<MEMBER FIRST LAST NAME<HCID>

October 2011

<MEMBER FIRST LAST NAME<HCID>

<STREET ADDRESS<Contract Code>

<CARE OF>

<CITY, ST ZIP>

Important Changes to your <MEDICAL PLAN NAME> Coverage

Dear [Name],

Thank you for choosing Anthem Blue Cross Life and Health Insurance Company (“Anthem”) for your Individual health coverage. We’re writing to let you know about upcoming changes to your policy. Enclosed are several policy documents, called“endorsements”, which update your health policy. Please review them carefully and keep them with your important insurance papers. Below is an outline of these changes.

YOUR BENEFITS ARE CHANGING

Earlier this year, we wrote to you about changes that would be made to your policy effective on January 1, 2012. As a reminder, we’re adjusting some of your benefits on January 1, 2012 to help keep your future premium increases lower and your policy benefits more in line with medical inflation. There will be changes to some of the “cost-sharing” amounts on your policy (such as your copays, coinsurance and/or deductible).We’re enclosing another copy of the chart we sent you earlier this year and an endorsement which outline the details of these benefit changes.

YOUR POLICY NAME IS CHANGING

Because your deductible and/or copay amount will be changing, your policy name will be updated to no longer include the deductible or copay amount. Your current policy name is <CURRENT POLICY NAME> and it will change to <NEW POLICY NAME> on January 1, 2012.The endorsement for this change is enclosed. You may see the old policy name for a period of time while we update all of our documents and systems.The old policy name may be included in some of the enclosed endorsements.

NEW TRAVEL TRANSPLANT BENEFIT

Yourtransplant benefit will change on January 1, 2012. This change is to clarify certain travel expenses in connection with an approved and specified transplant. As a result of this change, Anthem will pay a dollar amount for travel expenses, up to a total maximum of $10,000 per transplant for the recipient or donor. Certain expenses that are excluded such as tobacco, alcohol, drug and other expenses are listed in the endorsement. The endorsement for this change is enclosed.

CHANGE IN ANNUAL DOLLAR LIMITS

In an endorsement that was effective December 1, 2010, annual dollar limits for essential health benefits were removed from your policy.Since you are a “grandfathered’ member, this change should not have been communicated to you. Effective January 1, 2012, we are restoring the annual dollar limits for essential health benefits that existed on your policy prior to December 1, 2010. A revised endorsement for this change is enclosed. With the exception of the change to the annual dollar limits on essential health benefits, all of the other language included in this endorsement remains the same as the language in the endorsement effective December 1, 2010.

If you had services in 2011, annual dollar limits for essential health benefits will not apply. However, please be aware that as of January 1, 2012, your annual dollar limits are the same as they were prior to December 1, 2010.

CHANGE IN PRE-EXISTING WAITING PERIOD FOR CHILDREN UNDER AGE 19

We previously sent you information about the pre-existing condition waiting period for children under age 19 that was not correct. The endorsement we sent removed the waiting period.Since you are a “grandfathered” member, this change

should not have been communicated to you. We are adding the pre-existing condition waiting period back to your policy effective January 1, 2012. If you have a dependent added to your policy on or after January 1, 2012, a pre-existing condition waiting period may apply.The endorsement for this change is enclosed.

NOTICE OF PROTECTION

Also enclosed, please find the “Notice of Protection provided by the California Life and Health Insurance Guarantee Association” which briefly summarizes protections provided to you by them.

WE’RE HERE TO HELP

If you have questions about this letter and what it means for you, talk to your Anthem agent or call our Customer Service team at 800-333-0912. Hours are Monday – Friday, 8:30 a.m.-7:00 p.m. PST.

Sincerely,

James Oatman, Vice President and General Manager, Individual Business

Enclosures

• “Individual/Family Benefit Changes” chart (locate your current policy)
• Benefit changes endorsement
• Travel Transplant endorsement
• Name Change and Pre-existing condition waiting period endorsement
• Annual Dollar Limits endorsement
• Notice of Protection

Anthem Blue Cross Life and Health Insurance Company believes this policyis a ‘‘grandfathered health policy’’ under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health policy can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health policy means that this policy may not include certain consumer protections of the Affordable Care Act that apply to other policies, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health policies must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. Questions regarding which protections of the Affordable Care Act apply and which protections do not apply to a grandfathered health policy and what might cause a policy to change from grandfathered health policy status can be directed to Anthem Blue Cross Life and Health Insurance Company at the telephone number printed on the back of your member identification card. You may also contact the U.S. Department of Health and Human Services at .

Anthem Blue Cross Life and Health Insurance Company is an independent licensee of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.

CDI- GF-1a