Open Enrollment 2012

Health Care Commission (HCC) Approved employee & employer rates – Agency composite rates increases 12.5% on 7/1/10 15% on 7/1/11 7.5% on 7/1/12 – Return to the 95/55 employer contribution Coverage cost for employee-only will increase – Actual increase depends upon plan, tier and coverage level Continue to provide a 55% contribution toward dependent coverage

Other HCC Action No plan design changes for Plans A and B Plan design changes for Plan C pharmacy benefit Added Stormont-Vail HealthCare as a regional preferred lab vendor Quest will continue to offer a statewide preferred lab option Added the HealthQuest Rewards Program

Legislative Changes Autism Spectrum Disorder Pilot – Benefit will be continued for 2012 Limits placed on SEHP coverage for abortions – Only covered to protect life of the mother

2012 SEHP Medical Plans All plans are Preferred Provider Organizations (PPO) – Claims paid based on the network status – Network providers accept the plan allowance as payment in full – Non Network Providers can balance bill – All plans include preventive care

Covered Preventive Care Services Well Baby Exams - includes newborn screenings and age-appropriate office visits. Well Child Exam – includes office visit and age-appropriate screenings and counseling. Well Woman Exam - includes office visit and age-appropriate screenings and counseling. Well Man Exam - includes office visit and age-appropriate screenings and counseling. Prenatal Screening & Counseling - Limited screening services. See benefit description for details. Ultrasonography for Aortic Aneurysm - Limited to one for men ages with history of tobacco use. Age-Appropriate Bone Density ScreeningMammography – not limited to one. ImmunizationsRoutine Hearing Exam Colonoscopy – not limited to one.Vision Exam – one covered per person per year

Vendor Options PlansABC Blue Cross and Blue Shield of Kansas √√√ Coventry/PHS √√√ UnitedHealthcare Company √√√

Network Benefit*Plan APlan BPlan C Deductible $300 Single $600 Family $150 Single $300 Family $1,500 Single $3,000 Family Coinsurance20%35%20% Coinsurance Maximum $1,400 Single $2,800 Family $3000 Single $6000 Family None Out-of-Pocket MaximumNone $3,000 Single $6,000 Family Office Visit – Primary Care Providers $25 Copay $20 Copay - Adult $10 Copay - children < age 19 Deductible & Coinsurance Office Visit - Specialist$45 Copay $40 Copay - Adult $25 Copay - Children < age 19 Deductible & Coinsurance Preferred Lab BenefitYes No *Use of Non Network providers will increase your out-of-pocket cost.

Selecting a Medical Plan 1.Pick a plan design (A, B or C) – Which plan design provides the coverage you and your family need? 2.Review the Provider Networks – Each of the medical plans uses a different provider network 3.Review the other services each medical plan offers 4. Review the premiums

Quest Diagnostics Statewide & nationwide preferred lab vendor 100% coverage for eligible outpatient lab tests – For non-emergency outpatient lab work only – Testing must be performed and billed by Quest Available on Plans A and B only Your Doctor can draw the sample - or- Visit a Quest website for collection sites – Online appointment scheduling available Use Your Quest ID card or medical id card

Stormont-Vail HealthCare Stormont-Vail HealthCare is a new regional preferred lab vendor in NE Kansas. 100% coverage for eligible outpatient lab tests All Plan A and B members may use the Stormont-Vail draw site locations. Labs drawn at other Cotton-O’Neil locations may be included if by network providers. Covered lab procedures are covered at 100%. – Show your medical ID card to access benefit.

Stormont-Vail Draw Sites FacilityAddressCity/State Stormont-Vail HealthCare Laboratory1500 SW 10 th AveTopeka, KS Cotton-O’Neil 901 Laboratory901 SW GarfieldTopeka, KS Cotton-O’Neil 823 Laboratory823 SW MulvaneTopeka, KS Cotton-O’Neil Croco Laboratory2909 SE Walnut DriveTopeka, KS Cotton-O’Neil Urish Laboratory6725 SW 29 th StreetTopeka, KS Cotton-O’Neil Carbondale Laboratory211 East MainCarbondale, KS Emporia Medical Arts Clinic1301 W 12 th Avenue, Suite 401 Emporia, KS Cotton-O’Neil Wamego Laboratory1704 Commercial CircleWamego, KS

Plans A & B Drug Benefit Generic Drugs – 20% Coinsurance Preferred Brand – 35% Coinsurance Non Preferred Brand – 60% Coinsurance Special Case Medications – 25% to a max of $75 per 30-day supply www2.caremark.com/kse Up to a sixty (60) day supply of most drugs available

Generic Launches 2011 Nasacort3 rd Qtr Levaquin3 rd Qtr Tegretol XR3 rd Qtr Caduet4 th Qtr Lipitor4 th Qtr Zyprexa4 th Qtr nn 2012 Avalide1 st Qtr Avandia1 st Qtr Lexapro1 st Qtr Lescol2 nd Qtr Provigil2 nd Qtr Plavix2 nd Qtr Actos3 rd Qtr Diovan3 rd Qtr Maxalt4 th Qtr Singular 4 th Qtr Tricor4 th Qtr www2.caremark.com/kse

Plan C - Health Savings Account (HSA) Full-Time Employee Employee Only* Employee + Dependents* Employer Contribution$37.50 ($900 a yr) $56.25 ($1,350 a yr) Employee Contribution $25 to $91.66$25 to $ Maximum Annual HSA Contribution $3,100$6,250 *All columns represent 24 semi-monthly deductions Eligibility criteria for HSA Account is on Page 13 of Open Enrollment Book Each health plan uses a different bank for the HSA HSA banking info – HSA account and funds belong to the employee Minimum contribution to HSA of $25 semi-monthly by the employee is required

Plan C Drug Plan Plan C now has a Coinsurance Drug Plan Drugs are subject to the Deductible, then: – Generic 20% Coinsurance – Preferred Brand 35% Coinsurance – Non Preferred Brand 60% Coinsurance – Special Case Drugs25% Coinsurance to a max of $75 Generic Incentive Provision Not creditable coverage

Plan C Chronic Care Benefit Prescription Drugs for: Prescription Drug Product Member Responsibility Per 30-Day Supply Diabetes Generic DrugDeductible and then 10% to a maximum of $10 Preferred Brand Drug Deductible and then 20% to a maximum of $20 Asthma Generic DrugDeductible and then 10% to a maximum of $10 Preferred Brand Drug Deductible and then 20% to a maximum of $20

Dental Coverage Plan pays in full for two exams & cleanings per person per year Plan Deductible – Applies to Basic & Major Restorative Care – $50 per person, maximum of 3 per family Orthodontic benefit – $1,000 per person per lifetime Annual benefit maximum – $1,700 per person per year

Dental Benefit Benefit LevelPPOPremierNon Network Preventive Services Covered in full Covered in full Allowed amount covered in full Basic Benefit Basic Restorative Services 50% Enhanced Benefit Basic Restorative Services 20%40%

Vision Plan Basic Plan includes – $25 Materials Copay then : 100% single vision, standard bifocal, trifocal lenticular lenses Up to $100 allowance for frames – Elective Contact lens allowance $150 – Offi ce visit subject to $50 Copay Enhanced Vision Plan includes Basic, plus… – Contact Lens Fitting Fee subject to $35 Copay – High index or Poly-carbonate lenses up to $116 – Progressive lenses up to $165 – Scratch and UV coating

Flexible Spending Accounts Health Care Flexible Spending Account – For Plan A and B members only – Grace period for Health Care FSA – Debt Card available Dependent Care Flexible Spending Account – For Child care expenses Pre-tax contributions – Up to $5,000 per account per year Details on eligible expenses available at:

Optional HCFSA Debit Card Visa card to access funds – Documentation may still be required by ASI Debit card election form is mailed to you – You pay a $12 nonrefundable service fee per year Debit card enrollment rolls from year to year – Current debit card users must contact ASI to cancel debit card enrollment

Limited FSA for Plan C Can set aside funds for dental and vision expenses only Cannot be used for medical expenses – HSA account is designed for that purpose Debt card not available “Use it or lose it” applies to this account – Funds must be used by December 31 each year

Open Enrollment Enroll online: – Make health plan selections – Add/drop dependents – Declare tobacco status – Enroll in Flexible Spending Accounts – Enroll in HealthyKIDS Families at 250% of poverty level State pays 90% of children’s premium Enroll at: – Coverage effective January 1, 2012

Required Documentation If you are adding a dependent, documentation of eligibility is required. Provide copies of: – Birth certificates – Marriage licenses – Affidavit of common law marriage – Social Security numbers required Document due by 10/31/11 to HR office

Defaults Members currently enrolled in UMR who do not make an enrollment election will have United HealthCare for Members currently enrolled in Preferred Health Systems who do not make an enrollment election will have Coventry/PHS for If you fail to make a tobacco use election you will be defaulted to paying the base rates in 2012.

Identification Cards All medical plans are issuing new ID cards. Delta Dental is issuing new ID cards. Lab, Vision and Drug are not issuing new cards

Resources Review the Open Enrollment (OE) booklet ?’s: Call the health plan customer service – Phone numbers in the front of the OE booklet Visit the website: – Benefit descriptions available – Provider directory listings – Preferred drug list – Information on the HSA and FSA accounts ?’s to SEHP:

Questions?

Option Slides

Primary Care Providers (PCPs) General practice Family practice Geriatrics Internal medicine Physician extenders Pediatrics Plans A & B only PCPs have lower office visit copays Member may have more than one PCP No referrals required

Network vs. Non Network Plan A - Non Network Provider Service on 1/2/2011 Plan Pays Member Pays Provider Write-Off Billed Charge $1,500 Allowed Charge $1,400 $100$0 $500 Deductible ($500) $500 50% Coinsurance $900$ 450 Total $450$1,050$0 Plan A - Network Provider Service on 1/2/2011Plan Pays Member Pays Provider Write-Off Billed Charge $1,500 Allowed Charge $1,400 $100 $300 Deductible ($300) $300 20% Coinsurance $1,100$880$220 Total $880$520$100

Plan A – Network Providers Office Visit Copays – $25 for Primary Care Office Visits – $45 for Specialist Office Visits $300/$600 Deductible 20% Coinsurance Coinsurance Max $1,400/$2,800 Preventive Care Services paid at 100% Lab Card Benefit

Plan B – Network Providers Primary Care Office Visits – $20 Copay for Adults – $10 Copay for Children <age 18 Specialist Office Visits – $40 Copay for Adults – $25 Copay for Children <age 18 $150/$300 Deductible 35% Coinsurance Coinsurance max $3,000/$6,000 Preventive Care Services paid at 100% Lab Card benefit

Plans A & B Non Network Providers $500/$1,500 Deductible 50% Coinsurance Coinsurance Max $3,650/$7,300 Non Network Providers can balance bill Preventive care not covered

Preferred Lab Benefit Expanded Available on Plans A and B only 100% coverage for eligible outpatient lab tests Two vendors participating in the program – Quest Diagnostics -- Statewide/Nationwide access – Stormont Vail Healthcare -- Regional access

Stormont-Vail HealthCare Stormont-Vail HealthCare is a new regional preferred lab vendor in NE Kansas. Cotton O’Neil patients will automatically participate Non Cotton O’Neil patients in Plans A or B may visit one of the 8 draw site locations – Take your Medical ID card – Photo ID – Doctor’s Lab orders Covered lab procedures are covered at 100%.

Plan C w/ Health Savings Account Network Provider Coverage – $1,500/$3,000 Deductible – 20% Coinsurance – $3,000/$6,000 Out-of-Pocket Maximum – Preventive Care Services paid at 100% Non Network Provider Coverage – $2,000/$4,000 Deductible – 50% Coinsurance – $3,650/$7,300 OOP Maximum – Preventive Care is not covered

Dental Preventive Care Covered in full: – Prophylaxis/cleanings – twice per year. – Oral examinations – twice per year. – Bitewing x-rays – adults – 1 x a year children under x a year – Full mouth x-rays – once each five (5) years. – Limited coverage for children only: Sealants Space maintainers Topical fluoride – Ancillary – emergency relief of pain.

Dental Restorative Services Basic Restorative – Regular restorative dentistry – fillings – Oral surgery – Endodontics – root canals – Periodontics – treatment of gum & bone disease – Additional diagnostic X-Rays Major Restorative – Special restorative dentistry – crowns – Prosthodontics – bridges, implants, dentures – TMJ Treatment – Requires prior authorization Restorative care is subject to a $50 deductible

Dependent Eligibility Change Effective 1/1/11, dependents are eligible to be covered on the plan to age 26 even if: – they do not live with you – they are not a student – they are not dependent on you for support, or – are married Spouses of dependents are not eligible. Grandchildren are only eligible under limited circumstances. You can add coverage for your eligible dependents during this Open Enrollment.