regence group - zahra langford: user experience designer€¦ · · 2015-09-175a 3 7 2 6 8 6a 6b...

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General Business Rules

Description Business Rule

Dental / Medical EOBs Both types of services/claims can be combined on one EOB.

Key

HN Helvetica Neue 55 RomanHNLI Helvetica Neue 46 Light ItalicHNB Helvetica Neue 75 BoldHNM Helvetica Neue 65 Medium

FL Flush LeftFR Flush RightC CenteredD Decimal Aligned

SAP Space After ParagraphSBP Space Before Paragraph

blk Blackblu Bluegrn Greenwht White

Regence GroupExplanation of Benefits (EOB)

Design Specifications

• All x/y coordinates are based on 0/0 at the upper left corner of page.

• The x/y coordinates for each item indicate the center of that item.

• All measurements are in inches.

• All type is 100% black unless noted.

• Specs are given at the first appearance of an item and are not repeated if the item is common to every page.

• Text specification ‘10/12pt’ means that the text is 10 points in size with 12 point leading.

• Rule specs are given as an x/y value (indicating the center of the line) and length.

• EOBs shown with specs are for reference only. Use the specs listed and not measured from the statement. x/y and w/h values may be rounded up or down when creating the EOB using the composition system for more uniform specs.

• Color percentages less than 100% may need to be adjusted to print correctly on the target production press.

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9a

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14a 14b 14c 14d 14e 14f 14g 14h 14i 14j 14k

14l

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14m 14n

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19c

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EXPLANATION OF BENEFITS

# Description x/y w/h Specs Business Rules (if any) Rationale #

1 Regence Logo with tagline 1.4838 / .6684 2.4773 / .8592(variable)

Regence_ID_HLCblue.eps Logo file is variable, depending on state and if the EOBhas a check (logo must appear in black & white on checkEOBs).

2 Explanation of Benefits

This document shows howbenefits were applied torecent claims. It also calculates member responsibility.

8.8178 / .6883 3.8333 / .6233 19/16pt HNM FR, SAP .0125,Tracking: 112/1000 em10/10pt HNL

74

3 THIS IS NOT A BILL. 9.5325 / 1.145 2.425 / .167 11/11pt HNB FR, 100% blu Color is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blk

34, 75

4 Information about this claimtext area

3.4289 / 1.6385 5.3262 / .948 Column 1: 10/12pt HNL Column 2: Tab 1.0417 FL

11, 14, 23

4a Print Date:00/00/00

10/11pt HNL, SAP .0325 Variable data, 8 characters

4b Plan Subscriber:FIRST M LAST

10/12pt HNL Variable data, 53 characters max. (15-first name, 1-middleinitial, 35-last name, plus spaces), all caps

4c Subscriber ID:000000000-00

10/12pt HNL Variable data, 12 characters (9-ID, 2-suffix, plus dash)

4d Group Name:GROUP NAME

10/12pt HNL Variable data, 50 characters max., all caps

4e Group ID:000000000

10/12pt HNL Variable data, 8 characters

5 “Hot Dog” message graphic 4.1992 / 2.3419 3.5685 / .4387 hotDog.eps 95

5a “Hot Dog” message text 4.2002 / 2.3742 3.2587 / .3854 9/11pt HNL /HNM Variable data, limit 2 lines, max. 59 characters each 69, 158

6 Claims Summary graphic 8.4919 / 2.1045 4.5477 / 1.7026 ClaimSummaryBox_RGBblue.epsTop of graphic should be 1.2526below the top edge of the page.

Image file is variable. There are two different sizes(depending on the content of the box), in 3 different colors(blue for Regence, black for EOBs with checks and greenfor Asuris).

85

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EXPLANATION OF BENEFITS (continued)


6a Claims Summary 7.694 / 1.3939 2.7131 / .1768 14/15pt HNM, 100% wht

6b Claims Summary text area 8.5227 / 2.0788 4.3636 / .9986 (Text area contains items 6c-6e) 20, 50, 54

6c We processed xxxxxxxxxxclaim(s) on your behalf

9.5/10pt HNL, SAP .125 Number of claims is variable, 15 characters

6d Contact the provider(s) toarrange payment, if notalready paid.

9/9pt HNM, SAP .3125 Color is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blk

90, 218

6e Total Regence Paid:$0,000,000.00

9.5/11pt HNB10/11pt HNB, Tab 2.7222 D

Color is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blkDollar amount is variable data, 12 characters max.

136

6f Total Member ResponsibilityTo Provider(s): $0,000,000.00

10.0284 / 2.2281 1.3977 / .7491 Tab 1.1806 R9.5/10pt HNB, SAP .0325Tab 1 D10/12pt HNB

Color is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blkDollar amount is variable data, 12 characters max.

5, 53

7 Claims Detail- How your benefits wereused to calculate theseclaims.

3.1831 / 2.7839 5.8088 / .1569 11/9pt HNM9/9 HNLBaseline of this text should be.0511 above the top of theClaims Detail frame (item 8).

8 Claims Detail frame 5.5 / 3.8598 10.5 / 1.9621 .75pt, 100% blkFrame appears .1997 below theleft edge of the Claims Summarygraphic (item 6).

The claims for each person on an EOB are contained with-in this black ruled box. The bottom of the frame should be.054 below the baseline of the last text.Claims should be grouped by member name and are inorder first by member name, then provider name, thenclaim number (lowest to highest) and then date (older tomost recent).

9 Patient and Claim informa-tion text area

3.0371 / 3.2534 5.3617 / .6297 (Includes items 9a-9e)Text area appears .05 below theClaims Detail frame (item 8).

9a Patient: FIRST M LAST

8.775/10pt HNL10/10pt HNB

Patient name is variable data, 53 characters max. (15-firstname, 1-middle initial, 35-last name plus spaces), all caps

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9b Patient Year of Birth: 0000

8.775/10pt HNL Year is variable data, 4 characters 51, 222

9c Patient Account withProvider:00000000000000000000

8.775/10pt HNL, SAP .0325 Account number is variable data, 20 characters

9d Claim ID triangle .2874 / 3.4692 .0561 / .1477 smallTriangle_RGBblack.epsPoint of triangle should align withthe center of the Claim ID text(item 9e).

9e Claim ID: 000000000000

8.775/10pt HNB Variable data, 12 characters

10 Provider text area (Text area includes items 10a-10c)Text area appears .05 below theClaims Detail frame (item 8).

11, 14, 150,153, 154,175, 211

10a FIRST M LAST Variable data, 55 characters, all caps

10b PROV. ADDRESS LINE 1 /PROV. ADDRESS LINE 2

PROV. ADDRESS LINE 3

Address Line 1 and 2 are combined into one line to savespace. Address Line 3 can appear on its own line. Variabledata, 40 characters max. per line, all caps

10c PROVIDER CITY, ST ZIP Variable data, 19 characters max. for City, 2 characters forState, 11 characters max. for zip code, all caps

10d Provider category icon 6.2115 / 3.1115 .2045 / .3068 IE_Doctor_Icon_2_HLC.epsis 12.5% of original size;Top of icon appears .0938 belowthe Claims Detail frame (item 8).

Icon is variable, can be Category 1, 2 or 3:IE_Doctor_Icon_1_HLC.epsIE_Doctor_Icon_2_HLC.epsIE_Doctor_Icon_3_HLC.eps

7

10e Category 2 Provider 5.7911 / 3.3044 1.0276 / .1269 7/7pt HNL FRTop of text box aligns with bottomof Provider category icon (item10d).

Variable data, depends on type of Provider, 19 characters;can be Category 1, 2 or 3

7

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10f Provider category cost label 5.8429 / 3.4321 .9237 / .1446 7/7pt HNL FR, 100% bludollarSigns_Blue_HLC.eps is44.47% of original size, placedinline with the text;Top of text box appears .0234below baseline of Provider cate-gory label (item 10e).

Color and image is variable, depending on type of EOB:Regence EOB - 100% blu, dollarSigns_Blue_HLC.epsAsuris EOB - 100% grn, dollarSigns_Green_HLC.epsEOB with check - 100% blk, dollarSigns_black_HLC

7

11 Amount Regence Paid shaded box

8.8201 / 4.1707 1.0956 / 1.3336 25% bluBottom of box should align withbottom of the Claims Detailframe (item 8); box shouldappear underneath the frame.

Color is variable, depending on type of EOB:Regence EOB - 25% bluAsuris EOB - 25% grnEOB with check - 25% blk

12 Member’s Responsibility ToProvider shaded box

10.0514 / 4.1707 1.3721 / 1.3336 7.5% bluBottom of box should align withbottom of the Claims Detailframe (item 8); box shouldappear underneath the frame.

Color is variable, depending on type of EOB:Regence EOB - 7.5% bluAsuris EOB - 7.5% grnEOB with check - 7.5% blk

13 Claim table text area 5.5 / 4.2219 10.333 / 1.3688 (contains items 13a-14q)Top of text area appears .0363below baseline of Claim ID text.

Height varies by number of claims. 32

13a Claim table header Tabs: .5833 FL, 2.3194 FR,3.3056 FR, 4.25 FR, 4.8611 FR,5.5972 FR, 6.5972 FR, 7.6944FR, 8.8889 FR, 10.1086 FR

Rule below this line is .5pt and offset .025Rule color is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blk

185

13b Claim table data 1 Tabs: .5883 FL, 2.1528 D, 2.4167C, 3.125 D, 3.375 C, 4.0833 D,4.3194 C, 4.6944 D, 4.9583 C,5.4306 D, 5.7222 C, 6.4036 D,6.7083 C, 7.5278 D, 7.8 C, 8.722D, 10 D

If the procedure only as one line, then the rule below thisline is .25pt and offset .0425 (otherwise it has no rule).Rule color is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blkNOTE: Only the first row of table data contains dollar signs

13c Claim table data 2 Tabs: 1.778 FL, 7.6944 FR,10.1086 FR

Rule below this line is .25pt and offset .0425 (unless it isthe last service in the claim and then the weight is .5pt)Rule color is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blk

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13d Table footer Tabs: 7.9028 FR, 8.722 D, 10 D All the totals in this row should have dollar signs.

14a Date of Service00/00/00

7.5/7.5pt HNL, SAP .03259/9pt HNL

Variable data, 8 characters

14b Service DescriptionDescription text

7.5/7.5pt HNL, SAP .03259/9pt HNL

Variable data, 15 characters max.

14c Amount Charged ByProvider$0,000,000.00

7.5/7.5pt HNL, SAP .03259/9pt HNL


14d Amount Not Covered$0,000,000.00

7.5/7.5pt HNL, SAP .03259/9pt HNL


14e Regence Member Rate$0,000,000.00

7.5/7.5pt HNL, SAP .03259/9pt HNL

Variable data, 12 characters max. 25, 29, 217

14f Co-Pay$000.00

7.5/7.5pt HNL, SAP .03259/9pt HNL

Variable data, 6 characters max. 58

14g Deductible$0,000.00

7.5/7.5pt HNL, SAP .03259/9pt HNL


14h Remaining Amount$0,000,000.00

7.5/7.5pt HNL, SAP .03259/9pt HNL


14i Member’s Coinsurance$0,000,000.00

7.5/7.5pt HNL, SAP .03259/9pt HNL


14j Amount Regence Paid$0,000,000.00

7.5/7.5pt HNM, SAP .0325,100% blu9/9pt HNM, 100% blu

Color is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blkVariable data, 13 characters max.

8


14k Member’s Responsibility ToProvider$0,000,000.00

7.5/7.5pt HNL, SAP .03259/9pt HNL

Color is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blkVariable data, 12 characters max.

5

14l Remark code text 8/8pt HNL, SAP .1 Variable data: limited to two lines, max. 70 characters each 10, 80, 81,92, 162

14m (0,000,000.00 x 000%) 7/8pt HNL, SAP .1 Variable data, 21 characters max.

14n (Amount Not Covered + Co-Pay + Deductible +Coinsurance)

7/8pt HNL, SAP .1, 100% blu Color is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blkThis information is variable, depending on what applies tothe claim; it is limited to 3 lines of 22 characters each

14o Totals for this claim 9.5/8pt HNB

14p $0,000,000.00(Amount Regence Paid total)

10/8pt HNB, 100% blu Variable data, 12 charactersColor is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blk

14q $0,000,000.00(Member’s Responsibility ToProvider total)

10/8pt HNB, 100% blu Variable data, 12 charactersColor is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blk

15a Benefits Status horizontalrule 1

9.8599 / 5.0642 length: 1.2184 1pt stroke, 100% bluThis line should always haveexactly .2169 inches of spacebetween it and any object above it.


15b Benefits Status text 9.7487 / 5.324 1.4437 / .4285 9/10pt HNM, SAP .0625Text should be centered verticallybetween the two rules (items 15aand 15c).

Text is variable; limit 3 lines of 20 characters each.

15c Benefits Status horizontalrule 2

9.8599 / 5.5571 length: 1.2184 1pt stroke, 100% bluDistance between the two rulesshould remain at .4929.

Color should be the same as item 15a.


9


15d Benefits Status large arrow 10.6341 / 5.3097 .2682 / .5256 bigArrow_RGBblue.eps Arrow image is variable, depending on type of EOB:Regence EOB - bigArrow_RGBblue.epsAsuris EOB - bigArrow_RGBgreen.epsEOB with check - bigArrow_RGBblack.epsArrow should be centered between the two rules.

16 Have questions frame graphic

3.9984 / 7.7484 7.5385 / 1.0769 haveQuestionsFrame_RGBblue.eps

Frame image is variable, depending on type of EOB:Regence EOB - haveQuestionsFrame_RGBblue.epsAsuris EOB - haveQuestionsFrame_RGBgreen.epsEOB with check - haveQuestionsFrame_RGBblack.eps

96

17 Have questions?Contact your provider if youneed to arrange payment. Tolearn more about your benefits, contact Regence:

3.9615 / 7.3976 7.3952 / .2058 11/11pt HNM9.5/11pt HNL

102, 113

18 myRegence.com logo .7491 / 7.7303 .3367 / .3545 MyRegence.com_logo_Black_HLC.eps is 28.69% of original sizeand cropped by the boundingbox.

134

19 my Regence.com text area 1.8796 / 7.8366 1.8488 / .537 (Contains items 19a-19c) 36, 97

19a www.myRegence.com 10/8pt HNM, SAP .02 Text is variable; could also be www.myAsuris.com 9

19b 24-hour access to: 8/9pt HNL, SAP .01

19c • your policy • claim activity• health tools • wellnessresources

Tab: .8056 FL8/9pt HNL, SAP .01

20 Have questions vertical rule 1

3.2742 / 7.809 length: 4.958 .25pt, 100% blu Color is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blk

21 Customer Service text area 4.4607 / 7.809 1.3497 / .5666 (Contains items 21a-21d)

21a Customer Service 10/9pt HNL, SAP .03


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21b 0-000-000-0000 10/8pt HNM Number is variable per state or company (Regence orAsuris), 14 characters

21c TTY 0-000-000-0000 8/9pt HNL, SAP .02 Phone number is variable data, 14 characters 42, 42a

21d 8:00 a.m.-5:00 p.m. PT 8/9pt HNL, SAP .02 Can be variable if necessary to reflect regional servicecenters/hours of operation/time zones, 23 characters max.

166

22 Have questions vertical rule 2

5.4588 / 7.809 length: 4.958 .25pt stroke100% blu


23 Mailing Address text area 6.6952 / 7.801 1.4392 / .5505 (Contains items 23a-23c) 187

23a Mailing Address(including appeals)

10/8pt HNL8/8pt HNL

135

23b Mailing Address line 1 8/9pt HNL Variable data, 26 characters

23c Mailing Address line 2 8/9pt HNL Variable data, 26 characters

24 Help keep health care costsdown. If you suspect fraudrelated to your claim, pleasecall 0-000-000-0000.

4.9825 / 8.2362 5.408 / .1861 8/9pt HNLI Phone number is variable data by state; 14 characters 27

25 Page 0 of 0 9.9618 / 8.2042 1.5486 / .1861 9/11pt HNL Variable data, according to page number and total pagesin EOB; 2 characters max. are allotted for each number

26

26a 26b

26c

26d

27

44

45

2928

30 31a

3332

34b

34a34d 34e 34f

35

36

38

39

40

41

42 43

49

4646a

46b

47 48a 48b 48c 48e

5051

5253 54

55

56

57

58

59

37

34 34c

47a

47b

48d

48h

48g48f

50a50b

31

31b31c

58a

58b

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26 Managing health care textarea

1.8912 / 1.3125 3.0787 / 1.875 (Contains items 26a-d) 202

26a Managing health care is easier than ever withmyRegence.com

9/9pt HNM, 80% blk Name of website is variable; it could also be myAsuris.com 133

26b Use myRegence.com... 9/10pt HNM/HNL, SAP .0625,80% blk

Name of website is variable; it could also be myAsuris.com

26c Are you covered by otherinsurance?

9/9pt HNM, 80% blk 31, 94, 110

26d Take full advantage of all... 9/10pt HNM/HNL, 80% blk Name of website is variable; it could also be myAsuris.com

27 Benefits Status large arrow 3.7482 / .5117 .2477 / .5089 bigArrow_RGBblue.eps Arrow image is variable, depending on type of EOB:Regence EOB - bigArrow_RGBblue.epsAsuris EOB - bigArrow_RGBgreen.epsEOB with check - bigArrow_RGBblack.epsNOTE: Benefits Status area items (27-51) always appearon the page immediately after the last claim.

28 Benefits Status frame 7.2641 / 3.125 6.9773 / 5.75 6pt stroke, 25% blu Height is fixed on EOBs when the mailing address appearson the same page (as in this example), but variable whenthe mailing address appears on a separate page.Color is variable, depending on type of EOB:Regence EOB - 25% bluAsuris EOB - 25% grnEOB with check - 25% blk

44, 89, 182

29 Your Benefits Statusas of 00/00/00

6.4758 / .5402 4.9795 / .237 15/18pt HNB10/12pt HNM

Variable data, 8 characters for date 173

30 small triangle graphic 1 3.8835 / .8359 .0561 / .1477 smallTriangle_RGBblue.epsThe point of the triangle shouldline up with the middle point ofthe first line of text in the section.

Triangle image is variable, depending on type of EOB:Regence EOB - smallTriangle_RGBblue.epsAsuris EOB - smallTriangle_RGBgreen.epsEOB with check - smallTriangle_RGBblack.eps

31 Up-Front Benefits text area 7.345 / .9969 6.707 / .5932 (Contains items 31a-c)Top of text area appears .1146below the baseline of theBenefits Status title text (item 29).

Appears first after the Your Benefits Status title. If the plandoes not have Up-Front Benefits, the first item thatappears are the Medical Deductible(s).

Repeat this text box for every member that is representedon the EOB with .0649 between the baseline of the lasttext and the next text box.

If the plan does not have Up-Front Benefits, MedicalDeductible(s) appear first.

6, 147, 176

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31a FIRST Name’s RemainingUp-Front Benefits:

12/13pt HNB100% blu

Color is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blkFirst name in all caps

31b • 0 covered office visits(Category 1 or 2), not subject to your deductible

10/11pt HNM, SAP .0125 Number of visits is variable, 1 characterBullet color is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blk

31c • $000.00 (from a total of$000) for Radiology and Labservices

10/11pt HNM, SAP .0125 Remaining dollar amount is variable, 6 characters max.Initial dollar amount is variable, 3 characters max.Bullet color is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blk

32 small triangle graphic 2 3.8835 / 1.5192 .0561 / .1477 smallTriangle_RGBblue.epsThe point of the triangle shouldline up with the middle point ofthe first line of text in the section.


33 Medical Deductible 6.004 / 1.5309 4.025 / .2011 12/11pt HNMTop of text appears .192 belowthe baseline of the last line in theUp-Front benefits section (item31c).

Text is plural if there is more than one person on the EOB. 101

34 Medical Deductible text area 7.3814 / 1.6257 6.729 / .3506 (Contains items 34a-f)

34a Medical Deductible tableheader

Tabs: 4.797 FR, 5.6806 FR,6.4722 FRBaseline of this text should alignwith the baseline of the MedicalDeductible title (item 33).

Rule below this line is .5pt and offset .025, right indent .25Rule color is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blk

34b Medical Deductible tabledata

Tabs: 4.0556 FR, 4.6 D, 5.4861D, 6.2917 D

Medical Deductible information should appear for everymember represented as a patient on the EOB.

14



34c FIRST M LAST 10/11pt HNL, SAP .0325 Variable data, 53 characters max. (15-first name, 1-middleinitial, 35-last name, plus spaces), all caps

34d Total$0,000.00

8/11pt HNL, SAP .032510/11pt HNL, SAP .0325


34e Amount Applied$0,000.00



34f Remaining$0,000.00

8/11pt HNM, SAP .032510/11pt HNM, SAP .0325, 100% blu

Variable data, 8 characters max.Text color is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blk

35 Medical CoinsuranceMaximum

6.004 / 1.9661 4.025 / .2011 12/11pt HNMTop of text area appears .1203below the baseline of the last line in the Medical Deductiblesection.

36 Medical CoinsuranceMaximum text area

7.3814 / 2.0608 6.729 / .3506 Same as 34a-f Use Medical Coinsurance Maximum figures.

37 small triangle graphic 3 3.8835 / 2.3898 .0561 / .1477 smallTriangle_RGBblue.epsThe point of the triangle shouldline up with the middle point ofthe first line of text in a section.


15



38 Prescription Deductible 6.004 / 2.4039 4.025 / .2011 12/11pt HNMTop of text area appears .1234below the baseline of the last linein the Medical CoinsuranceMaximum section.

39 Prescription Deductible textarea

7.3814 / 2.4987 6.729 / 3.506 Same as 34a-f Use Prescription Deductible figures.

40 Prescription Out-of-PocketMaximum

6.004 / 2.8373 4.025 / .2011 12/11pt HNMTop of text area appears .1203below the baseline of the last linein the Prescription Deductiblesection.

41 Prescription Out-of-PocketMaximum text box

7.3814 / 2.9321 6.729 / 3.506 Same as 34a-f Use Prescription Out-of-Pocket Maximum figures.

42 Prescription deductibles andout-of-pocket maximumcosts do not apply to medicaldeductibles or coinsurancemaximums.

6.9702 / 3.1907 5.9318 / .148 8/11pt HNLTop of text area appears .0649below the baseline of the last linein the Prescription Out-of-PocketMaximum section.

198

43 Blue horizontal rule 1 7.2614 / 3.3492 length: 6.9545 6pt, 25% blu Color is variable, depending on type of EOB:Regence EOB - 25% bluAsuris EOB - 25% grnEOB with check - 25% blk

44 Left border vertical rule 1 3.6845 / 3.125 length: 5.75 1pt, 25% blu

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45 Left border vertical rule 2 3.7334 / 3.125 length: 5.75 2pt, 25% blu

46 Why Your Health CareChoices Matter text area

7.2445 / 3.718 6.513 / .397 (Contains 46a and b)Top of text area appears .1276below the horizontal rule (item43).

46a Why Your Health CareChoices Matter

14/11pt HNB 22, 35

46b You always pay less out-of-pocket when you useGeneric drugs. Discuss yourprescription options with yourprovider.

11/12pt HNL

47 Costs / Co-Pay table textarea

7.2289 / 4.4941 6.4187 / .8728 (Contains 47a-48e)Top of the text area appears.0352 below the Costs / Co-Paytable frame (item 48g).

47a Costs / Co-Pay table headerand content

Tabs: 1.6389 R, 2.4861 C,4.0417 C, 5.5972 C

47b Costs / Co-Pay table subtext Tabs: 4.856 C

48a Your costs:Your Prescription Co-Pay:

9/11pt HNM, SAP .05259.5/13pt HNM, SAP .0175

48b $ Least Expensive

Generic Drugs

$5.00 per fill

9/11pt HNM, SAP .0525, 100% blu,dollarSigns_Blue_HLC.eps is60% of original size, placed inlinewith the text and cropped bybounding box to show only 1 dol-lar sign ($).

11/8pt HNB, SAP .0425, 100% blu

11.5/9pt HNM, SAP .01758/9pt HNL, SAP .0175, 100% blu

Color and image are variable, depending on type of EOB:Regence EOB - 100% blu, dollarSigns_Blue_HLC.epsAsuris EOB - 100% grn, dollarSigns_Green_HLC.epsEOB with check - 100% blk, dollarSigns_black_HLC

Color is variable (see above)

Variable data; 5 characters max. for amount, color is variable (see above)

17



48c $$ More Expensive

Brand name formulary drugs

$25.00 per fill

9/11pt HNL, SAP .0525, 100% blu,dollarSigns_Blue_HLC.eps is60% of original size, placed inlinewith the text and cropped bybounding box to show only 2 dol-lar signs ($$).

10/8pt HNL, SAP .0425



Variable data, 5 characters max. for amount

48d (after prescription deductibleis met)

8/8pt HNL 181

48e $$$ Most Expensive

Brand name non-formularydrugs

$50.00 per fill

9/11pt HNL, SAP .0525, 100% blu,dollarSigns_Blue_HLC.eps, is60% of original size, placed inlinewith the text.

10/8pt HNL, SAP .0425



Variable data, 5 characters max. for amount

48f $ Least Expensive shadedbox

6.4853 / 4.4749 1.57 / .9028 5% blu Color is variable, depending on type of EOB:Regence EOB - 5% bluAsuris EOB - 5% grnEOB with check - 5% blk

137, 151

48g Costs / Co-Pay table frame 8.0786 / 4.4749 4.7563 / .9031 .5pt, 25% bluTop of frame appears .1852below the baseline of the last linein the Why Your HealthcareChoices Matter text area (item 46).


48h Costs / Co-Pay table dividingvertical rule

7.2817 / 5.1881 length: 6.338 .25pt, 100% blu Color is variable, depending on type of EOB:Regence EOB - 100% bluAsuris EOB - 100% grnEOB with check - 100% blk

18



49 Blue horizontal rule 2 7.2614 / 5.1881 length: 6.9545 6pt, 25% bluRule appears .0538 above thetop of the myRegence.com logo(item 51).


50 See all your benefits... textarea

6.0683 / 5.6262 4.1593 / .5417 (Contains items 50a and 50b)

50a See all your benefits onlineat myRegence.com

12/15pt HNM, SAP .0325 Name of website is variable; can also be myAsuris.com

50b You will need yourSubscriber ID:000000000000, your GroupID: 00000000, and your birthdate to register.

9/10pt HNL Variable date; Subscriber ID is 12 characters, Group ID is8 characters

186

51 myRegence.com logo 9.1885 / 5.5897 2.4513 / 6.794 myRegence.com_logo_Black_HLC.eps is 42.5% of original size.

3, 18, 51,160

52 REGENCE ADDRESS 1REGENCE ADDRESS 2

.6135 / 4.5279 1.543 / .4397 8/9pt HNL Variable data; depending on state, 30 characters max. perline, all caps

NOTE: Items 52-57 (address information) must alwaysappear on the back of the very last page of the EOB.

53 000000 2.3672 / 4.1093 .7614 / .1494 7/8pt HNL C Human-readable text for address 2D mark, 6 characters

54 Address 2D mark 2.79 / 4.115 .75 / .75 smallBarCode.tifMark requires .5 inches of spacearound it.

Image is for placement only. 2

55 Regence Logo with tagline .6766 / 6.8816 2.4773 / .8592 Regence_ID_HLCblue.eps is rotated 90 degrees counter-clockwise.

Logo file is variable, depending on state and if the EOBhas a check (logo must appear in black & white on allEOBs with a check).

19



56 PAYEE NAMESUBSCRIBER NAMESUBSCRIBER ADDRESS 1SUBSCRIBER ADDRESS 1SUBSCRIBER ADDRESS 1CITY, STATE, ZIP

2.334 / 5.5818 4.0955 / .932 9/11pt HNR Variable data, 53 characters max.53 characters max.40 characters max.40 characters max.40 characters max.19 characters max.for City; 2 characters max. for State; 11characters max. for zip code; all caps

57 Large 2D mark 2.8934 / 8.0872 .8105 / .7957 largeBarCode.tifMark requires .5 inches of spacearound it.

Image is for placement only.This mark appears in this position on the back of everypage of the EOB.NOTE: There can be no content printed behind this markon the previous page, to ensure readability of the mark.

2

58 Review and Appeals textarea

7.2625 / 7.1688 6.975 / 2.165 12, 27, 187

58a Review and Appeals 8/8pt HNM, SAP .03, 80% blk

58b If you’re concerned about... 8/9pt HNL, SAP .03, 80% blk

59 Page 0 of 0 9.9135 / 8.2042 1.6452 / .1861 9/11pt HNL Variable data, according to page number and total pagesin EOB; 2 characters max. are allotted for each number

regence group - zahra langford: user experience designer€¦ · · 2015-09-175a 3 7 2 6 8 6a 6b...

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