NEFB Dec. 30, 2020 NEFB Member Health Plans Portfolio

Nebraska Farm Bureau Member Health Plans

NEBRASKA SHORT TERM ASSOCIATION HEALTH PLANS

OPTIONS & INFORMATION FOR PLANS STARTING DEC. 30, 2020

Together, Medica and Nebraska Farm Bureau designed an exclusive portfolio of short term coverage options for farmers, ranchers and those in agribusiness who are looking for health insurance for themselves and their families. We designed these plans with you in mind. We know you want competitive options. We also know you want to choose your doctor. Medica plans let you personalize your coverage to meet your unique needs and preferences. Take a look through our entire portfolio of Nebraska Farm Bureau Member Health Plan offerings — you'll find a plan that fits your needs. PERSONALIZED COVERAGE FOR FARMERS, RANCHERS & AGRIBUSINESS.

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STEPS TO PERSONALIZING YOUR COVERAGE

Determine what’s available where you live. Not all health plans are available in all areas.

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Choose your network. Decide who and where your care comes from. Not all networks are available in all areas. Choose your plan. Decide if you want a copay, deductible/coinsurance or health savings account (HSA) compatible plan. Choose individual or family coverage. Single only coverage is available to those age 0 – 64. Family coverage for two or more is available to those age 0 – 64. You can cover your spouse (any age) and eligible dependents age 0 – 25. Calculate your monthly premium. Contact your Nebraska Farm Bureau Financial Services agent to calculate your monthly premium. Your Nebraska Farm Bureau membership level, who's covered and their age and the plan you select determines your monthly premium cost.

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CHOOSE YOUR NETWORK. This is who and where your care comes from. You have the option to choose a broad tiered network that will give you access to the largest system of providers. Or, you may be able to choose a local care system network that will provide you with significant cost savings.

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Care System Provider Network Option Medica with CHI Health Network

Broad Provider Network Option Insure Tiered Network

AVAILABILITY For individuals and families living in Buffalo, Burt, Butler, Cass, Colfax, Cuming, Dodge, Douglas, Fillmore, Hall, Hamilton, Kearney, Johnson,

AVAILABILITY For individuals and families living throughout Nebraska (all counties).

Lancaster, Nance, Nemaha, Nuckolls, Otoe, Pawnee, Saline, Sarpy, Saunders, Seward, Thayer and Washington counties.

CARE DETAILS Access to CHI Health doctors, clinics and hospitals plus others.

CARE DETAILS Access to doctors, clinics and hospitals at many health care systems. The network includes:

The network includes: § § 1,400+ Primary and specialty care providers § § 30+ Hospitals

Tier 1 – Preferred Providers § § 8,290+ Primary and specialty care providers § § 133+ Hospitals

Featured health care systems : § § Boys Town § § CHI Health § § CHI Health Partners § § Children's Hospital & Medical Center

Tier 1 health care systems: § § Avera Health § § Boys Town § § Bryan Health § § CHI Health § § Children’s Hospital & Medical Center § § Children’s Physicians § § Genesis Health System

§ § Great River Health System § § Mary Lanning Health Care § § Mercy Iowa City PHO § § Methodist Health System

§ § Nebraska Medicine § § UnityPoint Health § § University of Iowa Health Care

Tier 2 – Standard Providers § § 8,136+ Primary and specialty care providers § § 142+ Hospitals

With a copay or deductible/coinsurance plan, your benefits will vary depending on the provider you visit. You receive your highest level of benefits and typically the lowest out-of-pocket costs when you see Tier 1 – Preferred providers. With an HSA- compatible plan, your benefits are the same for network (tier 1 and 2) providers.

SEARCH THE NETWORKS To search what health care systems and other providers are in the network, use the online search tool at Medica.com/NEFBplans . Unless it's an emergency, there is no coverage if you visit a provider who's not in the network. This means you'll be responsible for the full cost of any care.

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Copay, Deductible/Coinsurace & HSA-Compatible Plans Comparison Nebraska Farm Bureau Member Health Plan CHOOSE YOUR PLAN. It's important for you to have a plan that fits you. So we offer different types of short term plans to meet your individual needs and preferences .

COPAY PLANS

INSURE TIERED NETWORK

MEDICA WITH CHI HEALTH NETWORK

NETWORK BENEFITS

TIER 1 - PREFERRED

TIER 2 - STANDARD

Deductible

Individual plan: $3,800 Family plan: $7,300 Individual plan: $6,800 Family plan: $11,300

Individual plan: $4,800 Family plan: $10,300 Individual plan: $7,800 Family plan: $11,800

Individual plan: $3,800 Family plan: $7,300 Individual plan: $6,800 Family plan: $11,300

Out-of-pocket maximum

Family plan cost sharing details

Embedded deductible Embedded out-of-pocket maximum

Embedded deductible Embedded out-of-pocket maximum

Embedded deductible Embedded out-of-pocket maximum

OFFICE VISITS Preventive care

You pay nothing – 100% coverage You pay nothing – 100% coverage You pay nothing – 100% coverage

Primary and urgent care

$60 copay

$120 copay

$60 copay

Convenience or retail care

$10 copay

$20 copay

$20 copay

Specialty care

$100 copay

$200 copay

$100 copay

PRESCRIPTION DRUGS (MEDICA DRUG LIST) Generic $20 copay

$20 copay

$20 copay

Preferred brand

$120 copay

$120 copay

$120 copay

Non-preferred brand

50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible

Insulin

$25 copay

$25 copay

$25 copay

MEDICAL SERVICES Lab, X-rays and imaging services

30% coinsurance after deductible 30% coinsurance after deductible 30% coinsurance after deductible

Emergency room services

30% coinsurance after deductible 30% coinsurance after deductible 30% coinsurance after deductible

Emergency medical transportation (e.g. Ambulance) Hospital services (Facility & physicians services)

30% coinsurance after deductible 30% coinsurance after deductible 30% coinsurance after deductible

30% coinsurance after deductible 30% coinsurance after deductible 30% coinsurance after deductible

Maternity (Delivery & inpatient services)

30% coinsurance after deductible 30% coinsurance after deductible 30% coinsurance after deductible

Home health care, rehabilitation services, habilitation services and skilled nursing care

30% coinsurance after deductible 30% coinsurance after deductible 30% coinsurance after deductible

Other eligible health care services

30% coinsurance after deductible 30% coinsurance after deductible 30% coinsurance after deductible

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DEDUCTIBLE/COINSURANCE PLANS INSURE TIERED NETWORK

HSA PLAN

MEDICA WITH CHI HEALTH NETWORK

INSURE TIERED NETWORK & MEDICA WITH CHI HEALTH NETWORK

TIER 1 - PREFERRED

TIER 2 - STANDARD

Individual plan: $7,500 Family plan: $14,500 Individual plan: $8,100 Family plan: $16,200

Individual plan: $8,500 Family plan: $17,000 Individual plan: $8,550 Family plan: $17,100

Individual plan: $7,500 Family plan: $14,500 Individual plan: $8,100 Family plan: $16,200

Individual plan: $6,500 Family plan: $13,000 Individual plan: $7,000 Family plan: $14,000

Embedded deductible Embedded out-of-pocket maximum

Embedded deductible Embedded out-of-pocket maximum

Embedded deductible Embedded out-of-pocket maximum

Embedded deductible Embedded out-of-pocket maximum

You pay nothing – 100% coverage You pay nothing – 100% coverage You pay nothing – 100% coverage You pay nothing – 100% coverage

20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible

20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible

20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible

20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible

20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible

40% coinsurance after deductible 40% coinsurance after deductible 40% coinsurance after deductible 20% coinsurance after deductible

$25 maximum

$25 maximum

$25 maximum

$25 maximum

20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible

20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible

20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible

20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible

20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible

20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible

20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible

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EXTRAS TO MAKE YOUR PLAN EVEN BETTER

A great plan is only one piece of the puzzle when it comes to maintaining your health. So we provide you with the extra resources you need to stay healthy each and every day.

No Cost Preventive Care All plans provide access to preventive care services at no cost. This includes exams, screenings, immunizations and more that can help avoid health problems or catch them early.

Your Own Personal Health Advocate

Advocates are available to help you find doctors, estimate costs, and help you make informed health care decisions. This service is confidential — and provided at no additional cost.

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Healthy Pregnancy Support Tap into personalized guidance, support and coaching for your entire parenthood journey. This extra gives you on-demand support and clinically backed guidance to help you achieve your health goals, whether that's tracking your period, getting pregnant or navigating pregnancy, postpartum and parental wellness. This service is provided at no additional cost.

24/7 NurseLine Trusted support for non-urgent care questions 24/7. Nurses are available to help answer your questions about symptoms, medications and health conditions, and offer self-care tips. They can even help you determine the best location for accessing care. This service is provided at no additional cost.

93-Day Refill Option You can get a 93-day supply of a drug that you can take regularly. Pick it up at a network pharmacy — or have it sent through the mail, with no shipping or handling fees.

Online Health Program with Reward Opportunities You'll have access to online programs to motivate and support you in maintaining a healthy lifestyle. Stay active, eat healthy, manage stress and find direction for your life. Plus, as you participate, you earn hearts that can be entered into reward drawings. This service is provided at no additional cost.

Complex Specialty Care Program Receive care for transplants, certain rare cancers and other complex specialty care at Mayo Clinic. An allowance for transportation, lodging and living expenses is also included. Before you use the program, you need a referral from your network doctor and approval from Medica.

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Open Enrollment Period The period each year anyone can enroll in a plan. For coverage that starts December 30, 2020, this period is November 1 - December 15, 2020. Special Enrollment Period A 31-day period outside of the Open Enrollment Period when you can make adjustments to your plan. You only qualify if you experience certain life events like getting married, losing coverage, having a baby, or adopting a child.

READY TO ENROLL?

CHECKLIST

Gather this information for each person enrolling before you work with your insurance agent to complete your enrollment forms: o o Nebraska Farm Bureau Member ID o o Date of birth

o o Home and/or mailing address o o Current insurance information o o Social Security number

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THERE ARE THREE EASY STEPS TO SIGN UP FOR COVERAGE:

Work with your Nebraska Farm Bureau Financial Services agent to complete these steps.

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Step 1 Enroll in the Nebraska Farm Bureau Association.

Step 2 Complete Medica's Nebraska Farm Bureau Member Health Plan application form.

Step 3 Set up where you'd like your monthly premium invoice to mail.

ENROLLMENT TIP You can search for and contact a Farm Bureau Financial Services Agent at Medica.com/NEFBplans .

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WHAT TO EXPECT AFTER ENROLLMENT

What's next after you enroll in the Nebraska Farm Bureau Member Health Plan? Here’s a quick summary of the materials you'll receive from Medica so you can start using your plan.

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What Medica is doing:

Reviewing your application form and setting up your policy. We’ll contact you if we need more information.

Creating your ID card. You'll receive your card a few weeks before your coverage starts.

Building your Welcome Kit. You'll receive your kit a few weeks before your coverage starts. It includes information to help you get the most from your plan.

What you can do:

Register for your secure member site. After you receive your ID card, visit MedicaMember.com to register. Your site is your one- stop resource for the information you need to manage your health plan benefits and help improve your health. »» View your ID card. »» See what's covered by your plan, including important plan documents. »» Track your plan balances, such as your deductible and out-of-pocket maximum. »» Track your claims and explanation of benefits (EOB). »» Look up prices for prescriptions. »» Wellness tools and support. »» Check to see if a doctor or other health care provider is in your plan's network.

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OTHER IMPORTANT INFORMATION Eligibility and Requirements

Prior Approvals and Excluded Services Some services and procedures require prior approval from Medica before they are covered. Services not covered include, but are not limited to, custodial care, adult eyewear, most dental services, cosmetic services, refractive eye surgery, costs covered by a drug manufacturer savings card, those received while on military duty and services that are investigational or not medically necessary. For a complete list see a Medica certificate of coverage available on Medica.com/ NEFBplans or call your insurance agent. Health Savings Account The HSA plan can be paired with a health savings account (HSA) — which is a special savings account for IRS-approved medical expenses. Learn more about the benefits of an HSA or how to open an account by visiting Medica.com/HSA . Deductible and Out-Of-Pocket Maximum Details The deductible and out-of-pocket maximum are subject to a “cost of living” increase on a yearly basis. This increase is tied to the Consumer Price Index.

To qualify for a Nebraska Farm Bureau Health Plan, 50 percent of your gross income must be in production agriculture or agribusiness, and your Principal Business must have less than 50 employees. You must be a Nebraska Farm Bureau member in good standing since August 31, 2020. You also must maintain your Nebraska Farm Bureau membership throughout your coverage period. You must live within your selected network's service area to enroll in and remain in the plan. Understanding Benefits and Coverage Details This brochure is a brief overview of the plans. For complete benefit details, limitations, and exclusions please see a Medica policy of coverage. This can be found by visiting Medica.com/NEFBplans or request a paper copy by calling your insurance agent. Member Complex Case Management We have services and programs designed to help members with certain health conditions manage their overall care and treatment. Find more information about the programs and services available by visiting Medica.com .

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Prescription Drug Coverage To help keep your share of the costs at their lowest, our plans cover drugs on the Medica Drug List. The list includes drugs that provide the most value and have proven safety and effectiveness. Your cost will vary depending on which tier your drug belongs to. For your plan to cover a drug on the drug list, you need to visit a network pharmacy. To see what drugs are covered or to find a network pharmacy, use the online search tool at Medica.com/NEFBplans . Medica Privacy Notice Medica takes its responsibility of protecting your personal information seriously. Where possible, Medica de-identifies or encrypts personal information. We use and disclose personal information only to the extent necessary to conduct treatment, payment and health care operations, or to comply with legal, regulatory or accreditation requirements. Medica’s full Privacy Notice is available upon request by calling your insurance agent or by going to Medica.com/Privacy .

Short Term Policy Year Nebraska Farm Bureau Member Health Plan is a short- term medical policy. This means your coverage will last for 364 days. Coverage will start on December 30, 2020 and end December 29, 2021. About Short Term Coverage This coverage is not required to comply with certain federal market requirements for health insurance, principally those contained in the Affordable Care Act. Be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of preexisting conditions or health benefits (such as hospitalization, emergency services, maternity care, preventative care, prescription drugs, and mental health and substance use disorder services). Your policy might also have lifetime and/or annual dollar limits on health benefits. If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage.

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QUESTIONS? CONTACT YOUR NEBRASKA FARM BUREAU FINANCIAL SERVICES AGENT. Search for a licensed agent at Medica.com/NEFBplans .

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© 2020 CHI Health. HealthAdvocate SM is a service trademark of Health Advocate, Inc.

© 2020 Medica. Medica® is a registered service mark of Medica Health Plans. “Medica” refers to the family of health services companies that includes Medica Health Plans, Medica Community Health Plan, Medica Insurance Company, Medica Self-Insured, MMSI, Inc. d/b/a Medica Health Plans Solutions, Medica Health Management, LLC and the Medica Foundation. © 2020 Nebraska Farm Bureau Federation and its affiliates. All rights reserved.

AHP18485-7-00920

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