1. My Health. My Life. Open Enrollment: October 19 – October 27

2. 22 Agenda  Timeline  Process  Communications  Highlight of changes for 2010 Why is your health important to you?

3. 33 Open Enrollment: October 19 – October 27 [hr.duke.edu/selfservice] 1.Enroll online through the Duke@Work Self-Service website Or 2.By phone at 919-684-5600 Enrollment for 2010.”

4. 44 Communications WhenWhat Aug. 1 -Article: Rising cost of health claims Sept. 1 -Article: Value of reimbursement accounts Sept. 9-30Manager Presentations: Open enrollment for 2010 benefits Sept. 21Memo: Open enrollment for 2010 benefits Oct. 1 -Article: Open enrollment for 2010 benefits Oct. 2Information sessions: Open enrollment for 2010 benefits Oct. 3Webcast: Open enrollment for 2010 benefits Oct. 6Guide: Print guide mailed home. Oct. 19Open Enrollment Period Begins Oct. 19Email: Open enrollment period begins Oct. 26Article: Reminder about deadline Oct. 26Email: Reminder about deadline Oct. 27Open Enrollment Period Ends

5. Current Environment for Health Care

6. 66 Health costs on the rise  Drivers: increased utilization and higher costs for prescription drugs.

7. 77 Premium comparison for 2009

8. 88 Comparing the cost of health care Did You Know ? As of June 30, 2009, the average annualized health cost per employee was $6192, most of which was covered by Duke. (based on 2009 figures)

9. 99 What you can do to help?  Exercise and eat healthy, balanced meals  Take the health risk assessment to better understand your risks  Establish a relationship with a primary care physician  Request generic drugs and use Medco mail order for maintenance prescriptions  Utilize appropriate health care facilities Did You Know? Nearly 80% of disease in this country is preventable.

10.  10 Where should you go?

11.  11 Duke Urgent Care

12. Medical Insurance Plans for 2010

13.  13 Highlights for 2010  Despite increasing cost, coverage remains intact for 2010  No co-pay increases for primary care, urgent care, mental health visits or generic drugs.  Still offering four plans to provide individual choice based on cost and needs  Adjustments to premiums and some co-pays to keep plans financially viable

14.  14 Duke’s medical insurance plans  Duke offers 4 plans: Duke Basic Duke Select Blue Care Duke Options  Consider: Cost Coverage Physician network Dependents, etc.

15.  15 $438.00$412.36$95.00$89.24Duke Options $444.00$418.74$99.00$92.57Blue Care $355.00$334.87$60.00$56.19Duke Select $225.00$212.20$23.00$20.97Duke Basic 2010200920102009 FamilyIndividual Medical insurance premiums for 2010  Duke’s premium increases are about half of the projected increases nationally  Increases will range from $2.03 for individual coverage to $25.64 for family coverage. $2.03 – $6.43/month$12.80 – $25.64/month

16.  16 Expanded coverage  As part of the Mental Health Parity Act, Duke has removed the limits for inpatient and outpatient care from network providers.  Applies to all health plans. Did You Know? Personal Assistance Service (PAS) has expanded the number of visits from 6 to 8.

17.  17 Expanded coverage, cont.  Bariatric surgery Covered if meet minimum qualifications: –Must meet physician’s medical/psychological criteria –BMI of 40 or more, unless significant co-morbid condition with a BMI of 35-39 –Employed at Duke in benefit eligible category for 5 years –Participated in supervised weight loss program for 6 mos. –Available through Duke Select, Blue Care, Duke Options If eligible, surgery will only be available at a Duke facility. There will be a co-pay of $4,000.

18.  18 Co-payment changes  No changes in co-pays for primary care, urgent care, mental health visits, or generic drugs.  Increases in co-pays for specialist visits, outpatient surgery and most emergency and inpatient services

19. Pharmacy Plan for 2010

20.  20 Pharmacy benefits  No changes in co-pay for generic drugs.  New $100 annual deductible* for brand and non-formulary drugs purchased at local pharmacies  Deductible waived if ordered through Medco home delivery program Did You Know? Typically, generic drugs cost 30 percent to 60 percent less than the brand-name drug. *Duke Basic deductible for all pharmacy remains in effect.

21.  21 Retail Pharmacy (34-day supply)  Co-pay for generic drugs remains same at $10  Co-pay increases for retail purchases of brand and non-formulary medications Type20092010 Generic$10 (or cost of drug if less) $10 (or cost of drug if less) (no deductible) Brand$35 $40 (after $100 deductible) Non-Formulary (Brand) $50 $55 (after $100 deductible) Pharmacy benefits, cont.

22.  22 Save with generics  If you use generics, the $100 deductible is waived.  If you choose a brand drug when the generic equivalent is available, you'll pay a $10 co-pay plus the cost difference between the brand and the generic drug.

23.  23 Incentive for mail order Mail Order for Maintenance Medications  Cost savings for mail order  Increased cost for retail purchases Type Retail (initial 3-months) Retail (after initial 3-months) Medco Home Delivery Generic (no deductible) Co-pay of $10 per month = $30 (or cost of drug if less) Co-pay of 50% of cost of drug (min: $10, max $25) = $30-$75 $20 (no deductible) Brand ($100 deductible before co-pay takes effect) Co-pay of $40 per month after $100 deductible = $120 Co-pay of 50% of cost of drug (min: $55, max $125) per month = $165-$375 $100 (deductible waived) Non-Formulary ($100 deductible before co-pay takes effect) Co-pay of $55 per month after $100 deductible = $165 Co-pay of 50% of cost of drug (min: $65, max $135) per month = $195 - $405 $138 (deductible waived)  3-month supply 

24.  24 Switching to mail order… New Maintenance Prescription:  Ask your physician to write 2 prescriptions: 1) 34-day prescription for retail pharmacy 2) 90-day prescription for Medco home delivery, plus refills Existing Maintenance Prescription:  Complete Medco Mail Order form  Contact your physician and request a 90-day prescription for Medco home delivery, plus refills

25.  25 Step Therapy  For seven therapies, participants are required to try the generic or target formulary drug before the plan will “step up” to pay for more expensive alternatives. These therapies are: Proton Pump Inhibitors (reflux) Sleep Agents Depression (exception for current Rx for anti-depressants) Osteoporosis Intranasal Steroids (asthma, allergies) Migraine Therapy Angiotensin Receptor Blockers (hypertension)

26. Duke’s Vision Plan for 2010

27.  27 Duke’s vision plan for 2010  No increase in co-pays or premiums in 2010.  Duke SuperOptics (Medical Center) now in-network Vision Plan: provides coverage for prescription lenses and frames or contact lenses (in lieu of eyeglasses), as well as a complete annual eye exam. Individual Employee & Child Employee & Children Employee & Spouse/ Partner Family $8.85$16.95$17.84$16.96$27.47

28. Duke’s Dental Plan for 2010

29.  29 Duke’s dental plans for 2010  No increase in premiums for Dental Plan B.  Premiums for Dental Plan A will increase $1.90/month for individual coverage and $5.75/month for family coverage. $40.40 $10.88 Dental Plan B $104.95$99.20$34.65$32.75 Dental Plan A 2010200920102009 FamilyIndividual

30. Reimbursement Accounts for 2010

31.  31 Save with reimbursement accounts  Pre-tax savings is about $30-$40 for every $100 of eligible expenses  Health Care Reimbursement Account  Dependent Care Reimbursement Account

32.  32 Another way to explain it … Play

33.  33 Reimbursement account examples

34.  34 Health care reimbursement made easy  Pay at point of sale  Purchase home delivery Rx without credit card or check  Works like a debit card … deducts pre-tax dollars from your reimbursement account  Helps cover co-pays and deductibles.  Helps reduces paperwork, waiting for reimbursement Did You Know? Despite being one of the best ways to save money on health care expenses, only 6,800 faculty and staff took advantage of the Health Care Reimbursement Account last year.

35. Duke’s Investment in You through Benefits

36.  36 Investing in you …  Duke contributes about 25 cents in additional benefits for every dollar an employee earns.  Average cost of health care per employee last year was $5,868, most of which was covered by Duke. Did You Know? Collectively, benefits represent an additional 20 - 25 percent of your compensation. 25% Benefits 75% Salary

37.  37 Investing in you …  In 2008 alone, Duke contributed more than $89.7 million to the retirement plans of faculty and staff.  In 2009, Duke increased reimbursement for tuition assistance to $5,250 per year.

38.  38 Questions?