St Louis Public Schools 2010 Benefits Renewals MEDICAL = 9.7% Effective 1/1/2010 November 5, 2009

Historical Renewal Summary 2.Medical Renewal Summary and Joint Benefit Committee Recommendation 3.RX Renewal Summary and Joint Benefit Committee Recommendation 4.Dental Renewal Summary and Joint Benefit Committee Recommendation 5.Life, STD, LTD, Vision Renewal Summary and Joint Benefit Committee Recommendation 6. Cost Containment Strategies for

1.Holmes Murphy managed the RFP Process and 66 Insurance Companies and TPA’s were asked to quote. 62 Proposals were received. 2.Joint Benefit Committee participated in finalist presentations by UHC, Anthem, Caremark, Medco, Express Scripts, MetLife, Guardian, and BJC. 3.Pharmacy vendor change from CareMark to Medco. 4.Dental carrier change from Guardian and St. Louis Dental Care to UnitedHealthcare. 5.Life insurance carrier change from Reliance Standard Life to UnitedHealthcare. Increased benefit from $30,000 Life to $40,000 Life and AD&D. 3

Coverage2009 Carrier2009 Rate Change Rate Guarantee(s)Comments MEDICALUHC3.6%2010: 14% Max. 2011: loss ratio determines increase Increased ER copays. Includes full Wellness Program RXMedco (was Caremark) Est. 1.8%*2010: no increase* 2011: no increase* * Medco fee guarantees does not mean Premium guarantees as Premiums are determined by utilization. Rate increase estimate was based on historical claims experience DENTALUHC (was Guardian & Dental Source) (7.8%)2010: 6% Max.Packaged savings discount brings savings to (21.9%) each year for two years BASIC LIFEUHC (was Reliance Standard) (25.3%)2010: no increase 2011: no increase Packaged savings discount brings savings to (97.4%) each year for two years STDCigna(21.9%)2010: no increase LTDCigna(5.9%)2010: no increase VISIONVBA1.7%2010: no increase 4

MEDICAL RENEWAL SUMMARY:  14% Initial premium increase from UnitedHealthcare as expected from 2009; however, revised to 9.7% increase after medical marketing.  This reduced the annual estimated District responsibility for the Active population from $21,012,731 to $20,203,147.  88% Loss Ratio – Paid Premium versus Paid Claims 6/08-5/09  Renewal includes continuation of the Wellness Plan  Wellness eligible incentive dollars totals $556,675 which is funded by UnitedHealthcare  Modest plan design changes were reviewed; however, no significant premium savings available without drastically reducing employee/retiree benefits Joint Benefit Committee Recommendation: Renew with current plan designs at 14% rate increase. However, now increase is 9.7% 5

Rx RENEWAL SUMMARY:  8.3% Premium increase recommended  Premium increase determined by claims utilization from 6/08-5/09 plus 9% annualized trend Joint Benefit Committee Recommendation: Maintain current benefit levels at recommended 8.3% premium increase 6

DENTAL RENEWAL SUMMARY:  6% Premium increase from UnitedHealthcare  71.5% Loss Ratio – Paid Premiums versus Paid Claims 1/09 – 5/09 Joint Benefit Committee Recommendation: Maintain current benefit levels at 6% rate increase 7

LIFE, STD, LTD, VISION RENEWAL SUMMARY:  All under rate guarantee for 2010 (no increase from 2009)  Life and Dental Packaged Savings Discount still applies to the Medical Premium throughout 2010 Joint Benefit Committee Recommendation: Maintain current benefit levels at current rates 8

The District is considering several options to help control future costs:  Dependent audit  More emphasis on premium statement reviews/audits  Continued Wellness efforts  More Wellness and Disease Management claim analysis  Aggressive dialogue with JBC regarding additional strategies 9