Lane Community College Proposed plan and benefit changes for 7/1/17 – all plan and benefits changes are subject to bargaining Want more photo options? Contact MarComm.

Agenda What is SmartChoice? New Plan Option, Plan D Alternative Care Changes 4th Quarter Carry Over Removed Want more photo options? Contact MarComm.

SmartChoice Network is one of PacificSource’s Coordinated Care Networks What is a Coordinated Care Network? An integrated network of providers working collaboratively with PacificSource to drive positive health outcomes, improve member experience, reduce cost of care and provide market differentiation. Care is coordinated through a designated primary care provider. Want more photo options? Contact MarComm.

SmartChoice - A Coordinated Care Network Goal of SmartChoice Establish a primary care physician relationship, with self-referral capabilities to specialists Shared vision that includes member engagement and openness to innovation Network of high quality providers providing member access - both geographic and specialty Alignment with Triple Aim: better health, better care, and lower costs Primary Care Physician Requirement How we contract Development of Medical Homes Shared savings alignment (pay for performance, cost-effectiveness, and quality metrics) Providers paid on value, rather than volume Network adequacy determined by travel time and distance Nominations are welcome - by providers and members Engaged Providers = Engaged Members

Primary Care Physician (PCP) Rules How to Pick your PCP Online – www.pacificsource.com - Find a provider Once find your PCP, click “Set as PCP” button Paper form Can change your PCP if needed Will be effective first of the month following update to PacificSource If you don’t select a PCP, you’ll receive a letter from PacificSource reminding you to select one. Currently, 93% of total PSN providers within a 25 mile radius of Eugene area in SmartChoice.

Common Network Questions What happens if my doctor leaves the network? Most PacificSource contracts require a 6 month contract termination clause. PacificSource notifies members who’ve seen that provider within the 6 months prior to contract termination Can I keep seeing my provider after they leave my network? For some types of care, PacificSource offers a 90 day transition period to find a new provider. Your claims pay at the participating benefit level, however you can still be balance billed the difference in the billed charge and the allowed charge. Contact PacificSource for more information. Can a doctor in my network turn me away because I have SmartChoice? There is nothing in the PacificSource contract that limits the number of patients a provider can have in their practice. However, a provider can always adjust when a practice is considered full and not accepting new patients. This is not tied to SmartChoice, but normal within any provider group. The PacificSource website says the provider is “accepting new patients”, however I called the doctor and was told they are not. The PacificSource website is only as current as the information we have from the doctors office. If we aren’t notified, we won’t update our website. Engaged Providers = Engaged Members

2017/18 Changes – Management & Classified Move to a consoled alternative care benefit across all plans Management – changes the way out of network providers are paid Classified – Changes to the current management plan, which is modified for payment of out of network providers Add a Plan D option Eliminated the 4th quarter carry-over benefit No major change in dental plans

Plan Changes - effective 7/1/17 Benefit Change SmartChoice Plan D (new plan) SmartChoice Network Deductible $1,300/person Out of Pocket $5,000/person participating provider Classified Alt Care Changes $2,500 combined max $25 copay par/nonpar Member at risk for balance billing for nonpar services i.e. billed over allowed charges Management Alt Care Changes $2,500 combined max remains Already set up with $25 copay for participating providers; Nonpar also now $25 copay

Select the best Plan for you and your family All Management and Classified employees now have seven medical plan options All plans now have the same pharmacy, alternative care and vision coverage – only difference is deductible, out-of-pocket maximum and provider network. How to choose your medical plan? Choose your deductible & out of pocket maximum that best fit your and your family’s needs. Choose your network - PSN or SmartChoice The SmartChoice panel in Lane County has approximately 85% of the providers also in the PSN Network. The percentage is even higher match up when looking at the providers LCC members actually see. The SmartChoice plans are a great option for members to consider. Other considerations Premium cost from your paycheck Services pay the same on all plans (i.e. $25 copay, 100% preventive care, 20% co-insurance)

Plan deductibles and out-of-pocket maximums Individual in/out Network Family in/out Network A (PSN & SC) $500/$1,000 $1,250/$2,500 $2,000/$3,250 $4,250/$7,000 B (PSN & SC) $750/$1,500 $1,875/$3,750 $3,250/$5,250 $6,875/$11,250 C (PSN & SC) $1,000/$2,000 $2,500/$5,000 $4,000/$6,500 $8,500/$14,000 D (SC only) $1,300/$2,000 $2,600/$5,000 $5,000/$6,500 $10,000/$14,000 To get the best benefits – “stay in network” – SmartChoice may not save you any money if you go out of network.

New Plan Option - Plan D SmartChoice Network Only Like Plan Options A,B & C except for increased deductible and out-of- pocket maximum levels Lowest premium cost option

Classified Alternative Care Current Benefit New Benefit 7/1 Services include Massage, Chiropractic Manipulation & Acupuncture No change Maximum Benefit 24 visits massage & acupuncture; 24 visits chiro $2,500 combined – no visit count Cost per claim Deductible first, then 20% co-insurance $25 copay for both, participating or nonparticipating providers Balance billing - Nonparticipating providers None Can happen. This means if the provider charges above the PacificSource allowed fee, you can be billed by the provider for the difference between billed and allowed

Management Alternative Care Current Benefit New Benefit 7/1 Services include Massage, Chiropractic Manipulation & Acupuncture No change Maximum Benefit $2,500 combined Cost per claim $25 copay participating providers Deductible then 40% co-insurance for nonparticipating providers $25 copay for both, participating or nonparticipating providers* Balance billing- Nonparticipating providers Can happen. This means if the provider charges above the PacificSource allowed fee, you can be billed by the provider for the difference between billed and allowed

What action to take? Submit a new enrollment form ONLY if you wish to make changes to your plan(s) or dependent(s) enrolled. No action is needed if you do not wish to make any changes. Want more photo options? Contact MarComm.