Agenda

1. It’s Your Choice Health Insurance Open Enrollment Period October 3-28, 2011Coverage Effective: January 1, 2012

2. Agenda • Important Health Plan, Program and Contract Changes                                 • Optional Plans • Navigation Tips – Where to find information? • Question & Answer

3. 2012 Important Changes • True Open Enrollment Period! Employees who are not currently insured and do not have a qualifying event to join can enroll during It’s Your Choice for coverage effective January 1st of the following calendar year. • Employees not insured but want to join immediately prior to retirement in order to escrow sick leave (preserve post-retirement credits) may enroll prior to retirement. Need to be insured at least 1 month prior to ‘escrow’.

4. Important Changes - 2012 • Dependent eligibility ends at the end of the month he/she turns 26 for most. http://etf.wi.gov/publications/dc_content/dc_2012/dependent_eligibility.htm • COBRA/Continuation will now follow federal and state law. For continuation coverage that begins on or after 1-1-12, most employees will have coverage for 18 months, not 36. Exceptions described in IYC • Health insurance coverage for an employee will end at the end of the month in which he/she terminates employment.

5. 2012 State Employee Premium Contribution • State of Wisconsin Employees • Tier Single Family • Tier – 1 $81.00 $201.00 • Tier – 2 $118.00 $297.00 • Tier – 3 $219.00 $548.00 • UW Graduate Assistants/Short-Term Academic Staff • Tier Single Family • Tier – 1 $40.50 $100.50 • Tier – 2 $59.00 $148.50 • Tier – 3 $109.50 $274.00

6. Important Changes – 2012 • New for Uniform Benefits: • Dental implant max of $1,000 per tooth, following injury • Palliative care consult, 1 time in-home upon terminal diagnosis • Board and ETF initiative to facilitate improvements in end-of-life care

7. 2012 Important Benefit Information for State Employees and non-Medicare Annuitants • Coinsurance (usually 90%/10%) • Versus Copays, NOT a Deductible • Applies to all services, except for federally required preventive care services • Out-of-pocket maximum (OOPM) $500 individual, $1,000 family • Emergency Room (ER) Copay change to $75 from $60. After copay, coinsurance applies

8. 2012 Important Benefit Information for State Employees and non-Medicare Annuitants • Illness/injury related & non-federally required services 90%/10% to the annual out-of-pocket of maximum (OOPM) not to exceed $500 per individual / $1,000 per family • Preventive services as required by federal law 100% • Emergency Room Copay (Waived if admitted as an inpatient directly from the emergency room or for observation for 24 hours or longer.) $75 does not accumulate to OOPM, 90% coinsurance thereafter to OOPM. • Medical Supplies, Durable Medical Equipment and Durable Diabetic Equipment and Related Supplies 80%/20% to the annual OOPM not to exceed $500 per individual / $1,000 per family

9. 2012 Important Benefit Information for State Employees and non-Medicare Annuitants • Federally required preventive care: • http://www.healthcare.gov/law/about/provisions/services/lists.html • http://www.healthcare.gov/law/provisions/preventive/ • http://www.healthcare.gov/center/regulations/prevention/taskforce.html

10. 2012 Uniform Benefits Health Plan Network Changes Refer to the map in the IYC: Decision Guide Page 29 • GHC Eau Claire • Will no longer offer providers in Barron, Chippewa, Dunn, Eau Claire, Pepin, Polk or Rusk counties. • GHC-EC INSURED EMPLOYEES WISHING TO CONTINUE TO RECEIVE SERVICES IN THESE COUNTIES MUST SUBMIT AN APPLICATION TO CHANGE TO AN ALTERNATE HEALTH PLAN - Electronic Submission not available link to paper application on HR website

11. 2012 Uniform Benefits New Health Plan - WEA TRUST NW • WEA Trust PPP Northwest in WI and a number of counties in MN • WI counties: Ashland, Barron, Burnett, Chippewa, Douglas, Dunn, Eau Claire, Jackson, Pierce, Polk, Rusk, St. Croix, Sawyer, Trempealeau & Washburn counties

12. WEA Trust PPP Northwest con’t • Page 66 Decision Guide • Provider Directory: • PPP – Care outside Service Area • Dental Benefits

13. Qualified – Non Qualified Plan • Qualified Plan: A qualified plan meets minimum requirements for provider availability in a given county: five primary care providers, a hospital (if one exists in the county), a chiropractor, and a dental provider (if the plan offers dental coverage). • Non-Qualified Plan: A non-qualified plan has limited provider availability in a given county: the plan is missing one or more of the minimum required providers, but is still an available option in the county. See the definition for Qualified Plan.

14. Standard Plan ‘Changes’ • Preferred, In-Network Provider: • $200 single/$400 family deductible, (was $100 single/$200 family) • 90%/10% coinsurance thereafter to an out-of-pocket maximum (OOPM) of $800 single/$1,600 family per year. • Non-Preferred, Out-of-Network Provider: • Deductible remains at $500 single/$1,000 family. • Coinsurance changing to 70%/30% to the existing OOPM of $2,000 single/$4,000 family. • A $75 ER copay applies both in- and out-of-network. Services thereafter apply to the in-network deductible and coinsurance. • See Comparison of Benefits in Decision Guide Pages 31, 34 and 35.

15. Options by County • Map on Page 29, Decision Guide • Based on where you choose to RECEIVE your services • Determine Plans Available and look at Individual Information in the Decision Guide (listed Alphabetically) for specific information and links to provider directory, dental coverage, etc • Minnesota Providers not shown on Map, look plans available in boarding WI counties and research provider directory

16. ERA Considerations • ERA (Employee Reimbursement Account) through FBMC • Increased out-of-pocket medical expenses make it more valuable than ever to participate in the ERA Program. It allows employees to contribute tax-free money to pay for his/her family’s health plan out-of-pocket for coinsurance, prescription drug copays and other qualifying expenses such as dental, orthodontics and vision care. • Employees can contribute up to $7,500 annually to a medical expense account. Medical expenses incurred through 3/15/13 can be reimbursed with any remaining 2012 dollars. Review the 2012 ERA enrollment booklet at etf.wi.gov.

17. Mail Order Pharmacy Change • Effective 1/1/2012 Mail Order prescriptions will be filled by the WellDyneRx mail order pharmacy • Members still only pay 2 copays for prescriptions (Level 1 & 2) filled using mail order. • Members currently enrolled in Prescription Solutions will be contacted directly on how to change over to WellDyneRx. • WellDyneRx: (888) 479-2000 welldynerx.com

18. Navigation of Information Including Optional Plans • Refer to HR website http://www.uwstout.edu/hr • Navigation – tips