2019 Health Plan ASU is a self-insured health plan. Employees and ASU pay premiums into the plan, and those premiums are used to pay claims, administrative fees, and excess loss insurance for our very large claims. Each year we analyze the costs to the health plan and adjust premiums or cost sharing to ensure we have enough funding in our plan to pay projected claims. >

Keeping Health Care Affordable You can help keep our health plan affordable by: Selecting a primary care physician. He or she will: Provide preventive care and teach healthy lifestyle choices; Identify and treat common medical conditions; Assess the urgency of your medical problems and direct you to the best place for that care; and Make referrals to medical specialists when necessary. >

Keeping Health Care Affordable You can also help keep our health plan affordable by: Visit www.blueadvantage.com to help manage your health care. You can: Find doctors and compare costs and quality rates; Track your claims, account balances, and deductibles; Print a temporary ID card. Seeking appropriate non-emergency care after-hours. You can: Seek care at an urgent care center; Call your physician’s office – they may have a nurse available by phone on nights and weekends; or Call the toll-free number on the back of your card to speak to a nurse who can help you decide where and when you should get treatment. >

Health Plan Options ASU offers 2 different health plan options. The Classic Plan utilizes the Arkansas True-Blue PPO Network and is a good choice for employees who primarily use Arkansas providers or providers in Memphis who are part of the Baptist network. The Premier Plan utilizes the National Blue Card Network and is generally the best choice for employees who utilize providers outside the state of Arkansas including Methodist in Memphis. >

Medical Plan Comparison Summary Classic Lower Premiums Higher Deductible Higher Out-of-Pocket Maximum Primarily Arkansas Network but does include the Baptist Network in Memphis Premier Higher Premiums Lower Deductible Lower Out-of-Pocket Maximum National Blue Card Network including both Baptist and Methodist in Memphis < >

Health Plan A list of providers for the network is available on the Arkansas Blue Advantage website at: https://secure.blueadvantagearkansas.com/healthcare-providers/#/ChooseNetwork For Classic select True Blue PPO For Premier select Nationwide Providers >

Health Plan Premiums – Employee Cost   CLASSIC PLAN PREMIER PLAN  12 Month Employees - 24 Pay Periods Employee Only Employee and Spouse Employee and Child(ren) Family $44 $163 $133 $180 $54 $181 $148 $202 9 Month Employees – 18 Pay Periods $58.67 $217.33 $177.33 $240.00 $72.00 $241.33 $197.33 $269.33 10 Month Employees – 20 Pay Periods $52.80 $195.60 $159.60 $216.00 $64.80 $217.20 $177.60 $242.40 < >

Health Plan Cost Sharing – In Network   CLASSIC PLAN PREMIER PLAN Deductible (amount employee pays before plan starts paying if service subject to deductible) $1,500 individual/$3,000 family $1,000 individual/$2,000 family Coinsurance (percent of covered service employee pays) 20% Out-of-pocket Maximums (includes deductibles, co-insurance, and copays) - Excludes Pharmacy $4,000 per individual $8,000 per family $3,000 per individual $6,000 per family Outpatient Provider Services Primary Care Physicians Mental Health Provider Specialist Services $35 copay $50 copay (additional services in office may also be subject to co-insurance) Urgent Care Emergency Room (for non-emergency services) $35 copay (additional services may be subject to co-insurance) Covered 80% after deductible, plus $200 copay Telemedicine (new for 2019) $20 copay Outpatient Rehabilitation Physical Therapy Occupational Therapy Speech Therapy (20 visits per year) < >

Health Plan Cost Sharing– In Network   CLASSIC PLAN PREMIER PLAN  Hospital and Outpatient Services (e.g., diagnostic services, medical procedures, advanced imaging, surgery) Covered 80% after deductible Preventive Care Annual GYN Exam Wellness & Adult Immunizations Well Child Care & Immunizations $0 copay Pregnancy Physician Charges - Prenatal Care & Delivery Hospital Charges Breast Feeding Equipment Rental Covered 80% deductible waived Covered 100% Inpatient Mental Health/ Substance Abuse Chiropractic Services – Limit of 20 visits per year 50% coinsurance deductible waived Prescription Drugs (participating pharmacy) Generic Preferred Brand Brand Maximum Annual Out of Pocket $12 $50 $80 $2,000 Individual/$4,000 Family < >

Health Plan Cost Sharing – Out of Network   CLASSIC PLAN PREMIER PLAN Deductible (amount employee pays before plan starts paying if service subject to deductible) $3,000 individual/$6,000 family $2,000 individual/$4,000 family Coinsurance (percent of covered service employee pays) 40% Out-of-pocket Maximums (includes deductibles, co-insurance, and copays) - Excludes Pharmacy $8,000 per individual $16,000 per family $6,000 per individual $12,000 per family Outpatient Provider Services Primary Care Physicians Mental Health Provider Specialist Services Covered 60% after deductible Urgent Care Emergency Room (for non-emergency services) Covered 60% after deductible, plus $200 copay Telemedicine (new for 2019) Not available Outpatient Rehabilitation Physical Therapy Occupational Therapy Speech Therapy (20 visits per year) < >

Health Plan Cost Sharing– Out of Network   CLASSIC PLAN PREMIER PLAN Hospital and Outpatient Services (e.g., diagnostic services, medical procedures, advanced imaging, surgery) Covered 60% after deductible Preventive Care Annual GYN Exam Wellness & Adult Immunizations Well Child Care & Immunizations Available in-network only $0 copay children under age 19 Pregnancy Physician Charges - Prenatal Care & Delivery Hospital Charges Breast Feeding Equipment Rental Covered 80% deductible waived Covered 80% after deductible Covered 100% Inpatient Mental Health/ Substance Abuse Chiropractic Services – Limit of 20 visits per year Not covered No covered Prescription Drugs Non-participating pharmacies Not Covered No Covered < >

ASU Wellness Benefits Routine Physical Exam One annual wellness exam In-Network paid at 100% Must be billed with a “routine diagnosis” or wellness visit Routine Gynecological Exam One In-Network per calendar year paid at 100% Mammography One In-Network screening per calendar year, paid at 100% Age 35-39 one exam; Age 40 and over annual exam Immunizations Covered adult and child immunizations are paid at 100%. Vaccines covered are subject to recommended age and population < >

Pharmacy Plan 31-day supply Generic copay - $12 * 07/16/96 Pharmacy Plan 31-day supply Generic copay - $12 Preferred brand name copay - $50 Non-preferred brand name copay - $80 90-day supply Generic copay - $36 Preferred brand name copay -$150 Non-preferred brand name copay - $240 < *