and older. To receive the incentive, eligible Federal plan members must complete the Sharecare RealAge Test by December 31, You must register for Sharecare, enter your HMSA subscriber ID when creating your Sharecare account, and complete the RealAge Test in order to receive a debit card to use for medical expenses. Within four to six weeks of completing the RealAge Test, you ll receive a $50 incentive to this debit card to use for medical expenses. Please keep in mind that the incentive funds expire one year from when we issue your card. Use for expenses described in IRS Code Section 213(d). The incentive funds expire one year from the date of issue. Please also note that lost or stolen cards will not be reissued.

10 More for your well-being Save money with our member discount program and Active&Fit Direct Learn something new at a health education workshop Get food and health inspiration in Island Scene Quit smoking for good with Hawaii Tobacco Quitline hmsa.com/well-being Active&Fit Direct is a trademark of American Specialty Health Incorporated (ASH). The Active&Fit Direct program is provided by American Specialty Health Fitness, Inc., a subsidiary of ASH. American Specialty Health (ASH) is an independent company providing chiropractic, acupuncture, fitness programs, and/or massage therapy services on behalf of HMSA.

11 Stay connected hmsa.com/federalplan My Account Request or print your HMSA membership card View your claims history, Report to Member, and Guide to Benefits Use an annual maximum out-of-pocket calculator Access discounted gym memberships These benefits are neither offered nor guaranteed under FEHB Program, but are made available to all enrollees and family members who become members of HMSA Plan 87.

12 Federal Plan 87 Oahu: , option 2 Neighbor Islands: 1 (800) toll-free For HMSA Center and office locations and hours: hmsa.com/contact For plan information: hmsa.com/federalplan This is a summary of the features of the HMSA Plan. Before making a final decision, please read the Plan s Federal brochure (RI ). All benefits subject to the definitions, limitations, and exclusions in the brochure.