A nonprofit independent licensee of the Blue Cross Blue Shield Association

RISING TO THE CHALLENGE TO BEST SERVE YOUR CLIENTS

2019 BROKER GUIDE

• A commission for Individuals, Small and Large Group contracts, Rx Program forClaims Based Business, in addition to Medicare employer contracts and MedicareDirect Pay Referral Bonus.

• Commissions on all new and existing Medicare Supplemental plans and SimplyPrescription plans.

• Commission on all new and existing community and experience rated dental plans.

• For every Small and Large Group plan, our enhanced online Blue on DemandSM

comparison tool allows you to easily find and compare plans with suggesteddental plans.

• More web tools to help you manage your business – monthly commissionreports, electronic Broker of Record submission option, online group enrollment &account maintenance, online bill pay, forms & applications, and much more.

• A steady stream of communications – including newsletters, tutorials and industryupdates – to help you stay informed about the latest news and product updates.

• Special pricing on life insurance products and Employee Assistance Programs.

• Improvements to our processes, including our new Annual Group InformationTool and streamlined processing with simpler underwriting guidelines and lesspaperwork.

Also, don’t forget to ask us about the Blue Honors reward program.

Thank you for your continued support.

Best regards,

Jim Reed Sr. Vice President of Marketing and Sales, CNY Regional President

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You want your clients to feel confidentabout their health plan selection. As you navigate the complexity of health insurance products, you can be assured knowing we’re here to help meet the challenges they face each step of way.

We want our brokers to have that same sense of confidence. The programs and tools outlined in this guide demonstrate our commitment to helping you better serve your clients and grow your business.

These are just some of the many ways we’re here to help you along the way:

What’s NEW for 2019• Suggested dental plans with every Small & Large Group plan

• All Small Business quotes include suggested Reimbursement Plan options (HSA, HRA & FSA) provided by our partner, Lifetime Benefit Solutions

• Medicare Advantage plans are now available for Small business renewals

As part of our commitment to making your job easier, we provide the Blue on Demand Plan Comparison Tool – an online resource that allows you to view and compare medical and dental plan options in just a few clicks.

Blue on Demand includes packages for small businesses, experience rated businesses, and direct pay members, including individuals & families and sole proprietors. Features include:

• Administrative and COBRA services provided by our partner, Lifetime Benefit Solutions

• View and compare all medical plans or shop by Preferred Packages for small businesses

• Shop by product design Signature Preferred plans for experience rated businesses

For Small Business

• Shop and compare by product type, metal levels, and other key variables • Access Summary of Benefits & Coverage (SBC) for all Plan IDs and Mid-Segment Packages (MSPs) • Package-level mapping and side-by-side comparisons

• Pre-populated rate sheets with Plan IDs and enrollment codes

• Print detailed benefit summaries and rates

• Obtain forms and other resources to request a rate quote & implement a group

• Easily search by either the type of plan or price range you’re looking for, and a number of plan options will instantly appear for a simple, side-by-side comparison

To use Blue on Demand, visit ExcellusBCBS.com/Broker

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Access detailed 2019 plan benefits and view side-by-side comparisons.

Contact your Account Consultant or visit ExcellusBCBS.com/Broker

Finding the right plan for your clients is easy with the online Blue on DemandSM tool

4 Contact your Account Consultant or visit ExcellusBCBS.com/Broker

Eligibility & Underwriting

• View group eligibility guidelines and what’s needed to enroll a new group

• View Annual Group Information Forms for your groups (must have broker access)

Training & Resources

• Sign up to attend a broker information session

• Register as Broker of Record and e-submit

• Learn about our new broker training

Engage Members

• Download brochures, posters, online tours and more

MORE web toolsOur broker website also offers the following features and tools to help you manage your business.

Online Enrollment & Account Maintenance

• Enroll a new subscriber, add/remove family members, change coverage, view member roster, order ID cards, or reinstate a canceled policy

• Get applications, forms and instructions

• Get answers to membership and billing questions

Online Bill Pay

• View invoices & payment activity

• Get email notification of new invoices

• Create customized reports

• Pay invoices online with checking or savings accounts

Commission & Reporting

• View our commission payment schedule

• Learn about our account reporting tools for small and large group

When information comes to you, it’s EASIER TO DO BUSINESS

With your busy schedule, it can be hard to stay up-to-date with the latest products, regulatory changes and industry news. That’s why Excellus BlueCross BlueShield makes it easier to stay informed with ongoing communications and tools, including:

• Broker eblasts monthly • Online product tutorials

• Product brochures, posters, toolkits and flyers Interactive sales tools like Blue on DemandSM

• Dedicated Web site, including group enrollment tools

• Training and Information Sessions to help grow your business

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Information consulting – BETTER PARTNERSHIPS through BETTER INFORMATION

Our Information Consulting team is dedicated to providing easily accessible group reporting that supports an understanding of health plan experience, and helps target actionable improvement opportunities. Most reports are available online and can be scheduled monthly, quarterly, or annually based on group needs. Report eligibility varies with group size and funding, but can include the following:

• 50+ contract groups - utilization-based (non-financial) reports including topics such as emergency room utilization, prevalence of chronic conditions, telemedicine utilization, and generic fill rates

• 100+ contract experience rated groups – designated Information Consultant, utilization and financial reports, enrollment census reporting, out of pocket costs reports, claims vs. premium reporting, high cost claimant reports, online data cube for custom reporting on demand

• Claims based billing groups – all of the above, plus weekly billing detail, high claim early alerts, and detailed financial reports

• 50+ contract dental groups - financial and enrollment reports, claims vs premium reports, utilization reports including services by dental class and member utilization

• Claims based billing dental groups - all of the above and monthly claim detail to support billing

Additional online tools are available specifically for brokers, including a multigroup dashboard and multigroup data cube to support analysis, and a Monthly Rate Summary Report for community rated groups. For additional information contact us at general.ic@lifethc.com.

5Contact your Account Consultant or visit ExcellusBCBS.com/Broker

2019 Commission schedule Base Medical Commission: Small Group (Includes HMO Business)

Product Description CommissionOff NY State of Health Exchange: SimplyBlue Plus PPO, Healthy New York

4%

On NY State of Health Exchange: SimplyBlue Plus PPO 4%

Base Medical Commission: Large Group (excludes HMO business)

Cumulative YTD Premium CommissionFirst $500,000 4.5%$500,001 - $1,000,000 4.0%$1,000,001 - $1,500,000 3.5%$1,500,001 - $2,000,000 2.5%$2,000,001 - $5,000,000 1.5%$5,000,001 + 1.0%

Base Medical Commission: Individual Market

Product Description CommissionOff/On NY State of Health Exchange: ExchangeBlue EPO, ExchangeBassett EPO

$25 Per Contract Per Month (PCPM)

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2019 Commission schedule (continued)

Base Dental Commission: New and Existing Community and Experience Rated Business

Cumulative YTD Premium CommissionFirst $20,000 12%

$20,001 - $30,000 10%$30,001 - $40,000 8%$40,001 - $50,000 6%$50,001 - $100,000 5%Greater than $100,000 2%

Bonus program Medical Override Commission: New Business

New Medical Contracts New Medical Group Minimum Applicable Payout100 - 249 contracts 2 new groups $15,000250 - 499 contracts 2 new groups $30,000500 - 999 contracts 3 new groups $50,000

1,000 - 1,499 contracts 4 new groups $100,0001,500 or more contracts 5 new groups $150,000

• Broker must attain both new medical contract and new medical group minimum targets to qualify• Qualifying new contracts are from prospect medical clients only; “growth on existing” does not count toward goal• Quarterly payouts based on year-to-date performance and paid on Large Group (non-HMO) business only • LBS business will be included in the calculation

Medical Override Commission: Retention of Business

Percentage of Medical Contracts Retained Applicable Payout Maximum Payout95.0% 0.50% of in-force premium $50,000 per agency98.0% 0.75% of in-force premium $75,000 per agency

• Calculation to include new medical business • Annual payout based on year-end retention performance and paid on Large Group (non HMO) business only • LBS business will be included in the calculation

Dental Override Commission: New Business

New Dental Contracts New Dental Group Minimum Applicable Payout100 - 199 contracts 1 new group $2,000200 - 299 contracts 1 new group $5,000300 - 399 contracts 1 new group $10,000400 - 499 contracts 1 new group $15,000500 or more contracts 1 new group $30,000

• Broker must attain both new dental contract and new dental group minimum targets to qualify• Qualifying new contracts are from prospect dental clients only; “growth on existing” does not count toward goal• Quarterly payouts based on year-to-date performance• LBS business will be included in the calculation

6 Contact your Account Consultant or visit ExcellusBCBS.com/Broker

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Dental Override Commission Schedule: Retention of Business

Percentage of Dental Contracts Retained Applicable Payout Maximum Payout95.0% 3% of in-force premium $20,000 per agency98.0% 5% of in-force premium $40,000 per agency

• Calculation to include new dental business • Annual payout based on year-end retention performance

Claims Based Business Pharmacy Broker Commission Program

New and Existing Claims Based Business Accounts

Commission Structure• Broker agencies appointed with Excellus Health Plan, Inc. will be eligible for commission of $.60 per script for

any pharmacy CBB placed with Excellus Health Plan, Inc. prior to January 1, 2017.• Broker agencies appointed with Excellus Health Plan, Inc. will be eligible for commission of $.85 per

script effective for any pharmacy CBB placed with Excellus Health Plan, Inc. between January 1, 2017 and December 31, 2017.

• Broker agencies appointed with Excellus Health Plan, Inc. will be eligible for commission of $1.00 per script effective January 1, 2018 for any new pharmacy CBB placed with Excellus Health Plan, Inc. between January 1, 2018 and December 31, 2019.

• An additional $.10 per script will be paid if the broker agency maintains a 95% pharmacy retention rate on their CBB pharmacy book of business. Book of business retention measurement will be calculated on a calendar year basis for each year following the initial qualification year for the commission payment. Broker agencies would need to requalify for this additional payment annually.

Medicare Group Commission

Product Description CommissionMedicare Supplemental 5% paid premiumSimply Prescription $5 per contract per month (PCPM)

• Applies to contracts for new and existing Medicare Supplemental and Simply Prescription plans • To be eligible brokers must be appointed, state licensed, and trained on our products

Product Description CommissionMedicare Advantage $12.50 per contract per month (PCPM)

• Applies to contracts for new Medicare groups or new Medicare Advantage offerings that are effective January 1, 2019 and later*

• Small Group or Large Group plans are paid the same PCPM commission• New contracts are defined as new Medicare Group business coming from a competitor, coming from

Medicare age-ins (newly established MA plan), coming from Medicare Supplement plans (newly established MA plan), or coming from commercial carve-out plans (newly established MA plan)

• Prior certification and product training is required. Contact MedicareGroup@excellus.com for more information.

Medicare Direct Pay Referral Bonus

Product Description Referral PaymentMedicare Advantage (HMO/PPO) $100

Prescription Drug Plan $25

• Referral will be paid on new enrollment • Referral payment will be a one time payment • Referral must be enrolled within 5 months from date of scope of appointment form to receive payment• Scope of appointment form must be completed and submitted to designated Sales Rep• Medicare group business is excluded

*New Medicare Group business is commissionable for employer groups that have not offered Excellus Health Plan, Inc. Medicare products for six months prior to the effective date of coverage.

7Contact your Account Consultant or visit ExcellusBCBS.com/Broker

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General program terms Monthly commission payments are paid based on the prior month’s premium receipts and are targeted for issue by the 15th business day. Dental and experience rated medical commissions are paid on an accumulated premium formula. Each monthly premium payment is added to the effective year-to-date cumulative received premium and the appropriate commission schedule applied. Override program payments will be issued in the quarter following the close of the measurement period.

A $150,000 commission cap applies to existing medical business. Existing medical business classification applies to groups that were unbrokered with the health plan at the time of the sale, and added a broker at a later date.

Broker of Record (BOR) on group accounts is eligible to receive commission according to the terms of the applicable Schedule A on the BOR effective date. A valid BOR letter must be presented on the account’s letterhead and signed by an officer of the account. BOR’s will be considered effective on the first of the month following receipt of the valid BOR.

Qualifying Agent/Brokers must have signed Agent/Broker and Business Associate agreements on file with Excellus BCBS including a current NYSID appointment to be eligible to represent Excellus BCBS products and receive commission payments. Agent/Broker must maintain all standards and provisions of the Agent/Broker Agreement.

Discrepancies in commission statements and other Agent/Broker reports must be raised promptly. Excellus BCBS will review commission questions and consider adjustments no longer than 90 days retroactively from the current month’s commission statement. For more information contact us at BrokerContractsExcellus@excellus.com

Producers must be appointed by Excellus BlueCross BlueShield.

Commissions, bonuses and the value of prizes will be reported to all groups of 100 or more contracts for their preparation of ERISA 5500 form whether or not they are required to submit a form. Only the amount applicable to that group will be reported to them.

Health Plan may change the rate of commission applicable to specific contract forms upon 30 days’ written notice and may impose rates of commission on new contract forms by written notice to Agent/Broker.

Note: Excellus BlueCross BlueShield reserves the right to alter or void the compensation program at any time in response to issues and conditions that affect the corporation, business, marketplace or economy. Entitlement to commissions and bonuses is subject to terms and conditions contained in the Agent/Broker Agreement. Excellus BlueCross BlueShield reserves the right to make final determination of eligibility for case (group/contract) credit, premium credit and commission/bonus payments.

If you have any questions about our program or product offerings, please contact your Account Consultant or visit ExcellusBCBS.com/Broker.

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