Non State Groups Open Enrollment for Plan Year 2013

 No employee & employer rate increases  No plan design changes for Plans A and B  Autism Spectrum Disorder Pilot – Benefit will be continued for 2013

 Plan Design Changes for Plan C – Lower premium – Deductible Single $2,500/ Family $5,000 Single family member only has to meet the single deductible – In Network services for medical & pharmacy have NO member Coinsurance – Employer HSA Funding Increased Maximum of $1,500 for single & $2,250 for family Employer may pays HSA funding in a lump sum All HSA accounts will be with US Bank

 Preventive Care Coverage for Contraception – Medical coverage for implantable & injectable contraceptives – Medical coverage for sterilization – Pharmacy coverage for prescription birth control products Must be on the Preferred Drug List Does not include over the counter items  Preventive Care Coverage for Breastfeeding – Includes counseling and equipment rental

 Summary of Benefits & Coverage (SBC) –  Uniform Glossary of Health Coverage & Medical Terms* – lossaryofHealthCoverageMedicalTerms.pdf lossaryofHealthCoverageMedicalTerms.pdf * Note: This is not specific to the SEHP Coverage

1. Pick a plan design (A, B or C) – Which plan design provides the coverage you and your family need? – What is the total plan cost? What is the member contribution Premiums + Deductible & Coinsurance = ? 2. Review the Provider Networks – Each of the medical plans uses a different provider network

 All are Preferred Provider Organizations (PPO) – Plans A, B and C all use the same provider networks & same basic coverage – Claims paid based on the network status – Network Providers accept the plan allowance as payment in full – Non Network Providers can balance bill – All plans include preventive care PlansABC Blue Cross and Blue Shield of Kansas XXX Coventry/PHS XXX UnitedHealthcare Company XXX

Services Well Baby Exams - includes newborn screenings & age- appropriate office visits. Contraceptive Coverage – Designated prescription drugs, implantable & injectable contraceptives & sterilization procedures. Well Woman, Man & Child Exams - includes an office visit & age- appropriate screenings, contraception services & counseling. Ultrasonography for Aortic Aneurysm - Limited to one for men ages with tobacco use history Prenatal Screening & Counseling - Limited screening services. Mammography – not limited to one. Age-Appropriate Bone Density Screening Vision Exam – one covered per person per year ImmunizationsRoutine Hearing Exam Colonoscopy – not limited to one.

 A set amount of eligible expenses a covered person must pay out of their own pocket before the health plan will begin paying on their claims.  Network and Non Network Deductibles accumulate separately.  Deductible and “Not Covered” do not mean the same thing.

Deductible Example Claim Information Plan C Deductible is $2,500 Network Dr. billed $600 for a covered service. Health Plan allowance is $500. Member has met $0 of their deductible this year Claim Processing $500 Allowed Charge -$500 Deductible $0 Paid by health plan Your responsibility = $500 Plan Pays $0 Member Pays $500 * Dr. writes off $100 * Members on Plan C have a Health Savings Account that could be used to pay this deductible amount.

 A cost sharing formula for health care services  Coinsurance is expressed as a percentage of the allowed charge that will be paid by the member and the balance paid by the Plan  You must meet the deductible before coinsurance is applied

Coinsurance Example Claim Information Member has Plan A Network Dr. billed $125 for service Plan allowed $100 for service Member has met their $300 Deductible Member Coinsurance is 20% Claim Processing $100 allowed by Plan 20% Coinsurance $20 Paid by Member Plans pays the other 80% Plan Pays $80 Member Pays $20 $100 Dr. writes off $25

Network Benefits Plan APlan BPlan C Deductible $300 Single $600 Family $150 Single $300 Family $2,500 Single $5,000 Family Coinsurance 20%35%0% Annual Coinsurance $1,400 Single $2,800 Family $3,000 Single $6,000 Family None Total Deductible & Coinsurance $1,700 Single $3,400 Family $3,150 Single $6,300 Family $2,500 Single $5,000 Family Pharmacy Covered under separate policy Included with Medical Preferred Lab Yes No Office Visits Adults (age 19+) PCP $25 Copay Specialist $45 Copay PCP $20 Copay Specialist $40 Copay Deductible & 0% Coinsurance Children (< age 19) PCP $25 Copay Specialist $45 Copay PCP $10 Copay Specialist $25 Copay Deductible & 0% Coinsurance

 100% Coverage of eligible outpatient lab tests  Two vendors – Quest Diagnostics – Stormont-Vail  Cannot be used for: – Hospital outpatient or inpatient lab services – Labs needed on a STAT basis

 Statewide & nationwide preferred lab vendor  Testing must be performed and billed by Quest  Your Doctor can draw the sample and call for specimen pick up  For draw site locations visit: - Online appointment scheduling available  Use Your Quest ID card or medical ID card

 Stormont-Vail HealthCare is the regional preferred lab vendor in NE Kansas  100% coverage for eligible outpatient lab tests  All Plan A and B members may use the Stormont-Vail draw site locations  Labs drawn at other Cotton-O’Neil locations may be included if by network providers  Show your medical ID Card to access benefit

Generic Drugs – 20% Coinsurance Preferred Brand – 35% Coinsurance Non Preferred Brand – 60% Coinsurance Special Case Medications – 25% to a max of $75 per 30-day supply  Coinsurance Maximum Is $2,580 per person for Generic, Preferred Brand & Special Case medications. www2.caremark.com/kse Up to a sixty (60) day supply of most drugs available Caremark Prescription Drug Benefit – Plans A & B

2012 Actos3 rd Qtr Diovan3 rd Qtr Singulair 3 rd Qtr Maxalt4 th Qtr Maxalt MLT4 th Qtr Tricor4 th Qtr Requip XL4 th Qtr 2013 Reclast1 st Qtr Zomig2 nd Qtr Zomig ZMT2 nd Qtr Advicor2 nd Qtr Niaspan3 rd Qtr Achiphex4 th Qtr Cymbalta 4 th Qtr www2.caremark.com/kse

 Network Coverage for Medical & Pharmacy – $2,500/$5,000 Deductible – No Coinsurance – $2,500/$5,000 Total Deductible & Coinsurance – Preventive Care Services paid at 100%  Non Network Coverage – $2,500/$5,000 Deductible – 20% Coinsurance – $4,000/$8,000 Total Deductible & Coinsurance – Preventive Care is not covered  Does not include dental or optional vision plan

 Same Preferred Drug List as Plans A & B  Covered drugs are subject to the Network Plan C deductible  After the deductible, the plan pays covered prescription drugs at 100%  100% coverage for contraceptives on the PDL  Discount Tier drugs are not covered drugs – Only eligible for Caremark’s negotiated discount  Plan C is a credible drug plan

Plan C Network BenefitsSingleFamily Deductible$2,500$5,000 Coinsurance0% Total Member Pays$2,500$5,000 HSA AccountSingleFamily State Maximum HSA Contribution $1,500$2,250 Minimum $25 EE Contribution $600 Total Annual HSA Contribution $2,100$2,850

 An employee-owned bank account for saving money to pay for current or future medical expenses for members enrolled in a qualified high deductible health plan  Unspent HSA funds roll over and accumulate year to year and can be invested  Portable - The account and the money belong to you

 The following members are not eligible for an HSA: – Enrolled in Medicare – Enrolled in TRICARE or TRICARE for Life – Enrolled with the Veteran’s Administration (VA) and/or have received VA medical services within a three-month period immediately preceding their enrollment in Plan C – Receiving benefits from Social Security – Covered as a dependent under another plan that isn’t a QHDHP – Can be claimed as a dependent on another individual’s tax return (i.e. Parents) – Spouse has Health Care Flexible Spending Account See page 12 of the OE Book

 Employer may pay HSA contribution as a lump sum  Payment date depends on HCFSA: – Account funded in January if no HCFSA in 2012 or if all money has been used by 12/31/12 – Account funded after March 15, 2013 if enrolled in HCFSA in 2012 and you have funds during the grace period

Full Time Employee - (24 semi-monthly deductions) SingleFamily Employer (ER) Contribution$1,500$2,250 Employee (EE) Contribution$25 to $72.91$25 to $175 Maximum Annual HSA Contribution (ER+EE) $3,250$6,450 Over age 55 “Catch up” amount$1,000 HSA Contributions are governed by the Internal Revenue Service (IRS). Eligibility criteria for HSA Account is on Page 12 of the Open Enrollment Book Minimum contribution of $25 semi-monthly by the employee is required Contributions may be made with pre- or post-tax funds. Members over age 55 can contribute additional funds to “catch up”

26  All Plan C options will have the same HSA vendor: – US Bank  A file with the members who enroll in Plan C will be sent by SEHP to US Bank  Employees receive “welcome” notification via – Letter if no  Employee completes online enrollment process – Must accept the Terms and Conditions – Order additional cards for dependents – Select account beneficiaries  Online Tools to manage your account

27  Use your HSA Bank Card at a Pharmacy – Fill a prescription – Swipe your HSA Bank Card for payment – Save a copy of receipt for your records  Use your HSA Bank Card for Medical Services – Health plan processes claim & sends you an Explanation of Benefits (EOB) – Pay the provider using your HSA Bank Card – Save a copy of the bill or EOB for your records

28  You Pay the Provider through Bill Pay – You go online and use Bill Pay to issue payment to the provider of service  Reimburse yourself for expenses paid out of your pocket – With Bill Pay you can send a direct deposit reimbursement to your checking or savings account for health care services

 Plan pays in full for 2 exams & cleanings  $50 Plan Deductible max of 3 per family  Implant Coverage – 50% Coinsurance to a max of $1,250 per year – Benefit subject to annual benefit max  Annual benefit maximum – $1,700 per person per year  $1,000 Lifetime Orthodontic benefit

Benefit LevelPPOPremier Non Network Preventive Services Covered in full Allowed amount covered in full Basic Benefit Basic Restorative 50% Enhanced Benefit Basic Restorative20%40%

 $25 Materials Copay then: – 100% single vision, standard bifocal, trifocal lenticular lenses – Up to $100 frame allowance  Elective Contact lens allowance $150  Offi ce visit subject to $50 Copay  Contact Lens Fitting Fee subject to $35 Copay

Includes Basic benefits plus… – Frame allowance of up to $150 – Contact Lens Fitting Fee subject to $35 Copay – High index or Poly-carbonate lenses up to $116 – Progressive lenses up to $165 – Scratch and UV coating

 Requirements for 2014 incentive discount – Complete the required online health questionnaire (10 Credits) – Earn 20 additional credits  HQ Rewards deadline is July 31, 2013  Non Tobacco usage is worth 10 credits – Non Tobacco Use declaration is now online at: – You may complete declaration at anytime before the deadline.  Tobacco cessation program is no longer required for tobacco users.

 Enroll online: – Make health plan selections – Add/drop dependents Dependent documentation required by October 31. – Coverage effective January 1, 2013

 Coventry/PHS and UHC are issuing new ID cards for Plan C members  Delta Dental is issuing new ID cards for all  For all others, new cards will only be issued if the member makes a plan/coverage change

 Review the Open Enrollment (OE) booklet  ?’s: Call the health plan customer service – Phone numbers in the front of the OE booklet  Visit – Benefit descriptions, Provider directories, & Preferred drug list available – Information on the HSA and FSA accounts  Summary of Benefits & Coverage (SBC)  ?’s to SEHP:

 Hold for link to the health plan tool that will be on our web site soon  US Bank Tool place holder  There is a Payroll Calculation tool available at

Questions?

Option Slides

Primary Care Providers (PCPs) General practice Family practice Geriatrics Internal medicine Physician extenders Pediatrics Plans A & B only PCPs have lower office visit copays Member may have more than one PCP No referrals required

FacilityAddressCity Stormont-Vail HealthCare Laboratory 1500 SW 10 th Ave.Topeka Cotton-O’Neil 901 Laboratory901 SW GarfieldTopeka Cotton-O’Neil 823 Laboratory823 SW MulvaneTopeka Cotton-O’Neil Croco Laboratory2909 SE Walnut Dr.Topeka Cotton-O’Neil Urish Laboratory6725 SW 29 th St.Topeka Cotton-O’Neil Carbondale Laboratory 211 East MainCarbondale Emporia Medical Arts Clinic1301 W 12 th Ave. Suite 401 Emporia Cotton-O’Neil Wamego Laboratory 1704 Commercial Circle Wamego

Network vs. Non Network Plan A - Non Network Provider Service on 1/2/2013 Plan Pays Member Pays Provider Write-Off Billed Charge $1,500 Allowed Charge $1,400 $100$0 $500 Deductible ($500) $500 50% Coinsurance $900$ 450 Total $450$1,050$0 Plan A - Network Provider Service on 1/2/2013Plan Pays Member Pays Provider Write-Off Billed Charge $1,500 Allowed Charge $1,400 $100 $300 Deductible ($300) $300 20% Coinsurance $1,100$880$220 Total $880$520$100

 Office Visit Copays – $25 for Primary Care Office Visits – $45 for Specialist Office Visits  $300/$600 Deductible  20% Coinsurance  Coinsurance Max $1,400/$2,800  Preventive Care Services paid at 100%  Lab Card Benefit

 Primary Care Office Visits – $20 Copay for Adults – $10 Copay for Children <age 19  Specialist Office Visits – $40 Copay for Adults – $25 Copay for Children <age 19  $150/$300 Deductible  35% Coinsurance  Coinsurance max $3,000/$6,000 Preventive Care Services paid at 100%  Lab Card benefit

 $500/$1,500 Deductible  50% Coinsurance  Coinsurance Max $3,650/$7,300  Non Network Providers can balance bill  Preventive care not covered

 Covered in full: – Prophylaxis/cleanings – twice per year. – Oral examinations – twice per year. – Bitewing x-rays – adults – 1 x a year children under x a year – Full mouth x-rays – once each five (5) years. – Limited coverage for children only: Sealants Space maintainers Topical fluoride – Ancillary – emergency relief of pain.