Cleveland Metropolitan School District HealthSpan Special Enrollment Cleveland Metropolitan School District Tuesday, November 27, 2018

Agenda HealthSpan Update CMSD Plan Options Special Enrollment Opportunity Questions

HealthSpan Update HealthSpan was created through acquisition of Kaiser-Permanente in 2013 Continued to operate initially through owned and operated facilities Change in model of delivery Cleveland Clinic to University Hospitals – 2013 Addition of select non-HealthSpan providers to network: MetroHealth, Summa, Mercy, University Hospital – 2014 & 2015 Expansion of retail pharmacy network – 2015 Cleveland Heights & Parma urgent care transferred to MetroHealth – 2015 Announced disbanding of HealthSpan Physicians effective 4/1/2016 – 2015 HealthSpan Physician providers are not scheduling services past March

What will occur by April 1st MetroHealth will begin to operate the Cleveland Heights and Parma Medical Centers Laboratory and Radiology services will continue to be provided at these locations HealthSpan pharmacies will continue to operate until March 25, 2016 for both retail and mail order Further information regarding prescriptions is expected HealthSpan Physicians providers may affiliate with other network affiliates including MetroHealth, Mercy, Summa and University Hospital MetroHealth has announced it has contracted with over 40 HealthSpan primary care providers MetroHealth has announced it will continue to operate the Bedford, Cleveland Heights, Parma and Rocky River facitlities Further information from HealthSpan is expected over the next two weeks

CMSD Plan Options CMSD offers three health plan options for members HealthSpan (www.healthspan.org) Aetna (www.aetna.com) Provides access to all major hospital systems throughout Northeast Ohio Provides national network coverage www.aetna.com Medical Mutual of Ohio (MMO) (www.medmutual.com) Provides access to all major hospital systems throughout Northeast Ohio, except: University Hospital main campus & Bedford

CMSD Health Plan Comparison Deductible – Amount of member out-of-pocket responsibility for services including co-insurance HealthSpan Network Only Aetna Network / Non-Network Medical Mutual (MMO) Single $0 $0 / $250 Family $0 / $500 This summary represents a general overview of select plan elements. Please refer to the CMSD 2016 Benefits Enrollment Guide for further detail.

CMSD Health Plan Comparison Co-Insurance – Percentage of member out-of-pocket responsibility for select services including hospital, surgery, diagnostic services etc capped at the co- insurance maximum (Maximum Excludes Deductible) HealthSpan Network Only Aetna Network / Non-Network Medical Mutual (MMO) Member Co-Insurance 100% 100% / 70% 100% / 80% Single Co-Insurance Maximum $0 $0 / $2,250 $0 / $2,000 Family Co-Insurance Maximum $0 / $4,500 $0 / $4,000 This summary represents a general overview of select plan elements. Please refer to the CMSD 2016 Benefits Enrollment Guide for further detail.

CMSD Health Plan Comparison Co-Payment – Member out-of-pocket responsibility for select services. HealthSpan Network Only Aetna Network / Non-Network Medical Mutual (MMO) Primary Care Office Visit $10 $15 / 70% $15 / 80% Specialist Office Visit $25 $25 / 70% $25 / 80% Urgent Care Services $35 / 70% $35 / 80% Emergency Services $50 $75 This summary represents a general overview of select plan elements. Please refer to the CMSD 2016 Benefits Enrollment Guide for further detail.

CMSD Health Plan Comparison Prescription Co-Payment – Member out-of-pocket responsibility for prescription drugs. HealthSpan Network Only Aetna Network / Non-Network Medical Mutual (MMO) Retail: Generic Formulary Non-Formulary $5 $10 $15 Mail Order (90 day): $20 $30 This summary represents a general overview of select plan elements. Please refer to the CMSD 2016 Benefits Enrollment Guide for further detail.

CMSD Prescription Drug Programs Aetna & MMO utilize the Express Scripts pharmacy network, and include the following plan requirements: Mandatory Generic: Members are required to pay the appropriate drug co- payment plus the difference between the brand and generic cost if a brand drug is selected when a generic equivalent is available. Mandatory Mail Order: Members are required to fill all maintenance medications through the mail order pharmacy after the third fill (initial and two refills). Prior Authorization & Step Therapy: Certain high cost drugs may be subject to prior authorization and / or step therapy requiring that generic and lower cost alternative brand therapies are attempted prior to most costly alternatives. This summary represents a general overview of select plan elements. Please refer to the CMSD 2016 Benefits Enrollment Guide for further detail.

Member Payroll Contributions Please refer to the 2016 CMSD Benefits Enrollment Guide for your applicable payroll contribution for each plan option

Special Enrollment Opportunity The IRS permits mid-year changes for certain significant changes in coverage, consistent with the changes in coverage Currently enrolled HealthSpan members may make a change to their medical carrier election only Non-HealthSpan members are not permitted to make a change No changes may be made to any other benefit elections including dental or flexible spending elections This change does not allow for addition or deletion of any dependents (unless there is a specific qualifying event) If you have a Qualifying Event which overlaps please follow the CMSD notification process for Qualifying Events This Special Enrollment period is February 15, 2016 through February 29, 2016 Any carrier changes will be effective April 1, 2016

Special Enrollment Opportunity This will be the only opportunity to make a change during the year unless you experience a Qualifying Event Marriage, Divorce, Birth of a Child etc Consult your current HealthSpan provider to determine his or her plans to continue as a HealthSpan participating provider

Thank you! Questions?