Pace University Oxford Health Plans Benefit Presentation

2 Benefits Overview  There are many benefits to being an Oxford Member  An overview of common characteristics of Oxford’s primary products as well as the key procedures for accessing medical care: Network Service What is a Primary Care Physician? In-Network and Out-of-Network Coverage Precertification Requirements Emergency and Urgent Care Coverage Pharmacy Coverage

3 Network Overview Freedom Network  87,637 providers in Oxford’s service area (New York, New Jersey, and Connecticut)  99% Board certified or recently board eligible, one of the best available measures of physician quality.

4 Network Overview Choice Plus Network  500,000 physicians Nationwide  4200 hospitals  250,000 physicians and 1500 hospitals added nationally in the last 5 years  National scope, local presence

5 What is a Primary Care Physician? Primary Care Physician (PCP) An Oxford participating physician who acts as the Member’s personal physician, providing routine exams and other basic medical care The PCP is responsible for:  Knowing the Member’s medical history  Maintaining the Member’s medical records  Providing routine exams and basic medical care

6 What is the difference between In-network & Out-of-network Coverage? In-network coverage The services provided by Oxford participating providers or providers participating with one of Oxford’s affiliated networks such as Freedom and United Healthcare Choice Plus Network  In order to obtain services at the in-network level of cost share, a Member must use a provider that participates one of the above networks. Emergency and urgent care may also be covered on an in-network basis Out-of-network coverage A Member can seek care from providers who do not participate in his/her Oxford network  Covered services obtained from non-participating providers will be subject to a higher level of cost share than those services obtained from Oxford participating providers. Not all services are covered on an out-of-network basis A Member should check his/her Summary of Benefits and Certificate of Coverage in order to determine the specific coverage available to him/her

7 Preventive Care No charge or co-payment in network for routine preventive care, including: Annual physicals Well-baby care Children’s immunizations For women: Two preventive care visits a year to the OB/GYN

8 Freedom EPO Plan Option #1 (No claim forms) In Network Benefits $20 co-pay for Office Visits to PCP/Ob-Gyn $20 co-pay to see a Specialist; No charge for hospital $75 Emergency Room co-pay Rx - $15/25/50, Mail Order 2x Out of Network Benefits Do Not Apply

9 Freedom Direct 90/70 Plan Option #2 In Network Benefits Annual Single Deductible: $250 Annual Family Deductible: $500 $20 co-pay for Office Visits to PCP $20 co-pay to see a Specialist Deductible and 10% Coinsurance for Hospital $75 Emergency Room co-pay $15/25/50 Rx, Mail Order 2x Out-of-pocket maximum for the calendar year: $750 Single out-of-pocket maximum $1,500 Family out-of-pocket maximum Out of Network Benefits Annual Single Deductible: $500 Annual Family Deductible: $1000 Coinsurance: 70% Oxford responsibility, 30% Member responsibility All charges subject to usual, customary, and reasonable (UCR) rates (80% of HIAA Out-of-pocket maximum for the calendar year: $2,000 Single out-of-pocket maximum $4,000 Family out-of-pocket maximum

10 Freedom Access 100/70 Plan Option #3 In Network Benefits $ 10 co-pay for Office Visits to PCP/Ob-Gyn $15 co-pay to see a Specialist; No charge for hospital $75 Emergency Room co-pay $15/25/50 Rx, Mail Order 2x Out of Network Benefits Annual Single Deductible: $300 Annual Family Deductible: $600 Coinsurance: 70% Oxford responsibility, 30% Member responsibility All charges subject to usual, customary, and reasonable (UCR) rates (80% of HIAA Out-of-pocket maximum for the calendar year: $1,800 Single out-of-pocket maximum $3,600 Family out-of-pocket maximum

11 When is Precertification Required?  All planned Inpatient Hospitalizations and Professional Services and all outpatient procedures performed at: Hospital outpatient departments Ambulatory surgical facilities Freestanding facilities  Major Diagnostic Tests, precertification will be required for: CT scans Magnetic Resonance Imaging (MRI) Magnetic Resonance Angiography (MRA) Positron Emission Tomography (PET) scans Nuclear medicine studies

12 Who is Responsible for Obtaining Precertification? In-network covered services A Member’s participating provider must obtain the necessary precertification directly from Oxford Out-of-network covered services When a Member seeks care out-of-network (s)he will be responsible for obtaining any necessary precertification  Members who do not receive precertification for services received out-of- network will be obligated to pay for all charges, or may be subject to a reduction in coverage, depending on their plan Self Referrals and Pre-Authorizations are not the same.

13 In accordance with your health plan coverage, Oxford covers only medically necessary physical/occupational therapy and chiropractic services  Physical/Occupational Therapy Outpatient physical therapy and occupational therapy services that are received from in-network (participating) providers are covered based on your Oxford plan (these may require precertification through OrthoNet)  Chiropractic Services Oxford participating chiropractors are required to pre- approve all chiropractic visits through TRIAD for most commercial Members (this requirement only applies to Members whose plans require precertification) Physical Therapy, Occupational Therapy, and Chiropractic Services Covered

14 How Emergencies & Urgent Care are Covered What to do in case of an emergency  Go straight to the emergency room, you are covered 24 hours a day, 7 days a week, Worldwide.  You will be responsible for the $75 emergency room co-payment Co-payment is waived if admitted to hospital through the Emergency Room. If the ER visit results in a hospital admission, the Member must notify Oxford’s Customer Service Department within 48 hours of the admission.

15 Pharmacy Coverage Oxford contracts with a pharmacy benefit manager, Medco Health, to help administer Oxford’s retail and mail-order pharmacy services Working with Medco Health helps Oxford to Better manage prescription drug costs Provide Members with comprehensive clinical programs and industry-leading customer service Offer mail-order prescription drug coverage, 2 Rx co-pays for 90 day supply.  When Members visit a participating pharmacy for covered prescriptions, they will be responsible only for co-pay of $15, $25 or $50, for tier 1, tier 2, and tier 3 drugs respectively

16 Value Added Benefits QuitnetSTOTT PILATES General Vision ServicesWeight Watchers Chelsea PiersYoga Journal Healthy Bonus ® A preventive program offering Members access to discounts and special offers on health-related products and services  Offers include weight loss, nutrition, wellness and important health issues such as pediatric nutrition and condition management (diabetes and asthma) Gym Reimbursement  Members and spouses are eligible for up to $200/$100 reimbursement of the membership fee  Must complete a minimum of 50 visits per six-month period

17 GENERAL VISION SERVICES:

18 Vision Plan VISION CARE: EXAMINATION: Oxford covers one routine eye examination per Member per 12 month period. There is a maximum payment of $50 per examination. HARDWARE: Oxford provides coverage for corrective eye glass lenses and frames up to a maximum amount payable of $70 per Member once every 24 month period.

19 Cancer Resource Services (CRS), a United Resource Network

20 Oxford’s Member Service Member Service Associates 8 AM to 6 PM, Monday through Friday Oxford Express® Available 24 hours a day, seven days a week Oxford On-Call ® Team of experienced Registered Nurses, 24/7 Healthcare guidance over the phone, based on your specific symptoms Medical Management Medical professionals led by doctors and registered nurses 8 AM to 6 PM, Monday through Friday Available to discuss surgical procedures, emergency care, and hospitalizations Precertification for diagnostic procedures at CareCore National at (877- PREAUTH) Pharmacy Customer Service from Medco Health Solutions at or log onto

21 Check Benefits Online  Visit and log into Your Account page  Click on the “Check” tab and highlight “Benefits” from the drop-down menu  Enter the employee’s Oxford Member ID# or Social Security # and click Enter  The employee’s Summary of Benefits will be displayed

22 & Q A