Broker Forms Agent Agreement Assignment of Commission/Agent of Record Form W-9 Small Group (2-50) Checklist FAQs Broker FAQ Chambers of Commerce Benefit Plan Information Errors and Omission Coverage

Group Forms Application for Group Policy Authorization of Health Information Release Continuity of Care Electronic Census Form Enrollment/Change Application Health Statement Important ADVANTAGE Contact Information Mail Service Order Form Step Therapy

Benefit Summaries

Marketing Materials About ADVANTAGE ADVANTAGE Brochure ADVANTAGE FAQ ADVANTAGE 2-Tier Formulary ADVANTAGE 3-Tier Formulary ADVANTAGE 4-Tier Formulary ADVANTAGE Benefit Matrix ADVANTAGE-Choice Highlights ADVANTAGE Health Savings Account ADVANTAGE High Deductible Health Plans Matrix Alere Health Risk Assessments (HRA) Care-ADVANTAGE® Brochure Care-ADVANTAGE® Trifold Member Quick Reference Self-Funded Solutions Service Area Map Tobacco Education Underwriting Guidelines Wellness Within

HMO HMO 100 HMO 101 HMO 102 HMO 103 HMO 104 HMO 105 HMO 106 HMO 107 HMO 108 HMO 109 HMO F HMO G HMO H HMO J HMO K HMO P HMO Q HMO R POS POS 100 POS 101 POS 102 POS 103 POS 104 POS 105 POS 106 POS 107 POS 108 POS 109 POS L POS M POS N POS P POS Q POS R HDHP HDHP 1 HDHP 2 HDHP 3 HDHP 5 HDHP 6

Rider Summaries

Prescription Drugs No Deductible Rx Plan 1 ($10/20/30) Rx Plan 2 ($10/20/50) Rx Plan 3 ($10/25/40) Rx Plan 4 ($10/30/50) Rx Plan 5 ($15/30/60) Rx Plan 6 ($10/30/50%) Rx Plan 7 ($10/20/50/50%)

Prescription Drugs $100 Deductible Rx Plan 1 ($10/20/30) Rx Plan 2 ($10/20/50) Rx Plan 3 ($10/25/40) Rx Plan 4 ($10/30/50) Rx Plan 5 ($15/30/60) Rx Plan 6 ($10/30/50%) Rx Plan 7 ($10/20/50/50%)

Prescription Drugs $250 Deductible Rx Plan 1 ($10/20/30) Rx Plan 2 ($10/20/50) Rx Plan 3 ($10/25/40) Rx Plan 4 ($10/30/50) Rx Plan 5 ($15/30/60) Rx Plan 6 ($10/30/50%) Rx Plan 7 ($10/20/50/50%)

Family Planning Services 50% Coinsurance (standard) HDHP 1 HDHP 2 HDHP 3 HDHP 5 Morbid Obesity Surgical Treatment for Morbid Obesity Option

Chiropractic Services Please note, Chiropractic Services are not available with High Deductible Health Plans Chiropractic Services Rider Vision Basic - Exam Plus (standard) Enhanced - B20 Enhanced - B18