Groton Dunstable RSD Open Enrollment - July 2019

1. Groton Dunstable RSDOpen Enrollment - July 2019 March 2019

2. Thank you Groton Dunstable RSD!Harvard Pilgrim Health Care -A Partner for Massachusetts Public Sector Clients • The carrier of choice for more than 150 cities and towns in Massachusetts. • More than 25 Regional School Districts in Massachusetts offer Harvard Pilgrim plans to their employees and retirees. • Dedicated Municipal Sales Staff with longtime account management experience working with public sector clients.

3. Harvard Pilgrim Health Care –A local partner with national access More than 70,000 doctors and other clinicians and 182 hospitals across Harvard Pilgrim’s network Access to the largest national network in the USA with 775,000 providers and more than 5,500 hospitals provided by UnitedHealthcare

4. Today’s Agenda • Open Enrollment • Health Plan Options For July 1, 2019 • Additional Plan Information • Transition From Plans Offered Through The GIC • Tools And Technology • Recap • Questions?

5. Open Enrollment - 2019

6. Open Enrollment: March 18 – May 3, 2019 All benefit-eligible employees mustcomplete an enrollment form to have coverage starting July 1, 2019 Enrollment Forms Due to HR No Later Than May 3rd What if you don’t complete an enrollment form? You will not have coverage through GDRSD effective July 1, 2019 Your next opportunity to join one of the District’s health plan options will be July 1, 2020, unless you have a “qualifying event”. Examples of a qualifying events are: Birth or Adoption Death Marriage or Divorce Loss of Job or Reduction of Hours

7. Open Enrollment Communications • Early June You’ll receive a termination letter from your current health plan carrier stating your current coverage through the GIC will end as of midnight on 6/30/19. Please note:this is a procedural letter sent when a group leaves its current health plan. • Mid-to-Late June You’ll receive a new Harvard Pilgrim ID card with a new ID number and an effective date of 7/1/19. Continue to use your current (GIC) card through 6/30/19. • July 1st and Forward Use your newGDRSD Harvard Pilgrim ID card and inform your providers and pharmacy of the change to avoid any confusion relative to the billing and payment of your post-July 1 claims.

8. Health Plan Options for July 2019

9. Health Plan Options Effective July 1, 2019

10. ChoiceNet Tiered Copay HMO:Benefits at-a-Glance

11. ChoiceNet Tiered Copay PPO:Benefits at-a Glance

12. Best Buy HMO HSA: Benefits at-a-Glance

13. Employee Monthly Contribution Rates

14. ChoiceNet Tiered Copay Plans – How the Tiers Work Members pay different levels of cost sharing depending on the tier of the provider delivering the medical service. How much you spend on your health care depends on where you go for medical care. When you receive care from a Tier 1 provider, you pay less. Tier 1Tier 2Tier 3 • PCP Office Visit Copayment $ $$ $$$ • Specialist Office Visit Copayment $ $$ $$$ • Hospital Admission $ $$ $$$ • Deductible $ $$ $$$ FACT: More than 75% of Harvard Pilgrim PCPs, specialists and hospitals are in either Tier 1 or Tier 2.

15. ChoiceNet Tiered Copay Plans Additional Information • Your Tier 3 deductible is the most that you will pay for an annual deductible. • Services that apply to one tier apply to the other tiers’ deductible. • Subject to a Tier 1 cost sharing: • Chiropractors • Optometrists • Physical, Occupational, and Speech Therapists • Behavioral Health Services • Independent or Free standing X-ray facilities • Care at Skilled Nursing Facilities and Outpatient Rehab • If admitted to the Hospital from an ER Visit • Services that do not require a referral for an HMO Plan • Routine Gynecological Care • Chiropractic Care • Routine Eye Exams

16. Plan and Network Differences for July 1, 2019 vs. Current GIC-Harvard Pilgrim Offerings Harvard Best Buy ChoiceNet – HMO (July 1, 2019 Offering) PCP required, referrals to specialists requiredFull Harvard pilgrim network GIC Primary Choice Plan – HMO PCP required, referrals to specialists requiredLimited network ----------------------------------------------------------------------------------------------------------------- HPHC Best Buy ChoiceNet – PPO (July 1, 2019 Offering) PCPnotrequiredReferrals to specialists notrequired; access to full Harvard Pilgrim network and ability to see providers out-of-network GIC Independence Plan – POS (Point of Service Plan)PCP requiredReferrals to Specialists (in-network); access to full Harvard Pilgrim network and ability to see providers out-of-network

17. Hospital Tiers: GIC-Harvard Pilgrim Primary Choice vs. Harvard Pilgrim ChoiceNet Plans GIC Standalone Hospital Primary ChoiceChoiceNet Baystate Franklin Medical Center --- 3 Berkshire Medical Center 2 3 Brigham and Women’s Hospital --- 3 Cape Cod Hospital --- 3 Children’s Hospital 2 3 Cooley Dickinson Hospital --- 3 Fairview Hospital --- 3 Falmouth Hospital --- 3 Massachusetts General Hospital --- 3 Newton-Wellesley Hospital --- 2 Northshore Medical Center --- 2 Shriner’s Hospital --- 2 St. Elizabeth’s Medical Center 2 3 UMASS Memorial Medical Center --- 3 --- Non-Participating (not part of the network), PC = Primary Choice, CN = ChoiceNet

18. Additional Plan Information

19. Worldwide Coverage for Emergencies • Emergency care is covered worldwide • Deductible and copay would apply • No referrals necessary • Call your PCP if hospitalized • You may be asked to pay at the time of service if the provider is not part of our network • You can file a claim for reimbursement upon return to our service area 19

20. Urgent care / Minute Clinics • Need care when your primary doctor isn’t available? Consider the benefits of a Harvard Pilgrim-participating urgent care clinic • Reasons you may visit an urgent care clinic: • Infections • Coughs, cold and flu • Minor injuries • Sprains and strains • Burns rashes, bites, cuts, and bruises • Respiratory infections • If you think you’re having a medical emergency, call 911 or go to the emergency room. 20

21. Doctor on Demand • Well‐known telemedicine provider group of board‐certified physicians • Improve member experience through increased convenience • Services accessed via smartphone and tablet using free app or by computer – virtual visit • Pediatric and adult services are available • No referral or authorization required • Cost share (lowest PCP visit tier) paid at time of visit • Designed to address low acuity, urgent medical visits • Examples include sore throat, cough, conjunctivitis, rash, etc. • Prescriptions electronically sent to a member’s pharmacy • Visit summary can be sent to PCP upon member’s request

22. Transition to Harvard Pilgrim from GIC Plan Offerings

23. TotalAssist Groton Dunstable RSD employees/dependents: A dedicated phone number for your specific needs/questions – available through June 30 “How does a deductible and coinsurance work? (866) 874-0817 “Is my doctor in the plan?” “I have surgery scheduled on 7/8!” “What about my son’s physical therapy appt?” 23

24. Clinical Transition • In the midst of medical treatment for a particular condition and concerned about the continuity of your care? • Call our Clinical Transition Program at (888) 888-4742, ext. 31209, then press # • Leave your name, employer name and telephone number (including area code) • You’ll receive a call back from one of our nurses within 24 hours or the next business day 24

25. Behavioral Health • Do I need a referral from a PCP to visit a behavioral health clinician? • No referral, however authorization is required. • Call United Behavioral Health (UBH) at (888) 777-4742 for authorization before your first appointment. • I am joining Harvard Pilgrim from another health plan and I’m in the middle of treatment with a behavioral health clinician. What should I do? • If your clinician accepts Harvard Pilgrim coverage • You can continue treatment after calling UBH • If your clinician does not accept Harvard Pilgrim coverage • Call the UBH to ask for transitional benefits for one time exception within 30 days of the effective date of your coverage with Harvard Pilgrim. Otherwise you may not be eligible for transitional benefits. • If you receive approval for transitional benefits, you will be covered for medically necessary services at the in-network level of coverage for 90 days. During that time, you and your clinician can either conclude treatment or arrange for a coordinated transition to a practitioner who accepts Harvard Pilgrim coverage. 25

26. Prior Authorization – Medical Treatment Currently receiving medical treatment that required prior authorization from your current carrier? • Current Harvard Pilgrim members through GIC: There is nothing you need to do. Existing approvals will carry over to your new plan. • If you are not currently a Harvard Pilgrim member: Your doctor must obtain authorization on your behalf. • Be sure to notify your doctor of your plan change and provide your new ID number. If you have questions, please contact the TotalAssist line at (866) 874-0817

27. Prior Authorization - Prescriptions If prior authorization or step therapy is required for any of your current prescriptions: • You must get approval, even if you are a current Harvard Pilgrim member. • You mustnotify your doctor of the change in plan and provide your new ID number. If you have questions, please contact the TotalAssist line at (866) 874-0817

28. Tools and technology for a simpler member experience

29. A Simple Way to Estimate Health Care Costs Online medical cost transparency tool empowers members to: Plan ahead for out-of-pocket costs Be more engaged in their health plan Make informed decisions

30. Finding Your Provider Go to www.harvardpilgrim.org Click on Find a provider in upper banner Click on Tiered/Limited Choicenet HMO or PPO 2019

31. Finding Your Provider (cont) • Enter ZIP code, address or doctor name to search for providers in your area • Filter by provider specialty if necessary • ChoiceNet provider tier copays are as follows: • PCP: T1: $10 T2: $20 T3: $40 • Specialists: T1: $30 T2: $60 T3: $75

32. How to Look up Your Prescription Drugs On www.harvardpilgrim.org scroll to the bottom and click on Look up a drug Select 2019 and Premium 3 Tier Look up drugs by tier or category or download entire directory alphabetically

33. Recap • Must complete an enrollment form and return to the Human Resource Office no later than May 3, 2019 • You will receive a termination letter from your current medical carrier mid-June as coverage through the GIC is terminating June 30, 2019 • When receiving services on or after July 1, 2019 show your new ID card

34. Questions?