Office of Group Benefits Annual Enrollment 2012 Overview

Office of Group Benefits Annual Enrollment 2012 FOR ACTIVE EMPLOYEES & RETIREES WITHOUT MEDICARE 1

Welcome This presentation is a summary of information and does not purport to present complete details of all plan options offered by the Office of Group Benefits. For complete information on each plan option, individuals should read plan documents carefully and also consult other OGB and plan administrators publications.

Welcome This presentation will cover: Ways to Save Eligibility Overview of Health Plans Life Insurance Flexible Benefits

Office of Group Benefits OGB serves state agencies, universities and school boards Prescription Drug Benefits 21.9% Administrative Costs 3.5% Mental Health Benefits 1% Medical Benefits 71.4% Life Insurance 2.2% OGB s administrative costs are only 3.5% of total costs (June 30, 2011)

Annual Enrollment Timeline Annual Enrollment ends Deadline for employees to submit health plan enrollment forms to HR (if changing plans) Annual Enrollment begins January 1 October 3 November 4 Flexible Benefits Annual Enrollment ends Deadline for employees to submit Flexible Benefits forms to HR (may be earlier for some agencies) 2012 plan year begins

Ways to Save

Your Health: Our Premium Priority 7 Ways to Save Choose the right health plan for you Out-of-state coverage differs by plan Out-of-state dependent? Job transfer? Travel? Are your providers in the plan s network? All plans accessible through OGB website www.groupbenefits.org 1 2 Stay in your health plan s provider network Avoid balance billing 3 Request generic drugs Same active ingredients and big savings Preferred drug list at www.CatalystRx.com

Your Health: Our Priority 7 Ways to Save 4 Get preventive (wellness) exams Prevention Early diagnosis 5 Use Flexible Benefits (active employees) Pre-tax deduction saves money More take-home pay Sign up for Diabetic Sense program (PPO & HMO plans) Get test supplies free Free glucometer Provided by Catalyst Rx through Liberty 1-888-341-8582 6 Sign up for Living Well Louisiana program (PPO & HMO plans) Access to health coaches 24 hours a day, 7 days a week Prescription drug incentive for active LWL participants Lower co-pays 1-800-383-0115 7

Prescription Cost Comparison Average Cost per Prescription * Approved Generic Alternative Average Cost per Prescription * Brand-Name Drug Ambieninsomnia Imitrexmigraines Neurontinseizures Flomaxprostate hyperplasia Effexor XRdepression Valtrex anti-viral Ultram ER pain Wellbutrin XLdepression Lamictal seizures Prozac depression Topamax seizures Zocor cholesterol Pravachol cholesterol Paxil depression $ 173.36 342.63 231.48 143.47 198.93 268.43 260.89 258.79 404.79 320.23 422.89 147.35 147.95 140.85 zolpidem sumatriptan gabapentin tamsulosin venlafaxine XR valacyclovir tramadol ER bupriopion XL lamotrigine fluoxetine topiramate simvastatin pravastatin paroxetine $ 4.06 66.85 21.54 42.06 129.85 149.43 138.33 61.16 24.26 12.39 31.06 9.59 12. 20 13.68 * Average costs as of 8-31-11 utilization; subject to change. Source: Catalyst Rx

Living Well Louisiana Health Management Program For PPO and HMO Plans Free health management program for active employees, retired employees without Medicare and rehired retirees without Medicare who are diagnosed with 1 or more of these 5 ongoing health conditions: Diabetes Heart disease Heart failure Asthma Chronic obstructive pulmonary disease (COPD) Living Well Louisiana is not available to individuals who have Medicare as primary coverage

Living Well Louisiana Health Management Program For PPO and HMO Plans Once enrolled, you have access to... Health coaches 24 hours a day, 7 days a week Online health information and resources Reduced co-payments to eligible LWL participants for prescription drugs used to treat these 5 chronic conditions When Medicare Part A and/or B become primary, you are no longer eligible for LWL program

Living Well Louisiana Health Management Program For PPO and HMO Plans Active participation requires: Initial assessment by phone Follow-up contacts by phone, mail or email Ongoing relationship with LWL health coaches (contact at least once every 3 months) If plan member fails to maintain contact with health coaches, or if Medicare becomes plan member s primary health coverage, participant is no longer eligible to participate in LWL program or receive reduced co-pay on applicable prescription drugs

Premium Cost-Saving Strategies Married Couples If both are state or school employees... Both eligible? May save if split coverage

Eligibility

Eligibility Same for All Plans Full-Time Employees and Dependents Legal spouse Louisiana does not recognize same-sex marriages regardless of other states laws Children up to age 26 regardless of child s student, marital or tax status No one can be enrolled simultaneously as both an employee and a dependent in OGB health plans or life insurance No dependent can be covered by more than one employee Dependent verification required

Eligibility Children Natural child of you or your legal spouse Legally adopted child Child placed in home for adoption Child in home under legal guardianship or custody Grandchild dependent on you whose parent is your covered dependent

Dependent Verification Plan member must provide proof of the legal relationship of each dependent within 30 days of date of application for coverage Proof: Official documents Marriage certificate Birth certificate Other court records or legal documents

Eligibility Change Newborns Effective July 1, 2011, OGB must receive child s birth certificate within 6 months of birth Birth letter will suffice for first 6 months only if received within 30 days of DOB OGB will send reminder letter 90 days after birth date

Over-Age Dependents Covered child under age 26 who is or becomes incapable of self-sustaining employment is eligible to continue coverage as an overage dependent OGB must receive required medical records before dependent reaches age 26 Definition of incapacity broadened now includes both mental and physical incapacity

Pre-Existing Condition Limitation for New Hires and Late Applicants Must complete enrollment form (GB-01) within 30 days for new dependent otherwise, pre-existing condition limitation (PEC) applies If diagnosed or treated within 6 months prior to enrollment date, condition is pre-existing ... no benefits are payable for that condition in first 12 months of coverage PEC limitation does not apply to anyone under age 19 May be exempt from pre-existing condition limitation if continuously covered without 63-day break in coverage prior to enrollment date

Retirement Coverage must be in effect prior to retirement date Participation schedule applies to... Employees who joined an OGB health plan on or after January 1, 2002 Dependents who joined an OGB health plan on or after July 1, 2002 Prior OGB health plan coverage as a spouse qualifies in computing years of participation

Retiree Participation Schedule Years of OGB Health Plan Participation State Premium Subsidy % 19% Less than 10 years 38% 10 years or more, but less than 15 years 56% 15 years or more, but less than 20 years 75% 20 years or more Schedule not affected when you change OGB health plans

Medicare and OGB Coverage If you reached age 65 on or after July 1, 2005, AND are retired AND are eligible for Medicare Part A premium-free, then You MUST enroll in Medicare Part B to receive OGB health plan benefits for medical expenses covered by Medicare Part B You must submit Social Security verification to OGB: If eligible submit copy of Medicare card If not eligible submit letter from Social Security This also applies to your covered spouse If you are not yet retired, this will apply when you retire

Overview of Health Plans

OGB Health Plans for 2012 HMO (Nationwide) Regional HMO (Regions 6, 7, 8 & 9) PPO (Statewide) Administered by Blue Cross and Blue Shield of La. Fully insured by Vantage Health Plan Administered by OGB CDHP-HSA * (Nationwide) Medical Home HMO (Statewide must choose PCP in Region 9) Administered by UnitedHealthcare Fully insured by Vantage Health Plan * CDHP-HSA plan is not available to retirees; other plans are available to all employees and retirees

Key Points Can change health plans during Annual Enrollment Compare costs, benefits and restrictions when choosing a plan Active employees and retirees who choose to keep same plan do not have to fill out a form Active employees who want to change plans must notify your HR office

Key Points Retirees who want to change plans must Fill out an OGB enrollment form or Write a letter to OGB that includes: Your plan choice Your name and address Your date of birth Your daytime phone number Sign form or letter and mail it to ... OGB Eligibility Division P.O. Box 66678 Baton Rouge, LA 70896 ... or visit any OGB Agency Services office

Plan Member Out-of-Pocket Expenses In-Network PPO HMO Medical Home HMO CDHP-HSA Regional HMO Statewide *** PCP must be in Region 9 (northeast LA) Regions 6, 7, 8 & 9 *** (Baton Rouge, Alexandria, Shreveport & Monroe) Coverage Area All regions Nationwide Nationwide Administrator OGB Vantage Health Plan UnitedHealthcare Vantage Health Plan Blue Cross Lifetime Maximum Unlimited $500 active $300 retiree 3-person maximum $1,250 employee $2,500 employee + 1 $3,000 family None Deductible None None $1,000 per person $3,000 per family Out-of-Pocket Maximum $1,000 per person $3,000 per family $1,000 per person ** No maximum $2,000 per person $100 per day $300 maximum per admission Pre-certification required $100 per day $300 maximum per admission Pre-certification required 10% of $100 per day $300 maximum per admission Pre-certification required 20% of Hospital In-Network contracted rate* Pre-certification required contracted rate* Pre-certification required Co-pay $10 PCP $25 specialist Referral required for most specialists; PCP required Co-pay $15 PCP $25 specialist Referral required for most specialists; PCP required 20% of 10% of Co-pay $15 PCP $25 specialist No referral required contracted rate* (primary care & specialty care) contracted rate* No referral required Doctor Visits * Subject to plan year deductible and/or applicable co-insurance ** Active employees and retirees without Medicare *** Active employees and retirees without Medicare

Plan Member Out-of-Pocket Expenses In-Network PPO HMO Medical Home HMO CDHP-HSA Regional HMO Required for all specialists except OB/GYN; 1 routine eye exam every year Required for most specialists Referrals None required None required None required $90 co-pay (first visit only) No referral required Maternity Doctor Visits 10% of $90 co-pay (first visit only) $10 co-pay (first visit only) 20% of contracted rate * contracted rate * MRI or 10% of 20% of $50 co-pay $50 co-pay $50 co-pay contracted rate * contracted rate * CAT Scans *** 10% of 20% of Sonograms *** $25 co-pay $25 co-pay $25 co-pay contracted rate * contracted rate * Chemotherapy Radiation Therapy *** 10% of 20% of $15 co-pay $25 co-pay per treatment $25 co-pay contracted rate * contracted rate * Routine 0% of Member pays $0 $0 co-pay 100% covered $0 co-pay Mammograms ** contracted rate 0% of 100% covered Member pays $0 Routine PSAs ** $0 co-pay $0 co-pay contracted rate 10% of 20% co-insurance Pre-authorization required Up to 18 visits in 6-week period Cardiac contracted rate * Complete within 6 months 20% of $15/$25 co-pay $15/$25 co-pay contracted rate * Rehabilitation *** 20% of Emergency Care $150 deductible $100 co-pay $100 co-pay $100 co-pay contracted rate* * Subject to plan year deductible and/or co-insurance * * Age and time restrictions may apply *** Prior authorization may be required

Plan Member Out-of-Pocket Expenses Out-of-Network Providers PPO HMO Medical Home HMO CDHP-HSA** Regional HMO $1,000 deductible per person; $3,000 maximum per family 30% of reasonable and customary charge * Emergencies covered worldwide; all other services require prior plan approval 30% of Vantage allowable after separate $1,000 deductible * 30% of fee schedule * Louisiana resident 30% of fee schedule * Out-of-state resident 10% of fee schedule * Same as Louisiana resident * Same as Louisiana resident Same as Louisiana resident * Same as Louisiana resident * * Plan member owes deductible, co-pay, co-insurance and balance of billed charges ** No out-of-pocket maximum for non-network providers

Mental Health & Substance Abuse Treatment Benefit Medical Home HMO Vantage Health Plan Regional HMO Vantage Health Plan PPO HMO CDHP-HSA OptumHealth ValueOptions ValueOptions $100 co-payment per day; $300 maximum per admission Member pays 10% of contracted rate 1 $100 co-payment; $300 maximum per admission Member pays 20% of contracted rate 1 $100 co-payment; $300 maximum per admission Inpatient 2 Member pays 10% of contracted rate 1 100% after $25 co-payment per office visit 2 Member pays 20% of contracted rate 1 $25 office visit co-payment $25 office visit co-payment 2 Outpatient 1 Subject to plan year deductible and/or co-insurance 2Pre-authorization required

Prescription Drug Benefit PPO and HMO (Administered by Catalyst Rx) Prescription Drug Benefit In-Network Generic drug & brand-name drug with no generic available: Plan member pays 50% of cost Maximum $50 per 31-day fill After $1,200 per person per plan year, plan member pays co-pay of $15 for brand-name drug, $0 for generic drug Plan Member Out- of-Pocket Expense Brand-name drug with FDA-approved generic available: Plan member pays cost difference between brand-name drug and generic, plus 50% of brand-name drug cost Cost not applied to $1,200 out-of-pocket maximum Formulary Open * Mail Order Program Same as above *OGB s open formulary means EVERY FDA-approved prescription drug is covered by PPO and HMO health plans

Prescription Drug Benefit Regional HMO (Administered by VHP s Catalyst Rx) Prescription Drug Benefit In-Network Generic drug & brand-name drug with no generic available: Plan member pays 50% of cost Maximum $50 per 30-day fill After $1,200 per person per plan year, plan member pays co-pay of $15 for brand-name drug, $0 for generic drug Plan Member Out-of- Pocket Expense Brand-name drug with FDA-approved generic available: Plan member pays cost difference between brand-name drug and generic, plus 50% of brand-name drug cost Cost not applied to $1,200 out-of-pocket maximum Formulary Closed with exceptions * 30-day supply 1 co-pay 60-day supply 2 co-pays 90-day supply 3 co-pays Mail Order Program *Prescription drugs not on Vantage s formulary list may be available at higher out-of-pocket cost

Prescription Drug Benefit Medical Home HMO (Administered by VHP s Catalyst Rx) Prescription Drug Benefit In-Network Per 30-day fill Generic drugs $5 co-pay Preferred brand drugs $30 co-pay Non-preferred brand drugs $50 co-pay Specialty drugs 20% co-insurance Plan Member Out-of-Pocket Expense Formulary Closed with exceptions * 30-day supply 1 co-pay 60-day supply 2 co-pays 90-day supply 3 co-pays Mail Order Program *Vantage Health Plan s open formulary means prescription drugs not on the Vantage formulary list may be available at higher out-of-pocket expense

Prescription Drug Benefit CDHP-HSA (Administered by UHC s PrescriptionSolutions) Prescription Drug Benefit In-Network Per 31-day fill Generic drugs $10 co-pay Preferred brand drugs $25 co-pay Non-preferred brand drugs $50 co-pay Specialty drugs $50 co-pay Plan Member Out- of-Pocket Expense Prescription drugs subject to deductible except maintenance drugs Formulary Open Same as above for 90-day supply Mail Order Program Maintenance drugs not subject to deductible (See myuhc.com for list of maintenance drugs)

Life Insurance

Life Insurance Prudential Insurance Co. of America Group term life insurance policy State pays half of premium for employees and retirees Employee pays full premium for dependent life insurance 25% reduction in coverage and appropriate reduction in premiums on July 1 after plan member reaches age 65 and age 70

Life Insurance Basic Plan Option I $5,000 $1,000 $ 500 Option II $5,000 $2,000 $1,000 Employee Spouse Each Child Employee Premiums Schedule in Helpful Information Book Premiums for Dependent Life Employee Pays $0.88/mo $1.76/mo

Life Insurance Basic Plus Supplemental Plan Option I Same Option II Same Employee Schedule to maximum of $50,000 (amount based on employee s annual salary) Spouse $2,000 $4,000 Each Child $1,000 $2,000 Schedule in Helpful Information Book Employee Premiums Premiums for Dependent Life Employee Pays $1.76/mo $3.52/mo

Life Insurance Accidental Death and Dismemberment (AD&D) benefits available to all active and retired employees covered under Basic or Basic Plus plan Retirees over age 70 not eligible for AD&D ALL inquiries and changes in life insurance must be made through your agency s HR office

Sources of Information OGB website with links to all health plans .. www.groupbenefits.org www.groupbenefits.org OGB (PPO) ..1-800-272-8451 Blue Cross and Blue Shield of La. (HMO) .. 1-800-392-4089 Vantage Health Plan (Medical Home & Regional HMO) ..1-888-823-1910 UnitedHealthcare (CDHP-HSA) ..1-866-336-9374 Catalyst Rx ..1-866-358-9530 Living Well Louisiana Program ..1-800-383-0115 Diabetic Sense Program ..1-888-341-8582 ValueOptions ..1-866-492-7143 DataPath Administrative Services .1-877-685-0655

Flexible Benefits 2012 Plan Year January 1, 2012 December 31, 2012

Flexible Benefits Options Why Enroll? Easy to participate Increase spendable income Reduce taxes Flexible Benefits Plan

Flexible Benefits More Take-Home Pay Set aside eligible payroll deductions for health care premiums Premium Conversion Option Eligible premium deductions automatically continue in Premium Conversion from year to year unless you request to drop out during Annual Enrollment (no fee) Set aside money from paycheck for out-of-pocket medical expenses Health Savings Account MUST RE-ENROLL EACH YEAR during Annual Enrollment Must participate in OGB Consumer Driven Health Plan (CDHP) Set aside $600 - $5,000 (per plan year) from your paycheck for eligible out-of- pocket medical expenses (no fee) General-Purpose (Health Care) FSA MUST RE-ENROLL EACH YEAR during Annual Enrollment ($36/plan year) Limited-Purpose (Dental & Vision) FSA Set aside $600 - $5,000 (per plan year) from your paycheck for eligible out-of-pocket dental and vision expenses only MUST RE-ENROLL EACH YEAR during Annual Enrollment ($36/plan year) Dependent Care FSA Set aside money from your paycheck for dependent care expenses while you work ($36/plan year) MUST RE-ENROLL EACH YEAR during Annual Enrollment

Premium Conversion

More Take-Home Pay Example Premium Conversion Option Category Monthly Taxable Salary Pre-Tax Premium (Employee + spouse) * Taxable Income Federal Taxes (25%) After-Tax Premium Spendable Income * Employee + spouse is health plan premium for employee and spouse $105 monthly savings x 12 months = $1,260 yearly savings Participant Non-Participant $3,000 $3,000 - $420 - $0 $2,580 - $645 - $0 $1,935 $3,000 - $750 - $420 $1,830

Premium Conversion (Free Participation) Eligible Payroll Deductions OGB health plan premium OGB life insurance premium (Prudential) Employee portion only Some miscellaneous/statewide insurance premiums Cancer insurance deduction* Dental insurance deduction Hospital indemnity insurance deduction Intensive care insurance deduction Vision insurance deduction * Policy cannot have a cash value or a return-of-premium rider

Health Savings Account (HSA)

OGB Health Savings Account (HSA) You cannot participate in OGB HSA option if you have: General-Purpose (Health Care) FSA or your spouse has General-Purpose (Health Care) FSA Medical coverage under a non-CDHP TRICARE or TRICARE for Life coverage Used any VA benefits within previous 3 months Medicare Part A or Part B coverage You must participate in OGB Consumer Driven Health Plan (CDHP) to participate in Health Savings Account (HSA) option

Health Savings Account (HSA) You can use your HSA to pay these eligible expenses: Office visits (including deductibles and co-insurance) Chiropractic services Prescription drugs Over-the-counter medications with a prescription Dental expenses Eye glasses, contact lenses and solutions Eye surgery (including Lasik) Lab fees COBRA, Medicare and qualified long-term care premiums