2021 BENEFITS SUMMARY Blue Cross and Blue Shield

2021 BENEFITS SUMMARY Blue Cross and Blue Shield Service Benefit Plan

WE G I V E Y O U T H E C O V E R A G E Y O U N E E D. S O Y O U CAN TA K E C A R E O F W H AT ’ S I M P O R TA N T. For 60 years, we’ve been proud to be the #1 healthcare provider for federal employees, retirees and their families. And during these uncertain times, we want to uphold that trust by helping you focus on what matters most: you and your family’s well-being. Now more than ever, your coverage shouldn’t be something you have to worry about. 2

W E ’ R E H E R E F O R YOU During the COVID-19 pandemic, our coverage commitment is to ensure our members can quickly access the right care at the right time. FEP continues to waive cost shares and prior authorization to support members’ care for COVID-19. Learn more and stay up to date on our COVID-19 resources and coverage at fepblue. org/coronavirus. 3

AGENDA • The Basics • Benefit Plans • Pharmacy Benefits • Wellness Programs & Tools • Blue Cross Blue Shield FEP Dental • Blue Cross Blue Shield FEP Vision 4

THE BASICS 5

THE BASICS We have plans designed to fit every need and budget. S Standard Option B Basic Option F FEP Blue Focus With each of our plans, you’ll receive: Free preventive care from Preferred providers Referral-free care from specialists Worldwide coverage Wellness rewards and discounts 6

THE BASICS You can choose to cover: Yourself with Self Only You and one other eligible family member with Self + One You and multiple eligible family members with Self & Family 7

OUR NETWORK With a large nationwide network of doctors and hospitals, in-network care is never far away. 96% 95% 60, 000 of hospitals of doctors retail pharmacies Members of all three of our Plans have access to the same network of Preferred providers. 8

FIND A PROVIDER You can find a Preferred provider three different ways: Online at provider. fepblue. org. Via the fepblue mobile app. By calling the customer service number on your member ID card. 9

PREVENTIVE CARE When you see a Preferred provider, many preventive care services come at no cost to you. • Annual physicals • Blood pressure screenings • Cholesterol screenings • Well-child visits • Diabetes screenings • Flu shots • Shingles vaccinations • Cancer screenings • And more 10

GET CARE ANYWHERE With telehealth services provided by Teladoc®, you can meet with a doctor 24/7 to get care for minor conditions by phone, video chat or Teladoc app. In addition to general medical services, you also get access to: Behavioral health consults NEW Dermatology services Nutritional counseling Starting in 2021, you can receive covered telemedicine services offered by doctors outside of the Teladoc network. If you visit a non-Teladoc provider over the phone or by video, you will pay your regular cost share based on the service you’re receiving. 11

BENEFIT PLANS 12

BENEFITS AT A GLANCE S B F ✓ ✓ ✓ Out-of-Network Care ✓ X X Preferred Drug Coverage ✓ ✓ ✓ Non-preferred Drug Coverage ✓ ✓ X Access to Mail Service Pharmacy ✓ X* X Medicare Part B Reimbursement - $800 X ✓ X In-Network Care *Available if you have Medicare Part B primary. 13

DEDUCTIBLES Standard Option Basic Option FEP Blue Focus Self Only $350 $0 $500 Self + One and Self & Family $700 $0 $1, 000 *If you have Medicare Part B Primary, deductible, coinsurance and copays are waived, except for prescription drugs. 14

Out-of-pocket maximum (Preferred providers) Standard Option Basic Option FEP Blue Focus Self Only $5, 000 $5, 500 $7, 500 NEW Self + One and Self & Family $10, 000 $11, 000 $15, 000 NEW 15

WHAT YOU’LL PAY IN PREMIUMS Standard Option Non-Postal Premium (Bi-weekly) Postal Premium (Bi-weekly Category 1) Postal Premium (Bi-weekly Category 2) Self Only (104) Self + One (106) Self & Family (105) $123. 45 $280. 81 $300. 12 $120. 09 $273. 62 $292. 31 $110. 03 $252. 06 $268. 89 16

What you’ll pay in premiums Basic Option Non-Postal Premium (Bi-weekly) Postal Premium (Bi-weekly Category 1) Postal Premium (Bi-weekly Category 2) Self Only (111) Self + One (113) Self & Family (112) $78. 60 $189. 17 $201. 27 $75. 46 $181. 98 $193. 46 $65. 24 $160. 42 $170. 04 17

WHAT YOU’LL PAY IN PREMIUMS FEP Blue Focus Non-Postal Premium (Bi-weekly) Postal Premium (Bi-weekly Category 1) Postal Premium (Bi-weekly Category 2) Self Only (131) Self + One (133) Self & Family (132) $53. 14 $114. 25 $125. 67 $51. 02 $109. 68 $120. 65 $44. 11 $94. 83 $104. 31 18

WHAT YOU'LL PAY FOR COMMON SERVICES AT PREFERRED PROVIDERS Benefit Standard Option Basic Option FEP Blue Focus Primary care doctor $25 copay $30 copay Specialists $35 copay $40 copay $10 per visit for your first 10 primary, specialty and /or telemedicine care visits Virtual doctor visits by Teladoc® $0 first 2 visits $10 all additional visits $0 first 2 visits $15 all additional visits $0 first 2 visits $10 all additional visits Urgent care centers $30 copay $35 copay $25 copay Maternity $0 copay $175 inpatient $0 outpatient $0 for doctor's visits $1, 500 for facility care If you have Medicare primary or receive care overseas, different cost share amounts may apply. 19

WHAT YOU'LL PAY FOR COMMON SERVICES AT PREFERRED PROVIDERS Benefit Family Planning Standard Option Basic Option 100% Preferred Provider 100% Preferred (PPO) Covered Provider (PPO) Covered FEP Blue Focus 100% Preferred Provider (PPO) Covered 35% *Non-PPO Services associated with the fitting, insertion, implantation, or removal of the contraceptives listed Based on Plan Allowance • • • Depo-Provera Diaphragms and Contraceptive rings IUDs & Implantable contraceptives Services associated with the fitting, insertion, implantation, or removal of the contraceptives listed • • • Services associated with the fitting, insertion, implantation, or removal of the contraceptives listed Oral and Trans-dermal contraceptives Voluntary Sterilization, including Vasectomies Contraceptive Counseling If you have Medicare primary or receive care overseas, different cost share amounts may apply. 20

WHAT YOU'LL PAY FOR COMMON SERVICES AT PREFERRED PROVIDERS Benefit Standard Option Basic Option FEP Blue Focus Inpatient hospital $350 copay $175 per day; up to $875 per admission 30% of our allowance* Outpatient hospital 15% of our allowance* $100 per day per facility 1 30% of our allowance* Surgery 15% of our allowance* $150 in an office 1 $200 in a non-office setting 1 30% of our allowance† ER – accidental injury $0 within 72 hours $175 per day per facility NEW $0 within 72 hours ER – medical emergency 15% of our allowance* $175 per day per facility NEW 30% of our allowance* If you have Medicare primary or receive care overseas, different cost share amounts may apply. *Deductible applies. See previous page for deductible information. 1 You pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. †Deductible applies. In addition, you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. 21

WHAT YOU'LL PAY FOR COMMON SERVICES AT PREFERRED PROVIDERS Benefit Standard Option Basic Option FEP Blue Focus Lab work (such as blood tests) 15% of our allowance* $0 copay 1 $0 for first 10 specific lab tests** Diagnostic services (such as sleep studies, *X-rays and CT scans 15% of our allowance* Up to $100 in an office 1 Up to $150 in a hospital 1 30% of our allowance† Chiropractic care $25 for up to 12 visits a year $30 for up to 20 visits a year $25 for up to 10 visits a year 2 Physical Therapy Occupational Therapy Speech Therapy $25 Primary copay $35 Specialist copay 35% NON-PPO after $350 CYD 75 visits person, per calendar year for any combination of the three therapies $30 Primary copay $40 Specialist copay 50 visits person, per calendar year for any combination of the three therapies If you have Medicare primary or receive care overseas, different cost share amounts may apply. *Deductible applies. See previous page for deductible information. **Please see brochure for covered lab services. 1 You pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. 2 Up to 10 visits combined for chiropractic care and acupuncture. †Deductible applies. In addition, you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. $25 copay 25 visits person, per calendar year for any combination of the three therapies. 22

NEW FOR 2021 S B We provide benefits for hearing aids up to $2, 500 every five years. Previously, we provided benefits every three years. F We will provide benefits for continuous home hospice care at no out-ofpocket cost to you. Previously, you paid 30% of our allowance. To see a full list of benefit changes, download our brochures at fepblue. org/brochure. 23

MEDICARE REIMBURSEMENT ACCOUNT (MRA) B BASIC OPTION ONLY • Basic Option members enrolled in Medicare Parts A and B are eligible for up to $800 reimbursement account (optional enrollment) • The member must pay for Medicare Part B to qualify for MRA • Each member on the contract with Medicare Part A and Part B is eligible to earn up to $800 in the calendar year • For assistance members may call 888 -706 -2583 or visit www. fepblue. org/mra 24

PHARMACY BENEFITS 25

PHARMACY PROGRAMS We have three pharmacy programs designed to get members the prescriptions they need conveniently and affordably. S B F Retail Pharmacy Program ✓ ✓ ✓ Mail Service Pharmacy Program ✓ X* X Specialty Pharmacy Program ✓ ✓ ✓ *Available if you have Medicare Part B primary. 26

FORMULARY We organize our list of covered drugs by tier on our approved drug list. This list is called a formulary. In general, the lower the drug tier, the more cost effective the drug. See the full lists at fepblue. org/formulary. 27

STANDARD AND BASIC OPTION DRUG TIERS Standard and Basic Option have five drug tiers. Tier Drug Type Characteristics Tier 1 Generics Most affordable drug type. Equal to brand name counterparts in quality, performance and intended use Tier 2 Preferred brand name Brand name drugs that are cheaper and as safe and effective as Non-preferred brand name drugs Tier 3 Non-preferred brand name Safe and effective, but have a high cost because there’s a generic or Preferred brand name alternative available Tier 4 Preferred specialty Drugs used to treat complex health conditions. They are cheaper than their Non-preferred alternatives Tier 5 Non-preferred specialty Safe and effective, but you’ll pay more for these specialty drugs because there is a Preferred specialty drug available 28

FEP BLUE FOCUS DRUG TIERS FEP Blue Focus only has two drug tiers. TIER 1 TIER 2 DRUG TYPE PREFERRED GENERICS PREFERRED BRAND NAME, PREFERRED GENERIC SPECIALTY, AND PREFERRED BRAND NAME SPECIALTY CHARACTERISTICS MOST AFFORDABLE DRUG TYPE. EQUAL TO BRAND NAME COUNTERPARTS IN QUALITY, PERFORMANCE AND INTENDED USE PREFERRED BRAND NAME: BRAND NAME DRUGS THAT ARE SAFE AND EFFECTIVE SPECIALTY DRUGS: DRUGS USED TO TREAT COMPLEX HEALTH CONDITIONS 29

NEW FOR 2021 S B F Pharmacy Benefit Changes Preventive Care Bowel preparation medications associated with colon cancer screenings • $0 cost share for first purchase of certain bowel prep medications at a preferred retail pharmacy. Certain HIV medications for members at risk for HIV $0 cost share 30

NEW FOR 2021 S B F Pharmacy Benefit Changes FEP Blue Focus ONLY: Formulary Adjustments • 10 Additional Drugs Excluded • All excluded brand drugs have a therapeutic equivalent − Member Impact: 17 nationally • Drugs excluded on Basic Option are always excluded on FEP Blue Focus − Impacted members are notified during Open Season Download the updated drug lists at fepblue. org/whatsnew. 31

STANDARD OPTION PRESCRIPTION DRUG COST SHARES Tier 1 Retail Mail Order Up to $7. 50 copay $15 ($5 copay w/Part B Primary) ($10 w/Part B Primary) Specialty^ N/A 2 30% $90 N/A 3 50% $125 N/A 4 30%*# N/A $65* ($185 up to 90 -day supply) NEW 5 30%*# N/A $85* ($240 up to 90 -day supply) NEW Table Key: (*) 30 day fill only (#) First fill only (^) 90 day fill allowed after 3 rd fill 32

BASIC OPTION PRESCRIPTION DRUG COST SHARES Tier Retail Mail Order (Only with Medicare Part B Primary) 1 $10 $20 N/A NA 2 3 4 5 Specialty w/o Med B Specialty w/ Med B $55 ($50 w/ Part B Primary) 60% of our allowance ($75 minimum) 50% w/ $60 min w/Part B $65* ($60 w/ Part B Primary) $100 N/A NA $125^ N/A NA N/A $85* ($235 copay for up to 90 -day supply) NEW $80 ($210 for up to 90 -day supply) NEW $90* ($80 w/ Part B Primary) N/A $110* ($300 copay for up to 90 -day supply) NEW $100 ($255 for up to 90 -day supply) NEW Table Key: (*) 30 day fill only (#) First fill only (^) 90 day fill allowed after 3 rd fill 33

FEP BLUE FOCUS Tier Retail Specialty^ 1 $5 40% of our allowance ($350 max) 2 40% of our allowance ($350 max) 4 40% of our allowance ($350 max) 34

PRESCRIPTION DRUG COST TOOL Want to know drug costs before you drive to the pharmacy? Try our Prescription Drug Cost Tool. You can check drug costs, see if your drug is covered and compare the cost of covered drugs for all three plans. Get started at fepblue. org/rx. 35

WELLNESS PROGRAMS AND TOOLS 36

GETTING STARTED WITH MYBLUE® My. Blue is our member-only site that gives you access to exclusive tools and resources. You’ll need a My. Blue account to use most of the fepblue app’s features or to manage your benefits using a computer. To register: Visit fepblue. org/signup. Call 1 -800 -411 -BLUE (2583) and select the prompt for assistance setting up a My. Blue account. A representative will provide you with a unique PIN. Complete the registration fields on the signup page. Log in with your new username and password. 37

ROUTINE PHYSICAL INCENTIVE PROGRAM F F It’s important that you visit your doctor every year for an annual checkup. That’s why we’ll reward FEP Blue Focus members who get their annual physical. * Fitness Your Way by Tivity Health® Receive a four month, no cost gym membership Molecular Fitness® Sun Basket® Fitbit® Get a personalized diet and exercise plan based on your genetics Get a two-week meal kit delivery service Choose from a variety of Fitbit devices *You must be the contract holder or spouse, 18 or older, on an FEP Blue Focus plan to earn this reward. The rewards you can choose from vary by location. Some are limited to specific areas of the U. S. and none are available outside of the U. S. We encourage you to consider the possible tax implications of your rewards as part of this program, and to consult your tax legal or accounting advisors for additional information. 38

BLUE HEALTH ASSESSMENT S S BB The Blue Health Assessment (BHA) is an online questionnaire that gives you a personalized action plan to help you reach your goals. To get started: 1. Answer simple questions about your health 2. Receive a health score and personalized plan you can discuss with your doctor 3. Earn $50 the first time you complete the BHA in 2021* *You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option plan to earn incentive rewards. 39

ONLINE HEALTH COACH S B The Online Health Coach (OHC) encourages you to complete manageable activities each day to reach your health goals. You’ll earn $40 for each goal you complete, up to three, for a total of $120. * Wellness goals Condition goals • • • Reducing stress Losing weight Exercising more Feeling happier Eating better Asthma Heart Disease Heart Failure Hypertension Chronic Obstructive Pulmonary Disease (COPD) *You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option plan to earn incentive rewards. 40

MORE HEALTHY INCENTIVES S B Pregnancy Care Incentive Program Pregnant members can earn $75 and a Pregnancy Care Box for early and ongoing prenatal care. Learn more at fepblue. org/maternity. Breast Pump Kit Benefit Members who are pregnant or nursing can receive a free manual or electric Ameda breast pump kit and milk storage bags through the Pharmacy Program. Call 1 -800 -262 -7890 to learn more. Diabetes Management Incentive Program Earn up to $100 for taking steps to keep your A 1 c levels under control. Learn more at fepblue. org/diabetes. These programs are open to all Standard and Basic Option members, 18 or older on a contract. Members do not need to take the BHA to earn these rewards. 41

MORE HEALTHY INCENTIVES S B Diabetes Management Program by Livongo® Members with diabetes can receive one-on-one support from a diabetes coach, as well as a glucose meter and free test strips through Livongo. Learn more at fepblue. org/diabetes. Discount Drug Program The Discount Drug Program gives you up to a 24% discount on specific prescription drugs not covered by our Plan. See a list of eligible drugs at fepblue. org/pharmacy. 42

HELPFUL TOOLS AND RESOURCES Procedure Cost Estimates - Want to know how much a service is going to cost? Using our Provider Finder tool, you can search for certain treatments and get estimates for how much they’ll cost. The tool currently lists the average for some treatments, and we continue to update it to additional treatments. Financial Dashboard - See how close you are to meeting your annual deductible or visit limits, as well as what you’ve paid in claims this year using the Financial Dashboard. Personal Health Record - Your Personal Health Record makes it easy for you to keep track of your medical history via your My. Blue account. It gathers your health data from your claims, Blue Health Assessment and your personal entries in one secure place. 43

S S B B All monetary rewards earned are loaded onto your My. Blue Wellness Card 44

USE ON QUALIFIED MEDICAL EXPENSES Prescription drugs S S Acupuncture Doctor’s office copays Lab fees B B And more 45

WELLNESS PROGRAMS S B F Tobacco Cessation Incentive Program If you’re ready to quit, we can help. Learn more at fepblue. org/tobacco. Hypertension Management Program If you have high blood pressure, it’s important to know your blood pressure numbers. Get a blood pressure monitor to track your numbers at home. The Hypertension Management Program will be limited to the contract holder and spouse on your contract, 18 and older. If you are a Standard or Basic Option member, you must complete the Blue Health NEW Assessment (BHA) to receive the free blood pressure monitor. Learn more at fepblue. org/highbloodpressure. Care Management Care management can help members with long-term, complex or life-threatening illnesses. There is no additional cost for care management, and you can choose to enroll or leave the program at any time. Learn more at fepblue. org/caremanagement. 46

WELLNESS PROGRAMS S B F Health Club Discounts - You can visit over 10, 000 health clubs nationwide through our health club discount program. You can access the clubs as often as you want and are not limited to one location. You pay a one-time enrollment fee and a monthly membership fee to use this benefit. Learn more at fepblue. org/healthclub. Nurse Line - If you’re looking for health advice, you can speak to a nurse for free 24/7 by calling 1 -888 -258 -3432. You can also chat with a nurse via the fepblue app or My. Blue. 47

GET EXCLUSIVE DISCOUNTS WITH BLUE 365® S B F Blue 365 is a discount program that’s only available to BCBS members. Each month, you’ll get access to exclusive health and wellness deals ranging from discounts that support financial health to nutrition. If you sign up to receive emails from Blue 365, you’ll get the deals sent directly to your inbox each month. Learn more at fepblue. org/blue 365. 48

BLUE 365® DISCOUNTS S B F You have access to exclusive health and wellness deals through the Blue 365 program, including some of the industry’s best discounts including: Low-cost gym memberships – Low cost monthly gym membership with access to over 10, 000 locations through Fitness your Way Fitbit wearable devices – Discounts on Fitbit® smartwatches and activity trackers, plus free shipping Gym shoes and athletic apparel – Discounts on Reebok and Skechers Dental products – Discounts on items such as electric toothbrushes and teeth whitening products. 49

BLUE 365® DISCOUNTS Hearing aids – Discounts on hearing aids plus free batteries from various hearing aid companies including but not limited to Beltone and Tru. Hearing. Save up to 40% on discrete hearing aids with the latest technology. Dieting and healthy eating – Discounts on Jenny Craig, Nutrisystem and Sun Basket food delivery. S B F And other discounts on family travel, personal care, financial health, pet insurance and much more! See all the deals at blue 365 deals. com/fep. 50

BLUE 365® DISCOUNTS: MORE GREAT DISCOUNTS • Vision Care Affinity Program – Members receive discounts on additional pairs of eyewear when using the Davis Vision network providers. • Vision Correction Surgery: Save up to 50% on traditional LASIK surgery at Qual. Sight LASIK. • Additional eyewear savings: 20% discount on additional frames, spectacle lenses or daily wear contacts and 10% discount when you buy additional disposable contacts. 51

FEPBLUE. ORG Ask. Blue. SM FEP® Healthcare Cost Advisor Access your brochures NEW Need help deciding which of our three plans is right for you? Use our product selection tool, Ask. Blue. The tool will ask you a series of questions and then provide a recommendation on which of our three plans best suits your needs. Get started at askblue. fepblue. org. The FEP Healthcare Cost Advisor gives you access to the amount of money you've paid out of pocket for healthcare services for the previous year. This information can help you to understand your healthcare spending. Learn more at fepblue. org/TBD. The Blue Cross and Blue Shield Service Benefit Plan brochures for Standard and Basic Option and/or FEP Blue Focus are your official statements of benefits. Download the brochures today at fepblue. org/brochure. We’ve recently redesigned our website, fepblue. org, to make it even easier to access the information you need. Plus, we’ve added some new features, as well. 52

KEEP UP WITH YOUR BENEFITS ON THE GO With the fepblue app, you have access to your benefits in the palm of your hand. Keep track of out-of-pocket costs View claims information Find Preferred providers Use your digital member ID card Access the 24/7 Nurse Line and Teladoc Receive messages via our Secure Message Center Receive important notifications and alerts Use our Interactive Benefits Tool You must have a My. Blue® account to access most of the app’s features. Visit the App Store or Google Play to download the fepblue app today. 53

RESOURCE: EMPLOYEE CALL LINE Call the National Information Center 1 -800 -411 -BLUE (2583) Available weekdays (excluding holidays) from 8 a. m. to 8 p. m. , Eastern time 54

2021 BLUE CROSS BLUE SHIELD FEP DENTAL A FEDVIP dental plan offered by Blue Cross Blue Shield NEW

OUTLINE • Why get dental coverage? • BCBS FEP Dental benefits • Savings and discounts • Enrolling in coverage

WE P R O V I D E C O M P R E H E N S I V E D E N TA L B E N E F I T S. S O Y O U CAN H AV E A H E A LT H Y S M I L E. Blue Cross and Blue Shield has been a trusted provider of health insurance for federal employees, retirees and their families for 60 years. Our supplemental dental plan, FEP Blue. Dental, is now called Blue Cross Blue Shield FEP Dental—and our coverage is better than ever. It provides you with comprehensive dental benefits that give you peace of mind about your family’s dental health. 3

WHY GET DENTAL COVERAGE?

THE IMPORTANCE OF SEEING A DENTIST Visits to the dentist are especially important for: • Pregnant women • Diabetics • Heart disease patients • Cancer patients • Transplant patients • People with osteoporosis • People with respiratory infections

BCBS FEP DENTAL BENEFITS

CLASS A, B AND C SERVICES Benefits High Option In-network Class A (Basic) Services e. g. , oral and diagnostic exams, cleanings, X-rays, sealants Class B (Intermediate) Services Restorative services such as oral surgery, fillings, gum scaling, extractions, denture adjustments Class C (Major) Services e. g. , crowns, bridges, implants, root canals, dentures 100% Standard Option Out-ofnetwork 90% Three cleanings a year covered In-network Out-ofnetwork 100% 60% Three cleanings a year covered 70% 60% 55% 40% 50% 40% 35% 20% 61

CLASS A, B AND C DEDUCTIBLES AND BENEFIT MAXIMUMS Benefits High Option Standard Option In-network Out-ofnetwork Annual Deductible for Class A, B and C Services No deductible $50 person No deductible $75 person Annual Maximum Benefits for Class A, B and C Services Unlimited maximum person $3, 000 person $1, 500 person $750 person Does not apply to Class D (Orthodontics) 62

BCBS FEP DENTAL ORTHODONTIC BENEFITS Benefits High Option In-network Class D (orthodontic) services Adults & children Out-of-network 50% up to $3, 500 lifetime maximum per allowed amount person Standard Option In-network Out-of-network 50% up to $2, 500 lifetime maximum person 50% up to $1, 250 lifetime maximum person NEW No waiting period 63

Ask. Blue. SM FEP Dental Plan Finder NEW Need help choosing between High Option and Standard Option? Ask. Blue makes it easy. In just 10 minutes, you can answer some simple questions and get recommended a plan based on your needs. Try Ask. Blue by visiting askblue. bcbsfepdental. com. 64

FIND YOUR BCBS FEP DENTAL PREMIUM NEW We’ve updated our rating areas for 2021. To find your premium, check the rating area for your state or zip code and then match it to the appropriate rating area to your enrollment type on the next slide. Dental Rating Regions for NC State First 3 digits of your ZIP code Rating Area NC 275 -277, 283 3 NC 270 -274, 278, 280 -282, 284 -289 2 NC Rest of the state 1 You can also find your premium at bcbsfepdental. com/premiumfinder. 65

HIGH OPTION PREMIUMS High Option Premiums Self Only Self + One Self & Family Rating Area BI-WEEKLY MONTHLY 1/INTL $17. 31 $37. 51 $34. 63 $75. 03 $51. 94 $112. 54 2 $19. 40 $42. 03 $38. 77 $84. 00 $58. 16 $126. 01 3 $21. 12 $45. 76 $42. 23 $91. 50 $63. 35 $137. 26 4 $22. 88 $49. 57 $45. 72 $99. 06 $68. 59 $148. 61 5 $25. 60 $55. 47 $51. 17 $110. 87 $76. 77 $166. 34 66

STANDARD OPTION PREMIUMS Standard Option Premiums Self Only Self + One Self & Family Rating Area BI-WEEKLY MONTHLY 1/INTL $9. 16 $19. 85 $18. 32 $39. 69 $27. 49 $59. 56 2 $10. 04 $21. 75 $20. 09 $43. 53 $30. 13 $65. 28 3 $11. 42 $24. 74 $22. 83 $49. 47 $34. 22 $74. 14 4 $12. 33 $26. 72 $24. 64 $53. 39 $36. 94 $80. 04 5 $13. 62 $29. 51 $27. 25 $59. 04 $40. 87 $88. 55 67

BCBS FEP DENTAL’S PROVIDER NETWORK A broad network of dentists and specialists: • • Providers in all 50 states Denta. Max-new national provider • Over 375, 000 access points nationwide • We welcome provider nominations NEW To find a provider, visit bcbsfepdental. com and click Find a Dentist, or call 1 -855 -504 -BLUE (2583). 68

COORDINATING WITH MEDICAL COVERAGE Your medical plan may include some preventive dental coverage. Show your dental and medical member ID cards to your dentist Your dentist will file the claim directly with the local BCBS Plan or other medical carrier for primary coverage The claim will then be sent to us Don’t forget: Bring your FEHB and BCBS FEP Dental member ID cards to your dental appointments to ensure you receive prompt payment under each program. 69

INTERNATIONAL BENEFITS Need to see a dentist while in another country? You’re covered overseas. • English-speaking dentists • Located in approximately 100 countries • Receive in-network benefits levels • You pay the dentist and then submit a claim to us To learn more about international benefits, visit bcbsfepdental. com and click International Services, or call 1 -855 -504 -BLUE (2583). 70

SAVINGS & DISCOUNTS

BRUSH UP ON SAVINGS Two Dental Exams Three Cleanings One Set of X-rays Two Fillings One Root Canal (molar) One Crown (porcelain) Total out-of-pocket Without BCBS FEP Dental High Option* Standard Option* $120 $0 $0 $295 $0 $0 $170 $0 $0 $350 $65 $97 $1, 570 $450 $580 $1, 540 $435 $565 $4, 045 $950 $1, 242 72

FSAFEDS PAPERLESS REIMBURSEMENT FSAFEDS is the flexible spending account (FSA) program for federal employees. Electronic processing Save time and money Enroll at FSAFEDS. com This program applies to federal employees only. 73

ENROLLING IN COVERAGE

WHO’S ELIGIBLE BCBS FEP Dental is available to federal and U. S. Postal Service (USPS) employees, annuitants, survivor annuitants and their family members eligible for the FEHB. • You do not have to be enrolled in the FEHB. • Annuitants receiving an immediate annuity are eligible for dental and vision coverage. • Premiums are paid pre-tax for employees. • Dependent children are covered until age 22. 75

WHO’S ELIGIBLE (CONT. ) BCBS FEP Dental welcomes retired uniformed service members and their families. • Same benefits and premiums as federal employees. • Dependent children are covered until age 21 (non-students) or 23 (full-time students). • You’re eligible for coverage if you were medically retired or if you’re enrolled in TRICARE for Life. • Survivor annuitants can enroll in coverage. 76

EASE OF ENROLLMENT To enroll Go online to BENEFEDS. com or call 1 -877 -888 -3337 and select Blue Cross Blue Shield FEP Dental Open Season runs November 9 through midnight December 14, 2020, Eastern time. 77

DIGITAL RESOURCES | MOBILE APP Stay up to date on your coverage Download our BCBS FEP Dental app on the App Store® or Google Play. SM today. In addition, follow us on our new Facebook and Twitter pages @bcbsfepdental 78

CONTACT US Learn more about BCBS FEP Dental Ready to enroll Online: bcbsfepdental. com Online: BENEFEDS. com Phone: 1 -888 -504 -2583 (8 a. m. to 8 p. m. EST, M-F) Phone: 1 -877 -888 -3337 (8 a. m. to 8 p. m. EST, M-F) 79

2021 BLUE CROSS BLUE SHIELD FEP VISION A FEDVIP vision plan offered by Blue Cross and Blue Shield NEW

OUTLINE • Why get vision coverage? • BCBS FEP Vision benefits • Savings and discounts • Enrolling in coverage

WE HELP TAKE CARE OF YOUR EYES. SO YOU CAN SEE EVERY DETAIL. Blue Cross and Blue Shield has been a trusted provider of health insurance for federal employees, retirees and their families for 60 years. Our supplemental vision plan, FEP Blue. Vision, is now Blue Cross Blue Shield FEP Vision. We’re still offering the same great vision benefits that support healthy eyes—plus some new benefits too. 3

THE VALUE OF ROUTINE EYE EXAMS A comprehensive eye exam delivers the most effective savings in preventive care. An eye exam is a full look at your eyes from front to back. Routine eye exams can also detect diseases like Alzheimer’s, diabetes, and heart disease years before symptoms even appear. Everyone age 50 and older should make routine eye exams a part of their preventive care routine. Source: ‘Your Eye Exam is More Than Meets the Eye, ’ Blue Cross Blue Shield FEP Vision 2018. 83

WHY ARE EYE EXAMS IMPORTANT FOR CHILDREN? One in four school-age children have vision problems that, if left untreated, can affect learning ability and personality. The American Optometric Association recommends having your child’s eyes examined at the ages of 6 months, 3 years and 5 years, then every other year while your child is in school. 7 84

WHAT TO EXPECT IN AN EYE EXAM What’s included in an eye exam? A health review Refraction (vision test) A glaucoma test Dilation How much does an eye exam cost? Your BCBS FEP Vision eye exam is covered in full. 85

BCBS FEP VISION BENEFITS

BENEFITS YOU CAN CLEARLY SEE Our insurance is accepted by both independent and national providers, including Visionworks, Lens. Crafters, Costco, Walmart, Sam’s Club, Target Optical, Pearle Vision and more. Use your benefits at online retailers, including glasses. com, 1800 contacts. com, visionworks. com and befitting. com An extensive fully covered frame collection at independent providers Free comprehensive eye exams for all members A generous frame allowance at independent and national providers 87

BCBS FEP VISION BENEFITS Benefits High Option Standard Option Eye Exam You pay nothing for one exam per year. Spectacle Lenses You pay nothing for one pair per year. $10 copay for one pair per year. Lens Treatments We cover Transitions, Varilux Progressives and Crizal Anti-Reflective Coating lenses at low or no out-of-pocket cost. See additional covered lens options in the 2021 brochure. Frames Contact Lenses (in lieu of eyeglasses) NEW No copay for Exclusive Collection frames, covered every calendar year. Frame Allowance: $200 toward any other provider supplied frame, plus 20% off charges over $200. 1 Frame Allowance: $140 toward any other provider-supplied frame, plus 20% off charges over $140. 1 NEW Up to $150 per calendar year toward contact lenses plus 15% off charges over $150. 1 Evaluation, fitting and follow-up fees fully covered for non-specialty lenses and covered up to $60 for specialty contact lenses. NEW Up to $130 per calendar year toward contact lenses, plus 15% off charges over $130. 1 88

COPAYS FOR COMMON LENS TREATMENTS Other Vision Services High Option Standard Option In-network only Ultraviolet protective coating No copay Polycarbonate lenses No copay Blended segment lenses $20 Intermediate lenses $30 Standard progressives No copay $50 Premium progressives $90 Ultra progressive lenses $140 Ultimate progressive lenses $175 Optional lenses and treatments High Option members receive ultraviolet coating, polycarbonate lenses, standard progressives and Transitions® Signature™ lenses covered at no additional cost 89

COPAYS FOR COMMON LENS TREATMENTS Other Vision Services High Option Standard Option $20 No copay $65 Polarized lenses $75 Standard anti-reflective (AR) coating $20 $35 Premium AR coating $33 $48 Ultra AR coating $45 $60 Ultimate AR coating $70 $85 High-Index lenses (up to 1. 67) $55 Blue light filtering $15 Digital single vision & computer lenses $30 Photochromic glass lenses Plastic photosensitive lenses (Transitions Signature) 97

FIND YOUR BCBS FEP VISION PREMIUM Benefits High Option BI-WEEKLY Self Only Self + One Self & Family Standard Option MONTHLY BI-WEEKLY MONTHLY $5. 49 $11. 90 $3. 50 $7. 58 $10. 97 $23. 77 $6. 99 $15. 15 $16. 46 $35. 66 $10. 49 $22. 73 98

NATIONAL RETAILERS IN OUR NETWORK America’s Best My. Eye. Dr. Bard Optical National Vision Centers in Boscov’s Optical Walmart Clarkson Eyecare National Vision Centers Cohen’s Fashion Optical Nationwide Vision Costco Optical Pearle Vision Crown Optical Rosin Eyecare Dr. Tavel One-Hour Optical Sam’s Club Eye Doctor Optical Outlets SEE Inc. Eyeglass World Shopko Optical Sterling Opt Eyemart Express SVS Vision For Eyes Target Optical Heartland Visionworks Henry Ford Optim. Eyes Vista Optical in Fred Meyers JCPenney Optical Walmart Vision Centers Lens. Crafters Whylie Eye Care Centers Meijer Optical Wisconsin Vision Midwest Vision Centers 99

ONLINE RETAILERS IN OUR NETWORK We’ve also expanded the online retailers that you can use your benefits and order eyewear from. 100

TAKE YOUR BENEFITS ANYWHERE The BCBS FEP Vision app makes it easy to use your benefits on the go. NEW Search in-network doctors Check your benefits Share your member ID card Submit claims Access more tools Download the BCBS FEP Vision app for free on the App Store® and Google Play℠. 101

SAVINGS & DISCOUNTS

THE SAVINGS ARE CLEAR Average Retail Cost High Option* Standard Option* Eye Examination $103 $0 $0 Frames $200 $0 $48 $30 $0 $0 $125 $0 $0 Polycarbonate Lenses $50 $0 $0 Ultraviolet Coating $20 $0 $0 $120 $0 $65 $125 $33 $48 $295 $90 $1, 068 $123 $251 1 -Year Breakage Warranty Bifocal Lenses Plastic Photochromic Lenses (i. e. , Transitions® Signature. TM) Premium Anti-Reflective Coating Premium Progressive Lenses TOTAL OUT-OF-POCKET Based on High Option benefit and Designer level Collection frame 103

FSAFEDS PAPERLESS REIMBURSEMENT FSAFEDS is the flexible spending account (FSA) program for federal employees. Pre-tax contributions. Covers Vision items and services not fully paid by your benefit plan(s). Copayments for vision services and items. Paperless or “automatic” claims with Blue Cross Blue Shield FEP Vision. This program applies to federal employees only. 104

ENROLLING IN COVERAGE

THE BASICS BCBS FEP Vision offers three different levels of coverage for High Option and Standard Option: Yourself with Self Only You and one other eligible family member with Self + One You and multiple eligible family members with Self & Family 106

WHO’S ELIGIBLE BCBS FEP Vision is available to federal employees, retirees and dependents who are FEDVIP eligible. • Federal employees are eligible for vision coverage if they are eligible for the Federal Employees Health Benefits (FEHB) Program (they do not have to be enrolled). • Annuitants receiving an immediate annuity are eligible for vision coverage. • Premiums are paid pre-tax for employees. • Dependent children are covered until age 22. 107

WHO’S ELIGIBLE BCBS FEP Vision welcomes retired uniformed service members, their families and the family members of active duty service members • Same benefits and premiums as federal employees. • Must be enrolled in a TRICARE Health Plan to be eligible for vision coverage • Dependent children are covered until age 21 (non-students) or 23 (full-time students). • Survivor annuitants can enroll in coverage. 108

EASE OF ENROLLMENT To enroll Go online to BENEFEDS. com or call 1 -877 -888 -3337 and select Blue Cross Blue Shield FEP Vision. Open Season runs November 9 through midnight December 14, 2020, Eastern time. 109

CONTACT US Stay up to date on your coverage Download our BCBS FEP Vision app on the App Store® or Google Play. SM today. In addition, follow us on our new Facebook and Twitter pages @bcbsfepvision. s Learn more about Blue Cross Blue Shield FEP Vision Ready to enroll Online: bcbsfepvision. com Online: BENEFEDS. com Phone: 1 -888 -550 -2583 (8 a. m. to 11 p. m. EST, M-F; 9 a. m. to 4 p. m. EST, Sat. ; 12 p. m. to 4 p. m. EST, Sun. ) Phone: 1 -877 -888 -3337 (8 a. m. to 8 p. m. EST, M-F) 110

Thank you

Apple, the Apple logo, i. Pad and i. Phone, are trademarks of Apple Inc. , registered in the U. S. and other countries. App Store is a service mark of Apple Inc. , registered in the U. S. and other countries. Google Play and the Google Play logo are trademarks of Google LLC. This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Before making a final decision, please read the Plan’s Federal brochures (Standard Option and Basic Option: RI 71 -005; FEP Blue Focus: RI 71 -017). All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochures. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. The Blue Cross® and Blue Shield® words and symbols, Federal Employee Program® and FEP® are all trademarks owned by Blue Cross Blue Shield Association FBFPPT 2021 121