Urgent care centers & retail health clinics Getting quick medical care shouldn’t be a headache Life is unpredictable. One minute, you have a sniffle, and the next it’s a painful sinus infection, but your doctor’s office is closed. What now? If it’s not a true emergency, the hours you’ll spend waiting in the ER* will make an uncomfortable situation even worse. Now you can eliminate the wait. When a sudden illness or injury requires prompt medical attention, your choices for care include participating urgent care centers and retail health clinics. Just walk in, present your Independence Blue Cross member ID card, and get treated by a trusted health care professional. You don’t need an appointment or referral.

What is an urgent care center? A health care facility staffed by board-certified doctors that can provide medically necessary treatment for a sudden illness or injury that requires prompt medical attention but is not life-threatening. *The average emergency room wait time is four hours. This is a 31-minute increase in the nationwide average since 2002. Source: 2010 Emergency Department Pulse Report: Patient Perspectives on American Health Care, Press Ganey.

Locate a participating urgent care center near you. Visit ibx.com/findcarenow

What is a retail health clinic? A health care facility staffed by certified nurse practitioners that can treat minor, uncomplicated illnesses and injuries.

When I need medical treatment right away, where should I go for care?

Questions about urgent care? We can help. Call 1-800-ASK-BLUE (1-800-275-2583) or visit ibx.com/findcarenow

Urgent care centers and retail health clinics offer a convenient, safe, and affordable treatment alternative when you can’t get an appointment with your own doctor but your condition is not serious enough for a trip to the emergency room.

What type of services do urgent care centers and retail health clinics offer? These providers can treat many of the same non-emergency illnesses and injuries that your doctor can. A retail health clinic employs certified nurse practitioners who can treat minor, uncomplicated illnesses and injuries, such as fevers and colds, rashes, bumps, and scrapes. Some retail health clinics may also offer flu shots and vaccinations. An urgent care center employs board-certified doctors for the treatment of cuts, sprains, broken bones, sinus infections, and other types of urgent medical conditions.

Does my health plan cover visits? Yes. Simply present your member ID when you arrive. With this new benefit, you’ll pay less to visit a participating urgent care center or retail health clinic than you’ll pay for an emergency room visit.

Remember: If you have a life-threatening medical situation, such as uncontrolled bleeding or chest pain with shortness of breath, you should always seek treatment at the nearest hospital emergency room.

Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.

2013-1303 10/13

Get money back when you make healthy choices The choices you make have a big impact on the kind of life you lead. To encourage you to make healthy choices, Independence Blue Cross offers incentives through our Healthy LifestylesSM Solutions programs. It’s easy to get reimbursed for the healthy choices you make. Simply complete 120 visits (in a 365-day period) at an approved fitness center, participate in an approved weight loss program, or complete a tobacco cessation program, and you’ll be eligible for up to $150 back for each program.

Get up to $150 back on: • Your fitness center fees • An approved weight management program • Programs to help you quit tobacco

Make exercise a priority We’re committed to helping you stay healthy by reimbursing you up to $150 for completing 120 fitness center visits in a 365-day period. You don’t have to enroll in the Healthy Lifestyles Solutions Fitness Program to become eligible for reimbursement. All you have to do is join an approved fitness center, visit your fitness center 120 times during a 365-day period (example: June 1, 2014 to May 31, 2015), and record your workouts. After you complete 120 workouts, upload your proof of payment and a record of your workouts to ibx.com/reimbursements, and you can request your reimbursement.

Lose weight and keep it off No one said weight loss is easy, but support from others can make the goal more attainable. Enroll in Weight Watchers®, Weight Watchers® Online, or an approved weight management program at any network hospital and you can get encouragement to manage your weight for the long haul. We will reimburse you up to $150 for the cost of an approved weight management program.

You are only eligible for one reimbursement per program, per calendar year.

Quit tobacco for good You probably know many of the reasons why you should quit smoking — it can help you breathe easier, live longer, and protect the health of those around you. Quitting isn’t easy, and many people try more than once before they succeed, but it’s worth it. To help you quit for good, we will reimburse you up to $150 for completing an approved tobacco cessation program. If your program costs less than $150, you can apply the difference toward reimbursement of nicotine replacement products or medications prescribed to help you quit.

Log on to ibx.com/reimbursements to get started.

Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.

18086 2014-1834  8/14

How can a Personal Health Record help me? It’s an organized, online, and secure way of storing important medical information — all for free on ibxpress.com. Do you remember the last time you had a physical or what your cholesterol levels are? Do you draw a blank when your doctor asks if your medication is 10 mg or 20 mg? With the private, secure, online Personal Health Record on ibxpress.com, you won’t have to remember anymore. The Personal Health Record will keep track of your health information for you. It will be automatically updated each time your provider submits a claim for things like office visits, surgeries, tests, immunizations, and certain lab results — like those cholesterol levels you have a hard time remembering. You can update your Personal Health Record with additional information such as overthe-counter medications you take, so you have a complete picture of your health. • Have meaningful conversations with your doctor. Your doctor may not have all of your health information handy, especially if you are going to a new doctor or see several doctors. Print a copy of your Personal Health Record and bring it to your next doctor’s appointment. You will be prepared for any questions the doctor has about your health history and will be able to have an in-depth discussion about your health.

Let us do the work for you! When a provider submits a claim, your health information will be automatically populated in your Personal Health Record.

• Know when it’s time to put your health in check. With all of your health information stored in one convenient location, you won’t have to remember the details, and you won’t have to keep track of when you need routine and preventive care. You’ll get reminders to set up annual doctor’s appointments and tests like routine physicals and immunizations.

Log on to ibxpress.com and get started today.

• Reach your future health goals. After your Personal Health Record is populated, it will feed other ibxpress.com applications, like your Wellness Profile and Health Trackers. When all applications work together, you’ll get online notices about your health goals, like losing weight or quitting smoking, and even be able to chart your progress all online. • Share with a caregiver. If you have an elderly parent who participates in an Independence Blue Cross (Independence) medical plan, the Personal Health Record can also be a valuable resource for a caregiver. In an emergency, a detailed record of medical conditions and medications can save valuable time.

Feel confident that your information is secure Only you have access to your Personal Health Record, and only you decide what you want to record. Your doctor sees personal health information only when you print it and share it. The same goes for a loved one or anyone who helps with your care. Independence complies with the provisions of the Health Insurance Portability and Accountability Act (HIPAA) and other legal requirements to keep your Personal Health Record confidential and secure.

Get started today To start, log on to ibxpress.com. After your initial visit to the site, you’ll begin to see medical and pharmacy claims data and certain lab results automatically populated in your Personal Health Record. You can find your Personal Health Record through the “Health & Wellness” section tab.

Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield — independent licensees of the Blue Cross and Blue Shield Association. WebMD is an independent company offering online health information and wellness education to Independence Blue Cross members. The Personal Health Record should not be viewed as the single source for your medical history. The information included in the Personal Health Record is believed to be accurate at the time it is posted but is subject to change.

2015-2522 3/15

When it comes to your health

Numbers are Important Complete the Wellness Profile and find out your numbers

1

Wouldn’t it be great to know how your health adds up? Take our Wellness Profile, a 15-minute survey about your health history and habits, and you will receive a health score from 0 to 100. You will also learn what you’re doing right and simple changes you can make to improve your score.

Log on or register at ibxpress.com To begin taking the Wellness Profile, follow these steps: 1. Click on Wellness Profile on the main page of ibxpress.com and then Take Wellness Profile Now on the next screen. 2. Enter some personal information, like height and weight. Don’t worry, this information is kept private and confidential.

2

3. Answer some questions about preventive screenings and exams you’ve completed and when they were done. You’ll also be asked questions about your eating habits and how much you exercise. Make sure you complete all questions before continuing. 4. Click Complete to get your health score.

3

4

Feel empowered with more information about your health 5. View your score and click on the sliders to see how small changes like adding an exercise routine can affect your overall score as well as decrease your risk for developing certain health conditions.

5

6. C  lick on the topics on the left side of the screen to get more information about your health, including: • Risk Reports that detail your risks and give you a personalized action plan • Condition Reports, which are based on your family history and Wellness Profile responses • Physician Summary you can print and share with your doctor

Get a head start on getting healthy Now that you’ve completed the Wellness Profile and reviewed your results, it’s a great time to visit our online health improvement programs. Just click the Healthy Living tab at the top of the page, then select My Health Assistant. When you do, you’ll find several programs, such as exercise, weight management, nutrition, and tobacco cessation, designed to inspire and support your positive health changes.

6

Questions? 1-800-ASK-BLUE (1-800-275-2583) ibxpress.com

Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association. WebMD is an independent company offering online health information and wellness education to Independence Blue Cross members.

13846 2015-2522 3/15

Enjoy exclusive discounts on wellness programs and services Being healthy doesn’t have to be hard. Blue365® is a value-added program that makes health decisions easier by offering special savings on products and services from national health and wellness leaders. As an Independence Blue Cross member, access to Blue365 is included with your medical plan, so you can enjoy peace of mind, feeling in control, and having an active lifestyle.

Savings and resources from national health and wellness leaders Blue365 offers discounts for fitness centers, nutrition and weight management programs, laser vision correction, parent and senior care, hearing aids, and fitness apparel. Some of the participating companies1 are: • Beltone™

• Reebok®

• Nutrisystem®

• SeniorLink™ Care

• LasikPlus®

• Snap Fitness™

• QualSight Lasik

• TruHearing

®

1 Subject to change.

SM

Learn more! Visit ibxpress.com

Get help reaching your wellness goals Whether your wellness goal is eating healthier or exercising more, you can achieve it with the help of Blue365 discounts and services. Blue365 empowers you to make healthy decisions for yourself and your loved ones by offering: • Discounts on weight-loss and nutrition programs • Access to a tailored, personal walking/fitness program • I nformation on eldercare and caregiver options for parents and dependent family members

Protect your baby’s future health with cord blood banking Cord blood and cord tissue collected at birth contain powerful stem cells that can help your baby fight future illness, including more than 80 lifethreatening diseases. Members receive a significant discount on CorCell’s® enrollment fee for cord blood banking. CorCell will store your baby’s umbilical cord blood in its safe, state-of-the-art laboratory. Storing your baby’s umbilical cord blood provides your family with a great medical resource that may save your baby’s life.

Special offer for members only You will also have access to the Healthways Fitness Your Way program, which includes a discounted fitness membership, a network of health and well-being specialists, as well as other products and services. When you purchase a discounted membership at one of more than 9,000 participating fitness centers nationwide, you can receive discounts of up to 30 percent for access to a network of over 40,000 health and well-being specialists including acupuncturists, massage therapists, personal trainers, dietitians, and much more.

Start saving today — Log on to ibxpress.com To take advantage of Blue365, just access the Blue365 website through ibxpress.com. Our exclusive discounts from leading, national brands are included at no cost to you as part of the Healthy Lifestyles Solutions programs.2 SM

2 Most discounts are free; some participating vendors may require an annual fee before discounts may be used. See ibxpress.com for more details on Blue365.The products and services described on these pages are neither offered nor guaranteed under the Independence contract with the Medicare program, but are made available to all enrollees who are Independence members.

Note: Blue365 offers access to savings on products that members may purchase directly from independent vendors. Blue365 does not include products covered under your Independence Blue Cross (Independence) health plans or any applicable federal health care program. To find out what is covered under your policy, call Independence at 1-800-ASK-BLUE (275-2583). The Blue Cross and Blue Shield Association (BCBSA), an association of independent Blue Cross and Blue Shield plans, may receive payments from Blue365 vendors. Neither BCBSA nor Independence recommends, endorses, warrants, or guarantees any specific Blue365 service, vendor, or product. These products are subject to change without notice. For more information about Blue365, go to ibxpress.com. The products and services described herein are neither offered nor guaranteed under the Independence contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield — independent licensees of the Blue Cross and Blue Shield Association.

2014-2454-01 (2/15)

Care Management – One Health Coach for all your health needs Get support when you need it most When you have a chronic condition or a serious health concern, you may find yourself in unfamiliar territory – juggling new medications, coordinating visits to doctors and specialists, and trying to keep information straight. That’s when an Independence Blue Cross Health Coach can lend a hand.

What are Health Coaches? Health Coaches are registered nurses who are available to you 24 hours a day, seven days a week to help you with your health needs and questions. Once you speak with a Health Coach, they become your trusted health advisor for all of your health-related issues.

Do I need a Health Coach? If you find that you have concerns about your condition, or you have questions about a health-related issue – pick up the phone and call a Health Coach. Health Coaches offer 24/7 support for chronic conditions and complex health issues, as well as everyday health concerns.

Get Personal Support Health Coaches can support you as you make important decisions about your health. Call 1-800-ASK-BLUE, 24 hours a day, seven days a week.

How can a Health Coach help? From information on chronic conditions to coordinating care and everything in-between, your Health Coach can help you meet your health goals. Together, you and your Health Coach will: • assess your current health status and history; • confirm your needs; • develop a care plan designed to meet your needs that could include home care, education, and coaching; • review your plan and goals and communicate with your doctor as necessary.

To speak with a Health Coach, call 1-800-ASK-BLUE, 24/7

Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.

2013-1127 08/13

Give your baby a healthy start Enroll in our free Baby BluePrints® maternity program and get resources and support for a healthy pregnancy Whether you’re a first time mom-to-be or a practiced parent, our maternity program can help you plan for the healthiest pregnancy and delivery possible. Enroll in the free Baby BluePrints maternity program for: • Prenatal resources and information that guide you through each stage of pregnancy • Support from an experienced, registered nurse Health Coach, which may include periodic health assessments over the phone

Sign up for Baby BluePrints® today: 1-800-598-BABY (1-800-598-2229)

If your pregnancy requires special care, your Health Coach will work directly with you and your doctor to help ensure you get the care you need.

Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.

2014-1615 4/14

Eat your way to better health with free nutrition counseling Members can take advantage of 6 free visits Eating healthy would be a lot easier with your own private chef to cook nutritious meals. We can’t hire a chef for you, but we can give you one-on-one time with nutrition experts to help you set goals for better eating habits.

Find a registered dietitian

As part of your benefits, Independence Blue Cross lets you schedule up to six visits a year for nutrition counseling* at no additional cost to you when you visit an in-network doctor or registered dietitian. No referrals needed!

2. Find a registered dietitian or doctor by selecting “Diet & Nutrition Providers.”

Eat your way to a healthier you Eating healthier doesn’t have to mean eating less. It means learning how to add nutritious foods into your diet. It means understanding how what you eat affects your overall health and happiness. A healthy diet and weight can give you more energy and may even lower your blood pressure and cholesterol. Many people develop chronic conditions, such as diabetes, heart disease, and high blood pressure, as a result of being overweight. Nutrition counseling can help you better manage your diet and your weight, and may reduce your risk for developing these health conditions.

1. Go to www.ibx.com/findadoctor.

3. Call your dietitian to schedule your nutrition counseling appointment. No referrals necessary!

Questions? Call 1-800-ASK-BLUE (1-800-275-2583).

*Not all employers offer nutrition counseling visits as part of their benefit plans. Please contact Customer Service or your benefits administrator to determine if this benefit applies to your coverage. If nutrition counseling services are provided in addition to other covered services, an office visit copay may apply. Deductible and coinsurance may apply to services obtained out of network.

ibx.com Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.

16977 2012-0542 (1/13)

Healthy Lifestyles Solutions Fitness Program SM

With Independence Blue Cross’ Fitness Program you can get up to $150 back You don’t have to enroll in the Healthy Lifestyles Solutions Fitness Program to become eligible for reimbursement. When you meet the eligibility requirements, just submit your documentation to ibx.com/reimbursements to request reimbursement.

Four easy steps 1. Join an approved fitness center. Choose a full-service fitness center that includes amenities for continuous cardiovascular, flexibility, and resistance training. You’ll find more information about choosing an approved fitness center on page 2. 2. Exercise at your chosen fitness center regularly. You need to work out at your approved fitness center 120 times during a 365-day period (example: June 2014 through May 2015). Your workouts must include continuous cardiovascular, flexibility, and resistance training and last approximately 30 minutes. 3. Record your workouts. Record each workout using one of the methods listed on page 4. You may record only one workout per day with a minimum of eight hours between logged workouts. After you complete 120 workouts, you can request a reimbursement. 4. Submit your documentation and request your reimbursement. Log on to ibx.com/reimbursements and upload copies of the following documentation: • proof of payment (receipts must be submitted on fitness facility letterhead, or a copy of the membership contract must accompany the receipt); • record of your workouts (completed logbook found at the end of this document or a computer printout of your workouts from your gym). Once all of your documentation is submitted, you can request your reimbursement be paid by direct deposit or American Express rewards card.* * Please note that American Express charges a fee of $4.00 plus three percent of reimbursement amount.

1

Fitness Program guidelines Eligible members In order to be eligible for reimbursement, participants must be age 18 or older.

Selecting an approved fitness center The Fitness Program rewards you for incorporating a well-rounded exercise program into your routine. To be eligible for the fitness center reimbursement, you must choose a full-service fitness center that offers a variety of cardiovascular, flexibility, and resistance training in a supervised setting.

Eligible fitness centers Eligible full-service fitness centers generally feature most of the following amenities: • group exercise classes (e.g. aerobics, spinning, body sculpting, kickboxing) • resistance training equipment (e.g., weight machines) • free weights • cardiovascular training equipment (e.g., treadmills, stationary bicycles, elliptical trainers) • pool for swimming laps • track for running/walking

Ineligible fitness centers Membership at athletic clubs that focus primarily on a single competitive or recreational sports activity are not eligible for reimbursement, even if the activity includes elements of a comprehensive exercise program. While we recognize that activities such as martial arts, rowing, tennis and basketball are excellent ways to stay fit, they often do not require consistent, year-round attendance or proper supervision. Nor do these activities incorporate all the elements of a comprehensive exercise program. Therefore, participation in these programs does not qualify for reimbursement. Examples of ineligible programs and facilities include: • tennis/squash/racquetball • basketball • golf • Pilates/yoga class • martial arts/karate class • sports leagues • recreational swim clubs • dance instruction • outdoor “boot camp” style program • sculling/style program rowing • chiropractic services 2

Lifetime fitness center memberships If you purchase a lifetime membership at a fitness center, you are eligible to receive a reimbursement of up to $150 of the membership fees paid once per calendar year as long as the required number of workouts are completed.

Family fitness center memberships Family memberships are eligible for the reimbursement under the following conditions: • Each family member who requests the reimbursement must be listed on the membership contract. • Each family member who requests the reimbursement must individually participate in the Fitness Program and fulfill all Fitness Program reimbursement requirements. Each eligible family member may receive reimbursement of up to $150 of his or her portion of the total annual membership fees once per calendar year. Example: • Family fitness center annual contract fee is $700. • Four family members are listed on the family fitness facility contract. • Two family members are 18 or older and, therefore, are eligible for reimbursement. • $700 ÷ 2 = $350 (each eligible family member’s portion of the total contract fee). In this example, if the two eligible family members complete all Fitness Program requirements, each will receive up to $150 (his or her portion of the family fitness facility annual contract fee). If only one eligible member completes all Fitness Program requirements, the family member will receive up to $150 (his or her portion of the family fitness facility annual contract fee).

3

Reimbursement rules and requirements • You must complete 120 workouts during a 365-day Fitness Program period. However, the 365-day time period does not need to be within the same calendar year as the reimbursement. For example, you could get a reimbursement paid out in January 2015 for 120 workouts documented in 2014. • You must have coverage with Independence Blue Cross at the time of your request for reimbursement. • You are only eligible for one reimbursement per program, per calendar year. • Dependents must be at least 18 years old to be eligible for reimbursement. • Logging in for another member at a fitness center is prohibited. • Falsification of information in order to receive your reimbursement is strictly prohibited.

How to record your workouts Choose a primary method of recording your workouts that works best for you: • logbook on page 6 • computer printout from your fitness center that shows all workout dates

Record workouts using the logbook To record workouts using the logbook on page 6, ask a fitness center representative to sign and date the logbook each time you work out. You may also use the logbook to record your workouts when you visit a fitness center other than your primary fitness center (e.g., when you work out while traveling or vacationing out of town).

Record workouts using a fitness center’s computer printouts You may choose to use your fitness center’s computer printout as your primary method of logging workouts. However, keep in mind that Independence Blue Cross cannot assume any responsibility for the reliability of fitness center computer systems. For this reason, if you select a fitness center computer printout as your primary method of logging workouts, you also accept the risk that all your workouts may not be credited toward your reimbursement should your fitness center have technical issues.

4

• ________ • ________ • ________ • ________

Other important information • Independence Blue Cross does not guarantee the solvency of any fitness center and, therefore, has no liability should a fitness center close. • For members other than those enrolled in a Medicare Advantage plan, Healthy Lifestyles Solutions programs are value-added. They are not part of the health care benefits you have purchased and, therefore, are subject to change without notice. • At Independence Blue Cross, we encourage all of our members to adopt and maintain a regular fitness program. However, if you are 40 or older, overweight, have a history of high blood pressure or heart disease, or have any other health concerns related to exercise, you are encouraged to consult your doctor before beginning any exercise program. • If you are unable to complete workouts due to a medical procedure, please call 1-800-590-8880.

5

Questions? Call Healthy Lifestyles Solutions at 1-800-590-8880.

Healthy Lifestyles Solutions Fitness Logbook SM

Member name ID # Instructor/fitness facility representative must acknowledge each w ­ orkout with date and signature. Credit will only be issued for workouts completed during supervised hours.

Date

Fitness facility representative signature

Workout time

Date

Fitness facility representative signature

Workout time

1.

❑ am ❑ pm

31.

❑ am ❑ pm

2.

❑ am ❑ pm

32.

❑ am ❑ pm

3.

❑ am ❑ pm

33.

❑ am ❑ pm

4.

❑ am ❑ pm

34.

❑ am ❑ pm

5.

❑ am ❑ pm

35.

❑ am ❑ pm

6.

❑ am ❑ pm

36.

❑ am ❑ pm

7.

❑ am ❑ pm

37.

❑ am ❑ pm

8.

❑ am ❑ pm

38.

❑ am ❑ pm

9.

❑ am ❑ pm

39.

❑ am ❑ pm

10.

❑ am ❑ pm

40.

❑ am ❑ pm

11.

❑ am ❑ pm

41.

❑ am ❑ pm

12.

❑ am ❑ pm

42.

❑ am ❑ pm

13.

❑ am ❑ pm

43.

❑ am ❑ pm

14.

❑ am ❑ pm

44.

❑ am ❑ pm

15.

❑ am ❑ pm

45.

❑ am ❑ pm

16.

❑ am ❑ pm

46.

❑ am ❑ pm

17.

❑ am ❑ pm

47.

❑ am ❑ pm

18.

❑ am ❑ pm

48.

❑ am ❑ pm

19.

❑ am ❑ pm

49.

❑ am ❑ pm

20.

❑ am ❑ pm

50.

❑ am ❑ pm

21.

❑ am ❑ pm

51.

❑ am ❑ pm

22.

❑ am ❑ pm

52.

❑ am ❑ pm

23.

❑ am ❑ pm

53.

❑ am ❑ pm

24.

❑ am ❑ pm

54.

❑ am ❑ pm

25.

❑ am ❑ pm

55.

❑ am ❑ pm

26.

❑ am ❑ pm

56.

❑ am ❑ pm

27.

❑ am ❑ pm

57.

❑ am ❑ pm

28.

❑ am ❑ pm

58.

❑ am ❑ pm

29.

❑ am ❑ pm

59.

❑ am ❑ pm

30.

❑ am ❑ pm

60.

❑ am ❑ pm

6

Date

Fitness facility representative signature

Workout time

Date

Fitness facility representative signature

Workout time

61.

❑ am ❑ pm

91.

❑ am ❑ pm

62.

❑ am ❑ pm

92.

❑ am ❑ pm

63.

❑ am ❑ pm

93.

❑ am ❑ pm

64.

❑ am ❑ pm

94.

❑ am ❑ pm

65.

❑ am ❑ pm

95.

❑ am ❑ pm

66.

❑ am ❑ pm

96.

❑ am ❑ pm

67.

❑ am ❑ pm

97.

❑ am ❑ pm

68.

❑ am ❑ pm

98.

❑ am ❑ pm

69.

❑ am ❑ pm

99.

❑ am ❑ pm

70.

❑ am ❑ pm

100.

❑ am ❑ pm

71.

❑ am ❑ pm

101.

❑ am ❑ pm

72.

❑ am ❑ pm

102.

❑ am ❑ pm

73.

❑ am ❑ pm

103.

❑ am ❑ pm

74.

❑ am ❑ pm

104.

❑ am ❑ pm

75.

❑ am ❑ pm

105.

❑ am ❑ pm

76.

❑ am ❑ pm

106.

❑ am ❑ pm

77.

❑ am ❑ pm

107.

❑ am ❑ pm

78.

❑ am ❑ pm

108.

❑ am ❑ pm

79.

❑ am ❑ pm

109.

❑ am ❑ pm

80.

❑ am ❑ pm

110.

❑ am ❑ pm

81.

❑ am ❑ pm

111.

❑ am ❑ pm

82.

❑ am ❑ pm

112.

❑ am ❑ pm

83.

❑ am ❑ pm

113.

❑ am ❑ pm

84.

❑ am ❑ pm

114.

❑ am ❑ pm

85.

❑ am ❑ pm

115.

❑ am ❑ pm

86.

❑ am ❑ pm

116.

❑ am ❑ pm

87.

❑ am ❑ pm

117.

❑ am ❑ pm

88.

❑ am ❑ pm

118.

❑ am ❑ pm

89.

❑ am ❑ pm

119.

❑ am ❑ pm

90.

❑ am ❑ pm

120.

❑ am ❑ pm

Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield — independent licensees of the Blue Cross and Blue Shield Association.

17863 2014-1987 (10/14) FITNESS

Healthy Lifestyles Solutions Weight Management Program SM

Get up to $150 back when you participate in an approved weight management program No one said weight loss is easy, but support from others can make the challenge feel more manageable. Enroll in Weight Watchers®, Weight Watchers® Online, or an approved weight management program at any network hospital and you can get encouragement to manage your weight for the long haul. The Healthy LifestylesSM Solutions Weight Management Program will reimburse you up to $150 for the cost of an approved weight management program.

How it works You don’t have to enroll in the Healthy Lifestyles Solutions Weight Management Program to be eligible to receive reimbursement. When you meet the eligibility requirements, just submit your documentation to ibx.com/reimbursements to request reimbursement. 1. Sign up for an approved weight management program. See page 2 for information about choosing an approved program that’s eligible for reimbursement. 2. Attend the approved program. Follow the requirements of your program and stick with it throughout the duration of your program year. A healthy weight reduces your risk for heart disease, high blood pressure, diabetes, and stroke. 3. Submit documentation and request your reimbursement. Log onto ibx.com/reimbursements and request your reimbursement by submitting proof of participation and payment. For example: • If attending Weight Watchers in person, you will need to submit receipts and copies of your booklets. • If participating in Weight Watchers Online, you should submit screen prints to show proof of payment and progress in the program. • If attending a hospital-based or youth program, proof of payment and participation is required. Once all of your documentation is submitted, you can request your reimbursement to be paid by direct deposit or American Express rewards card.* * Please note that American Express charges a fee of $4.00 plus three percent of the reimbursement amount.

Enroll in Weight Watchers®, Weight Watchers® Online, or an approved weight management program at any network hospital.

Weight Management Program guidelines Selecting an approved weight management program Choose Weight Watchers and attend weekly meetings, or opt for an approved weight management program based at a network hospital. Some weight management programs for members under age 18 may also be eligible for reimbursement. If you like, you may join more than one program per year; however, the maximum reimbursement you can receive is $150 per year issued once per calendar year.

Weight management with Weight Watchers The Weight Watchers program combines in-person group sessions, education, and tools to help you make the nutrition and exercise decisions that are right for you. With Weight Watchers Online, you can create a customized weight loss plan and use online and mobile tools to help you track your progress anywhere you go.

For more information, please contact Healthy Lifestyles Solutions at 1-800-590-8880.

Weight management at network hospitals Many of our network hospitals offer weight management classes to the community. Programs and schedules vary from hospital to hospital. For more information about available programs, contact the community health education department of your local hospital.

Weight management programs designed for youth and adolescents Reimbursement is available to help with the cost of programs designed for minors. The program must focus on behavior modification, nutrition education, and have a goal of losing weight. Youth programs are commonly available through YMCAs, community centers, and hospitals. Use the Find a Provider tool on ibx.com to locate a network hospital in your area, or call our Health Resource Center at 1-800-ASK-BLUE.

Not reimbursable: • Dietary supplements • Plans that require the purchase of food products designed for use with the plan

You are only eligible for one reimbursement per program, per calendar year.

• Injections • Meal plans; liquid meals

Weight loss programs that are not reimbursable: • Any online program other than Weight Watchers Online • Any programs offered at a medical practice other than a hospital ® Weight Watchers is a registered trademark of Weight Watchers International, Inc., an independent company. Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield—independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.

17890 2013-1467 (1/14) WEIGHT

Healthy Lifestyles Solutions Tobacco Cessation Program SM

Get up to $150 back when you complete an approved program to help you quit using tobacco You probably know many of the reasons why you should quit smoking — it can help you breathe easier, live longer, and protect the health of those around you. Quitting isn’t easy, and many people try more than once before they succeed, but it’s worth it. To help you quit for good, our Healthy LifestylesSM Solutions Tobacco Cessation Program will reimburse you up to $150 for completing an approved tobacco cessation program. If you’re 18 or older and your program costs less than $150, you can apply the difference toward reimbursement of nicotine replacement products or medications prescribed to you to help you quit.

How it works You don’t have to enroll in the Healthy Lifestyles Solutions Tobacco Cessation Program to be eligible for reimbursement. When you meet the eligibility requirements, just submit your documentation to ibx.com/reimbursements to request reimbursement. 1. Sign up for an approved tobacco cessation program. See page 2 for information about choosing an approved program that will work for you. 2. Complete the approved program. Complete an eligible program that focuses on behavior modification and provides frequent and regular support, such as weekly meetings or telephone-based sessions. 3. Submit documentation and request your reimbursement. Log on to ibx.com/reimbursements and submit the following documentation: • proof of your participation in an approved tobacco cessation program or a certificate of completion • all program receipts and receipts for nicotine replacement products or medications prescribed to you to help you quit Once all of your documentation is submitted, you can request your reimbursement to be paid by direct deposit or American Express rewards card.* * Please note that American Express charges a fee of $4.00 plus three percent of the reimbursement amount.

Approved tobacco cessation programs include those that focus on behavior modification and provide frequent and regular support.

Tobacco Cessation Program guidelines Selecting a tobacco cessation program No matter who you are, you can find a program that will give you the type of support and encouragement you need to kick the habit. Eligible programs include those that focus on behavior modification and provide frequent and regular support such as weekly meetings or telephone-based sessions. Work with your health care provider to determine which method is best for you. You can opt for an individual approach, or choose a program that offers group support. Some programs can even help you manage stress, avoid weight gain, and overcome barriers to quitting. You can also choose a program offered by a network hospital in your area. Search for a network hospital in your area at ibxpress.com or contact our Health Resource Center at 1-800-ASK-BLUE for more information.

You are only eligible for one reimbursement per program, per calendar year.

The following are not reimbursable: • Co-pays, coinsurance, deductibles • Hypnosis • Acupuncture • Dietary supplements; injections • Electronic cigarettes

Support for quitting other forms of tobacco There are 28 known cancer-causing substances in chewing tobacco, spit tobacco, and other smokeless tobacco products. All smokeless tobacco contains nicotine, so it’s just as addictive as cigarettes. And if you use any form of smokeless tobacco, you put yourself at an increased risk for serious health conditions including tooth decay, gum disease, and oral cancers of the lip, tongue, cheeks, gums, throat, and floor and roof of your mouth. If you’re using smokeless tobacco, make a commitment to quit today. Many of the tobacco cessation programs that are eligible for our reimbursement also support individuals who want to quit using smokeless tobacco.

Nicotine replacement and medication prescribed to assist with tobacco cessation You may be eligible to obtain nicotine replacement medications under your pharmacy plan with a prescription from your doctor.

Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.

For more information, please contact Healthy Lifestyles Solutions at 1-800-590-8880.

17889 2013-1467 (1/14) TOBACCO