2011 Plan Changes 1

Eligibility Changes 2 Notice of Eligibility to Age 26 Dependents are now eligible up to age 26, whether married or unmarried. Your election to re-enroll a dependent terminated due to turning age 25 must be made on your Option Period form and submitted to your Insurance Coordinator by the due date. See the new definition of eligible dependents in your Option Period Packet

PPACA Disclosure of Grandfather Status High Option and USA Plans Copays are being decreased to $30 for primary care office visits and specialist office visits are $50 $0 copay for scheduled well-child care visits, $30 office visit copay or immunization administration fee may apply NEW! HealthChoice Plan Changes 3

High Option and USA Plans Well-child visits for children through 12 months are increasing to eight One preventive services visit per calendar year, including one metabolic panel and one lipid panel NEW! HealthChoice Plan Changes 4

Basic and S-Account Plans The number of well-child visits for children through 12 months increases to eight; copays for S-Account remain $50 Pharmacy Benefits for All Plans No lifetime limit on pharmacy benefits Certain prescription tobacco cessation medications available for $5 copay; over-the-counter tobacco cessation products and telephone counseling are free NEW! HealthChoice Plan Changes 5

HMO Plan Changes All HMO Plans Aetna is not participating in 2011; select another health plan if you are enrolled in Aetna Service areas may have changed; check the ZIP Code List in the Employee Benefit Options Guide Preventive care office visits are covered 100% with no copay $0 copay for immunizations for members over age 19 6

HMO Plan Changes HMO Standard Plans $0 copay for hearing screenings for members under age 22; $30 copay for members age 22 and older CommunityCare Alternative HMO $0 copay for hearing screenings GlobalHealth Alternative HMO $0 copay for well-child visits and hearing screenings for member up to age 21 and the copay for outpatient mental health and substance abuse visits is being decreased to $25 7

HMO Plan Changes PacifiCare Alternative HMO $0 copay for hearing screenings, inpatient occupational and speech therapy, and inpatient physical therapy/physical medicine HMO Pharmacy Benefit Changes 30-day supply of medication applies to HMO Standard plans, as well as CommunityCare and GlobalHealth Alternative plans 8

Dental Plan Changes Assurant Freedom Preferred Orthodontia lifetime maximum for ages 19 and under is increasing to $2,000 and orthodontia waiting period is decreasing to 12 months 9

Dental Plan Changes Cigna Dental Copay for amalgam, one surface, permanent teeth is increasing to $22 Copay for root canal, anterior is increasing to $355 Orthodontia out-of-pocket maximum for children through age 18 is increasing to $2,280. For adults it’s increasing to $3,120 10

Dental Plan Changes Delta Dental Delta Dental PPO – Point of Service Plan is not available in 2011 Three Delta plans are available: Delta Dental PPO Delta Dental Premier Delta Dental PPO – Choice 11

Dental Plan Changes Delta Dental PPO Plan Year maximum for Preventive, Basic, and Major care is increasing to $2,500 and orthodontia lifetime maximum increasing to $2,000 Delta Dental Premier Annual deductible for Preventive, Basic, and Major Care is decreasing to $50 and the orthodontia lifetime maximum is increasing to $2,000 12

Other Plan Changes? There are no vision plan changes for There are no changes to the HealthChoice Life Insurance Plan or the HealthChoice Disability Plan. 13