1. August 4, 2009 ORANGE COUNTY 2010 MEDICAL PLAN CHANGES

2. PRESENTATION OUTLINE BACKGROUND TOBACCO USE SURCHARGE MEDICAL PLAN CO-PAY CHANGES PHARMACY PLAN CHANGES SPOUSAL WELLNESS FOR LIFE SCREENINGS ACTION REQUESTED

3. PRESENTATION OUTLINE BACKGROUND TOBACCO USE SURCHARGE MEDICAL PLAN CO-PAY CHANGES PHARMACY PLAN CHANGES SPOUSAL WELLNESS FOR LIFE SCREENINGS ACTION REQUESTED

4. BACKGROUND 2007 –County moved to self- funded medical 2009 –Approved new contract with UHC as ASO provider –Contracted with Express Scripts as PBM

5. BACKGROUND Move to Self-funded working well Provides the County: -More detailed claims experience information -Increased flexibility in plan design

6. BACKGROUND Plan Trend (Experience) Remains a Challenge Plan Costs Increase 8–10% Each Year Continued Increases Are Not Sustainable

7. BACKGROUND County Able to Absorb Costs in 2010 with No Premium Increase Plan Changes Needed To: –Help Offset Cost Increases in Specific Areas –Influence Member Lifestyle Choices and Plan Utilization

8. PRESENTATION OUTLINE BACKGROUND TOBACCO USE SURCHARGE MEDICAL PLAN CO-PAY CHANGES PHARMACY PLAN CHANGES SPOUSAL WELLNESS FOR LIFE SCREENINGS ACTION REQUESTED

9. TOBACCO USE SURCHARGE Tobacco Use Is a Leading Cause of Death and Key Driver of Medical Costs 2008 WFL Screenings Tied to Medical Claims Results Show Medical Claims Higher for Smokers -$5,412 – Current or Previous Smokers -$3,567 – Never Smoked

10. TOBACCO USE SURCHARGE Medical Plan Oversight Committee (MPOC) Recommends Implementing $25 Per Pay Period Tobacco Use Surcharge in 2010.

11. PRESENTATION OUTLINE BACKGROUND TOBACCO USE SURCHARGE MEDICAL PLAN CO-PAY CHANGES PHARMACY PLAN CHANGES SPOUSAL WELLNESS FOR LIFE SCREENINGS ACTION REQUESTED

12. MEDICAL PLAN C0-PAY CHANGES MPOC Met with UHC, HR Benefits & RobinsonBush Reviewed 2008 & 1 st Quarter 2009 Plan Experience Identified Key Cost Drivers and Solution Opportunities

13. MEDICAL PLAN C0-PAY CHANGES Outpatient Surgery –Hospital Outpatient Surgery Costs Increased 17.7% –Average Cost $3,700 - Versus $723 for Surgery Performed in Ambulatory Surgery Center –Average Cost of Colonoscopy $1,853 – Versus $513

14. MEDICAL PLAN C0-PAY CHANGES Inpatient Hospital –Inpatient Admissions Decreased by 5% –Average Cost per Admission increased 11% - From $10,708 in 2007 to $11,867 in 2008 Need to Better Align Inpatient & Outpatient Co-Pays

15. MEDICAL PLAN C0-PAY CHANGES MPOC Recommends: Increasing Co-Pay for Non- Preventive Outpatient Surgery and Preventive Colonoscopy Performed in a Hospital to $200 Moving Inpatient Hospital Co-Pay to $300 for 1 st Day and $100 for Next Three Days to Maximum $600 Per Admission

16. PRESENTATION OUTLINE BACKGROUND TOBACCO USE SURCHARGE MEDICAL PLAN CO-PAY CHANGES PHARMACY PLAN CHANGES SPOUSAL WELLNESS FOR LIFE SCREENINGS ACTION REQUESTED

17. PHARMACY PLAN CHANGES Outsourced Pharmacy to Express Scripts in 2009 Few Changes Made in First Year New Programs Recommended to Control Rx Costs

18. PHARMACY PLAN CHANGES Select Home Delivery & Call 4 Generics –Voluntary Programs –Projected Savings - $402,000 to County & $251,000 to members Step Therapy Program –Grandfather Provision –Projected County Savings - $539,000

19. PHARMACY PLAN CHANGES MPOC Recommends: Adding Select Home Delivery, Call 4 Generics and Step Therapy Programs to Pharmacy Plan

20. PRESENTATION OUTLINE BACKGROUND TOBACCO USE SURCHARGE MEDICAL PLAN CO-PAY CHANGES PHARMACY PLAN CHANGES SPOUSAL WELLNESS FOR LIFE SCREENINGS ACTION REQUESTED

21. SPOUSAL WELLNESS FOR LIFE SCREENINGS 2008 Spousal Claims Averaged 27.5% Higher Than Employee Claims Spouses Not Included in Health & Wellness Programs WFL Screenings Offered to Employees Only Need to Engage & Encourage All Plan Members to Make Wise Healthcare Decisions

22. SPOUSAL WELLNESS FOR LIFE SCREENINGS MPOC Recommends: Extending Voluntary Annual Wellness for Life Screenings & HRAs to Spouses Covered Under the County’s Medical Plan

23. PRESENTATION OUTLINE BACKGROUND TOBACCO USE SURCHARGE MEDICAL PLAN CO-PAY CHANGES PHARMACY PLAN CHANGES SPOUSAL WELLNESS FOR LIFE SCREENINGS ACTION REQUESTED

24. Approve the Following MPOC Recommended Changes to the County’s 2010 Medical & Pharmacy Plans: $25 Per Pay Period Tobacco Use Surcharge $200 Co-Pay for Non-Preventive Outpatient Surgery and Preventive Colonoscopy Performed in Hospital Surgery Center

25. ACTION REQUESTED Inpatient Hospital Co-Pay of $300 for 1 st Day and $100 for Next Three Days to Maximum $600 Per Admission Adding Select Home Delivery, Call 4 Generics and A Step Therapy Program to Pharmacy Plan Extending Voluntary Annual Wellness for Life Screenings & HRAs to Spouses Covered Under the County’s Medical Plan

26. August 4, 2009 ORANGE COUNTY 2010 MEDICAL PLAN CHANGES