1. Embracing a Healthy Lifestyle through the State Health Plan New Plan Options and Incentives for 2014

2. Why Are We Making Changes for 2014? 2 More choice for members. The Treasurer conducted a listening tour and the Plan conducted focus groups and surveys. The message was clear, members want more options. Encourage members to become more engaged in their health and take steps to live a healthier life. An engaged membership will help ensure that the State Health Plan remains financially stable in the years ahead.

3. Open Enrollment 2014 3 Open Enrollment will be conducted October 1 – 31, 2013. You must complete enrollment—otherwise, you and your covered family members will be enrolled in the Traditional 70/30 Plan effective January 1, 2014.

4. Health Plan Options for 2014 4 Enhanced 80/20 Plan NEW: Consumer-Directed Health Plan (CDHP) with HRA Traditional 70/30 Plan The current Standard 80/20 Plan with a new name to match the new features $0 ACA Preventive Services $0 ACA Preventive Medications New Wellness Incentives Reduced medical copay opportunities A new health plan option A high-deductible medical plan A Health Reimbursement Account (HRA) to help offset the deductible 85/15 Coinsurance $0 ACA Preventive Services/Medications CDHP Preventive Medication List ($0 deductible) New wellness incentives Additional HRA funds for visiting certain providers The current Basic 70/30 Plan with a new name No incentives available No $0 ACA (Affordable Care Act) Preventive Services/ Medications

5. A New Focus On Wellness 5 Enhanced 80/20 Plan NEW: Consumer-Directed Health Plan (CDHP) with HRA Traditional 70/30 Plan Wellness premium credits when: Subscriber completes a Health Assessment Subscriber attests for him/herself and spouse (if applicable) to not smoking Selecting a Primary Care Provider (PCP) for self and all dependents Additional wellness incentives Wellness premium credits when: Subscriber completes a Health Assessment Subscriber attests for him/herself and spouse (if applicable) to not smoking Selecting a Primary Care Provider (PCP) for self and dependents Additional wellness incentives No incentives available No $0 ACA Preventive Services No $0 ACA Preventive Medications

6. The Traditional 70/30 Plan Traditional 70/30 Plan – There are no changes to the Plan’s benefits for 2014 Copays and Deductibles – There will be no opportunities for copay reductions on the Traditional 70/30 Plan. Network Services – Members may visit any provider, but they will pay less when they go to a BCBSNC network provider Preventive Services – Copays still apply to preventive services. 6

7. Traditional 70/30 Plan Benefit Highlights 7 CoverageIn-NetworkOut-of-Network Annual Deductible$933 individual/$2,799 family$1,866 individual/$5,598 family Coinsurance (after deductible is met) 30% of eligible expenses 50% of eligible expenses plus 100% of amount above the allowed amount Coinsurance Maximum (excludes deductible) $3,793 individual/$11,379 family $7,586 individual/$22,758 family Office Visits $35 copay for primary doctor $81 copay for specialists 50% after deductible Preventive Care $35 copay for primary doctor $81 copay for specialists Only certain services are covered Inpatient Hospital $291 copay, then 30% after deductible $291 copay, then 50% after deductible Prescription Drugs (for 30-day supply) Tier 1 $12 copay Tier 2 $40 copay Tier 3 $64 copay Specialty medications 25% up to $100 maximum per 30-day supply Tier 1 $12 copay Tier 2 $40 copay Tier 3 $64 copay Specialty medications 25% up to $100 maximum per 30-day supply

8. Monthly Premiums—Traditional 70/30Plan 8 2014 Traditional Plan Premiums Coverage TypeEmployee/ Retiree Monthly Premium Dependent Monthly Premium Total Monthly Premium Employee Only$0N/A$0 Employee + Child(ren) $0$205.12 Employee + Spouse $0$528.52 Employeee + Family $0$562.94 Reminder: Wellness premium credits are not offered under the Traditional Plan.

9. The Enhanced 80/20 Plan New incentives to encourage members to manage their health and lower their health care costs Preventive Care – No copays on Affordable Care Act (ACA ) preventive services or preventive medications. Primary Care Provider (PCP) – $15 PCP copay reduction. If PCP is not available at the time of the appointment, the member may visit any provider in the same practice and still receive the copay reduction If a member wants to change PCPs, they can go to their enrollment portal and select a new PCP. The PCP change must be made before visiting the new PCP. Specialists – $10 Specialist copay reduction, choose a Blue Options Designated provider Hospitals – $233 Inpatient Hospital copay avoidance (Blue Options) 9

10. Enhanced 80/20 Plan Highlights in 2014 10 CoverageIn-NetworkOut-of-Network Annual Deductible$700 individual/$2,100 family$1,400 individual/$4,200 family Coinsurance (after deductible is met) 20% of eligible expenses 40% of eligible expenses plus 100% of amount above the Plan’s allowed amount Coinsurance Maximum (excludes deductible) $3,210 individual/$9,630 family$6,420 individual/$19,260 family Office Visits $30 copay for primary doctor; $15 copay if the PCP on the ID card is utilized $70 copay for specialists; $60 copay if a Blue Options Designated specialist is utilized 40% after deductible Inpatient Hospital $233 copay, then 20% after deductible; copay avoided if a Blue Options Designated hospital is utilized $233 copay, then 40% after deductible Prescription Drugs (for 30-day supply) Tier 1 $12 copay Tier 2 $40 copay Tier 3 $64 copay Specialty medications 25% up to $100 maximum per 30-day supply $0 for ACA Preventive Medications Tier 1 $12 copay Tier 2 $40 copay Tier 3 $64 copay Specialty medications 25% up to $100 maximum per 30-day supply $0 for ACA Preventive Medications

11. Lower Your Health Care Costs with Wellness Incentives— The Enhanced 80/20 Plan 11 Things you can do to reduce your costs… Enhanced Plan Incentives Visit the PCP listed on ID cardCopay is reduced by $15 Visit a Blue Options Designated specialistCopay is reduced by $10 Get inpatient care in a Blue Options Designated hospital $233 copay is avoided Remember: Get preventive services through an in- network provider in a non-hospital setting 100% coverage – this is provided at no cost to you ACA preventive medication list 100% coverage – this is provided at no cost to you

12. Who can be a Primary Care Provider? A Primary Care Provider can practice: General / Family Medicine Internal Medicine Pediatrics, or Obstetrics and Gynecology A Primary Care Provider can be: Licensed Nurse Practitioners Physician’s Assistants 12 Specialty Providers cannot be selected as a PCP.

13. Wellness Premium Credits 13 Wellness ActivityHow to Complete ItWhen Members Can Take It Subscriber selects a Primary Care Provider (PCP) A PCP must also be selected for each dependent covered on the State Health Plan. Log into the eEnroll system to select a PCP. If members have trouble contact 888-234-2416. If you change your mind, you can select a different provider any time. (It takes 5 calendar days to update in the system) Subscriber completes a confidential Health Assessment (HA ) Through the SHP website (www.shpnc.org), click on NC HealthSmart and log into Personal Health Portal.www.shpnc.org If you completed a Health Assessment since Nov. 1, 2012, through the Personal Health Portal, it will count toward the premium credit. Subscriber attests to being a non- smoker/commits to a cessation program and attests for spouse if applicable During enrollment, Oct. 1-31, 2013.

14. Lower Your Premiums with Wellness Premium Credits— The Enhanced 80/20 Plan 14 Complete up to Three Wellness Activities By October 31, 2013 Enhanced Plan Premium Credits Subscriber attests to being a non- smoker/commits to a cessation program and attests for spouse if applicable $20 per month Subscriber (only) completes a confidential Health Assessment (HA) $15 per month Subscriber and covered dependents select a Primary Care Provider $15 per month Reduce your premium by up to…$50 per month

15. Monthly Premiums—Enhanced 80/20 Plan 15 2014 Enhanced Plan Premiums Coverage Type Employee/ Monthly Premium Dependent Monthly Premium Total Monthly Premium Wellness Premium Credits* Net Monthly Premium* Employee Only $63.56N/A$63.56$50.00*$13.56* Employee + Child(ren) $63.56$272.80$336.36$50.00*$286.36* Employee + Spouse $63.56$628.54$692.10$50.00*$642.10* Employee + Family $63.56$666.38$729.94$50.00*$679.94* *Assumes completion of three wellness activities

16. The Consumer-Directed Health Plan (CDHP) with HRA A different kind of health plan with two components 16 Health Reimbursement Account (HRA) High-Deductible Health Plan The Plan funds the members’ Health Reimbursement Accounts (HRA) annually $500 for employee only $1,000 for employee + 1 $1,500 for employee + 2 or more dependents When HRA is depleted, the member must pay the remaining deductible & coinsurance Unused HRA funds roll to the following year 2 Covers the same services as other Plan options through the same PPO network In-network: Deductible $1,500 Individual/ $4,500 Family Out-of-Network: Deductible $3,000 Individual/ $9,000 Family After the deductible is met, 15% coinsurance The deductible applies to both Pharmacy and Medical expenses 1

17. CDHP Highlights in 2014 17 CoverageIn-NetworkOut-of-Network Plan-Provided HRA Contribution $500 employee/retiree $1,000 employee/retiree + 1 dependent $1,500 employee/retiree + 2 or more dependents Annual Deductible$1,500 individual/$4,500 family$3,000 individual/$9,000 family Coinsurance (after deductible is met) 15% of eligible expenses35% of eligible expenses Out-of-Pocket Maximum for medical and pharmacy (includes deductible) $3,000 individual/$9,000 family $6,000 individual/$18,000 family Office Visits (after deductible is met) 15% of eligible expenses; $15 added to HRA if the PCP on the ID card is utilized; $10 added to HRA if a Blue Options Designated specialist is utilized 35% of eligible expenses Inpatient Hospital (after deductible is met) 15% of eligible expenses; $50 added to HRA if a Blue Options Designated hospital is utilized 35% of eligible expenses ACA Preventive Medication List $0 coinsurance, $0 deductible CDHP Preventive Medication List 15% coinsurance, $0 deductible

18. Lower Member Health Care Costs with Wellness Incentives —CDHP 18 Things you can do to reduce your costs… CDHP Incentives Visit the PCP listed on ID card$15 added to the HRA Visit a Blue Options Designated specialist $10 added to the HRA Get inpatient care in a Blue Options Designated hospital $50 added to the HRA Remember: Get preventive care through an in- network provider in a non-hospital setting 100% coverage – this is provided at no cost to the member ACA preventive medication list 100% coverage –no cost to the member CDHP preventive medication list 15% of eligible expense with no deductible

19. Example: CDHP Office Visit and Prescription Present HRA ID Card at Office Visit. Total office visit $175 submitted to BCBSNC by provider. 19 Claim processes in primary claims system and applies towards $1,500 deductible – EOB/EOP issued. Claim automatically rolls over to HRA for adjudication - $175 remitted to provider- Member picks up prescription at pharmacy and pays $65 because deductible has not been met. Pharmacy claim automatically submitted to HR A. Member reimbursed $65. At end of the month, $15 credited to member’s HRA for visiting PCP on ID Card.

20. Lower Premiums with Wellness Premium Credits —CDHP 20 Complete up to Three Wellness Activities By October 31, 2013 CDHP Premium Credits Subscriber attests to being a non- smoker/commits to a cessation program and attests for spouse if applicable $20 per month Subscriber (only) completes a confidential Health Assessment (HA) $10 per month Subscriber selects a Primary Care Provider (and any covered dependents) $10 per month Reduce subscriber premium by …$40 per month

21. Monthly Premiums—CDHP 21 2014 CDHP Premiums Coverage Type Employee Monthly Premium Dependent Monthly Premium Total Monthly Premium Wellness Premium Credits* Net Monthly Premium* Employee Only $40.00N/A$40.00$40.00*$0* Employee + Child(ren) $40.00$184.60$224.60$40.00*$184.60* Employee + Spouse $40.00$475.68$515.68$40.00*$475.68* Employee + Family $40.00$506.64$546.64$40.00*$506.64* *Assumes completion of three wellness activities

22. Completing Open Enrollment Action must be taken during Open Enrollment: Choose a health plan Decide whom to cover Complete wellness activities Remember, NC Flex Benefits enrollment in Oct. also. Online enrollment only – https://shp-login.hrtintouch.com Effective January 1, 2014 through December 31, 2014 22 If you do not complete your enrollment by October 31, 2013, you, and any currently covered family members will be enrolled in the Traditional 70/30 Plan effective Jan. 1, 2014.

23. Enrollment Instructions eEnroll All changes need to be done through the eEnroll system by logging in to the system at https://shp-login.hrintouch.comhttps://shp-login.hrintouch.com For assistance in navigating eEnroll members can call Benefitfocus Customer Service at 855-859-0966. 23

24. NC FLEX – Vision Changes 24 Plan 1Basic PlanExam and Materials NEW FOR 2014 Reduced premiums $20.00 co-pay on contact lens exam. Increased frame allowance to $125 retail New calendar year frequency. Plan 2Materials onlyNo longer available Plan 3Enhanced PlanEnhanced Exam and materials NEW FOR 2014 Reduced premiums $20.00 co-pay on contact lens exam. Increased frame allowance to $175 retail New calendar year frequency.

25. NC FLEX – NEW Vision Benefit Core Wellness Exam Annual Comprehensive Eye Exam $20 copay In-network providers only Discounts on materials No premium – but MUST enroll 25

26. NC FLEX – NEW Group Term Life Option Employee and Spouse Coverage Rates based on age of employee Employee and Child(ren) Coverage Flat rate for child(ren) coverage If elected, premiums for Employee and Dependent(s) will be after-tax. 26

27. NC Flex - Flexible Spending Accounts MUST re-enroll each year. Employee-only contribution to reimburse yourself for eligible expenses Does not roll over Not to be confused with HRA (Health Reimbursement Account) 27

28. Please READ your mail! There will be 4 mailers sent to you to assist you in your decision. SHP Website There will be 4 instructional videos posted to the Plan’s website. Premium Rate Calculator tool available online 28 Resources for Members

29. Important Numbers 29 www.shp-login.hrintouch.com ELIGIBILITY AND ENROLLMENT for eEnroll 855-859-0966 BLUE CROSS AND BLUE SHIELD OF NC (BENEFITS, CLAIMS and HRA) 888-234-2416

30. www.shpnc.org www.nctreasurer.com 30 Thank you!