July 1, 2009

Dear GBP Participant:

Community First Health Plans is pleased to be the health maintenance organization (HMO) offered through the Texas Employees Group Benefits Program (GBP) in your service area for Plan Year 2010.

Community First is a locally owned and managed HMO based in San Antonio. What this means to you is that our corporate offices are right here, and the people responsible for the services you receive are your neighbors. The fact that we are a non-profit/tax-exempt organization means excess revenues stay in your community and are used to improve our level of service to you.

You will find detailed information about our benefits through the ERS website at www.ers.state.tx.us. The Certificate of Group Health Care Coverage on our website contains a complete description of how Community First delivers its medical care and an explanation of our complaints and appeals process. The website also includes an updated Preferred Drug List, which indicates Tier 1, 2, and 3 medications.

During PY 2009, we made the following changes to the Community First Preferred Drug List. These changes will apply to GBP participants for Plan Year 2010:

• Enhanced vision benefit - Through a new agreement with OptiCare, your vision benefit includes, in addition to the exam, the following:
  
  

  Lenses (single, bifocal, trifocal, lenticular)
  $125 allowance on frames
  $125 allowance for fitting and contact lenses in lieu of glasses
  A 15% discount on LASIK at LasikPlus
  
  Features you add to the lenses are an additional charge to you. A flyer announcing the enhancements is included in the PY 2010 Summer Enrollment materials.

• Web-based member portal - Our web-based member portal is now available. This feature allows you and your dependents to review your eligibility information, check the status of your claims, order ID card replacements, and communicate with our Member Services Department in a secure environment.
  
  
• Prescription Discount Card - We hope you have a family member who has been able to use the prescription discount card. This card allows anyone in your family who pays retail prices for medications to use the card at participating pharmacies. The discounts range from 20% to 40%, depending on the medication. We have found this program to be a successful value-added benefit for our members.

• If you have been diagnosed with end-stage renal disease, benefits will be determined in accordance with Medicare guidelines for members with end-stage renal disease.
  
  
• When Medicare benefits are primary, claims must be filed with Medicare first. You are responsible for sending the Medicare explanation of benefits form to us for determination of Community First benefits.
  
  
• In general, if you are an active, working employee, Community First is the primary payer for you and your dependents.
  
  
• If you are a GBP retiree enrolled in Medicare Part A, Medicare is the primary payer, Community First will pay the Medicare Part A deductible, and you will be responsible for any copayments.
  
  
• If you are a GBP retiree not enrolled in Medicare Part A, Community First is the primary payer.

• If you were retired and became Medicare-eligible before September 1, 1992, and are enrolled in Medicare Part B, Community First will provide benefits secondary to Medicare. If you are not enrolled in Medicare Part B, Community First will pay primary benefits.
  
  
• If you were retired and became Medicare-eligible on or after September 1, 1992, regardless of your Medicare Part B status, Community First will provide benefits secondary to Medicare Part B.
  
  
• If you choose not to enroll in Medicare Part B, you may have greater out-of-pocket expenses after Community First pays secondary benefits than an individual who is enrolled in Medicare Part B.