0 Open Enrollment State Health 2015

1 Welcome to open enrollment 2015! Website Open & Close Dates –Website opens at 12 a.m. October 27, 2014 –Website closes at 5:00 p.m. November 14, 2014 Online Election - Members make their health election at Open Enrollment 2015

2 State Health Open Enrollment Monday, October 27 th – Friday, November 14 th Open Enrollment 2015 Your password expires every 45 days. If you do not know your current User Name or Password: Click the Forgot User ID? Or Forgot Password? from the login page If the system does not recognize you: Please click on REGISTER HERE from the login page. Where do I go to enroll? - Go to by clicking on the RED buttonwww.mycalhounbenefits.com or - Go to

Plan Options Blue Cross Blue Shield – HRA & HMO United Healthcare – HMO & HDHP Kaiser Permanente– HMO (Only if you live or work in one of the 27 counties. Barrow, Bartow, Butts, Carroll, Cherokee, Clayton, Cobb, Coweta, Dawson, DeKalb, Douglas, Fayette, Forsythe, Fulton, Gwinnett, Haralson, Heard, Henry, Lamar, Meriwether, Newton, Paulding, Pickens, Pike, Rockdale, Spaulding, Walton.) Open Enrollment 2015

Plan Options… What’s new? Applied Behavior Analysis (ABA) for Autism Effective January 1, 2015, SHBP will provide limited coverage for medically necessary ABA treatment of Autism Spectrum Disorder Maximum benefit of $35,000 per year per approved member (through age 10) Co-payments, deductibles and/or co-insurance may apply Bariatric Pilot The Georgia Legislature has established a pilot program to provide benefit coverage for certain bariatric surgical procedures for the treatment and management of obesity and related conditions Effective January 1, 2015, the pilot program is limited to 75 non-Medicare Advantage members for the 2015 Plan Year Qualified applicants will be randomly selected by the vendors for which you are enrolled. Please contact your vendors for more information Hearing Aids Benefit allowance for hearing aids has increased for children up to age 19 from $1,500 to $3,000 every five years Incentive Accounts Includes well-being incentive credits that accompany the HMO and HDHP Plan Options. Credits can be earned by completing certain health actions Open Enrollment 2015

Plan Design – HRA BCBSGA / Gold PlanBCBSGA / Silver PlanBCBSGA / Bronze Plan Medical BenefitsNetwork Provider Out-of- NetworkRate Network Provider Out-of- NetworkRate Network Provider Out-of- NetworkRate Deductible You$1,500$3,000$166.08$2,000$4,000$108.64$2,500$5,000$66.28 You + Child(ren)$2,250$4,500$300.38$3,000$6,000$202.74$3,750$7,500$ You + Spouse$2,250$4,500$405.52$3,000$6,000$284.90$3,750$7,500$ You + Family$3,000$6,000$539.84$4,000$8,000$379.00$5,000$10,000$ Plan Pays after deductible85%60%80%60%75%60% ACA Preventive Care100%Not covered100%Not covered100%Not covered Out-of-Pocket Maximum You$4,000$8,000$5,000$10,000$6,000$12,000 You + Child(ren) or Spouse$6,000$12,000$7,500$15,000$9,000$18,000 You + Family$8,000$16,000$10,000$20,000$12,000$24,000 Base HRA Contribution You$400$200$100 You + Child(ren) or Spouse$600$300$150 You + Family$800$400$200 Pharmacy Benefits Tier 1 15%, Min $20, Max $50 Tier 2 25%, Min $50, Max $80 Tier 3 25%, Min $80, Max $125 Add $80 surcharge for tobacco use Open Enrollment 2015

Plan Design – HMO / HDHP BCBSGA / UHC HMO UHC HDHP KP HMO Covered ServicesIn –Network onlyMonthly Rate In-Network Provider Out-of- NetworkMonthly Rate In-Network OnlyMonthly Rate Deductible BCBSGA / UHC You$1,300$ / $181.32$3,500$7,000$53.02None$ You + Child(ren)$1,950$ / $326.86$7,000$14,000$108.74None$ You + Spouse$1,950$ / $439.26$7,000$14,000$169.84None$ You + Family$2,600$ / $584.80$7,000$14,000$225.56None$ Plan Pays after deductible 80%70%50%100% ACA Preventive Care100% Not covered100% Out-of-Pocket Maximum You$4,000$6,450$12,900$6,350 You + Child(ren) or Spouse$6,500$12,900$25,800$12,700 You + Family$9,000$12,900$25,800$12,700 Pharmacy Benefits Tier 1 $20 70% coverage; subject to deductible $20 Tier 2 $50 Tier 3 $90 $80 Add $80 surcharge for tobacco use Open Enrollment 2015

Wellness Incentives (Well-Being requirements must be met between January 15 to December 15, 2015) What to DOWhat you EARN 1. Assess Your Health Complete your 2015 Healthways Well-Being Assessment® (WBA), a confidential, online questionnaire that will take about 20 minutes. Complete BOTH and earn 240 Well-being incentive credits. (WBA must be completed before any incentive can be earned.) Know Your Numbers Complete a 2015 biometric screening and submit results (body mass index, blood pressure, cholesterol, glucose). The biometric screening must be completed at an SHBP sponsored screening event or by your physician and your results submitted appropriately on the 2015 Physician Screening Form. 2. TAKE Action It’s your choice! Complete the coaching pathway, online pathway or a combination of both. Coaching Pathway Complete your WBA and, Actively engage in telephonic coaching. Online Pathway Complete your WBA and, Record FIVE online activities using the same tracker within four consecutive weeks and earn 40 well-being incentive credits. HRA funds. You can earn these rewards up to six times. Sample activities: track exercise five times, record daily steps five times within four consecutive weeks. Earn up to 240 Well-being incentive credits. (WBA must be completed before any incentive can be earned.) Open Enrollment

8 Questions or Additional Information? Resource Contact #Website Blue Cross Blue Shield of Georgia (BCBSGa) Member Services: Monday thru Friday, 8:00 a.m. to 8:00 p.m. ET United Healthcare Member Services: Monday thru Friday, 8:00 a.m. to 8:00 p.m. ET www.welcometouhc.com/shbp Kaiser Permanente (KP) Member Services: 24 hours a day/7 days per week (Appointment Scheduling, Prescriptions and Nurse Advice) Healthways Member Services: Monday thru Friday, 8:00 a.m. to 8:00 p.m. ET Express Scripts Member Services: 24 hours a day/7 days per week SHBP Member Services: Monday thru Friday, 8:30 a.m. to 5:00 p.m. ET Open Enrollment 2015

9 State Health Benefit Plan Thank You Open Enrollment 2015 State Health Benefit Plan / Active Employee Rates January 1, 2015 – December 31, 2015 YouYou + Children You + Spouse You + Family BCBS Gold$166.08$300.38$405.52$ BCBS Silver$108.64$202.74$284.90$ BCBS Bronze$ 66.28$130.74$195.96$ BCBS HMO$130.74$240.88$333.06$ UHC HMO$181.32$326.86$439.26$ UHC HDHP$ 53.02$108.74$169.84$ Kaiser HMO$145.78$266.44$364.64$485.30