Sussex Wantage Regional School District Plan Options effective July 1, 2017 – June 30, 2018

Chapter 78 Legislation Chapter 78 was passed on June 28, 2011 Requires contributions based on actual cost of coverage and tiered by salary level The School Employees’ Health Benefits Program (SEHBP) and State Health Benefits Program (SHBP) must implement at least three plan options, AND a High Deductible/Health Savings Account (HSA) Employers with plans that are outside the SHBP/SEHBP are not required to implement at least three plan options or an HSA All Employers must offer a Section 125 Premium Only Plan (POP) and a Health Flexible Spending Account (FSA)

Salary Range Year 1 Year 2 Year 3 Year 4 Employee pays below or 1.5% of salary, whichever is greater Salary Range Year 1 Year 2 Year 3 Year 4 less than 20,000 1.13% 2.25% 3.38% 4.50% 20,000-24,999.99 1.38% 2.75% 4.13% 5.50% 25,000-29,999.99 1.88% 3.75% 5.63% 7.50% 30,000-34,999.99 2.50% 5.00% 10.00% 35,000-39,999.99 8.25% 11.00% 40,000-44,999.99 3.00% 6.00% 9.00% 12.00% 45,000-49,999.99 3.50% 7.00% 10.50% 14.00% 50,000-54,999.99 15.00% 20.00% 55,000-59,999.99 5.75% 11.50% 17.25% 23.00% 60,000-64,999.99 6.75% 13.50% 20.25% 27.00% 65,000-69,999.99 7.25% 14.50% 21.75% 29.00% 70,000-74,999.99 8.00% 16.00% 24.00% 32.00% 75,000-79,999.99 16.50% 24.75% 33.00% 80,000-94,999.99 8.50% 17.00% 25.50% 34.00% 95,000 and over 8.75% 17.50% 26.25% 35.00%

Member / Spouse or Parent Child(ren) Employee pays below or 1.5% of salary, whichever is greater Salary Range Year 1 Year 2 Year 3 Year 4 less than 25,000 0.88% 1.75% 2.63% 3.50% 25,000-29,999.99 1.13% 2.25% 3.38% 4.50% 30,000-34,999.99 1.50% 3.00% 6.00% 35,000-39,999.99 5.25% 7.00% 40,000-44,999.99 2.00% 4.00% 8.00% 45,000-49,999.99 2.50% 5.00% 7.50% 10.00% 50,000-54,999.99 3.75% 11.25% 15.00% 55,000-59,999.99 4.25% 8.50% 12.75% 17.00% 60,000-64,999.99 10.50% 15.75% 21.00% 65,000-69,999.99 5.75% 11.50% 17.25% 23.00% 70,000-74,999.99 6.50% 13.00% 19.50% 26.00% 75,000-79,999.99 6.75% 13.50% 20.25% 27.00% 80,000-84,999.99 14.00% 28.00% 85,000-99,999.99 22.50% 30.00% 100,000 and over 8.75% 17.50% 26.25% 35.00%

Salary Range Year 1 Year 2 Year 3 Year 4 Employee pays below or 1.5% of salary, whichever is greater Salary Range Year 1 Year 2 Year 3 Year 4 less than 25,000 0.75% 1.50% 2.25% 3.00% 25,000-29,999.99 1.00% 2.00% 4.00% 30,000-34,999.99 1.25% 2.50% 3.75% 5.00% 35,000-39,999.99 4.50% 6.00% 40,000-44,999.99 1.75% 3.50% 5.25% 7.00% 45,000-49,999.99 6.75% 9.00% 50,000-54,999.99 12.00% 55,000-59,999.99 10.50% 14.00% 60,000-64,999.99 4.25% 8.50% 12.75% 17.00% 65,000-69,999.99 4.75% 9.50% 14.25% 19.00% 70,000-74,999.99 5.50% 11.00% 16.50% 22.00% 75,000-79,999.99 5.75% 11.50% 17.25% 23.00% 80,000-84,999.99 18.00% 24.00% 85,000-89,999.99 6.50% 13.00% 19.50% 26.00% 90,000-94,999.99 21.00% 28.00% 95,000-99,999.99 7.25% 14.50% 21.75% 29.00% 100,000-109,999.99 8.00% 16.00% 32.00% 110,000 and over 8.75% 17.50% 26.25% 35.00%

Sussex Wantage Plan Options The Sussex Wantage Board of Education continues to offer three medical plan options and two prescription plan options for employees: Existing PPO Existing Direct Access Existing EPO Existing $15 Generic/$25 Preferred Brand/$40 Non- Preferred Brand Prescription Plan (RX # 2) Existing $10 Generic/$20 Preferred Brand/$40 Non-Preferred Brand Prescription Plan (RX # 1)

Medical Plan Comparison PPO Direct Access EPO NJ Network Horizon PPO Network Horizon Managed Network National Network Bluecard Primary Care Copay $10 $20 Specialist Copay $40 Annual Physical/Well Visits No copay 8 8

Medical Plan Comparison PPO Direct Access EPO Hospital Network Identical for all three plans Inpatient Coverage 100% In-Network 80% after deductible Out of Network No Out of Network coverage outside of emergency Inpatient Copay None $250/day Up to 5 Days ER Copay $25 $100 Appropriate emergency care at the ER is considered in-network regardless of network status

Medical Plan Rate Comparison Rates PPO Direct Access EPO Single $843.50 $799.71 $691.68 2 Adults $1,593.60 $1,510.85 $1,306.75 Family $2,151.19 $2,039.53 $1,763.99 Parent & Child(ren) $1,444.72 $1,369.68 $1,184.66

DA & EPO: Key Features Horizon Managed network in NJ. Same hospital & national Bluecard networks as PPO. No PCP selection and no referrals required. Lower out of pocket costs compared to PPO. No day/visit limits for mental health/substance abuse care. Continues to provide members with Horizon’s full suite of resources including case management, chronic care management, wellness discounts and My Health Manager.

Prescription Plan Comparison RX #2 Prescription RX #1 Type of Plan 3 Tier Copayment Generic vs. Brand vs. Non-Preferred Retail Copayments $15 Generic $25 Brand $40 Non-Preferred $10 Generic $20 Brand Mail Order Copayments (90 Day Supply) $30 Generic $50 Brand $80 Non-Preferred $5 Generic $10 Brand $20 Non-Preferred 12 12

Prescription Plan Rate Comparison Rates Rx Plan # 2 ($15/$25/$40 Copay) Rx Plan #1 ($10/$20/$40 Copay) Single $240.72 $280.04 2 Adults $365.14 $424.78 Family $493.10 $573.64 Parent & Child(ren) $275.42 $320.41 13 13