Wellness: Can we afford to look the other way Wellness: Can we afford to look the other way? Carole Khalife; Head of Human Capital and Employee Benefits Part of the Willis Towers Watson group © 2017 Willis Towers Watson. All rights reserved. © 2016 Willis Towers Watson. All rights reserved.

“Questions and feedback during the presentation: Are OK!” Agenda Medical inflation: Insurers and clients Potential challenges Health Statistics at a glance Pillars of a good wellness program How is the UAE doing Return on investment of wellness initiatives Contributing factors Dubai: A Case Study on Happiness! Impact on employers “Questions and feedback during the presentation: Are OK!” Traditional ways to solve the problem Decreasing benefits and increasing retention woes Downgrading the network Co-pays Categorization Gatekeeping Innovative solutions Wellness The real dimensions of wellness © 2017 Willis Towers Watson. All rights reserved. © 2016 Willis Towers Watson. All rights reserved. Proprietary and Confidential. For Willis Towers Watson and Willis Towers Watson client use only.

About Al Futtaim Willis Al Futtaim Willis is a commercial insurance broker & consultant operating within the UAE since 1976. A joint venture between Al Futtaim Services Co LLC and Willis Group Limited (an associate company of Willis Towers Watson PLC). Willis Towers Watson (NASDAQ: WLTW) is a leading global advisory, broking and solutions company that helps clients around the world turn risk into a path for growth. With roots dating to 1828, Willis Towers Watson has 41,500 employees in more than 140 countries. © 2017 Willis Towers Watson. All rights reserved. © 2016 Willis Towers Watson Plc. All rights reserved. Proprietary and Confidential.

(% = Percentage of Voters) Enter Number(s) and Press Send What % of healthcare spend is caused by people with one or more Chronic medical condition? Vote for up to 4 choices 1. 40-55% 33.3% 2. 56-70% 25.5% 3. 71-80% 4. 80% + 15.7% (% = Percentage of Voters) © 2016 Willis Towers Watson Plc. All rights reserved. Proprietary and Confidential. Vote Trigger

Health Statistics at a Glance 43% A recent report from Alpen Capital into healthcare in the GCC predicted that inpatient spending will grow from USD 16.4bn in 2015 to USD 28.9bn in 2020. That’s a rise of 43% in five years. 86% Eighty-six percent of all health care spending is for people with one or more chronic medical conditions Rockville, MD: Agency for Healthcare Research and Quality 75% Seventy five percent of chronic illnesses are caused by peoples lifestyle choices. 2.7 M More than 1 in every 4 adults in the UAE said they currently smoked tobacco of some form in a WHO report in 2015. The trend is alarming, in that the incidence of smoking is on the increase. © 2017 Willis Towers Watson. All rights reserved. © 2016 Willis Towers Watson. All rights reserved. Proprietary and Confidential. For Willis Towers Watson and Willis Towers Watson client use only.

Member reconciliation errors can cost in excess of 10% of premium Market Dynamics 30+ medical inflation continues to place pressure on costs and as new facilities and technology are introduced to this will only continue to rise >15% 8+ global medical insurers working through local partners capable of providing seamless cover and network access in the UAE and home country private medical insurers providing varying degrees of benefit options, network choice & solutions Regulation continues to evolve and places greater pressure on organizations to collect and maintain internal data warehouses for their employees >50% >40% claims incurred outside of the UAE, generally in home countries or specific medical COE’s claims account for outpatient claims – consultations, diagnostic, pharmacy medications Member reconciliation errors can cost in excess of 10% of premium © 2017 Willis Towers Watson. All rights reserved. © 2016 Willis Towers Watson. All rights reserved. Proprietary and Confidential. For Willis Towers Watson and Willis Towers Watson client use only.

What is the Impact on premiums? Historical 10 Year Medical Inflation Source: Willis Towers Watson 2016 Global Medical Trends Survey, National Bureau of statistics, UAE © 2017 Willis Towers Watson. All rights reserved. © 2016 Willis Towers Watson. All rights reserved. Proprietary and Confidential. For Willis Towers Watson and Willis Towers Watson client use only.

The health benefits funding gap is getting wider 2030 Medical Inflation Forecast Unsustainable: doing nothing is no longer an option © 2017 Willis Towers Watson. All rights reserved. © 2017 Willis Towers Watson. All rights reserved. Proprietary and Confidential. For Willis Towers Watson and Willis Towers Watson client use only.

What Contributes to Medical Inflation What are the six most significant factors driving medical cost (employee/provider behavior)? Fraud and Overuse Poorly Managed Chronic Conditions Poor Lifestyle Overuse of care due to medical practitioners recommending too many services Management of employees ongoing medical conditions Employees poor health and lifestyle habits © 2017 Willis Towers Watson. All rights reserved. © [yyyy] Willis Towers Watson. All rights reserved. Proprietary and Confidential. For Willis Towers Watson and Willis Towers Watson client use only.

What Contributes to Medical Inflation What are the six most significant factors driving medical cost (employee/provider behavior)? High Stress Minimal Data Low Staff Engagement Inefficiency at work due to external and internal anxiety Fact based decisions are difficult without data to support Education is key, staff engagement is therefore essential © 2017 Willis Towers Watson. All rights reserved. © [yyyy] Willis Towers Watson. All rights reserved. Proprietary and Confidential. For Willis Towers Watson and Willis Towers Watson client use only.

How does inflation impact employers   Benefits costs are the top challenge 56% for organisations' benefit programmes in the United Arab Emirates (% of ‘to a very great extent’ or ‘to a great extent’) United Arab Emirates gross medical trend, 2012-2017 How do insurers expect the medical trend in their overall book of business to change over the next three years compared to current rates? (Middle East and Africa) 42% * Projected Source: 2017 Benefits Trends Survey, Middle East - United Arab Emirates; 2017 Global Medical Trends Survey © 2017 Willis Towers Watson. All rights reserved. © 2017 Willis Towers Watson. All rights reserved. Proprietary and Confidential. For Willis Towers Watson and Willis Towers Watson client use only.

Traditional and innovative ways to solve the problem Avoidable Costs Unnecessary benefits Duplication of benefits Fraud Misuse and abuse Not clinical best practice Wellness initiatives A BenefitNet Consistent Local Claims Reports Advanced Analytics Global Claims Dashboard Claims Analytics Data Driven ACTionable Controllable Costs Manage the network of providers Employee communication/ education Case management (chronic conditions, cancer claims, high cost claims) Paying the claims as per protocol Second medical opinion C Our global analytics vision starts with a fully integrated data warehouse where claims data can be linked to plan design data, cost data, vendor data etc. to provide more powerful business insights into what is driving claims costs. We then focus on three main pieces as part of our offering – (1) consistent local claims reports that not only look and feel the same, but include consistent elements such as population analysis, claims ratio development, utilization by type of service and demographics, and diagnostic information mapped to standard ICD10 categories even where this information is not typically provided in the local market. (2) Our Benefits Insights tool includes a Global Claims Dashboard where you can compare key features of the experience in each country, identify the plans with the biggest concerns, and compare key health issues across countries. This helps HQ to know where to spend their time. And then (3) a range of services we call Advanced Analytics which is tailored to the needs of each plan. We analyze the performance of the plan within a framework that considers those costs that are Avoidable…… those that are Controllable…… and those that may be Transferrable….. We utilize the other integrated data to dig into these issues further. Transferable Costs Cost sharing with employees Deferred billing Capping benefits Captives & Risk Pooling T © 2017 Willis Towers Watson. All rights reserved. © 2017 Willis Towers Watson. All rights reserved. Proprietary and Confidential. For Willis Towers Watson and Willis Towers Watson client use only.

Traditional ways Decrease benefits Downgrade the network Apply copays Categorize benefits Bring in a ‘Gatekeeper’ © 2017 Willis Towers Watson. All rights reserved. © 2016 Willis Towers Watson. All rights reserved. Proprietary and Confidential. For Willis Towers Watson and Willis Towers Watson client use only.

Dimensions of Wellness Innovative Solutions Wellness Occupational Social Environmental Dimensions of Wellness Physical Intellectual Emotional Financial © 2017 Willis Towers Watson. All rights reserved. © 2016 Willis Towers Watson. All rights reserved. Proprietary and Confidential. For Willis Towers Watson and Willis Towers Watson client use only.

Potential Increase in LR Little Personalization Innovative Solutions Potential Challenges of Wellness Initiatives No Baseline Lack of participation No Structure Little Data Reporting Potential Increase in LR Little Personalization Length of tenure © 2017 Willis Towers Watson. All rights reserved. © 2016 Willis Towers Watson. All rights reserved. Proprietary and Confidential. For Willis Towers Watson and Willis Towers Watson client use only.

(% = Percentage of Voters) Enter Number(s) and Press Send Would you, as an insurer offer a premium discount if the employer is able to produce data around the overall population health status? (BMI, HRAs, biometric tests results, etc.) Vote for up to 2 choices 1. Yes 77% 2. No 23% (% = Percentage of Voters) © 2016 Willis Towers Watson Plc. All rights reserved. Proprietary and Confidential. Vote Trigger

Wellness Done Right! Multilevel leadership buy-in Planning it right! Planning, facilitating, incentivizing, and alignment with financial goals Scope and quality Wellness dimensions, individualization, quality partners and FUN! Accessibility The right partner(s) Communication © 2017 Willis Towers Watson. All rights reserved. © 2016 Willis Towers Watson. All rights reserved. Proprietary and Confidential. For Willis Towers Watson and Willis Towers Watson client use only.

Wellness – Return On Investment? ROI of wellness Johnson & Johnson estimate that wellness programs have cumulatively saved the company $250 million on health care costs over the past decade; in 6 years, the return was $2.71 for every dollar spent. Study by Dr. Milani & Lavi: 57% of high risk employees were converted to low-risk status within the six-months Medical claim costs declined by $1,421 per participant © 2017 Willis Towers Watson. All rights reserved. © 2016 Willis Towers Watson. All rights reserved. Proprietary and Confidential. For Willis Towers Watson and Willis Towers Watson client use only.

Wellness Works! © 2017 Willis Towers Watson. All rights reserved. © 2016 Willis Towers Watson. All rights reserved. Proprietary and Confidential. For Willis Towers Watson and Willis Towers Watson client use only.

The UAE gets it! Ministry of state for Happiness Happiness meter portal! 30 X 30 Dubai Challenge DHA Mandatory Screenings Various other initiatives © 2017 Willis Towers Watson. All rights reserved. © 2016 Willis Towers Watson. All rights reserved. Proprietary and Confidential. For Willis Towers Watson and Willis Towers Watson client use only.

Head of Health & Benefits - Al Futtaim Willis About the speaker Carole Khalifé Head of Health & Benefits - Al Futtaim Willis For more than 10 years in the MENA region, my team and I have supported some of the largest regional and international organizations in the areas of Risk Management, Employee Benefits - Medical, Life insurance, etc. I believe that the key to our success as a team is setting common goals and striving to exceed them by continuously trying to find a better, smarter way to do things - and there's always a better way. I'm passionate about people, innovation and lifelong learning. Please contact us for specific wellness consulting and employee engagement solutions on: carole.khalife@willistowerswatson.com © 2017 Willis Towers Watson. All rights reserved. © 2016 Willis Towers Watson Plc. All rights reserved. Proprietary and Confidential.

© 2017 Willis Towers Watson. All rights reserved. © 2016 Willis Towers Watson Plc. All rights reserved. Proprietary and Confidential.