State of Maine POS Benefit Changes

1. State of Maine POS Benefit Changes Effective July 1, 2012

2. Objectives for today…. Outline the benefit changes for the POS plan Introduce new partners & programs Answer your questions

3. Background – State Employee Health Commission 24-member labor/management group serves as plan trustees Plan participants – forest ranger, highway supervisor, corrections officer, retirees, classroom instructors Committed to value-based benefits – incentives to choose high-quality, safe, more effective care

4. Why the changes to the plan? Self-insured plan defined Plan expenses are paid by our employer The State of Maine Ancillary employer groups (e.g. Maine Turnpike, Maine Community College System, etc.) Flat funding Fiscal Year 2011 plan expenses = $222.6 million; benchmark for flat funding Premiums must remain the same FY2012 (current): 6% increase or $13.4 million FY2013 (July 1, 2012): 10% projected increase or $22 million

5. What is driving the increase? The FY13 10% increase is a direct result of: Provider price inflation Hospital in-patient services up 14.4% Hospital out-patient services up 7.8% Increased utilization Up 3.5%

6. Good News/Bad News Good News No premium increase Co-pay amounts will remain the same Bad News – plan expenses will have to be reduced in order to achieve flat funding

7. How Do We Get There? Plan Design Committee A series of 9 options were considered Reviewed over a period of 6 weeks Two objectives were required by SEHC: Continue to provide savings consistent with value-based benefits Limit members’ out-of-pocket expense as much as possible

8. Key Terms Revisited Copayment – The set dollar amount you are required to pay for certain services (office visits, emergency room, etc.) Deductible – The amount you have to pay before your health benefits kick in Coinsurance – After the deductible, the percentage you are required to pay for services (example: 5% of hospital care) Out-of-pocket limit – The calendar year maximum amount of deductible and coinsurance that you may pay in a calendar year. Copayments are not included.

9. Summary of Plan Design Changes: Comparison 8/1/11 to 7/1/12

10. Achieving Flat Funding Estimated Benefit Savings Hospital $18.4M Prescription Drugs (MaineMeds) $3.6M Total $22M

11. Co-pay Amounts Co-pay amounts will remain the same Primary Care office visit $0 or $20 Specialist office visit $25 Prescription Drug Copays 30-day supply - $10/$30/$45/$50 90-day supply - $15/$45/$70/$75 Generic/Name-brand formulary/Non-formulary/Lifestyle Emergency Room $100 & Walk-In Clinic $25 Advanced Imaging $50

12. Preferred Hospital Methodology Scoring Values Explained

13. Preferred Hospitals What’s changing How score is determined (a minimum score of 70 is still required) List updated once per year Based on most recent data available April 1st Effective date of new list will be July 1st We will send you the new list as soon as it is available.

14. New Weighting 7/2012 8/2011 Effective care (quality) = 30% 40% Safe (patient safety) = 30% 30% Patient satisfaction = 10% 10% Comparative cost = 30% 20% Results for effective care, safety & satisfaction can still be found at www.getbettermaine.org

16. Scoring Values For Effective care, Safe care, and Patient Satisfaction Points Low (below national average) = 1 Good (reflects average) = 2 Better (better than national average) = 3 Best (top 10% of nation’s hospitals) = 4

17. Comparative Cost:Small Maine Hospitals

18. Comparative Cost: Large Maine Hospitals

19. Scoring Values – Comparative Costs 8% or greater above the state average = 0 Between 4% and 7.9% above the state average = 1 point Between state average and 3.9% above state average = 2 points Below state average to 4.9% below state average = 3 points 5% or greater below state average = 4 points

20. Challenges Ahead SEHC continues to be engaged in several pilot projects with health systems and hospitals to improve care, enhance patient experience and reduce costs This is where the changes in delivery of care and the payment system have to be transformed SEHC members are participating in the evenings on their own time to advance better quality and more efficient care

21. Health Credit Premium Program For active State of Maine employees If you completed the Health Risk Assessment (HRA) last year you will continue to pay the same premium you do today; you will continue to receive the 5% discount. If you did not complete the HRA last year you will not have to continue paying the extra 5% towards your premium effective with your first check in July. Notices will be sent out by the end of July regarding the program requirements for this year. Statutory Reference: MRS Title 5, 285, 7-A

22. StayWell Health Management New in 2012 Their mission To help people achieve optimal health through solutions that set the standard for quality, effectiveness and value. Program Offerings: Health Risk Assessment Health Coaching Programs Disease Management Programs StayWell Online On-site Health Screenings 15 locations in the State of Maine 22

23. StayWell Health Management Programs Health Risk Assessment A 15-20 minute questionnaire covering topics such as nutrition, stress and physical activity Provides a snapshot of your current health and offers suggestions to inspire your future health goals Health Coaching and Disease Management Connect one on one with a health coach who provides encouragement, tips and ideas to help you reach your overall health goals Programs offered via phone, through the mail or online StayWell Online Access to your Health Risk Assessment Provide interactive tools to set goals, monitor your program progress and access to the latest health information 23 Strategy: Comprehensive wellness is our singular focus. Solid, consistent ownership. 31 years working with large employers in the US market. Simply put, our mission is to improve health and avoid progression into costly disease states which will positively impact your health care cost trend and improve overall productivity. StayWell Health Management is a division of The StayWell Company, which is a wholly owned subsidiary of MediMedia USA, a financially strong parent company. Our division of MediMedia, The StayWell Company, is comprised of other focused business units including, StayWell Custom Communications, Krames Health and Safety Education, (85% of hospitals), Consumer Health Publishing Group-Harvard Health Newsletters, American Red Cross Publishing, and several smaller groups, which were brought together through strategic “best-in-class” acquisitions. The combined strengths of our sister companies’ health content resources and StayWell Health Management’s leadership in providing integrated health management programs, allows us to deliver virtually an endless array of products and services to meet client needs. Our Organization December 31, 2009 - StayWell acquired LifeMasters Supported Care assets, adding disease management to our portfolio of population health management solutions StayWell brings over 30 years of experience delivering comprehensive wellness programs LifeMasters brings over 15 years of specialized experience with clinical depth in core conditions Both are recognized for scientifically-tested programs Our Clients Long-term partnerships, representing employers, union groups, health plans and government entities of all sizes and industries with very diverse needs Our People & Locations We employ a highly experienced, multidisciplinary team of credentialed health and business professionals, many recognized as industry though leaders Call centers in Albuquerque, Indianapolis, St. Paul Strategy: Comprehensive wellness is our singular focus. Solid, consistent ownership. 31 years working with large employers in the US market. Simply put, our mission is to improve health and avoid progression into costly disease states which will positively impact your health care cost trend and improve overall productivity. StayWell Health Management is a division of The StayWell Company, which is a wholly owned subsidiary of MediMedia USA, a financially strong parent company. Our division of MediMedia, The StayWell Company, is comprised of other focused business units including, StayWell Custom Communications, Krames Health and Safety Education, (85% of hospitals), Consumer Health Publishing Group-Harvard Health Newsletters, American Red Cross Publishing, and several smaller groups, which were brought together through strategic “best-in-class” acquisitions. The combined strengths of our sister companies’ health content resources and StayWell Health Management’s leadership in providing integrated health management programs, allows us to deliver virtually an endless array of products and services to meet client needs. Our Organization December 31, 2009 - StayWell acquired LifeMasters Supported Care assets, adding disease management to our portfolio of population health management solutions StayWell brings over 30 years of experience delivering comprehensive wellness programs LifeMasters brings over 15 years of specialized experience with clinical depth in core conditions Both are recognized for scientifically-tested programs Our Clients Long-term partnerships, representing employers, union groups, health plans and government entities of all sizes and industries with very diverse needs Our People & Locations We employ a highly experienced, multidisciplinary team of credentialed health and business professionals, many recognized as industry though leaders Call centers in Albuquerque, Indianapolis, St. Paul

24. Expert Medical Opinion Program Program Highlights Access to the world’s medical experts* Free 100% Confidential Open to any and all conditions and treatments Advance Medical 1-888-218-0992 www.advance-medical.com/maine (*EMO physicians are not a substitute for your current provider)

25. Anthem Vision - “Blue View Vision” Effective 7/1/12 Plan enhancements at no additional cost Retinal eye imaging Standard lenses with factory scratch coating Discounts on Transitions, premium progressive lenses and anti-reflective coatings You will receive a new ID card Open enrollment – May/June 2013

26. MaineMeds: A new voluntary prescription drug program Program Overview 90-day prescriptions Brand name medications Review list of eligible medications Safety Enrollment

27. MaineMeds (continued) Program Advantages Cost = FREE to you! Convenience of home delivery No shipping & handling costs

28. MaineMeds (continued) How to Enroll Complete enrollment form Ask your doctor for a new prescription for each medication 3-month supply with 3 refills Fax or mail form and prescription(s) to MaineMeds CanaRx Customer Service: 1-866-893-6337 www.mainemeds.com

29. Member Services Toll Free Number Nurseline Toll Free Number Welcome Guide ExpressLane Navigator DocFind

30. Member Services Toll Free Number 1-855-850-0039 Call between 8 & 6 Local time for questions on benefits, claims, or anything else you need assistance with…we are here to help! Nurseline Toll Free Number (Goes Live July 1st) 1-800-556-1555 Call anytime to talk to a Nurse

31. A Reference guide listing Online tools Programs Handy list of contact numbers A diagram of your ID Card Cards will begin to be delivered June 11th Keep this document for reference

32. Customized Web Site for State of Maine Members Access to Resources in one place Aetna Navigator DocFind Benefit Summaries Frequently Asked Questions…and more!

33. Manage your health & your benefits on this secure site any time Access Aetna Navigator thru ExpressLane Use Navigator to: View your claims Order a replacement ID card or print a temporary card Use the “Ask Ann” feature to get what you need fast!

34. Find out if your Doctor is in the Network Find out information about your Doctor… Certification Status Other Information (language spoken, handicap access) You can get to DocFind from the ExpressLane at www.AetnaStateofMaine.com

35. Questions? Aetna Member Services 1-855-850-0039 www.AetnaStateofMaine.com Employee Health & Benefits (207)287-6780 or 1-800-422-4503 www.maine.gov/beh