Wellesley College PPO Plus HSA Plan for 2015

© 2009 Harvard Pilgrim Health Care Components of the PPO Plus HSA Plan  Two parts: A qualified High Deductible Health Plan A Health Savings Account (HSA) o Administered by WageWorks 2

© 2009 Harvard Pilgrim Health Care Common Terms  Allowed Amount –The maximum amount on which payment is based for covered health care services. This may be called “eligible expense,” “payment allowance" or "negotiated rate." If your provider charges more than the allowed amount, you may have to pay the difference.  Balance Billing from Non-Preferred Providers –The difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services.  Copayment –A fixed amount (for example, $20) that you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service. 3

© 2009 Harvard Pilgrim Health Care Common Terms  Deductible –The amount you owe for plan services before the plan begins to pay. For example, if your deductible is $1,500, the plan won’t pay anything until you’ve met your $1,500 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.  Network –The facilities, providers and suppliers the plan has contracted with to provide health care services.  Non-Preferred Provider –A provider who doesn’t have a contract with the plan to provide services to you. You’ll pay more to see a non-preferred provider.  Out-of-network Co-insurance –The percent (for example, 40%) you pay of the amount for covered health care services to providers who do not contract with the plan. 4

© 2009 Harvard Pilgrim Health Care Common Terms  Out-of-Pocket Limit –The most you pay during the year before the plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges or health care services the plan doesn’t cover.  Primary Care Provider –A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of health care services.  Specialist –A physician specialist who focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care. 5

© 2009 Harvard Pilgrim Health Care PPO Plus HSA Plan Design  No need to designate a primary care physician (PCP)  No referral needed for specialist care  Full access to our local network, plus United Health Care’s national network of more than 650,000 providers 6

© 2009 Harvard Pilgrim Health Care The PPO Plus HSA Plan Puts You in Control  Access care from providers outside the network (with higher cost-sharing)  Access emergency care anywhere in the world at the in-network benefit level 7

© 2009 Harvard Pilgrim Health Care Preventive Services  Select in-network preventive services are not subject to the deductible –Covered in full: routine physicals, annual gyn visits, mammograms, pap smears, immunizations, routine blood work and urinalysis, and certain disease screenings 8

© 2009 Harvard Pilgrim Health Care PPO Plus HSA Plan  All diagnostics and treatments are subject to deductible: Visits for illness or injury Imaging and outpatient services Inpatient services Prescription drugs 9

© 2009 Harvard Pilgrim Health Care Prescription Drugs  Subject to in-network deductible  Payment is due at the time of purchase  Once you reach the deductible, a copay applies –$5 / $20 / $30 /$50 retail –$10/$40/$60/$150 mail order 10

© 2009 Harvard Pilgrim Health Care PPO Plus HSA Plan Summary 11 Plan ProvisionIn-Network BenefitsOut-of-Network Benefits Annual Deductible $1,500 – Individual contract $3,000 – Family contract HSA College Funding (50% of deductible) $750 – Individual contract $1,500 – Family contract Annual Out-of-Pocket Maximum $5,000 – Individual contract $10,000 – Family contract Preventive care including:  Adult annual visit  Well child visit  Annual gynecological visit  Immunization, including flu shot 100% No deductible applies 80% No deductible applies Emergency Room100% after deductible Other Services  Office visit for illness or injury  Lab test, diagnostic procedures  In and out patient hospital services  Treatment and procedures, such as surgeries, chemotherapy, allergy treatments, dialysis 100% after deductible80% after deductible DME80% after the deductible Prescription drug – retail$5/$20/$30/$50 after in-network deductible Prescription drug – mail order$10/$40/$60/$150 after in-network deductible

© 2009 Harvard Pilgrim Health Care PPO Plus HSA Premium Comparison to HMO (non union) Annual Plan Premium and HSA Comparison HMO PPO Plus HSA Premium Savings HSA College Contribution Total (savings and HSA) Individual$1,917$1,466$450$750$1,200 Family$5,195$3,973$1,222$1,500$2,722 12

© 2009 Harvard Pilgrim Health Care Reimbursement for Medical Claims You visit provider Provider submits claim Harvard Pilgrim processes claim Provider bills you You pay provider (you can use HSA funds) 13 All reimbursements to network providers are based on the negotiated amount Step 1

© 2009 Harvard Pilgrim Health Care HMO vs PPO Plus HSA HMO PPO Plus HSA (in-network) PCPYesNo ReferralsYesNo OON benefitsNoYes DeductibleNone$1,500 per individual contract or $3,000 per family contract Select preventiveCovered in full PCP visit$25 copayDeductible, then 100% Specialist visit$25 copayDeductible, then 100% LabCovered in fullDeductible, then 100% Imaging$75 copayDeductible, then 100% 14

© 2009 Harvard Pilgrim Health Care HMO vs PPO Plus HSA HMO PPO Plus HSA (in-network) Emergency$100 copayDeductible, then 100% Day surgery$250 copayDeductible, then 100% Inpatient$500 copayDeductible, then 100% Outpatient Rehab$25 copayDeductible, then 100% Behavioral health$25 copayDeductible, then 100% ChiropracticCopay, then 100%Deductible, then 100% DME80%Deductible, then 80% PrescriptionsCopayDeductible, then copay Health Savings AccountNone$750 per individual contract or $1,500 per family contract 15

© 2009 Harvard Pilgrim Health Care Becoming a Better Health Care Consumer  Determine when you need to access care  Choose the appropriate site of service –Medical appropriateness –Find lower-cost, high-quality providers –Compare hospitals  Research online with Now iKnow  Read your Harvard Pilgrim Activity Summaries 16

© 2009 Harvard Pilgrim Health Care Activity Summary 17

© 2009 Harvard Pilgrim Health Care HPHConnect  View all claims, authorizations, prescription drug history and monthly Activity Summaries  Compare provider cost and quality  Create a personal medical record  Research a condition  Review your plan documents –Schedule of Benefits and Benefit Handbook –Pharmacy program –Much more 18

Now iKnow Harvard Pilgrim's Cost Transparency Tool

© 2009 Harvard Pilgrim Health Care Now iKnow Overview 20  A secure online cost and quality tool that supports HPHC commercial members in making informed health care purchasing decisions  Offers cost and quality information to help members understand and plan for their potential out-of-pocket expenses related to their treatment options

© 2009 Harvard Pilgrim Health Care Now iKnow Highlights  Utilizes secure sign-on through HPHConnect  Displays real-time accumulator snapshots of out-of-pocket utilization  Estimates are based on member’s plan design  Shows costs for simple procedures and complex bundled treatments  Allows browsing functionality and provider comparisons based on location, treatment or condition  Displays physician and hospital quality  Displays member messages 21

© 2009 Harvard Pilgrim Health Care  Includes specific cost estimate or an estimated range, based on amount spent to date  Gives side-by-side provider comparison  Filters based on Harvard Pilgrim provider directory  Displays quality ratings for physicians and hospitals  Incorporates tiered/limited provider networks Now iKnow Provider Search Results 22

© 2009 Harvard Pilgrim Health Care  Uses Google maps to display provider locations/directions  Shows what is and is not included in the estimate  Breaks out price by facility and professional costs  Includes specific cost estimate or an estimated range Now iKnow Provider Price Details 23

© 2009 Harvard Pilgrim Health Care 24 The Basics: Annual PPO deductible: $1,500 HSA: College contributes $750; Sue contributes $275 Sue has some preventive care (covered in full by either plan), goes to the doctor for strep and purchases generic medication. If Sue chooses the PPO Plus HSA Plan, she pays $1,466 for the coverage and still has $852 in her HSA for future medical expenses. Under the HMO, she will pay $1,947 for the year (for coverage and copays). PPO Plus HSA Plan vs. HMO Scenario 1: Single Coverage – Sue Service Cost of Care PPO Plus HSA PlanHMO (in-network) Plan Pays Sue Pays Plan Pays Sue Pays (copays) Out-of-PocketFrom HSA Routine physical and flu shot (preventive) $200 $0 $200$0 Doctor’s visit (strep throat)$150$0 $150 $125$25 Medication (generic)$23$0 $23 $18$5 Totals$373$200$173$343$30 Annual Medical Premium*$1,466$1,917 Sue’s Total Cost$1,466*$1,947 Remaining HSA Balance+ $852N/A * Note that the College contributed $750 to Sue’s HSA, so she did not have to use any of her own HSA contributions

© 2009 Harvard Pilgrim Health Care 25 The Basics: Annual PPO deductible: $3,000 HSA: College contributes $1,500; John contributes $750 John’s family uses some preventive care and has other doctor’s visits, a generic prescription and outpatient surgery. If John chooses the PPO Plus HSA Plan, he pays $3,973 for the coverage and $115 out-of- pocket, with $2,250 coming from the HSA. With the HMO, he pays $5,195 for coverage and $315 out-of- pocket. PPO Plus HSA Plan vs. HMO Scenario 2: Family Coverage – John Service Cost of Care PPO Plus HSA PlanHMO (in-network) Plan Pays John Pays Plan Pays John Pays (copays) Out-of-PocketFrom HSA Routine physical for son$200 $0 $200$0 Doctor’s visit for John$150$0 $150$125$25 Outpatient surgery$2,000$0 $2,000$1,750$250 Doctor’s visit for spouse$150$0$50$100$125$25 Medication (generic)$65$0$65$0$50$15 Totals$2,565$200$2,365$2,250$315 Annual Medical Premium*$3,973$5,195 John’s Total Cost$4,838*$5,510 Remaining HSA Balance$0N/A * Note that the HSA paid $2,250 in medical expenses with $1,500 due to the College’s contributions

© 2009 Harvard Pilgrim Health Care 26 The Basics: Annual PPO deductible: $3,000 HSA: College contributes $1,500 Theresa’s family has two preventive visits, outpatient surgery and an MRI. If Theresa chooses the PPO Plus HSA Plan, she pays $3,973 for the coverage and $1,500 out-of-pocket, with another $1,500 coming from the College contribution to her HSA. With the HMO, she pays $5,195 for coverage and $325 out-of-pocket. PPO Plus HSA Plan vs. HMO Scenario 3: Family Coverage – Theresa Service Cost of Care PPO Plus HSA PlanHMO (in-network) Plan Pays Theresa Pays Plan Pays Theresa Pays (copays) Out-of-PocketFrom HSA Routine physical for self$200 $0 $200$0 Routine physical for son$200 $0 $200$0 MRI$3,000$0$1,500 $2,025$75 Outpatient surgery$2,000 $0 $1,750$250 Totals$5,400$2,400$3,000$4,175$325 Annual Medical Premium*$3,973$5,195 Theresa’s Total Cost$5,473*$5,520 Remaining HSA Balance$0N/A * Note that the College contributed $1,500 to Theresa’s HSA and this paid $1,500 of the family’s medical expenses

© 2009 Harvard Pilgrim Health Care QUESTIONS? 27