#2. Active Non Medicare Scenarios 8-9 — File 191787

City of Somerville 8/9/2011 Current BCBS HMO Subscriber Chooses Harvard Pilgrim PPO - Individual Plan Active and Non-Medicare Retirees - Calendar Year 2012 Projections Note: Copays shown are for non preventive services; certain preventive services are no member cost sharing under either the City or GIC Plans BCBS GIC Below Above Below Above HMO Harvard Pilgrim Average Average Average Average Average Average Current Independence Utilizer Utilizer Utilizer Additional Additional Additional Plan Design Element Benefit PPO # Services # Services # Services Costs Costs Costs Calendar Year Deductible None $250/$500/$750 0 1 1 $0 $250 $250 Physician Office Visits $5 $20 1 2 10 $15 $30 $150 Specialist Office Visits $5 $20/$35/$45 1 1 5 $30 $30 $150 Emergency Room Visits $25 $100 0 1 5 $0 $75 $375 I/P $0 $250/$500/$750 0 0 3 $0 $0 $1,500 O/P $0 $150 0 0 2 $0 $0 $300 Hi-Tech Imaging $0 $100 0 1 5 $0 $100 $500 Prescription Drugs-Retail Tier I $5 $10 3 7 35 $15 $35 $175 Tier II $10 $25 1 2 10 $15 $30 $150 Tier III $10 $50 0 1 5 $0 $40 $200 Prescription Drugs-Mail Tier I $5 $20 0 3 15 $0 $45 $225 Tier II $10 $50 0 2 10 $0 $80 $400 Tier III $10 $110 0 0 2 $0 $0 $200 City/Employee Split Total Additional Out of Pocket Costs 85/15 $75 $715 $4,575 Projected Premium Savings ($302) ($302) ($302) Net Impact ($227) $413 $4,273 Total Additional Out of Pocket Costs 80/20 $75 $715 $4,575 Projected Premium Savings ($403) ($403) ($403) Net Impact ($328) $312 $4,172 Total Additional Out of Pocket Costs 75/25 $75 $715 $4,575 Projected Premium Savings ($503) ($503) ($503) Net Impact ($428) $212 $4,072 Note: Amounts don't include mitigation amounts; Tier 2 is assumed for provider tiering

City of Somerville 8/9/2011 Current BCBS HMO Subscriber Chooses Harvard Pilgrim PPO - Family Plan Active and Non-Medicare Retirees - Calendar Year 2012 Projections Note: Copays shown are for non preventive services; certain preventive services are no member cost sharing under either the City or GIC Plans BCBS GIC Below Above Below Above HMO Harvard Pilgrim Average Average Average Average Average Average Current Independence Utilizer Utilizer Utilizer Additional Additional Additional Plan Design Element Benefit PPO # Services # Services # Services Costs Costs Costs Calendar Year Deductible None $250/$500/$750 0 1 1 $0 $750 $750 Physician Office Visits $5 $20 3 6 30 $45 $90 $450 Specialist Office Visits $5 $20/$35/$45 3 3 15 $90 $90 $450 Emergency Room Visits $25 $100 0 3 15 $0 $225 $1,125 I/P $0 $250/$500/$750 0 0 9 $0 $0 $4,500 O/P $0 $150 0 0 6 $0 $0 $900 Hi-Tech Imaging $0 $100 0 3 15 $0 $300 $1,500 Prescription Drugs-Retail Tier I $5 $10 9 21 105 $45 $105 $525 Tier II $10 $25 3 6 30 $45 $90 $450 Tier III $10 $50 0 3 15 $0 $120 $600 Prescription Drugs-Mail Tier I $5 $20 0 9 45 $0 $135 $675 Tier II $10 $50 0 6 30 $0 $240 $1,200 Tier III $10 $110 0 0 6 $0 $0 $600 City/Employee Split Total Additional Out of Pocket Costs 85/15 $225 $2,145 $13,725 Projected Premium Savings ($1,107) ($1,107) ($1,107) Net Impact ($882) $1,038 $12,618 Total Additional Out of Pocket Costs 80/20 $225 $2,145 $13,725 Projected Premium Savings ($1,476) ($1,476) ($1,476) Net Impact ($1,251) $669 $12,249 Total Additional Out of Pocket Costs 75/25 $225 $2,145 $13,725 Projected Premium Savings ($1,846) ($1,846) ($1,846) Net Impact ($1,621) $299 $11,879 Note: Amounts don't include mitigation amounts; Tier 2 is assumed for provider tiering