MASC Regional Meeting Overview Employee Insurance Program 803-734-0498

1. MASC Regional Meeting Overview Employee Insurance Program 803-734-0498 (Products, Legal, and Policy)

2. Disclaimer BENEFITS ADMINISTRATORS AND OTHERS CHOSEN BY YOUR EMPLOYER WHO MAY ASSIST WITH INSURANCE ENROLLMENT, CHANGES, RETIREMENT OR TERMINATION AND RELATED ACTIVITIES ARE NOT AGENTS OF THE EMPLOYEE INSURANCE PROGRAM AND ARE NOT AUTHORIZED TO BIND THE EMPLOYEE INSURANCE PROGRAM.THIS PRESENTATION CONTAINS AN ABBREVIATED DESCRIPTION OF INSURANCE BENEFITS PROVIDED BY OR THROUGH THE EMPLOYEE INSURANCE PROGRAM. THE PLAN OF BENEFITS DOCUMENTS AND BENEFITS CONTRACTS CONTAIN COMPLETE DESCRIPTIONS OF THE HEALTH AND DENTAL PLANS AND ALL OTHER INSURANCE BENEFITS. THEIR TERMS AND CONDITIONS GOVERN ALL BENEFITS OFFERED BY OR THROUGH THE EMPLOYEE INSURANCE PROGRAM. IF YOU WOULD LIKE TO REVIEW THESE DOCUMENTS, CONTACT YOUR BENEFITS ADMINISTRATOR OR THE EMPLOYEE INSURANCE PROGRAM.THE LANGUAGE USED IN THIS PRESENTATION DOES NOT CREATE AN EMPLOYMENT CONTRACT BETWEEN THE EMPLOYEE AND THE AGENCY. THIS PRESENTATION DOES NOT CREATE ANY CONTRACTUAL RIGHTS OR ENTITLEMENTS. THE AGENCY RESERVES THE RIGHT TO REVISE THE CONTENT OF THIS PRESENTATION, IN WHOLE OR IN PART. NO PROMISES OR ASSURANCES, WHETHER WRITTEN OR ORAL, WHICH ARE CONTRARY TO OR INCONSISTENT WITH THE TERMS OF THIS PARAGRAPH CREATE ANY CONTRACT OF EMPLOYMENT.

3. MASC Review of Informational Materials

4. Review of Informational Materials Insurance Benefits Guide Local Subdivision Handbook List of participating counties and municipalities Plan comparison matrices Cafeteria plan matrix

5. MASC Orientation Local Subdivision Handbook and Application

6. Local Subdivision Handbook and Application Eligibility Established by statute Section 1-11-720 of the 1976 S.C. Code of Laws, as amended

7. Local Subdivision Handbook and Application Participation Requirements Minimum of four years participation 90 days notice of intent to withdraw Minimum of four years before returning Must offer all EIP benefits to all eligible employees

8. Local Subdivision Handbook and Application Participation Requirements Designate a Benefits Administrator Verify eligibility of employees Make good-faith effort to notify eligible retirees, terminated employees, and surviving dependents of deceased employees/retirees

9. Local Subdivision Handbook and Application Funding Requirements Make same contribution as the state for employees and their dependents $3 administrative fee per employee Initial experience ratings <100 covered lives: 1.2% 100-500 covered lives : 2.2% >500 covered lives: 4.3%

10. Local Subdivision Handbook and Application Submission Deadline and Fees Submission of application to EIP by February 15 $500 non-refundable application fee

11. MASC Orientation Support Resources

12. MASC Orientation Support Resources On-site orientation and training Continuing training programs Employee Benefits Services (EBS) online inquiry/enrollment system Multi-media education materials Other web-based resources

13. MASC Orientation Frequently Asked Questions and Important Considerations

14. Frequently Asked Questions and Important Considerations Are HMO enrollees required to elect and disclose their PCP at time of enrollment? No How is the plan year determined? EIP’s plan year is always based upon the calendar year Does the State have an employee assistance program? No Does it cost extra for employers or employees to use the services of EIP’s Prevention Partners unit? There is no additional cost to the employer for Prevention Partners programs; however some workshops and programs may be offered at minimal fee to the employees and their dependents.

15. Frequently Asked Questions and Important Considerations What control does the employer have over which plans are offered? A participating employer must offer all EIP programs to employees and also must allow employees to elect any levels of coverage. Does the state administer its own COBRA? Employers are responsible for the day-to-day administration of COBRA continuation coverage. EIP offers many resources to support this function. Are elected members of participating county and city councils eligible to participate?Those elected members who contribute to the South Carolina Retirement Systems are considered full-time employees and are eligible

16. MASC Orientation Overview of EIP Plans of Benefits

17. Overview EIP Benefit Programs • Health Plans • Dental Plans • Vision Plan • Life Insurance • Long Term Disability • Long Term Care • MoneyPlu$ (Pre-tax programs)

18. Overview Eligibility

19. Eligibility Active Employee • Must be employed in permanent, full-time position • Work at least 30 hours per week unless • Employed as a part-time teacher (only eligible for health, dental, vision and MoneyPlu$) • Employed by employer who allows coverage for 20-hour employees

20. Eligibility Retired Employee • Must meet certain requirements to continue coverage in retirement • EIP will accept Benefits Administrator certification of eligibility

21. Eligibility Eligible Spouse • Spouse or former spouse* if coverage is court-ordered • Cannot cover spouse who is eligible for benefits through EIP as active employee or funded retiree * Documentation required to cover a former spouse

22. Eligibility Eligible Children • Under age 26* • No access to insurance through employer of child or child’s spouse • Approved for incapacitation* * To be eligible for Dependent Life-Child, a child age 19-24 must be a full-time student or certified incapacitated

23. Overview Enrollment Periods

24. Enrollment October Enrollment Periods • Annual Enrollment (Every year) • Change health plans • Enroll in or drop State Vision Plan • Enroll or re-enroll in MoneyPlu$ programs • Open Enrollment (Odd-numbered years, i.e., 2011, 2013) • Enroll in or drop health, dental or Dental Plus • Add or drop eligible dependents

25. Overview Health Plans

26. Overview Health Plan Options • State Health Plan • Standard Plan • Savings Plan • HMO • BlueChoice HealthPlan HMO • CIGNA HMO

27. State Health Plan State Health Plan (SHP) Administered by BlueCross BlueShield of South Carolina

28. State Health Plan Standard Plan and Savings Plan Common to Both • Worldwide coverage • In- and out-of-network benefits • Pharmacy network • Online access available www.SouthCarolinaBlues.com

29. State Health Plan Standard Plan and Savings Plan Limited Preventive Benefits* • Routine mammogram • Pap test • Well child care • Routine colonoscopy * Refer to the 2011 Insurance Benefits Guide for plan guidelines

30. Preauthorization Medi-Call Required for specific services, including maternity care If pre-authorization is not obtained, penalties apply $200 per inpatient admission Related charges do not satisfy any portion of the annual coinsurance maximum State Health Plan Standard Plan and Savings Plan

31. State Health Plan Standard Plan SHP Standard Plan

32. Annual Deductible • $350 individual • $700 family • In-network Coinsurance • Plan pays 80% • Subscriber pays 20% • Coinsurance Maximum • $2,000 individual • $4,000 family • Out-of-network Coinsurance • Plan pays 60% • Subscriber pays 40% • Coinsurance Maximum • $4,000 individual • $8,000 family Standard Plan Deductibles and Coinsurance

33. Standard Plan • Per-occurrence Deductibles • $10 Office visit • $75 Outpatient facility service • $125 Emergency room visit

34. Network Retail Pharmacy* (up to 31-day supply) $ 9 Tier 1 $ 30 Tier 2 $ 50 Tier 3 Medco Mail Order* (up to 90-day supply) $ 22 Tier 1 $ 75 Tier 2 $125 Tier 3 Retail Maintenance Network Standard Plan Prescription Drug Benefits *”Pay the Difference” applies $2,500 maximum copayment per person

35. State Health Plan Savings Plan SHP Savings Plan

36. Savings Plan • Annual Deductible • $3,000 individual • $6,000 family • In-network Coinsurance • Plan pays 80% • Subscriber pays 20% • Coinsurance Maximum • $2,000 individual • $4,000 family • Out-of-network Coinsurance • Plan pays 60% • Subscriber pays 40% • Coinsurance Maximum • $4,000 individual • $8,000 family Deductibles and Coinsurance

37. Savings Plan Rules • Subscriber pays 100% of • Allowable charges in-network • Actual charges out-of-network • Allowable charges at network pharmacies • After deductible is met, Plan will reimburse subscriber 80% of allowable charges

38. Savings Plan Added benefits • Annual flu shot • Annual physical that includes specific services • Eligibility to contribute to Health Savings Account (HSA)

39. HMOs Health Maintenance Organizations (HMOs)

40. HMOs Requirements • Must live or work in HMO service area • Must choose Primary Care Physician (PCP) in network and receive referrals before seeing specialist • Only out-of-network benefit is emergency care

41. BlueChoice HealthPlan (Available in all South Carolina counties) BlueChoice HealthPlan HMO Available in all South Carolina Counties

42. BlueChoice HealthPlan(Available in all South Carolina counties) • Annual Deductible • $250 individual • $500 family • Network Coinsurance • Plan pays 85% • Subscriber pays 15% Deductibles and Coinsurance • Coinsurance Maximum • $2,000 individual • $4,000 family Annual Benefits Maximum $2,000,000

43. BlueChoice HealthPlan(Available in all South Carolina counties) Copays Provider: • $15 PCP • $15 OB-GYN • $40 specialist • $35 urgent care Plan pays 100% after copay Facility: • $100 outpatient • $125 ER • $200 inpatient • Plan pays 85% • after copay

44. Network Retail Pharmacy (up to 31-day supply) $ 8 Lower-cost generic $ 15 Higher-cost generic $ 35 Preferred brand $ 55 Non-preferred brand $ 80 Preferred brand specialty pharmaceuticals $125 Specialty pharmaceuticals Mail Order (up to 90-day supply) $ 20.00 Lower-cost generic $ 37.50 Higher-cost generic $ 87.50 Preferred brand $137.50 Non-preferred brand BlueChoice HealthPlan (Available in all South Carolina counties)

45. CIGNA HMO CIGNA HMO Available in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda

46. CIGNA HMOAvailable in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda • Annual Deductible None • In-network Coinsurance • Plan pays 80% • Subscriber pays 20% Deductibles and Coinsurance • Coinsurance Maximum • $2,000 individual • $4,000 family

47. CIGNA HMOAvailable in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda Copays Hospital • $250 outpatient • $500 inpatient • Plan pays 80% • after copay Provider • $15 PCP • $15 OB-GYN • $30 specialist • $100 ER Plan pays 100% after copay

48. Mail-Order (up to 90-day supply) $ 14 generic $ 50 preferred brand $100 non-preferred brand Network Retail Pharmacy (up to 30-day supply) $ 7 generic $25 preferred brand $50 non-preferred brand CIGNA HMOAvailable in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda

49. Tobacco Surcharge Tobacco Surcharge • $40 per month for subscribers • $60 per month for subscribers who cover at least one dependent • Automatically charged unless certify no one uses tobacco • May certify by completing paper Certification Regarding Tobacco Use form

50. Overview State Dental Plan Administered by BlueCross BlueShield of South Carolina