Plan 1- Base Plan Information McLennan County Employee Health Plan Benefits 2016-2017 Plan Year Plan 1- Base Plan Information

What’s New for 2016-2017 Plan Year Information you should know about your health plan renewal for October 1st:   McLennan County Commissioners Court approved no changes to the health plan. The County will continue to contribute $510.04 to the total cost of the plans’ monthly premium for the Plan 1 Base Plan. McLennan County Commissioners Court approved no changes to the health plan. The County will continue to contribute $466.50 to the total cost of the plans’ monthly premium for the Plan 2 CDHP Plan and also will contribute $43.54 to the HSA monthly. (For retirees, the County will contribute $559.80 to the retiree only premium for employees that had 20 consecutive years of service at retirement) 2

What is a deductible and when does it apply? A deductible is the amount you pay for covered health care services before your insurance plan starts to pay. With a $1,000 deductible, for example, you pay the first $1,000 of covered services yourself. The only services that are not subject to the deductible are the ones with a co-pay stated in the plan summaries. The CDHP benefits are subject to the deductible before the plan pays. The only benefits that are not subject to the deductible for the CDHP are the age appropriate preventative services and the RX co-pays from the approved preventative drug list. McLennan County’s Health Benefit Plan starts October 1, 2016, and runs through September 30, 2017. Deductibles for both the Base Plan and the Consumer Driven Health Plan run from January 1 to December 31. Your deductible does not start over until January 1. If you have met a part of your deductible prior to October 1 it will carry over until December 31 and then start over on January 1, 2017. Scott and White recently expanded to cover TRS-Active Care members in North Texas. However, we have a long tradition of meeting TRS-Active Care members’ needs. Source: Guide to Texas HMO Quality: 2014 3

PLAN 1 – Base Health Plan Effective October 1, 2016 Employee Only Premium $28.09 Benefit In-network Calendar Year Deductible (Applies to Out-of-Pocket Maximum) Individual Deductible Family Deductible (Family deductible is embedded) $1,000 $2,000 Calendar Year Out-of-Pocket Maximum Individual Out-of-Pocket Maximum Family Out-of-Pocket Maximum $4,500 $9,000 Primary Care Office Visit $30 office copay Specialty Care Office Visit $50 office copay Treat-n-Go Walk-In Clinic $10 copay Allergy Serum 20% after deductible Outpatient Surgery Standard Lab and X-Ray No Charge Other Outpatient Services (Including other services, treatments, or procedures received at time of visit) Preventive Care Services (See list for full details) Skilled Nursing Facility (Pre-Certification Required) 20% after deductible (Unlimited) Scott and White recently expanded to cover TRS-Active Care members in North Texas. However, we have a long tradition of meeting TRS-Active Care members’ needs. Source: Guide to Texas HMO Quality: 2014 4

20% after deductible (Unlimited) PLAN 1 – Base Health Plan Effective October 1, 2016 Employee Only Premium $28.09 Benefit In-network Eye Exam (1 refraction annually) $30 office copay Copay for each day of Skilled Nursing Facility inpatient services. Max Skilled Nursing Facility days per year. 20% after deductible (Unlimited) Inpatient Services Hospital Room, Semi-private 20% after deductible Intensive Care Unit Other Hospital Services Emergency Care Services (could be balanced billed for services out of network) Emergency Room (In and out of area) Urgent Care (In and out of area) $50 copay Ambulance Outpatient - Mental Health/Chemical Abuse Services Serious Mental Illness (Requires referral and approval of medical director) $30 copay Inpatient - Mental Health/Chemical Abuse Services /Inpatient Serious Mental Illness (Requires referral and approval of medical director) Scott and White recently expanded to cover TRS-Active Care members in North Texas. However, we have a long tradition of meeting TRS-Active Care members’ needs. Source: Guide to Texas HMO Quality: 2014 5

PLAN 1 – Base Health Plan Effective October 1, 2016 Employee Only Premium $28.09 Benefit In-network Therapeutic Services Speech & Hearing visit Max Speech & Hearing visits per year $30 copay 20 visits per year Physical Therapy visit Max Physical Therapy visits per year Home Health Services (Precertification Required) $30 copay unlimited Home Infusion Therapy (Precertification Required) 20% co-insurance Hospice Services (Precertification Required) 20% co-insurance (unlimited) Maternity Services (Pre-Natal visits) No Charge Diagnostic Procedures in conjunction with Maternity Services 20% after deductible Outpatient Diagnostic Procedures in conjunction with Family Planning Services. Durable Medical Equipment/Orthotics/Prosthetic Medical Appliances 50% after deductible Inpatient Prescription Drugs Includes Specialty Pharmacy Drugs administered in an inpatient setting. Same as other inpatient services Diagnostic/Radiology (Limited to: angiograms, CT scans, MRIs, PET scans, myelography, stress tests, ultrasound) Diabetic Supplies, Equipment, and Self-Management Training Same as DME or Rx, as appropriate $30 copay for self-mgmt training Source: Guide to Texas HMO Quality: 2014 6

PLAN 1 – Base Health Plan Prescription Benefits In-network Annual Deductible No deductible for Rx Generic Drugs $10 copay Preferred Brand $30 copay Non-Preferred Lesser of $55 or 50% Non-Formulary Greater of $55 or 50% Generic (Maintenance Drugs; 3 Months Supply) $20 copay Preferred Brand (Maintenance Drugs; 3 Months Supply) $60 copay Non-Preferred (Maintenance Drugs; 3 Months Supply) Lesser of $110 or 50% Non-Formulary(Maintenance Drugs) Not Applicable Outpatient Specialty Drugs (Deductible does not apply) Level 1 10% copay Level 2 (Preferred) 20% copay Level 3 (Premium Preferred) 30% copay Level 4 (Non-Preferred) 50% copay Source: Guide to Texas HMO Quality: 2014 7

Examples of How “Plan 1: Base Health Plan” Works If you have to go into the hospital, you will have to pay the first $1,000 of charges and then you will have to pay 20% of the remaining charges until you have reached the out-of-pocket max. of $4,500. If you have a CT scan you will have to pay the first $1,000 of charges, then 20% of the remaining charges until you reach the $4,500. If you pay a copay for your office visit, you pay $500 for a sonogram test, then have a CT scan ,expect to pay another $500 of charges to satisfy the remaining deductible amount. Should you go into the hospital, you will have to pay 20% of the charges until the amounts that you have already paid and the 20% adds up to your out-of-pocket max. of $4,500. In August, you have an office visit with a copay of $30; and at that visit you also have a procedure such as having a mole removed. The charges for that are $85, you will pay a total of $115. The $85 will apply to the deductible, but the $30 will apply to the out-of-pocket maximum. In September, the doctor says that you need to have a MRI for your back and those charges are $2,900, you will pay $915 to meet the remaining deductible amount plus 20% being $397. On Nov. 10th, you go into the hospital and those charges are $13,000, you will have to pay 20% which is $2,600. You have met the deductible, but still have $473 of the out-of-pocket maximum to meet. Remember the deductible and out-of-pocket maximum will start over again on January 1st. ** Disclaimer: costs on these slides are fictitious and only for purposes of explaining how the plan works.

Examples of How “Plan 1: Base Health Plan” Works Continued Diabetic services example: Diabetic supplies that cost $65 per month, coverage is at 50% of the copay. If you go to the doctor every month for 3 months and the amount for the copay is $30 plus you have the monthly diabetic supplies, you will pay $187.50. Then on October 5th, you have to go into the hospital for outpatient surgery unexpectedly. When you receive the bill for the out patient surgery of $5,600, you will have to pay $1,000 deductible and 20% of the remaining charge which is $920 of the $5,600 billed from the provider. You have satisfied the deductible; however, only $2107.50 of the out-of-pocket was used for the calendar year. You will still be expected to pay $2392.50 of the remaining out-of-pocket maximum should you have additional services rendered before the end of the calendar year which ends in December. Please remember that if you have any services done out-of-network there are no benefits paid. ** Disclaimer: costs on these slides are fictitious and only for purposes of explaining how the plan works.

Prescription Coverage Is My Prescription covered and what will I have to pay? Calling or Emailing our Scott & White Health Plan Pharmacy Team will help you with your questions: prescriptionservices@sw.org or 1-800-728-7947 If you have questions about your prescription drug coverage, we’ll be there to help. Just go to our website or give us a call. 10

Get Preventive! Preventive Services Create a schedule of vaccines. Scott & White Health Plan encourages you to Get Preventive! Find providers in our network, manage your accounts with us, and learn what SWHP has to offer at: SWHP.org For recommended preventive services for: Adults Women Pregnant Women Children http://www.cdc.gov/prevention/ Create a schedule of vaccines. Birth to six years Make a schedule of recommended immunizations for your child from birth through 6 years. Review the schedule with your child’s doctor. http://www2a.cdc.gov/nip/kidstuff/newscheduler_le/   Take an online vaccination quiz. 11 years and older Take the quiz to see which vaccines you or your child may need. English: http://www2a.cdc.gov/nip/adultimmsched/ Spanish: http://www2a.cdc.gov/nip/adultimmsched/quiz-sp.asp Source: Guide to Texas HMO Quality: 2014

Wellness Program Options Wellness Assessment For Members and Non-Members Lifestyle Management Programs Balance Nourish Relax Breathe Care for Depression Dream Care for Your Health Care for Pain

SW Health Plan Service Enhancements For 2016-2017 SWHP portal information optimized for smartphone Improved member website: http//:mclennan.swhp.org Nationwide Pharmacies Scott and White Health Plan is working to keep costs in check while offering the tools and resources you need to access your health care coverage when and where you need. 13

S&W Health Plan Online Tools Through the member portal account at swhp.org,or through the McLennan County page at mclennan.swhp.org then click on the login button, members can: See required copays Print an ID card or request a new one Check the status of deductibles and out-of-pocket max  See claims and Explanations of Benefits (filtered by member/dependent) Get information on specific providers Review prescription usage Members can also send an e-mail to customer service advocates and receive responses through the portal’s secure messaging feature. The information noted above is available through you member portal, which can be accessed just as easily from a computer, tablet, or smartphone. 14

Member Portal Services mclennan.swhp.org Members can sign up for a member portal account or log in to their account at mclennan.swhp.org.

Member Portal Services FAQ Find commonly asked questions under Frequently Asked Questions. If you need to contact us please reach out to us at 1-800-299-8640.

Thank you!