State Employee Health plan

1. State Employee Health plan Non State Groups Open Enrollment for Plan Year 2013

2. Health Care Commission (HCC) • No employee & employer rate increases • No plan design changes for Plans A and B • Autism Spectrum Disorder Pilot • Benefit will be continued for 2013

3. Other Health Care Commission Action • Plan Design Changes for Plan C • Lower premium • Deductible • Single $2,500/ Family $5,000 • Single family member only has to meet the single deductible • In Network services for medical & pharmacy have NO member Coinsurance • Employer HSA Funding Increased • Maximum of $1,500 for single & $2,250 for family • Employer may pays HSA funding in a lump sum • All HSA accounts will be with US Bank

4. Changes Due to Health Reform • Preventive Care Coverage for Contraception • Medical coverage for implantable & injectable contraceptives • Medical coverage for sterilization • Pharmacy coverage for prescription birth control products • Must be on the Preferred Drug List • Does not include over the counter items • Preventive Care Coverage for Breastfeeding • Includes counseling and equipment rental

5. New Documents required by PPACA • Summary of Benefits & Coverage (SBC) • www.kdheks.gov/hcf/sehp/SBC.htm • Uniform Glossary of Health Coverage & Medical Terms* • www.kdheks.gov/hcf/sehp/download/UniformGlossaryofHealthCoverageMedicalTerms.pdf * Note: This is not specific to the SEHP Coverage

6. Selecting Your Health Plan • Pick a plan design (A, B or C) • Which plan design provides the coverage you and your family need? • What is the total plan cost? What is the member contribution • Premiums + Deductible & Coinsurance = ? • Review the Provider Networks • Each of the medical plans uses a different provider network

7. 2013 SEHP Medical Plans • All are Preferred Provider Organizations (PPO) • Plans A, B and C all use the same provider networks & same basic coverage • Claims paid based on the network status • Network Providers accept the plan allowance as payment in full • Non Network Providers can balance bill • All plans include preventive care

8. Covered Preventive Care

9. Deductible • A set amount of eligible expenses a covered person must pay out of their own pocket before the health plan will begin paying on their claims. • Network and Non Network Deductibles accumulate separately. • Deductible and “Not Covered” do not mean the same thing.

10. Deductible Example * Members on Plan C have a Health Savings Account that could be used to pay this deductible amount.

11. Coinsurance • A cost sharing formula for health care services • Coinsurance is expressed as a percentage of the allowed charge that will be paid by the member and the balance paid by the Plan • You must meet the deductible before coinsurance is applied

12. Coinsurance Example

14. Preferred Lab Card Benefit – Plans A & B Only • 100% Coverage of eligible outpatient lab tests • Two vendors • Quest Diagnostics • Stormont-Vail • Cannot be used for: • Hospital outpatient or inpatient lab services • Labs needed on a STAT basis

15. Quest Diagnostics • Statewide & nationwide preferred lab vendor • Testing must be performed and billed by Quest • Your Doctor can draw the sample and call for specimen pick up • For draw site locations visit: www.labcard.com - Online appointment scheduling available • Use Your Quest ID card or medical ID card

16. Stormont-Vail HealthCare • Stormont-Vail HealthCare is the regional • preferred lab vendor in NE Kansas • 100% coverage for eligible outpatient lab tests • All Plan A and B members may use the • Stormont-Vail draw site locations • Labs drawn at other Cotton-O’Neil locations • may be included if by network providers • Show your medical ID Card to access benefit

17. Caremark Prescription Drug Benefit – Plans A & B Generic Drugs • 20% Coinsurance Preferred Brand • 35% Coinsurance Non Preferred Brand • 60% Coinsurance Special Case Medications • 25% to a max of $75 per 30-day supply • Coinsurance Maximum Is $2,580 per person for Generic, Preferred Brand & Special Case medications. Up to a sixty (60) day supply of most drugs available www2.caremark.com/kse

18. Generic Launches 2013 Reclast 1st Qtr Zomig 2nd Qtr Zomig ZMT 2nd Qtr Advicor 2nd Qtr Niaspan 3rd Qtr Achiphex 4th Qtr Cymbalta 4th Qtr 2012 Actos 3rd Qtr Diovan 3rd Qtr Singulair 3rd Qtr Maxalt 4th Qtr Maxalt MLT 4th Qtr Tricor 4th Qtr Requip XL 4th Qtr www2.caremark.com/kse

19. Plan C • Network Coverage for Medical & Pharmacy • $2,500/$5,000 Deductible • No Coinsurance • $2,500/$5,000 Total Deductible & Coinsurance • Preventive Care Services paid at 100% • Non Network Coverage • $2,500/$5,000 Deductible • 20% Coinsurance • $4,000/$8,000 Total Deductible & Coinsurance • Preventive Care is not covered • Does not include dental or optional vision plan

20. Plan C- Caremark Drug Plan • Same Preferred Drug List as Plans A & B • Covered drugs are subject to the Network Plan C deductible • After the deductible, the plan pays covered prescription drugs at 100% • 100% coverage for contraceptives on the PDL • Discount Tier drugs are not covered drugs • Only eligible for Caremark’s negotiated discount • Plan C is a credible drug plan

21. Plan C - At a Glance

22. What is a Health Saving Account? • An employee-owned bank account for saving money to pay for current or future medical expenses for members enrolled in a qualified high deductible health plan • Unspent HSA funds roll over and accumulate year to year and can be invested • Portable - The account and the money belong to you

23. HSA Eligibility Requirements • The following members are not eligible for an HSA: • Enrolled in Medicare • Enrolled in TRICARE or TRICARE for Life • Enrolled with the Veteran’s Administration (VA) and/or have received VA medical services within a three-month period immediately preceding their enrollment in Plan C • Receiving benefits from Social Security • Covered as a dependent under another plan that isn’t a QHDHP • Can be claimed as a dependent on another individual’s tax return (i.e. Parents) • Spouse has Health Care Flexible Spending Account See page 12 of the OE Book

24. Employer Increases HSA Funding • Employer may pay HSA contribution as a lump sum • Payment date depends on HCFSA: • Account funded in January if no HCFSA in 2012 or if all money has been used by 12/31/12 • Account funded after March 15, 2013 if enrolled in HCFSA in 2012 and you have funds during the grace period

25. HSA Contributions • HSA Contributions are governed by the Internal Revenue Service (IRS). • Eligibility criteria for HSA Account is on Page 12 of the Open Enrollment Book • Minimum contribution of $25 semi-monthly by the employee is required • Contributions may be made with pre- or post-tax funds. • Members over age 55 can contribute additional funds to “catch up”

26. HSA Enrollment is Easy • All Plan C options will have the same HSA vendor: • US Bank • A file with the members who enroll in Plan C will be sent by SEHP to US Bank • Employees receive “welcome” notification via email • Letter if no email • Employee completes online enrollment process • Must accept the Terms and Conditions • Order additional cards for dependents • Select account beneficiaries • Online Tools to manage your account

27. Using Your HSA Funds • Use your HSA Bank Card at a Pharmacy • Fill a prescription • Swipe your HSA Bank Card for payment • Save a copy of receipt for your records • Use your HSA Bank Card for Medical Services • Health plan processes claim & sends you an Explanation of Benefits (EOB) • Pay the provider using your HSA Bank Card • Save a copy of the bill or EOB for your records

28. Additional Ways to Pay with Your HSA • You Pay the Provider through Bill Pay • You go online and use Bill Pay to issue payment to the provider of service • Reimburse yourself for expenses paid out of your pocket • With Bill Pay you can send a direct deposit reimbursement to your checking or savings account for health care services

29. Delta Dental - Dental Coverage • Plan pays in full for 2 exams & cleanings • $50 Plan Deductible max of 3 per family • Implant Coverage • 50% Coinsurance to a max of $1,250 per year • Benefit subject to annual benefit max • Annual benefit maximum • $1,700 per person per year • $1,000 Lifetime Orthodontic benefit

30. Delta Dental – Value Based Benefit

31. Superior Vision – Basic Vision Plan • $25 Materials Copay then: • 100% single vision, standard bifocal, trifocal lenticular lenses • Up to $100 frame allowance • Elective Contact lens allowance $150 • Office visit subject to $50 Copay • Contact Lens Fitting Fee subject to $35 Copay

32. Superior Vision – Enhanced Vision Plan Includes Basic benefits plus… • Frame allowance of up to $150 • Contact Lens Fitting Fee subject to $35 Copay • High index or Poly-carbonate lenses up to $116 • Progressive lenses up to $165 • Scratch and UV coating

33. HealthQuest (HQ) Rewards • Requirements for 2014 incentive discount • Complete the required online health questionnaire (10 Credits) • Earn 20 additional credits • HQ Rewards deadline is July 31, 2013 • Non Tobacco usage is worth 10 credits • Non Tobacco Use declaration is now online at: www.kansashealthquest.com • You may complete declaration at anytime before the deadline. • Tobacco cessation program is no longer required for tobacco users.

34. Open Enrollment • Enroll online: https://hrissuite.com • Make health plan selections • Add/drop dependents • Dependent documentation required by October 31. • Coverage effective January 1, 2013

35. Identification Cards • Coventry/PHS and UHC are issuing new ID cards for Plan C members • Delta Dental is issuing new ID cards for all • For all others, new cards will only be issued if the member makes a plan/coverage change

36. Resources • Review the Open Enrollment (OE) booklet • ?’s: Call the health plan customer service • Phone numbers in the front of the OE booklet • Visit www.kdheks.gov/hcf/sehp.htm • Benefit descriptions, Provider directories, & Preferred drug list available • Information on the HSA and FSA accounts • Summary of Benefits & Coverage (SBC) • Email ?’s to SEHP:benefits@kdheks.gov

37. Health Care Cost Tool • Hold for link to the health plan tool that will be on our web site soon www.kdheks.gov/hcf/sehp • US Bank Tool place holder • There is a Payroll Calculation tool available at http://www.kansas.gov/employee/

38. Questions?

39. Option Slides

40. Primary Care Providers (PCPs) • General practice • Family practice • Geriatrics • Internal medicine • Physician extenders • Pediatrics • Plans A & B only • PCPs have lower office visit copays • Member may have more than one PCP • No referrals required

41. Stormont-Vail Draw Sites

42. Network vs. Non Network

43. Plan A – Network Providers • Office Visit Copays • $25 for Primary Care Office Visits • $45 for Specialist Office Visits • $300/$600 Deductible • 20% Coinsurance • Coinsurance Max $1,400/$2,800 • Preventive Care Services paid at 100% • Lab Card Benefit

44. Plan B – Network Providers • Primary Care Office Visits • $20 Copay for Adults • $10 Copay for Children <age 19 • Specialist Office Visits • $40 Copay for Adults • $25Copay for Children <age 19 • $150/$300 Deductible • 35% Coinsurance • Coinsurance max $3,000/$6,000 • Preventive Care Services paid at 100% • Lab Card benefit

45. Plans A & B Non Network Providers • $500/$1,500 Deductible • 50% Coinsurance • Coinsurance Max $3,650/$7,300 • Non Network Providers can balance bill • Preventive care not covered

46. Dental Preventive Care • Covered in full: • Prophylaxis/cleanings – twice per year. • Oral examinations – twice per year. • Bitewing x-rays – • adults – 1 x a year • children under 18 - 2 x a year • Full mouth x-rays – once each five (5) years. • Limited coverage for children only: • Sealants • Space maintainers • Topical fluoride • Ancillary – emergency relief of pain.