Missouri Department of Transportation & Missouri State Highway Patrol Employee Benefits Meeting for 2007

2 What is New for the MoDOT/MSHP Medical Plan for 2007?  Employees will have one plan design effective January 01,  The plan will be called Open Access III (OAIII) Plan, but benefits will change  All active employees will have the same out-of-pocket premium structure.

3 Why is MoDOT/MSHP Not Offering the 100% Coverage Plan under OAIII l The current OAIII plan is not self-supporting and would require large increases in the monthly out-of-pocket premium for our members. l As of June 30, 2006, this plan has a deficit of $1,000,000+. l That means the claims paid is $1 million greater than the premiums collected for this plan.

4 Rates Required to Maintain Current 100% Coverage Plan OUT-OF-POCKET RATES CURRENT 2007 l Sub only $51$216 l Sub/spouse$234$564 l Sub/family$308$811 l Sub/child$173$503 l Sub/2 children$256$632

5 COMPARING SPOUSE CONTRIBUTION PLAN RATES l Spouse contribution plans are plan categories where both the subscriber and spouse work for MoDOT or MSHP. l They receive additional state share contributions. l Comparison of current 2006 out-of-pocket monthly premium costs to 2007 as follows: CURRENT2007 Sub/spouse$0$252 Sub/family$2$499

6 MoDOT/MSHP’s Plan for 2007 is HealthLink Open Access III Plan with Freedom Network Select In-Network Benefits Deductible -$300/individual/CY, $900 maximum per family). Coinsurance – 10% coinsurance after deductible is met Office Visit - $15 co-payment for office visit only. Other services applied to deductible and coinsurance Out-of-Pocket Maximums Individual coverage $750 Family coverage $2,000. Other co-pays which may apply  $75 ER  $15 urgent care (office visit only) Out-of-Network Benefits Deductible -$300/individual/CY, $900 maximum per family). Coinsurance – 20% coinsurance after deductible is met Office Visit – 20% coinsurance of allowed amount after deductible.Out-of-Pocket Maximum – Individual coverage$1,500 Family coverage $4,500. UCR – For out-of-network services you may be billed by the provider for any charges above usual, reasonable & customary.

7 OUT-OF-POCKET COST COMPARISON Out-of-Pocket Premium Costs to Maintain Current 100% Coverage Plan for 2007  Sub Only - $216 x 12 = $2,592  Sub/family - $811 x 12 = $9,732  Sub/spouse - $564 x 12 = $6,768  Sub/child - $503 x 12 = $6,036  Sub/2child - $632 x 12 = $7,584 Spouse Contribution Categories  Sub/family - $499 x 12 = $5,988  Sub/spouse - $252 x 12 = $3,024 Total Out-of-Pocket Costs for Covered Medical Services for 2007 Plan Utilizing in-network providers  Deductibles/CY - $300 Medical & $75 RX  10% Coinsurance – $750 max  Potential CY out-of-pocket costs (excluding co-pays for office visit, urgent care or ER, which you currently pay) are:  $1,125/individual  $3,125/family of 3 or sub/2child  $2,250/sub/spouse or sub/1child  Does not include increase from 20% to 30% for prescription drugs

8 Pharmacy Benefit Changes  $75 Deductible per participant per CY  After the deductible is met, the participant pays a 30% coinsurance or a minimum $5 co-pay (not both).

9 Pharmacy Benefits That Will Not Change From Your Current Coverage  30-day starter quantity if the drug is a new medication, has not been purchased in the past 6 months or the strength of the drug has changed.  Mandatory generic policy that requires generic drugs be used, unless a generic is not available or the individual has a Prior Authorization (PA) to use the brand over the generic.  There are some drugs that are not covered.  Examples include: Drugs for weight loss, hair loss, fertility and impotence

10 Pharmacy Benefits That Will Not Change From Your Current Coverage  Participants can fill a 90 day prescription at both retail or mail order participating pharmacies.  Some drugs are paid at a $50 maximum co- payment.  Some drugs require a prior authorization (PA)  Most PA’s must be renewed on an annual basis.  examples include: Cox inhibitors, hypertensive agents, anti-migraine agents and some asthma drugs

11 Pharmacy Benefits  The PBM has their own network of pharmacies that participants of the plan must use when purchasing their prescriptions.  A retail or mail order pharmacy may be used when purchasing maintenance drugs.

12 Pharmacy Benefits  The Medical Board is currently in the process of finalizing the bid process for the 2007 pharmacy benefits manager (PBM).  Once the PBM is selected you can access their website to verify if your pharmacy is participating.  Plan participants will receive a new prescription card that must be presented each time they have a prescription filled at a local retail pharmacy.

13 PREVENTIVE BENEFITS FOR 2007 l Preventive Benefits will remain the same except for your dependent children for 2007: l Non-Medicare Subscriber $350 l Non-Medicare Spouse $350 l Non-Medicare Child $200

14 MoDOT/MSHP’s Plan for 2007 is HealthLink Open Access III Plan with Freedom Network Select The Network Scenario is as follows:  In-Network Benefits – When you seek services from a provider that participates with HealthLink HMO and/or PPO Network, Freedom Network Select (western MO), AHI-HealthLink (Texas only) & Quincy Tri-State Coalition Network.  Out-of-Network Benefits – When you seek services from a provider that falls outside the service area of the networks mentioned above including those providers that participate with Freedom Network only.

15 Advantages of one Consolidated Health Plan for the MODOT/MSHP Employees  Precertification requirements have been simplified to only include inpatient precertification.  Employees currently in the Open Access – HMO Plan will have premium reductions effective January 01,  Exception may be spouse contribution plan members  Out of Network Benefits have improved in the 2007 MODOT/MSHP Plan as it compares to the current Open Access – HMO Plan.

16 DO I NEED TO DO ANYTHING TO ENROLL IN THE NEW MEDICAL PLAN? l NO l You and any participants currently enrolled in the 2006 OAIII medical plan will be automatically enrolled in the new OAIII medical plan for 2007 l New ID cards will be issued l Only requires action if you are making a plan change such as terminating coverage, etc. or have a qualifying event to add dependents, etc.

17 Benefits of one Consolidated Health Plan for MoDOT/MSHP Employees  Additional provider network savings to the MODOT/MSHP plan.  All employees will have access to the MedCall – 24 hour nurse & the Maternicall Program.

18 Service Area Map

19 GOOD NEWS l The eligibility of a dependent is changing for 2007 l Unmarried dependents can now be covered up to age 23 without full time student verification l They must meet the definition of a dependent.

20 How to Find a HealthLink Open Access III or Freedom Network Select provider?  HealthLink’s website is  Freedom Network Select’s website is (For Western MO)  HealthLink’s Customer Service (CS) number is (888)  When calling the CS number, specifically ask for Freedom Select if you live in their network area.

21 Meritain Health  The third party claims administrator for the MoDOT/MSHP Medical Plan.  Meritain continues to be your main contact for information regarding benefits, claims and eligibility questions.

22 Meritain Health  Meritain’s toll-free number is (888)  Meritain’s Customer Service Representatives are available Monday through Friday from 8:00 am – 5:00 pm.

23 CONTACT INFORMATION l Employee Benefit’s toll free # is l Look under “Benefits” on the MoDOT intranet site. l l Contact your local insurance representative in your district, division or troop

24 May we answer your questions?