Personalize the article templates below to educate your employees about the health reimbursement account. You have the option of sending this information out as one article or four mini-updates. Each article is designed so that you can include as much or as little information as you need. Article #1 – Announcing the HRA. Send before Open Enrollment.

IMPORTANT INFORMATIONabout your health reimbursement account (HRA)This year, [Insert Company Name] is pleased to announce that effective [Month XX, 20XX], we will transition to our new health care plan, [Insert name of health care plan] from Blue Cross and Blue Shield of North Carolina (Blue Cross NC). And this year, we’re pairing our health plan with an HRA fund to help you pay for your medical care. During the open enrollment period, you’ll receive more specific information regarding your HRA plan design. In the meantime, here are answers to some general questions you may have.

What is an HRA?An HRA is a specific type of fund account that can be combined with a health care plan to allow you or your dependents covered under your health plan to be reimbursed for certain out-of-pocket eligible medical expenses. Your employer determines which expenses will be eligible for reimbursement from among the qualified medical expenses as defined by the IRS. Contact your benefits administrator for a list of your company’s eligible medical expenses.

How much is contributed to my HRA?[Insert Company Name] is contributing a specific amount to your HRA. So when you, or any of your dependents covered under your health plan, have an eligible medical expense, you can be reimbursed from your HRA. Plus, your HRA funds can be used toward satisfying the deductible for your health plan.

Individual health plan: $X,XXX contributed to your HRA Family health plan: $X,XXX contributed to your HRA

What do my HRA funds cover?You can use your HRA funds to pay for eligible medical expenses as determined by [Insert Company Name] based on IRS guidelines. During open enrollment, we will discuss these eligible medical expenses, which may include:

Doctor office visits Eligible out-of-pocket expenses Coinsurance Copayments Deductibles

Article #2 (Funding option information)

YOUR HRA is simple to useYour HRA is simple and convenient to use. When you visit your provider, you can use your HRA funds to pay for eligible medical expenses.

[Optional section for First-Dollar Funding]

Upfront HRA paymentsYou can use your HRA funds to pay for eligible medical expenses – even before you meet your deductible. Meanwhile, you’ll pay less out-of-pocket for services when you visit a participating Blue Cross NC health care provider. You have the freedom to go outside the network, but keep in mind that you may pay more for out-of-network services.

How your HRA works with your medical plan

[Optional section for Last-Dollar Funding]

Last-dollar HRA paymentsOnce you meet a portion of your deductible, you can use HRA funds to pay for the remainder of the deductible. Meanwhile, you’ll pay less out-of-pocket for services when you visit a participating Blue Cross NC health care provider. You have the freedom to go outside the network, but keep in mind that you may pay more for out-of-network services.

[Optional section for Last Dollar Funding, cont.]

In-network coverage

1 2 3 4 5Your employer

contributes $X,XXX to your HRA, and you are reimbursed for eligible medical expenses up

to that amount.

After you use all of the HRA funds, you then pay $X,XXX out-of-pocket for eligible medical expenses, until your $X,XXX deductible is met.

When your deductible is met, you pay XX%

coinsurance for eligible medical expenses, and the medical plan pays

XX%.

You continue to pay coinsurance for eligible medical expenses until your out-of-pocket limit

of $XX,XXX is reached.

When your out-of-pocket limit is reached, the medical plan pays XXX% of eligible medical expenses until the

end of the benefit year.

How your HRA works with your medical plan

[Optional section for Shared Funding]

Shared HRA paymentsYou can use your HRA funds to pay for a percentage of the care you receive – even before you meet your deductible. Meanwhile, you’ll pay less out-of-pocket for services when you visit a participating Blue Cross NC health care provider. You have the freedom to go outside the network, but keep in mind that you may pay more for out-of-network services.

How your HRA works with your medical plan

[Optional section for Bridged Funding]

In-network coverage

1 2 3 4 5You pay the first

$X,XXX out-of-pocket for elgible medical

expenses.

Then, your employer contributes $X,XXX to your HRA, and you are reimbursed for eligible medical expenses up to that amount, until

your $X,XXX deductible is met.

When your deductible is met, you pay XX%

coinsurance for eligible medical expenses, and the medical plan pays

XX%.

You continue to pay coinsurance for eligible medical expenses until your out-of-pocket limit

of $XX,XXX is reached.

When your out-of-pocket limit is reached, the medical

plan pays XXX% until the end of the benefit year.

In-network coverage1 2 3 4

Your employer contributes to your HRA and reimburses XX% of each eligible medical expense, until your $X,XXX deductible is

met.

When your deductible is met, you pay XX%

coinsurance for eligible medical expenses, and the medical plan pays

XX%.

You continue to pay coinsurance for eligible medical expenses until your out-of-pocket limit of $XX,XXX is reached.

When your out-of-pocket limit is reached, the medical plan pays XXX% until the end of

the benefit year.

You pay XX% of each eligible medical expense, until your $X,XXX deductible is

met.

Bridged HRA paymentsYou can use your HRA funds to pay for eligible medical expenses – even before you meet your deductible. Then, you’ll need to meet a portion of your deductible before you can use additional HRA funds to pay for the remainder of the deductible. Meanwhile, you’ll pay less out-of-pocket for services when you visit a participating Blue Cross NC health care provider. You have the freedom to go outside the network, but keep in mind that you may pay more for out-of-network services.

How your HRA works with your medical plan

[Optional section for Modified Bridged Funding]

Modified Bridged HRA paymentsYou can use your HRA funds to pay for eligible medical expenses – even before you meet your deductible. Then, you’ll need to meet a portion of your deductible before you can use additional HRA funds to pay for the remainder of the deductible. Meanwhile, you’ll pay less out-of-pocket for services when you visit a participating Blue Cross NC health care provider. You have the freedom to go outside the network, but keep in mind that you may pay more for out-of-network services.

[Optional section for Modified Bridged Funding, cont.]

In-network coverage1 2 3 4 5 6

Your employer contributes

$X,XXX to your HRA, and you are

reimbursed for eligible medical expenses up to

that amount.

When you have used the HRA

funds contributed by your employer, you pay $X,XXX

out-of-pocket.

Then, your employer

contributes an additional $X,XXX to your HRA, and

you are reimbursed for eligible medical expenses until your $X,XXX deductible

is met.

When your deductible is met,

you pay XX% coinsurance for eligible medical

expenses, and the medical plan pays

XX%.

You continue to pay coinsurance

for eligible medical expenses until your out-of-pocket limit

of $XX,XXX is reached.

When your out-of-pocket limit is

reached, the medical plan pays XXX%

until the end of the benefit year.

How your HRA works with your medical plan

Article #3

Convenient payment options for health reimbursement account (HRA) expensesYou have a number of choices for reimbursement through the HRA.

Pay the Provider: Your provider will automatically be paid directly from your HRA, eliminating the need for filing claims for eligible qualified medical expenses.

Pay the Member: You will be paid directly from your HRA, eliminating the need for filing claims for eligible medical expenses.

Paper or Electronic Claim Reimbursement: You can mail or fax a paper claim for reimbursement, or reimburse yourself directly by visiting BlueConnectNC.com and clicking the Manage Your Account link. Please note that a service fee may apply for paper check payments, so we encourage you to enroll in direct deposit.

[First-Dollar Only] Debit Card: You can pay for eligible medical expenses conveniently at the point of service. Your HRA debit card eliminates the need to submit a subsequent claim and wait to be reimbursed. Remember to keep a record of all debit card transactions. You may be asked to provide a receipt for any purchase made with your HRA debit card.

Article #4

In-network coverage1 2 3 4 5 6

You pay $X,XXX out-of-pocket for eligible medical

expenses.

Then, your employer

contributes $X,XXX to your

HRA, and you are reimbursed for eligible medical expenses up to

that amount.

When you have used all of the

HRA funds contributed by your employer,

you pay $X,XXX out-of-pocket for covered eligible expenses until your $X,XXX

deductible is met.

When your deductible is met,

you pay XX% coinsurance for eligible medical

services, and the medical plan pays

XX%.

You continue to pay coinsurance

for eligible medical expenses until

your out-of-pocket limit of $XX,XXX is

reached.

When your out-of-pocket limit is reached, the medical plan pays XXX% until the end of

the benefit year.

MANAGING your HRAIntroducing HealthEquity®, your fund administratorBlue Cross NC makes it easy for you to get the most from your HRA funds. Once you enroll, you’ll receive a welcome kit in the mail from HealthEquity, your HRA fund administrator. Included will be detailed instructions for accessing your account on the web and via mobile phone – the easiest way to see your claims and account status and pay your share of your health care bills. If you don’t have Internet access, you can call a HealthEquity expert specialist any hour of every day at 877-713-7682.

Access anytime, anywhereYou can manage both your Blue Cross NC health plan and your HRA fund online and on-the-go. Visit BlueConnectNC.com to view your health benefits and claims, and to check your HRA balance. Click on the Manage Your Account link for instant access to the HealthEquity HRA member portal. Here, you can access and manage all accounts, send payments and reimbursements, submit claims and view claims status, and manage your debit card transactions, where applicable. You also have easy, on-the-go access to your HRA with the HealthEquity mobile app available for iPhone® and Android™ devices.

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is the HRA/FSA administrator. HealthEquity is an independent company that is solely responsible for the HRA/FSA administrative services it is providing. HealthEquity does not offer Blue Cross or Blue Shield products or services. BLUE CROSS®, BLUE SHIELD® and the Cross and Shield symbols are registered marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. All other marks are the property of their respective owners. Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association. U8815c, 1/18

NON-DISCRIMINATION AND ACCESSIBILITY NOTICEBlue Cross and Blue Shield of North Carolina (Blue Cross NC) provides:+ Free aids and services to people with disabilities to communicate

effectively with us, such as: qualified interpreters and/or written information in other formats (large print, audio, accessible electronic formats, other formats.)

+ Free language services to people whose primary language is not English, such as: qualified interpreters and/or information written in other languages

If you need these services, contact:Customer ServiceCall: 1-888-206-4697, 1-800-442-7028 (TTY and TDD)

If you believe that Blue Cross NC has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with:

Blue Cross NC, P.O. Box 2291, Durham, NC 27702 Attention: Civil Rights Coordinator-Privacy,Ethics & Corporate Policy OfficeCall: 919-765-1663, 1-888-291-1783 (TTY)Fax: 919-287-5613E-mail: civilrightscoordinator@bcbsnc.com

You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, the Civil Rights Coordinator-Privacy, Ethics & Corporate Policy Office is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at:

Online: https://ocrportal.hhs.gov/ocr/smartscreen/main.jsfMail: U.S. Department of Health & Human Services

200 Independence Avenue, SW Room 509F HHH Building Washington, D.C. 20201

Call: 1-800-368-1019, 1-800-537-7697 (TDD)Complaint forms are available online at: http://www.hhs.gov/civil-rights/filing-a-complaint/index.html

This notice and/or attachments may have important information about your application or coverage through Blue Cross NC. Look for key dates. You may need to take action by certain deadlines to keep your health coverage or help with costs. You have the right to get this information and help in your language at no cost. Call Customer Service: 1-888-206-4697.

Discrimination is Against the LawBlue Cross NC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.

Blue Cross NC does not exclude people or treat them differently because of race, color, national origin, age, disability or sex.

BLUE CROSS®, BLUE SHIELD®, and the Cross and Shield symbols are registered marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross

and Blue Shield Plans. Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association. NDM4L1001 v12. 6/15/2017, U13382a

ATTENTION: If you speak another language, language assistance services, free of charge, are available to you. Call 1-888-206-4697 (TTY: 1-800-442-7028).ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-206-4697 (TTY: 1-800-442-7028).

注意：如果您講廣東話或普通話， 您可以免費獲得語言援助服務。請致電 1-888-206-4697 file://localhost/tel/1-888-206-4697(TTY: 1-800-442-7028) 。CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-888-206-4697 (TTY: 1-800-442-7028).

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-888-206-4697 (TTY: 1-800-442-7028) 번으로 전화해 주십시오.ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-888-206-4697 (ATS : 1-800-442-7028)

بالمجان : ملحوظة لك تتوافر اللغوية المساعدة خدمات فإن العربية، اللغة تتحدث كنت .إذابرقم اتصل

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સુચના: જો� તમ� ગુજરાતી બોલતા હો, તો નિન:સુલ્કુ ભાષા સહાય સ� વાઓ તમારા માટ� ઉપલબ્ધ છ� . ફોન કરો 1-888-206-4697 (TTY: 1-800-442-7028).

ចំណា៖ំ ប្រ�សិនបើ��បើ កអ្នកនិយាយជាភាសាខ្មែ��រ បើសវាកម�ជំនួយខ្មែ�្នកភាសាមាន�្តល់ជូនសប្រមា�់បើ កអ្នកបើ$យមិនគិតថ្លៃ()។ សូមទំនាក់ទំនងតាមរយៈបើល�៖ 1-888-206-4697 (TTY: 1-800-442-7028) ។ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-888-206-4697 (TTY: 1-800-442-7028).

ध्यान दें: यदिद आप हि�दी बोलते � �ैं तो आपके लिलए मुफ्त में भाषा स�ायता सेवाए ंउपलब्ध �ैं।1-888-206-4697 (TTY: 1-800-442-7028) पर कॉल करें। ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ້າພາສາ ລາວ, ການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາ, ໂດຍບ່ໍເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-888-206-4697 (TTY: 1-800-442-7028).注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-888-206-4697 (TTY: 1-800-442-7028)まで、お電話にてご連絡ください

BLUE CROSS®, BLUE SHIELD®, and the Cross and Shield symbols are registered marks of the Blue Cross and Blue Shield Association, an association of independent Blue Crossand Blue Shield Plans. Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association. NDM4L1001 v12. 6/15/2017, U13382b