MASC Regional Meeting Overview Employee Insurance Program (Products, Legal, and Policy)

Disclaimer BENEFITS ADMINISTRATORS AND OTHERS CHOSEN BY YOUR EMPLOYER WHO MAY ASSIST WITH INSURANCE ENROLLMENT, CHANGES, RETIREMENT OR TERMINATION AND RELATED ACTIVITIES ARE NOT AGENTS OF THE EMPLOYEE INSURANCE PROGRAM AND ARE NOT AUTHORIZED TO BIND THE EMPLOYEE INSURANCE PROGRAM. THIS PRESENTATION CONTAINS AN ABBREVIATED DESCRIPTION OF INSURANCE BENEFITS PROVIDED BY OR THROUGH THE EMPLOYEE INSURANCE PROGRAM. THE PLAN OF BENEFITS DOCUMENTS AND BENEFITS CONTRACTS CONTAIN COMPLETE DESCRIPTIONS OF THE HEALTH AND DENTAL PLANS AND ALL OTHER INSURANCE BENEFITS. THEIR TERMS AND CONDITIONS GOVERN ALL BENEFITS OFFERED BY OR THROUGH THE EMPLOYEE INSURANCE PROGRAM. IF YOU WOULD LIKE TO REVIEW THESE DOCUMENTS, CONTACT YOUR BENEFITS ADMINISTRATOR OR THE EMPLOYEE INSURANCE PROGRAM. THE LANGUAGE USED IN THIS PRESENTATION DOES NOT CREATE AN EMPLOYMENT CONTRACT BETWEEN THE EMPLOYEE AND THE AGENCY. THIS PRESENTATION DOES NOT CREATE ANY CONTRACTUAL RIGHTS OR ENTITLEMENTS. THE AGENCY RESERVES THE RIGHT TO REVISE THE CONTENT OF THIS PRESENTATION, IN WHOLE OR IN PART. NO PROMISES OR ASSURANCES, WHETHER WRITTEN OR ORAL, WHICH ARE CONTRARY TO OR INCONSISTENT WITH THE TERMS OF THIS PARAGRAPH CREATE ANY CONTRACT OF EMPLOYMENT.

MASC Review of Informational Materials

Insurance Benefits Guide Local Subdivision Handbook List of participating counties and municipalities Plan comparison matrices Cafeteria plan matrix

MASC Orientation Local Subdivision Handbook and Application

Eligibility Established by statute  Section of the 1976 S.C. Code of Laws, as amended

Local Subdivision Handbook and Application Participation Requirements Minimum of four years participation 90 days notice of intent to withdraw Minimum of four years before returning Must offer all EIP benefits to all eligible employees

Local Subdivision Handbook and Application Participation Requirements Designate a Benefits Administrator Verify eligibility of employees Make good-faith effort to notify eligible retirees, terminated employees, and surviving dependents of deceased employees/retirees

Local Subdivision Handbook and Application Funding Requirements Make same contribution as the state for employees and their dependents $3 administrative fee per employee Initial experience ratings  <100 covered lives: 1.2%  covered lives : 2.2%  >500 covered lives: 4.3%

Local Subdivision Handbook and Application Submission Deadline and Fees Submission of application to EIP by February 15 $500 non-refundable application fee

MASC Orientation Support Resources

MASC Orientation Support Resources On-site orientation and training Continuing training programs Employee Benefits Services (EBS) online inquiry/enrollment system Multi-media education materials Other web-based resources

MASC Orientation Frequently Asked Questions and Important Considerations

Are HMO enrollees required to elect and disclose their PCP at time of enrollment? No How is the plan year determined? EIP’s plan year is always based upon the calendar year Does the State have an employee assistance program? No Does it cost extra for employers or employees to use the services of EIP’s Prevention Partners unit? There is no additional cost to the employer for Prevention Partners programs; however some workshops and programs may be offered at minimal fee to the employees and their dependents.

Frequently Asked Questions and Important Considerations What control does the employer have over which plans are offered?A participating employer must offer all EIP programs to employees and also must allow employees to elect any levels of coverage. Does the state administer its own COBRA? Employers are responsible for the day-to-day administration of COBRA continuation coverage. EIP offers many resources to support this function. Are elected members of participating county and city councils eligible to participate? Those elected members who contribute to the South Carolina Retirement Systems are considered full-time employees and are eligible

MASC Orientation Overview of EIP Plans of Benefits

Overview EIP Benefit Programs Health Plans Dental Plans Vision Plan Life Insurance Long Term Disability Long Term Care MoneyPlu$ (Pre-tax programs)

Overview Eligibility

Active Employee Must be employed in permanent, full-time position Work at least 30 hours per week unless  Employed as a part-time teacher (only eligible for health, dental, vision and MoneyPlu$)  Employed by employer who allows coverage for 20-hour employees

Retired Employee Must meet certain requirements to continue coverage in retirement EIP will accept Benefits Administrator certification of eligibility Eligibility

Eligible Spouse Spouse or former spouse * if coverage is court-ordered Cannot cover spouse who is eligible for benefits through EIP as active employee or funded retiree Eligibility * Documentation required to cover a former spouse

Eligibility Eligible Children Under age 26* No access to insurance through employer of child or child’s spouse Approved for incapacitation * * To be eligible for Dependent Life-Child, a child age must be a full-time student or certified incapacitated

Overview Enrollment Periods

Enrollment October Enrollment Periods Annual Enrollment (Every year)  Change health plans  Enroll in or drop State Vision Plan  Enroll or re-enroll in MoneyPlu$ programs Open Enrollment (Odd-numbered years, i.e., 2011, 2013)  Enroll in or drop health, dental or Dental Plus  Add or drop eligible dependents

Overview Health Plans

Overview Health Plan Options State Health Plan  Standard Plan  Savings Plan HMO  BlueChoice HealthPlan HMO  CIGNA HMO

State Health Plan (SHP) Administered by BlueCross BlueShield of South Carolina State Health Plan

Common to Both Worldwide coverage In- and out-of-network benefits Pharmacy network Online access available State Health Plan Standard Plan and Savings Plan

Limited Preventive Benefits * Routine mammogram Pap test Well child care Routine colonoscopy State Health Plan Standard Plan and Savings Plan * Refer to the 2011 Insurance Benefits Guide for plan guidelines

Preauthorization Medi-Call  Required for specific services, including maternity care  If pre-authorization is not obtained, penalties apply  $200 per inpatient admission  Related charges do not satisfy any portion of the annual coinsurance maximum State Health Plan Standard Plan and Savings Plan

State Health Plan Standard Plan SHP Standard Plan

Standard Plan Annual Deductible  $350 individual  $700 family Out-of-network Coinsurance  Plan pays 60 %  Subscriber pays 40 % Coinsurance Maximum  $4,000 individual  $8,000 family In-network Coinsurance  Plan pays 80 %  Subscriber pays 20 % Coinsurance Maximum  $2,000 individual  $4,000 family Deductibles and Coinsurance

Standard Plan Per-occurrence Deductibles  $10 Office visit  $75 Outpatient facility service  $125 Emergency room visit

Network Retail Pharmacy * (up to 31-day supply)  $ 9 Tier 1  $ 30 Tier 2  $ 50 Tier 3 Medco Mail Order * (up to 90-day supply)  $ 22 Tier 1  $ 75 Tier 2  $125 Tier 3 Retail Maintenance Network Prescription Drug Benefits $2,500 maximum copayment per person Standard Plan *”Pay the Difference” applies

State Health Plan Savings Plan SHP Savings Plan

Annual Deductible  $3,000 individual  $6,000 family Out-of-network Coinsurance  Plan pays 60%  Subscriber pays 40% Coinsurance Maximum  $4,000 individual  $8,000 family In-network Coinsurance  Plan pays 80%  Subscriber pays 20% Coinsurance Maximum  $2,000 individual  $4,000 family Deductibles and Coinsurance Savings Plan

Rules Subscriber pays 100% of  Allowable charges in-network  Actual charges out-of-network  Allowable charges at network pharmacies After deductible is met, Plan will reimburse subscriber 80% of allowable charges

Savings Plan Added benefits Annual flu shot Annual physical that includes specific services Eligibility to contribute to Health Savings Account (HSA)

HMOs Health Maintenance Organizations (HMOs)

HMOs Requirements Must live or work in HMO service area Must choose Primary Care Physician (PCP) in network and receive referrals before seeing specialist Only out-of-network benefit is emergency care

BlueChoice HealthPlan (Available in all South Carolina counties) BlueChoice HealthPlan HMO Available in all South Carolina Counties

Coinsurance Maximum  $2,000 individual  $4,000 family Annual Deductible  $250 individual  $500 family Network Coinsurance  Plan pays85 %  Subscriber pays 15 % Deductibles and Coinsurance BlueChoice HealthPlan (Available in all South Carolina counties) Annual Benefits Maximum $2,000,000

BlueChoice HealthPlan (Available in all South Carolina counties) Provider:  $15 PCP  $15 OB-GYN  $40 specialist  $35 urgent care Plan pays 100% after copay Facility:  $100 outpatient  $125 ER  $200 inpatient Plan pays 85% after copay Copays

Network Retail Pharmacy (up to 31-day supply)  $ 8 Lower-cost generic  $ 15 Higher-cost generic  $ 35 Preferred brand  $ 55 Non-preferred brand  $ 80 Preferred brand specialty pharmaceuticals  $125 Specialty pharmaceuticals Mail Order (up to 90-day supply)  $ Lower-cost generic  $ Higher-cost generic  $ Preferred brand  $ Non-preferred brand BlueChoice HealthPlan (Available in all South Carolina counties)

CIGNA HMO Available in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda

Coinsurance Maximum  $2,000 individual  $4,000 family Annual Deductible None In-network Coinsurance  Plan pays 80%  Subscriber pays 20% Deductibles and Coinsurance CIGNA HMO Available in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda

Copays Provider  $15 PCP  $15 OB-GYN  $30 specialist  $100 ER Plan pays 100% after copay Hospital  $250 outpatient  $500 inpatient Plan pays 80% after copay CIGNA HMO Available in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda

Mail-Order (up to 90-day supply)  $ 14 generic  $ 50 preferred brand  $100 non-preferred brand Network Retail Pharmacy (up to 30-day supply)  $ 7 generic  $25 preferred brand  $50 non-preferred brand CIGNA HMO Available in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda

Tobacco Surcharge $40 per month for subscribers $60 per month for subscribers who cover at least one dependent Automatically charged unless certify no one uses tobacco May certify by completing paper Certification Regarding Tobacco Use form Tobacco Surcharge

Overview State Dental Plan Administered by BlueCross BlueShield of South Carolina

State Dental Plan Features Free to choose dentist No pre-existing condition exclusions Two year plan – may not drop or change until next open enrollment $1,000 maximum benefit per year

* $25 Combined Deductible for Classes II and III Classes of Services Class I  Preventive services  100% of fee schedule Class III *  Prosthodontics  50% of fee schedule Class IV  Orthodontics (only children younger than 19; $1,000 lifetime maximum) Class II *  Basic services  80% of fee schedule State Dental Plan

Overview Dental Plus Administered by BlueCross BlueShield of South Carolina

Dental Plus Features Supplement to Basic Dental Higher allowance for Class I, II and III services Combined maximum benefit of $2,000 May enroll in or cancel coverage during open enrollment

Overview State Vision Plan Administered by EyeMed Vision Care

State Vision Plan Vision Care Services Eye exams Frames Lenses Contact lens services and materials Discounts on LASIK and PRK vision correction

State Vision Plan Providers In-network  No claims to file  Pay copayment and charges above the plan’s allowance Out-of-network  Pay provider for service  EyeMed will reimburse you for a portion of expenses for certain services * Locate a provider on EIP’s web site or by calling EyeMed at

State Vision Plan Eye Exams $10 copayment Standard contact lens fitting  No copayment Premium contact lens fitting  10% discount and  $55 allowance toward discounted price

State Vision Plan Eyeglasses Frames every 2 years  $140 allowance *  20% discount off balance Lenses every year  $10 copayment for single vision, bifocal, trifocal and lenticular plastic lenses  $45 copayment for standard progressive lenses * Cannot be combined with any other promotion or discount

State Vision Plan Contact Lenses * Every 12 months Conventional lenses  $130 allowance  15% discount off balance Disposable lenses  $130 allowance Declining balance * Subscriber may choose either eyeglass lenses or contact lenses, but not both in the same plan year.

Overview Vision Care Discount Program

Vision Care Discount Program Features No enrollment or premium Discount program Participating providers only  $60 for routine eye exam – excludes contact lens exam  20% discount on eyewear except disposable contact lenses

Overview Life Insurance Administered by MetLife

Basic Life $3,000 term life insurance to all eligible employees under age 70 Premium paid by employer Employees enrolled in any health plan are covered Accidental death and dismemberment benefits

Optional Life Premium based on amount of coverage and employee’s age Coverage up to three times salary if enrolled within 31 days of employment Medical evidence required for additional coverage Maximum coverage level of $500,000

Dependent Life Child coverage $15,000 per child Premiums ─ $1.24 per month, regardless of number of children covered Can enroll eligible children throughout the year without medical evidence of good health

Dependent Life Spouse coverage New hire can enroll spouse for $10,000 or $20,000 without medical evidence of good health Premiums based on employee’s age and amount of coverage Employee is beneficiary May enroll in up to 50% of employee’s Optional Life coverage with medical evidence

Overview Long Term Disability Insurance Administered by Standard Insurance Company

Basic Long Term Disability Insurance Basic Long Term Disability (BLTD) Premiums paid by employer Employee automatically enrolled with selection of a health plan 62.5 percent benefit, up to $800 per month 90-day waiting period

Supplemental Long Term Disability Insurance Supplemental Long Term Disability (SLTD) Provides protection for employee if annual salary exceeds $15,360 Benefit – 65% of monthly salary up to $8,000 per month Choice of two plans  90-day waiting period  180-day waiting period

Supplemental Long Term Disability Insurance Enrollment in SLTD New hire may enroll without providing medical evidence of good health Late entrant must provide medical evidence of good health to enroll Employee pays premium – based on monthly salary, plan chosen and age

Overview Long Term Care Administered by Prudential

Long Term Care Features Benefits paid when subscriber, for at least 90 days:  Is unable to perform at least two activities of daily living (ADL) or  Has severe cognitive impairment requiring ongoing help or supervision

Long Term Care Eligible Participants Active full-time permanent employees and their  Spouse, parents, parents-in-law, grandparents, grandparents-in-law, siblings, adult children (and their spouses) Retirees and their spouse Surviving spouses

Long Term Care Premiums Based on  Age at time of purchase  Selected plan Paid directly to Prudential -- subscriber may continue coverage upon retirement or leaving employment

Overview MoneyPlu$ Administered by Fringe Benefits Management Company (FBMC)

MoneyPlu$ Features Pretax premiums Medical Spending Account (MSA) Dependent Care Spending Account (DCSA) Health Savings Account (HSA)

MoneyPlu$ Pre-tax Premium Pretax Premiums Health Dental and Dental Plus State Vision Plan First $50,000 of Optional Life Tobacco Surcharge $0.28 monthly administrative fee

MoneyPlu$ Medical Spending Account Medical Spending Account (MSA) Employed for one year before participating $5,000 maximum annual contribution $3.50 monthly administrative fee “Use it or lose it” account

MoneyPlu$ Medical Spending Account Eligible expenses include Deductibles, coinsurance and copayments Medically necessary expenses Prescribed medications, approved OTC medications with prescription, approved OTC items

MoneyPlu$ Dependent Care Spending Account Dependent Care Spending Account (DCSA) $5,000 maximum contribution $3.50 monthly administrative fee

MoneyPlu$ Dependent Care Spending Account Eligible expenses Day care fees Care for qualified individuals in your home or someone else’s home Summer day camps

MoneyPlu$ Health Savings Account Health Savings Account (HSA) Employee must be enrolled in the SHP Savings Plan Money deposited into account carries forward from year to year Account is portable Fees  $1 per month to FBMC  $1 per month ($10/year) to NBSC

Health Savings Account Limited-Use Medical Spending Account (MSA) Limited-Use MSA Must be employed for one year Only used for dental and vision care expenses $5,000 maximum contribution $3.50 monthly administrative fee “Use it or Lose it” account

MASC Orientation Questions?