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HomeMy WebLinkAboutExhibit16Thank you for enrolling. Important information about your new health insurance plan. CIGNA At CIGNA, we believe that health insurance shouldn't complicate your life. That's why we've made it easy for you to get started: Step 1. Remove your ID Cards and carry them with you at all times. Step 2. Verify your coverage by confirming that the information above your ID cards is accurate. If your benefits are not correct, please call our toll -free customer service number at 1-877-209-7098 for assistance. Step 3. Fill out the Beneficiary Card (required) and Dependent Information Card (if applicable) which are located on the back of this page and return it to the address given. Step 4. Register your account at www.starbridge.com to gain access to online tools that will help you make the most out of your benefits. <Also, view health and wellness discounts through Healthy Rewards®.> Step 5. Below is a list of CIGNA HealthCare PPO Network* doctors in your area. This is not a complete list of doctors in the network. To get a complete list, call 1-877-209-7098 or log onto www.starbridge.com. Using one of these doctors will save you money and the discounts will help your benefit dollars go further. Anderson, Samuel M, MD 1224 E. Clemson Ave., Ste. 105 Phoenix, AZ 85014 (602) 956-9988 Adams, Julia S, MD 54486 S. 36th St. Phoenix, AZ 85021 (602) 412-5785 Carlson, Kathleen J, MD 9071 S. 54th St., Ste. 215 Phoenix, AZ 85271 (602) 704-1054 Frank, John B, MD 321 W. Cynthia Ave. Phoenix, AZ 85258 (480) 691-3369 Harrison, Robert K, MD 87756 E. Bm Rd. Phoenix, AZ 85016 (480) 918-2287 Lavine, Curt P, MD 37658 W. 79th St, Ste. 180 Phoenix, AZ 85254 (602) 214-3394 Morrison, Jane P, MD 987 E. Sycamore St. Phoenix, AZ 85024 (480) 854-9584 Sullivan, Michael G, MD 1125 N. 16th St, Ste. 430 Phoenix, AZ 85011 (480) 654-2294 Talbot, Aaron C, MD 7634 N. 36th St. Phoenix, AZ 85014 (602) 854-2842 Vernon, Kristen S, MD 1025 E. Cactus Rd. Phoenix, AZ 85045 (480) 684-0583 w benefits PNIVIC and • Dentist And s *snow vision Discount 14.41A llne,.ces wad . Meteas y� Ma.aa. My ia.H. Starbridge Limited -benefit health plan The Oxen -.. - ,�tittnisn.edi Ned tefind adotter. ski h.,.. When hospital earths.? wan yesctw+:aue+cinap ormelti..11cet WPM aspt pry the entrecoat ofyew M* to front. MMs Cast. Secafie sapenaiprk temp' owe totAe7eKfseles 061,MytM.e PLEASE won: The Yitaaxtor, eno13not tetbnAdtret netww'. you .have any questio ease call our Custot> t'r. ervice Departments 77-209 7098, Monda ay-5 am to 6 p•m (MS I neceslta esta nformacibn en„t spanol favor de rnarcar".el 17870 2 I pare habla j con ub top ese ttar t. sterviclos al cliente en' Espanol, ' mes a viemes`de las 5 an1 pasta, m (Hors de la Montana). 'lam plan: s rat a PPO proiiuc The reference to PPO r solely a•desoiptign,of the'netwctrk 1 ow hOva fable wlth ttws Brnited-beneM produc Underw itten and adm uslered by; Connecticut General <'. lrfe k>uuaiice Canpary Plan design and rates may vary ''CIGNA and CIGNA1-1 althCare refer to various operatingsiibsidiaiieso CIGNA corporation; ProdUd.sand>:: services are provided by these subsidiaries and not by. 'CIGNA : Corpo atton :,These";:subsidiaries : rrlclude ConrlecOcul General Lite Insurance Company. Tel Ong, Inc aM its aff3ates, `: CIGNA : tiehavroral Heal h ha. • krtiacap, and 1iNQ a service .company subsidiaries of CIGNA HeaJth Corporation and CIGNA Oental Health SBCII542 100407 Beneficiary Card/Dependent Information Card Please fill out and mail in a stamped envelope to: CIGNA HealthCare P.O. Box 55270 • Phoenix, AZ 85078-5270 1 YOUR NAME 2. SOCIAL SECURITY # ,� _ - _ _ _ _ 5. YOUR BENEFICIARY'S ADDRESS 3. YOUR ADDRESS STREET CITY STATE ZIP 4. BENEFICIARY Name of person who will receive benefit in the case of your accidental death. 4:s-� ✓"t'L. Yd.':L'�`k91' x:'.M..it:.f:�.:L:Wfi'.�..3m ._ ....v _.r v.. -a :.G'S(':3_ ADDRESS STREET STATE ZIP 6. AUTHORIZATION By signing below 1 confum that I have named my beneficiary SIGNATURE DATE a,:�.:•a,. z.';Ea:�.`x:.-s .c'F.:.....2.:::v;, �.�.. _.,�.�..-<-h.>v_ma.e . ,-._.a�,s.:--�c,:r��;-. DEPENDENT NAME DOB RELATIONSHIP Full-time student over age 19? O Yes CI No DEPENDENT SOCIAL SECURITY NUMBER DEPENDENT NAME DOB RELATIONSHIP Full-time student over age 19? 0 Yes O No DEPENDENT SOCIAL SECURITY NUMBER Company Name, Group # ': This is a partial listing of Participating. Pharmacies under the ScriptSave Select program and is subject to change. Many other pharmacy chains and local independent pharmacies also acceptyour card. Maintenance prescriptions; are available through mail order. If you have any questions, please call the ScriptSave Select Customer Assistance Call Center located :on the front of your Prescription ID Card. ACME: -Abortions Arrow Aurora - Bartell Drugs Bashas' Bi-Lo Bi .Mart Brooks Pharmacy Brookshire Brookshire Bros. Bruno's Caremax Cub Pharmacy CVS Pharmacy Dahl's Pharmacy Dillon's Discount Drug Mart Drug Emporium Drug Fair ;- Drug Warehouse Duane Reade Eckerd Fagen Pharmacy Farm Fresh Food City Food Lion Food World Fred Meyer Fred's Pharmacy Fruth's Fry's Gerbes Giant Eagle Pharmacy Giant Food Stores Hannaford Harmon's Harris Teeter Harvest Foods Heartland H.E.B. Hi School Hy-Vee ingles Kash 'n Karry Keltsch Kerr Drugs King Soopers Kinney Drugs Kmart Kopp Drug Kroger Longs Drug Stores Marsh Drugs Maxor Mays Drug Stores -Meijer NeighborCare Osco Drug Pamida Pathmark Pharmacy Plus Price Chopper (KS and MO Only) Publix Rainbow Foods Raley's - Ralphs Pharmacy Rite Aid Rosauers Safeway Sam's Club Sav-Mor Savon Drugs Schnucks Shaw's Supermarket ShopKo ShopRite Pharmacy Smith's Snyders Stop & Shop ',Super D Drugs Target .• Tops Pharmacy Ukrop's United Supermarkets USA Drug :` Valu-Rite . Waldbaum's • Walgreens Wal-Mart Weis Pharmacy • Winn Dixie Starbridge Choices - CIGNA HealthCare PPO TPv / Alanre Lo9O Provider Network CIGNA kbelUCCere PPO Coneetiblt General life Insurance Co 1pary Coverage Effective Oahe00/00/0000 ID: AMI woe: Member Name Account Number. 2466518 Employer Name: Employer Number: DOI Usrldor LAP Here Nelwak Sayings Program Starbridge Starnridge Choices Limited -Benefit Medical Plan vrvm.,moridgaChoic...coin doctor Visit $25 Specaist $25 Nenwrk Co%tstaaft0e: In 9396/2O% Out 8096/2096 www.starbridgechoices.com You May be sated to present this card when you receive care. The curd doss not guarantee coverage. You mule GOT* sell >t panne and commons a the pn wela misuse or this cad considered baud. Rd plan does nor require pre.catiicseon d °avenge lor Inpatient or outpatient seniors. Paine sit be pad accadi g to terms and Canc elons a the pin. In ere case a an enwgencx seek care ern* deta4t ihen W your ten* "seen for further assistance am deedion rogueing lobo up Cara Send Clare to: TPv / Mare WON Address Al orere to CIGNA Ne0tllCa.. P.O. Box 5909. Scranton. PA 18505 Payer6230e Customer Service: 1.800.XXX.XXXX Provider: Insured is auobed in a knited-0ePSPt pan. For hospital saviors. collect patient responsibility when service is rendered or make financial arrangements with the patient in accordance with your policies. This notice applies to residents el Louisiana: Notice: Your stave of the payment for hearth care services may be based on the agreement between your health pan and your provider. Under certain 0leumstanees. this agreement may allow your provider to bill you tor amounts up lo the providers regular baled Chats. AWAY FROM HOME CARE . Sturbridge Choices .:2(1.N.A IGNA Member Benefit Portal - Home Page .F4e: Fal.crites" • Tool • Help : rik Back . x ) Search Favorkes ' - -3 IAddress 1,0.1 httpslimembers.starenroliment.com/portal/server.pt Starbridge Choices A CIGNA beistrCare Frye_ • • ,-help contact us 1, log off Home ' Home My Benefits Find a Doctor Find a Pharmacy Vision Discount Health Resources Healthy Rewards Contact Us Manage My Profile Wekome This portal is an online resource designed to help you make informed health care choices for you and your family. These tools can assist you in saving money and getting the most out of your benefits. Here's what's available to you: > Find a doctor in your area on the Find A Doctor page > Check your coverage on the My Benefits page > Browse the latest health information, tips and trends on the HealthResources page > Review your claims history from the My Benefits page > And much more! "CIGNA" and "CIGNA HealthCare" refer to various operating subsidiaries of CIGNA Corporation. Products and services are provided by these HIPAA NFPP Terms operating subsidiaries and not by CIGNA Corporation. These operating subsidiaries include Connecticut General Life Insurance Company, TeI.Orug, Inc. and its affiliates, CIGNA Behavioral Health, Inc., Int racorp, and HMO or service company subsidiaries of CIGNA Health Corporation and CIGNA Dental Health, Inc. Copyright ©2004 StarbridgeChoices.com. All rights reserved. Ed. 20041030 Page 1 of 12 CIGNA Starbridge Choices Member Benefit Portal - My Benefits Coverage t-isultirCdj' F., `r • File Edit FasMt ; Svc Help .., .vey °,.}.vIca, ec �" I.-:' Search im' Favorites a C »' i Address 141 https:EJmembers.starenroNrnent com/portal/server.pt?space=Opener&contral=OpenObject&cached=trueeparentsame-ConrnurityPage&parentid=tear J Go • J Starbridge ChozCCs A CiGNA HeaH"Cer? Frx:icz > help a contact us > log off 1 ' i•ome My Benefits > Coverage > Claim; ;> Form: > Update Benefit; Find a Doctor _ ind a Pharmacy bision Discount health Resources healthy Rewards FAQs Contact Us k Manage My Profile` ry Your Personal Coverage Summary MEMBER ROBER) DEPENDENTS GROUP Group Name: ACME Company, Inc. Group t: 9999 COVERAGE Coverage Level: Employee pkis one Child Effective Date: 1 /1 /2007 To view your personal coverage summary simply click on tte plan below. Level 1 Dental Package Request ID Card Note: Enrollment updates may take 4-6 weeks to be reflected in the system. "CIGNA" and "CIGNA HealthCare" refer to various operating subsidiaries and not by CIGNA Corporation. Inc. and its affiliates, CIGNA Behavioral Health, Inc., Copyright e2004 opera_ing subsidiaries of CIGNA Corporation. Products and services are provided ty these HIPAA NFPP Terms -. Thep operating subsidiaries include Connecticut General Life Insurance Company, Tel -Drug, Intrazorp, and HMO or service company subsidiaries of CIGNA Health Corporation and CIGNA Dental Health, Inc. StarbridgeChoices.com. All rights reserved. Ed. 20041030 4.1 Page 2 of 12 i1.7NA Starbridge Choices A Member Benefit Portal - My Benefits - Temporary Medical ID Card Acme Company, Inc. Temporary cards do not contain all the information on the actual ID card and they expire soon - in ten days. If you are a new member, your permanent ID card should be arriving soon. If you need to replace a missing ID card, please contact customer service at 877-209-7098 Temporary Id Card Expiration: 10/05/2007 r Starbridge Provider Network: CIGl1A Health are PPO Starbridge Choices Connecticut General Life Insurance Company Limited -Benefit Medical Plan www.starbridgechoices.com Coverage Effective Date: 09/05/2007 ID: 763181501 Name: JOHN MILLER Account Number: 2466518 Employer Name: sbc Associates, Inc. Employer Number:701 1 Doctor Visit: $15 Specialist: $50 Network Coinsurance In: 75%125% Out: 80%/20% www. darbridgechoices. com 'Yap may be oared to praert tFis a rd w+enyw reodoe a re. TNs a rd e r rot Fa re race • os.,cage. You mint Gans* 'tithe ltleterms ranlaanidorsafthe Fbrt VAWWI. o a=of t Pis a rdis aorademd fraud. TN: Find— rot ns}i re pea rtifiationof oxcart fori rptiert orcutptiert senioe. ChimsriLLbe pidsowed rgtotermsordo>rdtiorsof tIe Fin trite seeks lei mmedatel/ gems LLyturfemiyptyidsnforfuthereZi:sroe oofdroaion ovr mina folbwupa re. Send Medical Claims to: CIGNA HealthCare P.O. Box S909 Scranton, PA 18S05 Payor:6Z303 Customer service:017-201}7o is IROVIDER: Irnneiisenoll dino Imired-benefit phn For Reprolseruos, o>Ueat pried reporofiftyvkeneeruxis rerde.edormekefirsroarlone rgemedswith the ptiertin ooa>mh roe xithywr polo e:. Tfe folb i rg rotiae ■ mac to rdderss of leader.: NOTICE: Ycur she re of the primer* for !so 'thorn re eeruaes may be lanai onus. .semen ter+.een ytur ha hh Fie no rd your Frr>vder. Il rderaertri nai mimeo roes, Ills oareemert may to lbw your Provider to li llyw for omains upto the povideesmph rbUoiahryes. AWAY FROM HOrtE CARE Page 3 of 12 CIGNA Starbridge Choices Member Benefit Portal - My Benefits - Claims 4 C. ';r. +-laa,rr,Car i=-o! f - ^m. C:r .•l .a . r ,onc -- +_--- ^air.... _ - - �;.0 Sac( ,- i x1 i t �"'� 1 ^t Scorch `' Favorites �!�f? _ ...r• ,. ; � •� �. 1 1 Lnt z » l 1 Lt c .� i Address __-1: 3 . https:j?members.starerroilment.cornjp rtaljserver.pt'space=Opener&contral=OpenObject&rached=trueErparentname=C yPage&parerrtid=4&irl 0 Go Starbridge Choices A �,li-.IJ4 hraallFCa a Frli;i ? help ti contact us > log off I .._.. _ . , _ _ . _. ,...-.----, Track and review your clam history quickly/ and easily online. You can review all claims submitted by your provider or 1-ome yourself within the last 12 months of your coverage. You can also review your claims payment history and check the My Benefits status of individual claims. ` > Coverag? > Claims The information provided represents all claims received and processed to date. > Forms > Update Benefits When checking on the status of your claim you will need to be familiar with the following terms: Find a Doctor g Find a Pharmacy 1. Processed: This status indicates that the specific claim that you are checking on has ixen received and has 1+rsion Discount _ been processed by our Bairns unit.* health Resources 2. Received: This status indicates that your claim has been received but has not yet been processed. i t-ealthy Rewards 3. Explanation of Benefits: A statement detailing your benefits account activity, containing complete FAQs information about the services provided and charges paid. - 4. Benefits Paid: Is the amount paid to the member or provider of service by Star HRG after all applicable co - Contact Us pays, deductibles and percentages are applied Manage My Profile - Date of Service - '• -' Physician t Facility Claim ' Number Status . Totai " Charge Explanation of Benefits UNITY HOSPITAL HARRISON Click here for 3/18/2007 0103260760348 Processed S340.00 COUNTY COMM details Click here for 2/15/2007 TH CT NORTH MO FAMILY HEAL 0103020752316 Processed $75.00 . details .: •;; UNITY HOSPITALHAPPJ50h1 Click here far 7/17/2006 0108040660526 Processed S54.50 COUNTY COMM details Click here for • 7/17/2006 THCTNORTHMOFAMILYI-IEAL 0107310653304 Processed 575.00 details "CIG'IA" and "CIGNA HealthCare" refer to various operating subsidiaries ofCIGNA Corporation. Products and services are provided ty these HIPaA NFPP Terms }4) Internet Page 4 of 12 I(,N.A file: "Edit Toi_k Starbridge Choices Member Benefit Portal - Forms Search Favorites I ' s Address 1-03 https:JJmembers.starerwogment.comjportaljserver.pt?space=Opener&control=OpenObiectatcached=trueaparentname=CommuntyPageefrarentid=4&ir� 0 Go thCarc• Frot`.:c- J Starbridge CIOices A CIGNA Hedt`cars > help : contact us > log off Home i Myf Benefits > Coverage > Claim; Forms ) Update Benefits Find afDoctor Find a Pharmacy Vision Discount Health Resources ! 1' Heed a form? No problem! Simply download the form you need and print it out. Note: Download times may vary based on the file size and your connection speed. You may choose from the following forms: Claim Identification Form Our goal is to provide timely and accurate processing of your clams. Submitting this form completed and sued with your claim helps us meet that goal. Healthy Rewards Dependent Verification Form FAQs `. Contact Us !. Manage My Profile Complete and include this form when submitting a claim for a dependent. Authorization from Individuals This form is required under the Health Insurance Portabiity and Accountablity Act of 1996 (HIPAA Privacy Act). The form confirms the authorization from an individual for StarHRG A Business Unit of CIGNA HealthCare to use or disclose protected health information for a particular purpose. The form can alsobe used to appoint an individual to personally represent an insured person. Beneficiary Desionation Notification Completing and returning this form allows insured person to pay a chosen beneficiary upon his or hers death. mc.rAaReader' edit. Adobe Acrobat Reader 6.0 or above is required to view downloadable forms and information on your claim. If you do not have the most recent version you may download it for free, click here. "CIGNA" and "CIGNA HealthCare" refer to various operating subsidiaries of CIGNA Corporation. Products and services are provided by these HIPAA NFPP Terms [ 1tsi >irternet �:- J Page 5 of 12 CIGNA Starbridge Chozces Member Benefit Portal - Find a Doctor Ai ,•'�P,19 1+ya+rr,Car F>at. Starbridge Choices Ao' 1•reehrmCareForw Help a Contact Lis a Log Off i Home My Benefits Find a Doctor > Highlights find a Dentist Find a Pharmacy Vision Discount : Health Resources Healthy Rewards FAQs Contact Use Manage My Profile CIGNA Find a Doctor Don't have a doctor? To firvi doctors that are closest to you, click the link below and simply enter your zip code. A fist of doctors in your area wi appear. To refne your search, you may provide more detailed information such as you maim address or doctors specialty. The doctor search uses the CIGNA PPO MI Network. With this plan, you have the freedom to visit any doctor, healthcare center or hospital of your choice. Need to find a doctor, dick here. Which Hospital can I use? With your plan you can choose your own hospital. Most hospitals wi NI us directly for any charges you incur. However, on occasion, some faciities may ask yt pay the entire cost of your services up front. In this case, you can fie a claim with us for reimbursement of these costs up to your Maximum Benefit Amount. Ya. may view and print forms by going to the "Forms" page under "My Benefits'. PLEASE NOTE: The fist of doctors should not be considered a recommendation or endorsement of doctors. ;id 'C,1J11, fej,:c te, car \tt.',,pi.ratirq ::Z:ltit, 2 1)e-l'viLt Ct.rpq/3tinn, and ._.. f.vah.idid tra .iGN31. J: �,fl itici TiY•". r,-snit.:.rhidiariesl.rrt._.t:r:rr:icy! irm.ralUfa 4rc:ar,:..,?+0u.1,:..:niiriG;- !GSA �-.'a.,i.:aNea+��la:, ..r.-.,a:M+ xuirs.:0T.parlf:ut•::i.iatie:otiaia::k Hvah Coror.ratim and CIGJNd Lh7:tal Fleas+h, rtt. i M,ti3ht+iil+;9 iN nzt'i roastvid cal ;rdi=ili Hh'i j rj:?F ! i?im Page6of12 1( A CIGNA .1 gl;sl:i:. Sturbridge Choices Member Benefit Portal — CIGNA Provider Search Provider Directory Provider Directory ( CIGNA HealthCare Physician Directory C CIGNA HealthCare Hospital Directory C CIGNA Facility & Ancillary Directory" Some doctors who participate in your plan may have admitting privileges only at hospitals that do not participate in your plan. Please check with your doctor to find out where he or she has admitting privileges. If you get care at a non- participating hospital, you could receive lower, out -of -network benefits. Remember, for emergency or urgent care, go to the closest hospital. ontinue Search` *" Facility/Ancillary services include but are not limited to: Dialysis Services, Durable Medical Equipment, Home Health, Laboratory Services & Prosthetics. Please check your plan or program materials for more information. © 2006 CIGNA Page 7 of 12 C.lGNA 3-set : Cr?t.,Pf i'anuiku,It,t,irus.f0aiNtofi Starbridge Choices Member Benefit Portal - Find a Pharmacy (1 E+k Fen Favorite; Tuns 1+aC j it 1 13 bed �i x (��I Search . Favodtes 4,01 r g ,i �� I !Lift IPalens. `httpar-/erwrees.RrenroMere.taNportdJurw.pVspace.OpenerYontrolmCmeriObjecteeachedwtrueborentrianedarmsvtyPeoeepsercfd_2le• Go Starbridge Choices a cum m hm SI Cwirmucm help :contact us slog on Nome M7Mrtrafits ,.._- • find s Doctor • Plod is Pharmacy IeMN/tts Vision Oiscount� Health Resources Healthy Rewards Contact th Menage My Profile - +--.— ^itl_i w Gil r!r,]:.;' icrif.ASava. Sel4Iii Discaunt Pra_cr-ip?:pn : et'wott: You and your family ere artomsticely emoted n the SereeSave fe eCtWescrptbndroC muMes pregrala this proven includes a rational network of over S2,000 pharmacies wade w or hdeperident as well as major Main. supermarket and retail pharmacies across the Lmhed States. Me ScrOtSeve Select program is most M.Ny accepted at the neignhorhood pharmacy you currently use. Me Seriatim* Lent Program also offers: • average savings of more than 21%en both trend name and generic prescriptions • No limits or caps on usage • As easy-to.se program with no paperwork to co.r eta • Savngs br everyone in the household regardess of age Find a Participating Pharmacy Otte here to access the SeriatSave Select Oiscauit Enter tale Group master that appears on year Preto l Fie .' Egg Nosy '.pas6tes ' Tocld _.' -ielP •`. participating pharmacies within that sip code. Ifa gads'' M v `� rl SerA. 1.;se Hears eye 'Ergs 1.61— :glletp:jl' r tydicsag f gamete to to .sores aveselect.comMakome.aspx8electOwSTMt ..— SCtki PTSAVE:. SELEir A Prescription Savings Program You Can Plan 0 hMmap;: Congratulations! Your organization is $ponaotng ins ScdptSays Sited prescription drug discount program. You can use the Scnp6ava Salad websNe to Vie )our addNional information stout Pe price Per oryour prescrip0Ons• or where to And a pharmacy. It`4 Oul-of-Pocket Savings and Service on All Your Prescriptions A ".P.i Hclaar:Car_'FrYx' Find A Pharmacy To hearth for a pharmacy In your ma: enter your sap code. and click Slants' ... Search eaFind aPlo,n cy 6.1 Mnswars to f.DPr.egy Asked Orn.Mons CDLeak up a Drug astls. Drug Rice Tier Look -Up Teel CaN M friendly and km oodgeabie Scripeave Select Customer Care team ifyou wantlo have another card mailed to you or if you have questions. We a toil -see cat Customer Care representalives are Mere to firer you Positively Outstanding Sonic* linty lime you call Call Toll-Free:1-866-225-3554 Weekdays 9:00 a.m. - 8:00 p.m. EST Page 8of12 aEittartan•ageSitsae8 = icsoiuT p L_I 'search C7 FevorRes• Address. ` http:jlwww,en econ filth GN I Starbridge Choices FlealthCare Pradj:.:r Member Benefit Portal - Vision Discount am ale �1 xJ t`' - .LJ LJ: :• �) ward, C'^� Favorites t' I ._ r ..j.,. l r. u is S '�` (Address 14.1https:umambers.starenoMnt.comfpertalfserver.a?s e-OPeneracon6'd•.Opy+ObIKtacached•true90arentnar.e-ConrdxrtyPageepareotid.22&J '` Go . Starbridge Choices A QOMrir~r,G•..Frtotttm - help contact us log off I. Home My benefits 11. I 'rind a Doctor 'rind a Pharmacy__ i Vision Discount HtiPPRI is Health Resources • Healthy Rewards - i contact us = l Manage My Profile You and your faulty are enroled n the Vision One Network which is honored at more than 6,500 locations nationay. Youl save on al eye care needs including eye exams, frames, lenses and contacts. You' save up to 60% on frames and lenses and up to $loon eye examinations. This discount program is not insurance. Cnck here to find a list of participating vision care centers. • 'CIGNA end "CIGNA Healtli are' refer to various operetirrt cperathg subsidiaries and not by CIGNA Corporation. These 0 arc. and its anliates, CIGNA Behavioral health, Inc., intraeor Copyright 02006 Starbridy FIND A PROVIDER Provider Locator Enter your information below for an instant listing of the providers most convenient to you. Because plans may vary, please call your chosen provider to verify his or her participation in your plan. This listing will not include laser vision correction providers. Participating providers can only be obtained by calling 1-888-705-2020. * You must enter a plan number and rip code in order to submit the provider search Repiaciig t Lost identification"Card The participating network provider uses the information on the Vision ID Card to verify eligfility and plan coverage for the participant and eligible dependents. If you have lost your ID card, simply click here to download and print a new ID card. Fill out the appropriate information prior to making an appointment or visiting your network provider. ",4D Cone 77 '1 I i Lrterrbt. Page 9 of 12 CIGNA Starbridge Choices Member Benefit Portal — Health Resources A i-,eal."Cia _ Fry, A .. .. .... .�'_-J._! 58E EGerlbec arRiurut7t ; 7r � -v 1 v ` .. �..: `� , m: - ' ?s ' X _ fie Edit ;'.:vieoM Favorites ;.Tools ..:,Help ...:. .. c -14 Back ... %�! " �%Search � Favorites' . T. 6y '� `' : ibl. .:a 1 Address l � hops://membe s.starenrorment.cariJportal(server.pt%spare=Openx&coxitrol=GpenObject8cached rue&parentname=CommurwtyPage&parentid=2 J Go Starbridge Choices A C1C,NA Neeetr.Care F od,cr .' help ? contact us > log off , r Hi,at to r.esCoui : - -r . , 't11 (AGM 24-Hour Employee- Assistance Programs Staying healthy is easier than ever. You can find links to several different health resources to help you make informed health care choices through the CIGNA 24-Hour Employee Assistance Program sm. Some topics include: • Family and Caregiving (examples include: Adoption, Chid Care, Parenting, Senior Care,Education, Pet Care) • Health and Wellness (examples include: Live Healthy, Health and Aging, Children's Health, Common Health Concerns) • Daily Living (examples include: Consumer Information, Travel and Recreation, Finances, Legal Issues) • Working Smarter (examples include: Teambuildirig, Career Transition and Growth, Supervisory Issues, Diversity, Productivity, Recognition) Caick here to visit this website. '`"- Home My Benefits Find a Doctor Find a Pharmacy Vision Discount Health Resources > HigNights Healthy Rewards FAQs _ _ Contact Us ` Manage My Profile - --•--- - -- - Once you have entered the website, you can also click on the mycarealies.com Zink to access additional medical health information including: • Your Health Library - an interactive source for thousands of articles. (examples include: illnesses, symptoms, medications, first aid, and wellness) • Smart Health Tools - a series of interactive questionnaires that provide personalized guidance. (examples include: related to health issues, access to online resources, and assistance with making smart health decisions.) • Smart Tart Newsletter - Quarterly online publication providing in-depth information on the health topics everybody's talking about. (examples include breakthrough new drugs and medical procedures.) 24-Hour Health Inforrnatiorn Line 24-Hour Health Information Line provides your employees and their famly members with tol-free access to a registered nurse any time of the day or night, seven days a week, for helpful medical information and advice. Carers can get answers to their health questions, direction on when and where to seek medical attention, and suggestions for home care. Call to speak with a registered nurse 24 hours a day, 7 days a week 1-866-909-3461. vi https://members.starenrollment.com/portal/server.pt?space=Opener&control=OpenObject&rathed=true&parertnametCt re .16 Internet , Page 10 of 12 LGNA Starbridge Choices Member Benefit Portal — Healthy Rewards i.. (.. i ..::f :=- Hr^iiErrCare Prix:..': sa tatYuaawi<itiE ham. en�st a" _ > 1 3�'� 3�. G(.. a. _ 4 u a .. 3 ir' ,N 't..,k — 0 J l � .". Milt' Vie W Fa`ror'tes -. Tocis , i-iel '. .-, - . - -. _ . i : ft ',t�. i » •-: Search uFavorites ' i r ._ J Lnk' I Address 1't https://members. starenrollment.com/portal/server,pt?space=Opener&cantral=OpenObject8cached=true parentname=CommunityPage&parentid=24& J :� .Go ' Starbridge Choices a C:GNA tiwdcK we F^rn�� -, help ..• contact us r log off Horne H =i t., t; ' ^, .70-ds. My Benefits ^ " Find a Doctor Find a Pharmacy ' Healthy [ 'i�, zu—(1 F'- I\lember I±1 (_t:;ltii} i iC;`c'7'.:11(! : Vision Discount Weight Management and Nutrition Health Resources • Healthy Rewards Fitness Club Discount; > Highlights FAQs Choose a participating facility and you'll have access to fitness activities from aerobics to weight -lifting -at a discounted rate! Find a fitness club*. Save on home fitness equipment : Contact Us also. i Manage My Profile Savings: Up to 60% Just Walk 10.000 Steps-a-DayTM Become more active and take control of your health just by taking 10,000 steps a dais. Curve;,: Get and stay in shape. Popular fitness clubs geared to women. Over 7,500 Iocations in the U.S. S49 service fee (discounted from up to $149) on a 12-month check draft membership at a participating Curves faciity (565 in Canada). Members are responsible for monthly fees. Take your CIGiIA ID card to a Curves location. Savings: Up to 68% _ Vision and Hearing Care Tobacco Cessation Alternative Medicine "find/Body Dental Care ritamincHealth anti WPIIc7PSi Prndnrta .; i ! FS f i Internet , Page 11 of 12 CIGNA MerAber roMMUnitY _ • - Member Benefit Portal FAQs EVPIrer,, Starbridge Choices :iitt•Ceirs F t:teszt_' T.ot:,"I's Eitet Fav Hpe.. Backi , i search ?Favorites il, i ; ; . • . ... 'Address 1.#1https://mernbers.starenrollment.comiportaliserver.pt?space=Openerecontrol=OpenObject&cached=trueEparentnarne=CommunityPagaparentidw25&2ifl•.c.-:' Starbridge Choices A cx-..,NA 1-1EuttICare Pryi...,..1 .> help > contact us 7.- log off • _..--------------- - _ - - .. We 1,-,no ve that insurance can be confusing, so we have supplied you with a iist of most frequently asked questions Home . listed in the left hand navigation regarding the Starbridge Choices plan. If you feel that your question has not been 1. My Benefits answered, please call us toll free at 1-877-209-7098. •.. • :: Find a Doctor ' . Gettino Started : Find a Pharmacy i Vision Discount •., Can anyone use the Starbridoe Choices member portal? $ ' Health Resources • ' I - Is Starbridoe Choices a maior medical plan? Healthy Rewards FAQs .., What rules govern my medical expenses?. > Getting Started - Who is the insurance company behind Starbridoe Choices? j > Using My Benefit; . , ). Claims and Billing :, who clays the claims? • . ! . > Provider/Hopital Search > Contact Info , This reference page is a brief summary of the benefit plan and related questions regarding such. The Insurance Certificate, the Insurance policy and state specific variations, are the official documents governing this plan. ,! Contact Us Administered by: Manage My Profile — 1 Star HRG ! P.O. Box 55270 Phoenix, AZ 85078-5270 "CIGNA" "CIGNA HealthCare" refer to various operating subsidiaries of CIGNA Corporation. Product and services are provided by these HIPAA NfPP Terms . . and operating subsidiaries and not by CIGNA Corporation. These operating subsidiaries include Connecticut General Life Insurance Company, TeJ-Drug, ..• Inc. and its affiiates, CIGNA Behavioral Health, Inc., Intracorp, and HMO or service company subsidiaries of CIGNA Health Corporation and CIGNA Dental Health, Inc. Copyright 02004 StarbridgeChoices.com. All rights reserved. Ed. 20041020 • _ — s,--5 • • ......,. ...„... .• . ;..2.. ..,_, .•, . ..-. pi -, 1 1 I.. 1 1/) Internet . ..- .....: • :::-.-,5s . . .. . . . _ Page 12 of 12