Cape Girardeau Public School District No. 63 Medical Benefits 2011

Base PPO In Network Deductible - $2,500 individual /$7,500 family Coinsurance – 20% Maximum out of pocket - $5,000/$10,000 Office visit co-pays Preventive care paid at 100% Regular office visits $30 Diagnostic (non-routine) tests and labs $50 Urgent care $75 then deductible, then 20% Emergency Room visit $200 then deductible, then 20%

Base Rx Plan Visiting Network Retail Pharmacies Anthem Mail Services 30-day supply Tier Co pays: $15/$40/$60 25% up to $150 Annual maximum of $2,500 Pharmacist processes Rx through Anthem computer system Anthem Mail Services 90-day supply Tier Co pays: $15/$100/$180

Base PPO Out of Network Deductible - $5,000/$15,000 Coinsurance – 50% Maximum out of pocket - $10,000/$20,000 No office visit co-pays must meet deductible then 50% to maximum out of pocket Emergency Room visit $200 then deductible then 20% Prescription $15/$40/$60 Mail order (90 day) - $15/$100/$180/25% up to $150

Summary of Changes to Base PPO Increase in diagnostic co-pay of $20 per visit Individual deductible increase of $500 Family deductible increase of $1,000 Increase out of pocket maximum of $2,000 Urgent care co-pay decreased to $75 from deductible. ER care co-pay decreased to $200 from deductible. Prescription tier 1 increase of $5, tier 2 increase of $10. Mail order tier 1 increase of $5, tier 2 increase of $25

Qualified High Deductible Health Plan In Network Deductible - $3,000 individual /$6,000 family Coinsurance – 20% Maximum out of pocket - $5,000/$10,000 No office visit co-pays Preventive care pad at 100% No prescription plan Health Savings account employer annual contribution of $909. Contribution will be used to offset spouse, child, or family premiums before being placed in HSA account.

Qualified High Deductible Health Plan Out of Network Deductible - $3,000 individual /$6,000 family Coinsurance – 40% Maximum out of pocket - $10,000/$20,000 No office visit co-pays Preventive care pad at 100% No prescription plan Health Savings account employer annual contribution of $909. Contribution will be used to offset spouse, child, or family premiums before being placed in HSA account.

Summary of Changes to QHDHP In network Addition of 20% coinsurance Increase in individual out of pocket maximum of $2,000 Increase in family out of pocket maximum of $4,000 Out of network Increase coinsurance by 10% Increase in individual out of pocket maximum of $4,000 Increase in family out of pocket maximum of $8,000

Buy Up PPO In Network Deductible - $1,500 individual /$4,500 family Coinsurance – 10% Maximum out of pocket - $2,500/$5,000 Office visit co-pays Preventive care paid at 100% Regular office visits $30 Diagnostic (non-routine) tests and labs $30 Urgent care deductible then 10% Emergency Room deductible then 10%

Buy Up Rx Plan Visiting Network Retail Pharmacies Anthem Mail Services 30-day supply Tier Co pays: $10/$30/$60 25% up to $150 Annual maximum of $2,500 Pharmacist processes Rx through Anthem computer system Anthem Mail Services 90-day supply Tier Co pays: $10/$75/$180

Buy Up PPO Out of Network Deductible - $3,000/$6,000 Coinsurance – 30% Maximum out of pocket - $6,000/$12,000 No office visit co-pays must meet deductible then 30% to maximum out of pocket Prescription $10/$30/$60 Mail order (90 day) - $10/$75/$180/25% up to $150

Summary of Changes Buy Up PPO There are no changes being made to the buy up plan at this time.

Medical Benefits 2011 Monthly Premiums Base Buy-Up QHDHP Cost Cost Cost Employee $ 524.13* $ 646.17 $ 448.38 Spouse $1,153.08 $1,421.55 $ 988.42 Child(ren) $ 995.83 $1,227.72 $ 853.64 Family $1,519.95 $1,873.85 $1,302.92 *District funds $524.13 of medical benefits.

Health Insurance Basics HIPPA (Health Insurance Portability and Accountability Act) HIPAA improves the portability, security and privacy of protected health information. When obtaining assistance regarding claims issues through the Benefits Office, employees must sign an authorization for release of information form.

Health Insurance Basics Health Insurance Opt Out Provisions Employees can decline individual health coverage. If opting out: Employee premium dollars are not available Cannot return to Anthem Blue Cross and Blue Shield until next annual open enrollment or IRS Qualifying Event Must sign disclaimer form verifying intention to decline coverage

Health Savings Account (HSA) Definition An interest bearing savings account owned by the employee to pay for current and future medical expenses. Offered with a High Deductible Health Plan Works similar to a flexible spending account, yet unused monies roll over year after year and continue drawing interest. Portable

Health Savings Account (HSA) Account Contributions Both employer and employee pre-tax contributions are permissible. 2010 maximum annual contribution (employer and employee contributions combined) $3,050 for employee only coverage $6,150 for family coverage Catch-up Provision at age 55: $1,000

Health Savings Account (HSA) Who is NOT Eligible? Employees covered by Base or Buy Up Plan. Employees covered by other medical insurance that is a non-high deductible health plan (at least $1,200). Employees enrolled in Medicare coverage. Employees claimed as a dependent child on someone else’s tax returns.

HSA Plan Cafeteria Plan Funding Employer Cafeteria Plan Funding = $909/year District funds 100% of employee Base Medical Plan premium. Offset dependent premiums . Contribution placed in Health Savings Account

Health Savings Account (HSA) Account Distributions Tax-free if used for qualified medical expenses. Qualified medical expenses incurred on or after account is established. Withdrawal only for monies in the account at time of distribution. Can apply qualified medical expenses of spouse and children, even if not covered by your medical insurance.

Health Savings Account (HSA) Account Distributions (continued) Qualified Medical Expenses: Deductibles, cost shares, and out of pocket costs on medical insurance claims. COBRA continuation of coverage premiums. Qualified long term care insurance premiums.

Health Savings Account (HSA) Account Features HSA services through Mellon Bank. Upon electing the HSA Plan coverage and electing an HSA, Welcome Kits will be mailed to home address. Forms must be completed by the employee and returned to Mellon Bank ASAP. Competitive mutual fund investment options available once account reaches $1,500.

Health Savings Account (HSA) Account Features (continued) Online management access of personal benefits and HSA details. Monthly account activity statements. MasterCard – a debit card to pay for qualified medical expenses. Checkbook Usage - initial 40 checks supply; free of charge.

Health Savings Account (HSA) Account Features (continued) Questions: Customer Service: (888) 224-4902 www.anthem.com, My Account page

Health Savings Account (HSA) Incentives Program Types of Incentives Health Assessment - $50 Personal Health Coach - $100 $200 incentive when achieving goals through program Smoking Cessation Program - $50 Weight Management Program - $50 All incentive programs available through the Anthem website: www.anthem.com

Base or HSA Plan Which is Right for You? Base Plan - $2,500 Deductible HSA Plan - $3,000 Deductible General Office Visits/Rx 4 Office Visits ($51/visit) = $ 120 Annual Physical = $ 0 4 Rx purchases ($100/Rx) = $ 160 Total Cost = $ 280 Less MRA Funding = $ 0 Net Cost $ 280 4 Office Visits ($51/visit) = $ 204 Annual Physical = $ 0 4 Rx purchases ($100/Rx) = $ 400 Total Cost = $ 604 Less HSA Funding = $ (909) Net Cost = $ (305) A $50,000 Surgery 4 Office Visits ($100/visit) = $ 120 4 Labs ($150/lab) = $ 200 4 Rx purchases ($100/Rx) = $ 160 Deductible & OOP Maximum = $ 3,500 Total Cost = $ 3,980 Less MRA Funding = $ 0 Net Cost = $ 3,980 4 Office Visits ($100/visit) = $ 400 4 Labs ($150/lab) = $ 600 4 Rx purchases ($100/Rx) = $ 400 Deductible & OOP Maximum = $ 4,000 Total Cost = $ 5,400 Less HSA Funding = $ ( 909) Net Cost = $ 4,491

Base or HSA Plan Which is Right for You? Base Plan - $2,500 Deductible HSA Plan - $3,000 Deductible General Office Visits/Monthly Rx 4 Office Visits ($51/visit) = $ 120 Annual Physical = $ 0 2 Monthly Generics ($25/Rx) = $ 360 1 Monthly Regular ($100/Rx) = $ 480 Total Cost = $ 960 Less MRA Funding = $ 0 Net Cost $ 960 General Office Visits/ Monthly Rx 4 Office Visits ($51/visit) = $ 204 Annual Physical = $ 0 2 Monthly Generics ($25/Rx) = $ 600 1 Monthly Regular ($100/Rx) = $ 1,200 Total Cost = $ 2,004 Less HSA Funding = $ (909) Net Cost = $ 1,095

SIS Portal https://employee.captigers.com Employee ID required (Contact Finance Dept.) Allows access to: Benefits and Deductions Leave Balances Pay Information Tax Forms (W2 and W4 information) Personal Information

Questions Visit our website Call us: (573) 335-1867 http://www.capetigers.com Departments – Business - Benefits Call us: (573) 335-1867 Lisa Smith – Benefits DeRhonda Gosche – Personnel/Benefits Robin Twiggs - Payroll