August 1, 2011

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 (PY) 2012.

Community First is a locally owned and managed HMO based in San Antonio. 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 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 our website. 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.

All GBP participants are required to select a primary care physician (PCP) from the Community First network:

1. Visit the Community First site at www.cfhp.com/members/ers2012
2. Click on "Provider Directory"
3. Click on "Find a Physician" at the bottom of the page.

• New Pharmacy Benefit Manager – As of September 1, Navitus Health Solutions is Community First's pharmacy benefit manager. Your new ID card will include this information. You should present your ID card the next time you fill a prescription. For more information and to access mail order services, visit our website at www.cfhp.com/members/ers2012.
  
  
• Enhanced vision benefit - Through an 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 at an additional charge to you. A flyer with details on the enhanced benefit is included in the PY 2012 Annual Enrollment materials.

• Enhanced Travel Network - You and your covered family members have the option to see a First Health Network provider in an urgent or emergency care situation while traveling outside of the Community First HMO service area. If you are in need of urgent or emergency care while you are traveling outside of the service area, you may contact First Health at (800) 226-5116 to locate a provider.
  
  
• Online Health Risk Assessment Program - We are pleased to once again offer members access to an online health risk assessment.
  

• 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, you must file claims 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 you 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.