Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. EASTERN MICHIGAN UNIVERSITY 2014 HEALTH CARE OPTIONS

Introduction Who you are 2

About Your Medical Coverage 100% Preventive Care Benefits - Based on age & gender - No deductibles or copays apply if rendered in- network and doctor codes as preventive (annual physical or annual screening) - Not covered out of network; exceptions for mammograms and colonoscopy 3

Available Options Community Blue PPO – Option 5 Simply Blue HSA Blue Care Network Healthy Blue Living 4

ACA Mandated Benefits The following are applicable to all Large groups: Coverage of routine care for participants in certain clinical trials Preventive drug coverage with no cost share that includes (all must be prescribed by a physician): –Coverage for select smoking cessation drugs –Aspirin for women ages 55 to 79 years when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage –Aspirin for men ages 45 to 79 years when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage –Folic acid for women planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400 to 800 µg) –Oral fluoride supplementation at currently recommended doses to preschool children older than age 6 months whose primary water source is deficient in fluoride –Routine iron supplementation for asymptomatic children ages 6 to 12 months who are at increased risk for iron deficiency anemia –Over the counter female contraceptive medications only when prescribed by a physician

BenefitsPPO Option 5PPO HSAHMO – Enhanced (Standard) Deductible$250 – employee $500 – 2-person $750 – family $1,250 – employee $2,500 – 2 or more $500 – employee/(1,500) $1,000 – 2 or more /($3,000) Fixed-dollar copays$20 for office visit* (*$15 - chiropractic) $50 emergency room None (chiropractic coverage is excluded) $5 allergy injections ($5) $20 office & urgent care ($35 office/$50 urgent) $100 emergency room ($100) Percent coinsurance (approved amounts after deductible) 10%20% other services20% or 50% (35% or 70%) depending on service; includes lab, x-rays, inpatient and outpatient hospital Annual out-of-pocket maximum $1,000 – employee $2,000 – 2 or more (includes coinsurance) $6,350 – employee $12,700 – 2 or more (includes deductibles, fixed dollar medical and Rs copays and coinsurance) $2,500 – employee $5,000 – 2 or more (includes deductible, fixed-dollar medical and Rx co-pays and coinsurance) $1,000 – employee $2,000 – 2 or more (includes deductible, fixed- dollar medical co-pays and coinsurance) $6,350 – employee $12,700 – 2 or more Separate out-of-pocket maximum will apply for Rx co- pays Refer to the Enrollment Guide posted online for more detailed info, including out-of- network coverage Deductible, Copays & Maximums

Community Blue PPO/HSA Option Who is eligible? - Must be enrolled in a qualifying High Deductible Health Plan (HDHP) - Deductibles at least $1,250 individual/$2,500 family - Not covered under any other health insurance (unless it is another HDHP) - Not enrolled in Medicare - Not receiving any VA benefit - Subscriber cannot be eligible to be claimed as a dependent on another persons tax return and must be over 18 years old 7

What is an HSA? Similar to checking account for health expenses - You own your HSA funds that are deposited into your Health Equity account - Debit card to pay for qualified medical expenses - HSA funds can be used for: - Deductibles, copays and coinsurance for medical, Rx, vision and dental plans - COBRA premiums - Health insurance premiums while receiving unemployment - Medicare Part A and B premiums - Qualified long term care 8

Who is Health Equity? A FDIC full-service financial institution Leader in HSA, HRA and FSA administration Free investment options through Charles Schwab 24/7 customer service available 9

HSA Tax Advantages All contributions are pre-tax All funds grow tax free in bank account Funds are not taxed when you use money to pay for a qualified medical expense – there is a 20% penalty if money is spent on a non-qualified expense prior to age 65 SAVE YOUR RECEIPTS 10

Blue Care Network – Healthy Blue Living Health Maintenance Organization (HMO) High performance network that encourages a health lifestyle Comprehensive network of providers Two levels of benefits - Enhanced - Standard Must select a primary care physician (PCP) from the Focus Network 11

Enhanced and Standard Benefits HMO participants are eligible for 2 benefit levels with cost sharing options - Enhanced – has lower deductible and copayments - Standard – has higher deductible and copayments You are automatically enrolled in the enhanced benefit for the first 90 days of coverage at the initial enrollment To qualify to remain in the enhanced plan you and your enrolled spouse must do the following: -Complete an online Health Risk Assessment (HRA) -Receive a physical exam and have your physician complete a qualification form - There are 6 Wellness Targets that will be measured 12

Wellness Targets for Enhanced Benefit Level 13 Health Measure Wellness Target If I do not meet the target – how can I qualify for the enhanced benefit? TobaccoNon-tobacco user Enroll in Quit the Nic tobacco cessation program Actively participate until you quit using tobacco WeightBody mass index below 30 Participate in Weight Watchers or WalkingSpree program until BMI falls below 30 Blood PressureBelow 140/90Commit to and follow doctors treatment plan Cholesterol LDL below target based on risk factors: <100, <130 and <160 Commit to and follow doctors treatment plan Blood sugar At or below target (Fasting Blood Sugar or A1C) Commit to and follow doctors treatment plan DepressionAny depression in full remission Commit to and follow doctors treatment plan

Selecting a PCP in the HMO -Employees residing in one of the 7 identified southeast counties must select a PCP from the PCP Focus Network: MacombWashtenawOakland MonroeSaint ClairWayne Livingston -Members residing outside of these 7 counties will select a PCP from BCNs existing network -Network includes all BCN contracted hospitals and specialists -Members that do not select a PCP upon enrollment will be assigned to a Focus PCP -Visit to view network providerswww.mibcn.com 14

About the BCBSM Pharmacy Cost Control Measures for PPO and PPO/HSA 15

Cost Savings Programs for Pharmacy Benefits EMU/Snow Pharmacy Discount Program - Lower Generic Snow Pharmacy - $3 copay for 30 day generic - $7 copay for 90 day generic BCBSM Pharmacy Cost Savings Programs - Mandatory Maximum Allowable Cost (MMAC) - Pharmacy Initiatives 16

About Your RX Coverage BenefitsPPO Option 5PPO & HSAHMO – Enhanced (Standard) Retail Copays* Tier 1Snow Health Center Pharmacy Discount ProgramPharmacy Discount Program $3 for 30-day supply of generic medication ($5 at other retail pharmacies) $7 for a 90-day supply of generic medication (not available at other retail) Tier 2$25 $25 ($40) Tier 3$50 $50 ($80) 90-day Retail / Mail Order Copays* 90-day retail only at Snow 2x retail only at Snow 2.5x copay at Medco Mail Order 2x retail copay up to 90 day supply at Snow and Medco Refer to the Enrollment Guide for more detailed info about your RX benefits. *The PPO Option 5 and PPO/HSA Plan includes certain drug initiatives that require you to use generic or pay higher out-of-pocket charges unless you receive approval from BCBSM to use generic when there is a brand equivalent. Read more online by clicking this link: 2014 RX Coverage Under New Health Plan Options.

Mandatory Maximum Allowable Cost (MMAC) * When a generic equivalent is available for a brand-name drug and the brand-name drug is purchased, the member is responsible for the difference in cost between the brand-name drug and the MAC price, in addition to the applicable brand-name copayment, regardless of whether the doctor indicates DAW or not 18

How MMAC Works Mandatory MAC (aka Mandatory Generic) Physician requests brand (DAW) Member pays cost difference between brand and generic PLUS applicable brand copay Additional cost may be waived with approved Medical Necessity Member requests brand Member pays cost difference between brand and generic PLUS applicable brand copay 19

BCBSM Pharmacy Initiatives Dose Optimization Brand-to-Alternate Generic Interchange Generic Copay Waiver Quantity Limits Off Label/High-Cost Specialty Review Preferred Therapy Details posted on the EMU Benefits website under Prescription Drugs 20