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Information on Providers & Benefits for the Lumenos Georgia Health Insurance Plan

Choice of Providers

Lumenos offers discounts to consumers through partnerships with providers throughout thenation.

Members have automatic access to provider directories, free of charge, by accessing themember site at www.lumenos.com, or by contacting the Lumenos Customer ServiceDepartment at (866) 835-6863.

With the Lumenos plan, you have the flexibility to see any licensed health care provider youchoose. The Doctors Plus Directory can help you locate a provider near you. The level ofyour health coverage under the Lumenos plan depends on whether you use providers whooffer Lumenos discounts or providers who do not offer Lumenos discounts.

Providers Who Offer Lumenos Discounts

If you visit a provider who offers Lumenos discounts, you will receive the highest levelbenefits offered under the Lumenos plan. These providers have agreed to charge a"discounted fee" for their services. You will never pay for charges in excess of thediscounted price, and in most cases, the provider will file a claim for you after your visit.

Providers Who Do Not Offer Lumenos Discounts

If you visit a provider who does not offer Lumenos discounts, you may have to pay their fullprice at the time of service, then file a claim for reimbursement. Under your TraditionalHealth Coverage, you will be responsible for coinsurance, as well as the difference betweenthe charge for the service and the Reasonable and Customary charges.

Traditional Health Coverage

In addition to your account, the Lumenos plan offers additional health coverage to protect youand your family in case you incur significant health care expenses or if your expenses exceedyour annual company allocation. This coverage begins once you have used the entire annualcompany allocation on covered services and pay your Bridge.

Coinsurance

When using the Traditional Health Coverage, you pay a certain percentage of the cost ofcovered services through coinsurance. Generally, the Traditional Health Coverage pays 60% to90% of the cost of most covered services, and your coinsurance amount is 10% to 40% up untila limit called the coinsurance maximum. The coinsurance maximum is the most you pay incoinsurance expenses for covered services in a Plan year.

The annual coinsurance maximums for the Traditional Health Coverage are:

• $1,000 -single coverage
• $2,000 - family coverage

Member Advance

In some cases, you will see an "advance" listed on the Explanation of Benefits (EOB) youreceive in the mail after receiving medical services. If necessary, an advance may need to bemade to your account to cover the cost of medical expenses. This occurs when a claim hasbeen paid but there are insufficient funds in your account to cover the entire expense.When there is an advance, your payment will automatically deduct the cost of the advance froma future claim (including claims for preventive care services) in order to reconcile your account.

Out-of-Pocket Maximum

The Lumenos plan's out-of-pocket maximum is the most that you will pay toward covered healthexpenses in a Plan year. Once you reach the out-of-pocket maximum under the Lumenos plan,the Plan pays 100% of covered services for providers who offer discounts and 100% ofReasonable and Customary charges for providers who do not offer discounts.

The Lumenos plan's out-of-pocket maximums are:

• $1,500 - single coverage
• $3,000 - family coverage

IMPORTANT! Amounts you pay toward the cost of certain medical services will not count towardyour annual out-of-pocket maximum. These include any cost you pay:

• for any service that is not a covered service under the Traditional Health Coverage
• toward expenses that are in excess of Reasonable and Customary charges
• toward expenses that are in excess of annual maximums

Lifetime Benefit Maximum

All benefits paid under any Lumenos plan (whether as an active employee or retiree) applytowards the Lifetime Maximum described herein. You and your covered dependent(s) eachhave a lifetime benefit maximum of $2,000,000 under the Plan. This is the total amount ofbenefits you can receive under the Plan in a lifetime. Once you or your covered dependentreach this limit, you are responsible for the full cost of any additional services you or yourdependent(s) may receive.

Inpatient Admission

To help assure that your treatment is Medically Necessary under the terms of your health plan,We have partnered with FutureHealth to provide admission and concurrent review of inpatientadmissions for hospital (medical and surgical), rehabilitation, skilled nursing facility, psychiatrichospital and detoxification facility. Transplant services require pre-certification before schedulingthe procedure. For these services you or your physician must notify the plan at the numberlisted on the back of your Lumenos ID card prior to admission.

In case of an emergency, notify the plan within 48 hours of your admission by calling thenumber listed on the back of your Lumenos plan ID card.

This notification process assists us in helping you manage your health care. If you have aserious or chronic condition, a Personal Health Coach will be available to help you or yourdependent in coordinating resources.

NOTE: Under federal law, benefits for any hospital stay in connection with childbirth for themother or the newborn cannot be restricted to less than:

• 48 hours - following a normal vaginal delivery
• 96 hours - following a cesarean section

Although you are encouraged to call, neither you nor your physician needs to pre-notify the planfor any length of stay less than these periods for childbirth. However, the physician, afterconsulting with the mother, may discharge the mother or newborn before the 48- or 96-hourtimeframe noted above.