RATING REGION 4 PORTNEUF QUALITY ALLIANCE (PQA) NON-TOBACCO USERS*

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1 For non-tobacco users* who live in Bonneville, Butte, Clark, Custer, Fremont, Jefferson, Lemhi, Madison and Teton counties. *Tobacco includes hookah, e-cigarettes, dissolvables, smokeless tobacco, cigarettes, all cigars, roll-your-own tobacco, pipe tobacco, and future tobacco products that meet the statutory definition of a tobacco product. ** Gold Connect 2000 is only available in Bonneville and Jefferson counties. Connect HSA Connect 6550 HSA Connect Connect 5500 PORTNEUF QUALITY ALLIANCE () NON-TOBACCO USERS* Gold Connect 2000** Connect and over

2 For tobacco users* who live in Bonneville, Butte, Clark, Custer, Fremont, Jefferson, Lemhi, Madison and Teton counties. *Tobacco includes hookah, e-cigarettes, dissolvables, smokeless tobacco, cigarettes, all cigars, roll-your-own tobacco, pipe tobacco, and future tobacco products that meet the statutory definition of a tobacco product. ** Gold Connect 2000 is only available in Bonneville and Jefferson counties. Connect HSA Connect 6550 HSA Connect Connect 5500 PORTNEUF QUALITY ALLIANCE () TOBACCO USERS* Gold Connect 2000** Connect and over

3 For non-tobacco users* who live in Bonneville, Butte, Clark, Custer, Fremont, Jefferson, Lemhi, Madison and Teton counties. *Tobacco includes hookah, e-cigarettes, dissolvables, smokeless tobacco, cigarettes, all cigars, roll-your-own tobacco, pipe tobacco, and future tobacco products that meet the statutory definition of a tobacco product. ** East Gold 2000 is not available in Bonneville or Jefferson counties. HSA 6550 HSA 5500 HOMETOWN EAST PROVIDER NETWORK (HEPN) NON-TOBACCO USERS* East Gold 2000** East and over

4 For tobacco users* who live in Bonneville, Butte, Clark, Custer, Fremont, Jefferson, Lemhi, Madison and Teton counties. *Tobacco includes hookah, e-cigarettes, dissolvables, smokeless tobacco, cigarettes, all cigars, roll-your-own tobacco, pipe tobacco, and future tobacco products that meet the statutory definition of a tobacco product. ** East Gold 2000 is not available in Bonneville or Jefferson counties. HSA 6550 HSA 5500 HOMETOWN EAST PROVIDER NETWORK (HEPN) TOBACCO USERS* East Gold 2000** East and over

5 For non-tobacco users* who live in Butte and Custer counties. *Tobacco includes hookah, e-cigarettes, dissolvables, smokeless tobacco, cigarettes, all cigars, roll-your-own tobacco, pipe tobacco, and future tobacco products that meet the statutory definition of a tobacco product. **SLHP Gold CarePoint 2000 is not available. CarePoint 6550 CarePoint 5500 ST. LUKE S HEALTH PARTNERS (SLHP) NON-TOBACCO USERS* CarePoint CarePoint CarePoint SLHP CarePoint and over

6 For tobacco users* who live in Butte and Custer counties. *Tobacco includes hookah, e-cigarettes, dissolvables, smokeless tobacco, cigarettes, all cigars, roll-your-own tobacco, pipe tobacco, and future tobacco products that meet the statutory definition of a tobacco product. **SLHP Gold CarePoint 2000 is not available. CarePoint 6550 CarePoint 5500 ST. LUKE S HEALTH PARTNERS (SLHP) TOBACCO USERS* CarePoint CarePoint CarePoint SLHP CarePoint and over

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