1. Cleveland Metropolitan School District
HealthSpan Special Enrollment
Cleveland Metropolitan School District
Tuesday, November 27, 2018

2. Agenda HealthSpan Update CMSD Plan Options
Special Enrollment Opportunity
Questions

3. HealthSpan Update
HealthSpan was created through acquisition of Kaiser-Permanente in 2013
Continued to operate initially through owned and operated facilities
Change in model of delivery
Cleveland Clinic to University Hospitals – 2013
Addition of select non-HealthSpan providers to network: MetroHealth, Summa, Mercy, University Hospital – 2014 & 2015
Expansion of retail pharmacy network – 2015
Cleveland Heights & Parma urgent care transferred to MetroHealth – 2015
Announced disbanding of HealthSpan Physicians effective 4/1/2016 – 2015
HealthSpan Physician providers are not scheduling services past March

4. What will occur by April 1st
MetroHealth will begin to operate the Cleveland Heights and Parma Medical Centers
Laboratory and Radiology services will continue to be provided at these locations
HealthSpan pharmacies will continue to operate until March 25, 2016 for both retail and mail order
Further information regarding prescriptions is expected
HealthSpan Physicians providers may affiliate with other network affiliates including MetroHealth, Mercy, Summa and University Hospital
MetroHealth has announced it has contracted with over 40 HealthSpan primary care providers
MetroHealth has announced it will continue to operate the Bedford, Cleveland Heights, Parma and Rocky River facitlities
Further information from HealthSpan is expected over the next two weeks

5. CMSD Plan Options CMSD offers three health plan options for members
HealthSpan (
Aetna (
Provides access to all major hospital systems throughout Northeast Ohio
Provides national network coverage
Medical Mutual of Ohio (MMO) (
Provides access to all major hospital systems throughout Northeast Ohio, except:
University Hospital main campus & Bedford

6. CMSD Health Plan Comparison
Deductible – Amount of member out-of-pocket responsibility for services including co-insurance
HealthSpan
Network Only
Aetna
Network / Non-Network
Medical Mutual (MMO)
Single $0
$0 / $250
Family
$0 / $500
This summary represents a general overview of select plan elements. Please refer to the CMSD 2016 Benefits Enrollment Guide for further detail.

7. CMSD Health Plan Comparison
Co-Insurance – Percentage of member out-of-pocket responsibility for select services including hospital, surgery, diagnostic services etc capped at the co- insurance maximum
(Maximum Excludes Deductible)
HealthSpan
Network Only
Aetna
Network / Non-Network
Medical Mutual (MMO)
Member Co-Insurance
100%
100% / 70%
100% / 80%
Single Co-Insurance Maximum $0
$0 / $2,250
$0 / $2,000
Family Co-Insurance Maximum
$0 / $4,500
$0 / $4,000
This summary represents a general overview of select plan elements. Please refer to the CMSD 2016 Benefits Enrollment Guide for further detail.

8. CMSD Health Plan Comparison
Co-Payment – Member out-of-pocket responsibility for select services.
HealthSpan
Network Only
Aetna
Network / Non-Network
Medical Mutual (MMO)
Primary Care Office Visit
$10
$15 / 70%
$15 / 80%
Specialist Office Visit
$25
$25 / 70%
$25 / 80%
Urgent Care Services
$35 / 70%
$35 / 80%
Emergency Services
$50
$75
This summary represents a general overview of select plan elements. Please refer to the CMSD 2016 Benefits Enrollment Guide for further detail.

9. CMSD Health Plan Comparison
Prescription Co-Payment – Member out-of-pocket responsibility for prescription drugs.
HealthSpan
Network Only
Aetna
Network / Non-Network
Medical Mutual (MMO)
Retail:
Generic
Formulary
Non-Formulary $5
$10
$15
Mail Order (90 day):
$20
$30
This summary represents a general overview of select plan elements. Please refer to the CMSD 2016 Benefits Enrollment Guide for further detail.

10. CMSD Prescription Drug Programs
Aetna & MMO utilize the Express Scripts pharmacy network, and include the following plan requirements:
Mandatory Generic: Members are required to pay the appropriate drug co- payment plus the difference between the brand and generic cost if a brand drug is selected when a generic equivalent is available.
Mandatory Mail Order: Members are required to fill all maintenance medications through the mail order pharmacy after the third fill (initial and two refills).
Prior Authorization & Step Therapy: Certain high cost drugs may be subject to prior authorization and / or step therapy requiring that generic and lower cost alternative brand therapies are attempted prior to most costly alternatives.
This summary represents a general overview of select plan elements. Please refer to the CMSD 2016 Benefits Enrollment Guide for further detail.

11. Member Payroll Contributions
Please refer to the 2016 CMSD Benefits Enrollment Guide for your applicable payroll contribution for each plan option

12. Special Enrollment Opportunity
The IRS permits mid-year changes for certain significant changes in coverage, consistent with the changes in coverage
Currently enrolled HealthSpan members may make a change to their medical carrier election only
Non-HealthSpan members are not permitted to make a change
No changes may be made to any other benefit elections including dental or flexible spending elections
This change does not allow for addition or deletion of any dependents (unless there is a specific qualifying event)
If you have a Qualifying Event which overlaps please follow the CMSD notification process for Qualifying Events
This Special Enrollment period is February 15, 2016 through February 29, 2016
Any carrier changes will be effective April 1, 2016

13. Special Enrollment Opportunity
This will be the only opportunity to make a change during the year unless you experience a Qualifying Event
Marriage, Divorce, Birth of a Child etc
Consult your current HealthSpan provider to determine his or her plans to continue as a HealthSpan participating provider

14. Thank you!
Questions?