Plan Cost Estimator User’s Module Guide for Human Resource Staff

1. Plan Cost EstimatorUser’s Module Guide for Human Resource Staff This guide is not intended for distribution to members using the PCE tool.

2. Plan Cost Estimator (PCE) Overview The Plan Cost Estimator assists users in choosing the best health plan offered through their employer for their individual or their family's personal situation. Using average costs based on a large claims database and the benefit design for each of their health plan options, the tool is able to generate cost estimates for each plan based on the user’s individual or family composition and health status. The information entered into this tool will be treated as Protected Health Information (PHI) under the provisions of the Health Insurance Portability and Accountability Act (HIPAA). If a client chooses to implement the “Claims History” option in the PCE, information pre-filled in the tool from claims data provided by their health plan is also PHI and will be treated accordingly. This tool does not save a user’s information. Any information shared with employers in utilization reports will be "de-identified" so employers will not be able to identify any of the inputs or responses by individual. The "de-identified information" may be shared with non-profit research organizations for conducting medical utilization studies. Ingenix, Inc. has designed this tool with the user’s privacy in mind so they cannot be identified.

3. Step One : Coverage Information Users will need the following information for themselves and each family member to use this tool: • Gender and age • Current conditions (such as asthma and diabetes) • Current prescriptions each family member is taking, the strength of each prescription (such as 10 mg), and the number of annual refills based on a 30-day supply • Planned medical procedures during the next year • Durable medical equipment expected to need next year (such as a wheelchair or crutches) • If applicable, the Schedule or Summary of Benefits for the spouse/domestic partner's health plan option(s) offered by their employer • User’s tax filing status • User’s estimated annual income for the upcoming year

4. Step One : Coverage Information We estimate that it will take the average user approximately 15-30 minutes to get out-of-pocket cost comparisons for the health plan options offered by their employer. Other optional features (e.g., FSA or HSA calculator) which may be available in the tool will take additional time. The PCE tool includes a glossary that can be accessed by clicking the Glossary button in the upper right corner of most pages. The glossary is a scrollable window that provides definitions to terms used within the tool, organized alphabetically for easy navigation.

5. Step One: Enter Home Zip Code • ① The zip code entered will be used to associate costs for covered services under the defined plans.

6. Step One: Coverage for Spouse/Domestic Partner ② Member’s will select “No” for individual coverage or “Yes” to include a spouse/domestic partner. Selecting “Yes” will add another row under ③.

7. Step One: Type of Coverage This area will dynamically change to reflect the coverage tier available for the family members included in coverage.

8. Step One: Personalize Family Members Names • The text in the boxes under the Family Member column can be personalized with the family member’s names. • ③For each family member the gender and age must be selected before continuing to Step Two.

9. Step One: Add Dependent • Select the Add Dependent button to include each additional covered family member. Personalize each additional member’s name as desired and update their gender and current age. • To remove a dependent, click the Delete button under the Action Column. • To remove a spouse/domestic partner, select No for question number 2.

10. Step One: Navigation Click the Continue button to move to Step 2: Healthcare Needs or The Back button to go to the previous screen.

11. Step Two : Healthcare Needs The Healthcare Needs page allows users to enter the anticipated costs for the employee and family members that they anticipate will be covered under their benefit plan. This page also collects ongoing known medical conditions and other information on each member. The PCE can also include non-emergency medical procedures that a user expects to have during the next year. The accuracy of the information entered on this page for each family member will have a direct impact on the family’s out-of-pocket estimates for each benefit plan their employer offers. Note: Within the PCE, when a user clicks on blue underlined text a definition for the word or term will display.

12. Step Two: Information About Your Healthcare Needs

13. Step Two: Select a Family Member • ①Select a family member – This list box will display the family members added in Step One. For each family member, select the conditions, prescriptions, procedures and durable medical equipment that you anticipate needing over the next year. • As selections are made they will be populated in the box on the right side of the page labeled Your healthcare selections:.

14. Step Two: Show Conditions List • ②Which conditions does this family member have? • Click the Show conditions list button. This will display a view with three tabs as shown below. • The three tabs allow a user to search by common conditions, alphabetically by condition, or search by a specific condition. To add a condition to the member’s healthcare selections, select the condition and click the Add button.

15. Step Two: Show Prescriptions List • ③Which prescriptions does this family member require? • Click the Show prescriptions list button. This will display a view with three tabs as shown below. • The drugs that appear on the Common Drugs tab reflect drugs most commonly associated with the conditions this member selected in ②.

16. Step Two: Show Prescriptions List (continued) • Provide additional details for each drug selected as applicable: • Drug form – package, pills, liquid, etc. • Strength – select from the pre-populated list • Count/Quantity –If enabled, enter the desired count/quantity (30=one month supply). • Number of prescriptions per year – select the number of refills used each year from 1-12 • To add a drug to the member’s healthcare selections, select the drug and click the Add button.

17. Step Two: RX Shopping-Apply Cost Savings Options Apply Cost Savings Option(s) is designed to help you understand cost savings alternatives for your prescription. The cost savings alternatives (i.e., Mail Order, Generic, Pill Splitting) are based on the prescription drug you select. As a default, all prescriptions are assumed to be filled at a retail pharmacy (e.g., your local drug store). Any changes to your prescription regimen should be done in consultation with your physician. When this feature is enabled for an account, the Show prescriptions list will display with additional options as shown below: Users can choose one of more of the options that are enabled.

18. Step Two: Apply Cost Savings Options – Mail Order Mail Order - Certain drugs can be ordered by mail at a lower cost alternative to retail pharmacies. Generally, mail order is used for drugs that are used to treat chronic conditions for a period of 90 days or more. Members typically order their drugs from mail order pharmacies via fax, email or the internet. Once a prescription order is transmitted to the mail order pharmacy, members usually receive their prescription within 6-10 days. If this cost savings option is available for the drug selected, the Mail Order check box will be enabled. To apply this option check the box to the left. The Number of prescriptions per year must be at least 3 or more for this option.

19. Step Two: Apply Cost Savings Options - Generic Generic - Generic is a cost saving option for certain brand name drugs. If a generic drug is available for the drug indicated, this option will be presented to the user to evaluate if there is a potential cost savings. If this cost savings option is available for the drug selected, the Generic check box will be enabled. To apply this option check the box to the left.

20. Step Two: Apply Cost Savings Options – Pill Splitting Pill Splitting - Pill Splitting is a cost saving option for certain prescription tablets. Pill splitting involves breaking a pill that is twice the strength of the current dose and taking half a pill. Not all pills can be split because of their design and coatings. If pill splitting is an option for the drug indicated, this option will be presented to the user to evaluate if there is potential cost savings. If this cost savings option is available for the drug selected, the Pill Splitting check box will be enabled. To apply this option check the box to the left. NOTE:See slide #30-33 for calculation details when the Apply Cost Savings Option is selected.

21. Step Two: Show Procedures List • ④ Which procedures are expected for this family member during the coming year? • Click the Show procedures list button. This will display a view with three tabs as shown below. • To add a procedure to the member’s healthcare selections, select the procedure from one of the tabs and click the Add button.

22. Step Two: Show DME List • ⑤What durable medical equipment (DME) will this family member require in the coming year? • Click the Show DME list button. This will display a view with two tabs as shown below. • The DME area has only two tabs used to look up items. The Index tab provides an alphabetical search and the Search tab allows a user to search for a specific item. • To add DME to the member’s healthcare selections, select the item and click the Add button.

23. Step Two: Healthcare Needs for Each Family Member ⑥Repeat 1 thru 5 for each family member Click the Next Family Member>> button or <<Previous Family Member. This will automatically enable the next or previous family member for healthcare selections. Users can manually change family members by selecting from the list available in ①.

24. Step Two: Print Summary Report The Print Summary Report button found in the lower right-hand corner of the Step Two page will provide a summary of the family’s healthcare selections in a printable format as shown below.

25. Step Three: Compare Your Healthcare Plans The Compare Plans page displays the healthcare cost estimates based on inputs the user provided in previous steps and preventive care costs, PCE assumes each family member will incur, based on the age and gender. The estimates provided through the software are intended as estimates only and are not intended as financial or medical advice.

26. Step Three: Compare Your Healthcare Plans

27. Step Three: Compare Your Healthcare Plans (continued) ③ ① ② ④ ① The state of this box indicates if the plan components are expanded (-) or collapsed (+). ② The Details button will provide component level details about the member’s annual expenses found listed under each plan. Examples of this page will follow. ③ The Annual Estimated Expenses provide a snapshot by plan component, of dollars incurred by the healthcare selections on the previous page of the Plan Cost Estimator. This information is available for In Network and Out of Network expenses. The Details button will provide information by each service for each member included in the scenario. ④ These are the components of each plan, employee premium, deductible, copayment, and coinsurance.

28. Step Three: Calculation Details The Calculation Details header will list the plan name. The Family Accumulators and Family Member Details area displays deductible, OOP maximums and coverage maximums that must be met, the amount used and the amount remaining based on the healthcare selections made

29. Step Three: Calculation Details (continued) The lower portion of this grid provides estimated benefits for each plan. NetworkDetails are presented first for each family member. After the last family member’s Network Details the following button will be displayed: Click on the + to view the Out of Network Details.

30. Step Three: Calculation Details – Apply Cost Savings Option

31. Step Three: Calculation Details – Apply Cost Savings Option Episode – Drug name Service Name – Generic name (if available) and strength of drug selected Cost** - Click on the blue underlined figure to see cost of drug details Copay – The total copay for one or a combination of cost savings options. Coinsurance - The total coinsurance for one or a combination of cost savings options. ** Cost shown for prescriptions is the minimum among all the options selected. Click on the cost figure for details.

32. Step Three: Drug Cost Scenarios option option Click the figure link in the cost column to display the Drug Cost Scenarios for that drug. The legend under the chart defines the values in the Options column. In the example above, the Mail Order option (2-90 day orders) is compared against the retail cost for the same drug (prescription filled 6 times separate times). The plan copay for the drug is charged based on the number of refills. Using the example above, the copay for Lipitor is $70. Multiply the copay by the number in the Refill column = Estimated Consumer Responsibility.

33. Step Three: Drug Cost Scenarios option option Multiple cost saving options may be available for a drug. The Estimated Consumer Responsibility column will list the total amount saved for each available combination.

34. Step Three: Account Optimizer Column The Account Optimizer column may contain a link to an FSA or HSA Optimizer tool if applicable to the plan. These tools allow users to optimize their unique contributions for either type of savings account based on their individual or family healthcare selections and each benefit plan for which they are eligible.

35. Step Three: FSA Optimizer • ① Select the tax filing status that applies to your situation. Options include: • Single • Head of Household • Married – Filing Jointly • Married – Filing Separately • ② Select your income level from the options listed. • ③ Select the health plan that you would like to base the FSA calculations. The list will include the plans for your employer that you are eligible to participate in. • ④ Your estimated out-of-pocket expenses will adjust with the correct In Network and Out of Network OOP for your families healthcare selections based on the plan selected in ③. • ⑤ The remaining text boxes allow users to include expenses for services not covered by the selected health plan, but within the coverage guidelines of the FSA.

36. Step Three: FSA Optimizer (continued) To calculate the FSA contributions click the Calculate button located in the lower right-hand corner of the page. The RESET button will clear the fields on the FSA Optimizer and allow the user to enter new values. The Close button will close the FSA Optimizer window. After the Calculate button has been selected, the button will change to Recalculate. This allows a user to change values within fields without resetting all of them.

37. Step Three: FSA Optimizer (continued) This row is designed to estimate the user’s expenses for the next year for both in and out of network services. This row estimates the FSA contribution that the user should make. The user needs to understand how they will use in network vs. out of network providers to determine which figure best represents their individual situation. The employer determines the maximum annual contribution amount to the FSA account. That amount is listed in the column on the far left. These figures are an estimate of the amount you would save by contributing the previous amount to an FSA. They are based on your tax filing status, your income, and the medical expenses you entered. After the user clicks the Calculate or Recalculate button a dialog with the following information is displayed.

38. Step Three: FSA Optimizer-Print Summary Report Sample FSA Summary

39. Step Three: HSA Optimizer-Part 1 • ① Select the tax filing status that applies to your situation. Options include: • Single • Head of Household • Married – Filing Jointly • Married – Filing Separately • ② Select your income level from the options listed. • ③ Select the health plan that you would like to base the HSA calculations. The list will include the plans for your employer that you are eligible to participate in, that are eligible for an HSA. • ④ Your estimated out-of-pocket expenses will adjust with the correct In Network and Out of Network OOP for your families healthcare selections based on the plan selected in ③. • ⑤ The text boxes allow users to add the estimated cost of services not covered by the selected health plan, but within the coverage guidelines of the HSA.

40. Step Three: HSA Optimizer - Part 2 ⑥ In the first text box the user enters any HSA rollover amount that you estimate will remain at the end of the current year. In the second text box the user enters the amount they plan to contribute to the HSA for the next year. The Annual employer contribution to HSA box, will display any Employer contribution to the HSA account. This box cannot be modified by the user. It is static and based upon information provided by the employer, used to set up this benefit plan within the PCE.

41. Step Three: HSA Optimizer (continued) To calculate the HSA contributions click the Calculate button located in the lower right-hand corner of the page. The RESET button will clear the fields on the HSA Optimizer and allow the user to enter new values. The Close button will close the HSA Optimizer window. After the Calculate button has been selected, the button will change to Recalculate. This allows a user to change values within fields without resetting all of them.

42. Step Three: HSA Optimizer - Print Summary Report Sample HSA Summary

43. Step Three: View Assumptions The Plan Cost Estimator uses a database of patient claims information to estimate costs. The costs are based on age, gender, health care needs, and geographic area. These figures are based on certain assumptions about the number of medical services that the user and their family members would likely need, including preventive services. View/Change Assumptions This button allows a user to further customize the services chosen in Step 2 to more closely match their individual situation. Click the View/Change Assumptions button to view or edit the assumptions for one of more family members. This is also where you can input payroll contribution costs.

44. Step Three: View Assumptions (continued) Timothy ①In the example above, if Timothy normally sees his physician 4 times each year for his condition of Asthma, he can change the value in the Quantity column from 3 to 4. He could also decrease the value if necessary. By clicking the Recalculate button in the lower left corner of the page, the annual cost estimates will update based on changes made in the Quantity column. The Reset button will restore the original values in the Quantity column.

45. Step Three: View Assumptions (continued) ②Edit zip code – This option allows a user to change the zip code to see how it will effect their estimated healthcare costs. The Recalculate button must be used to reprocess the annual expense amounts. ③ Enter unspecified employee premiums for appropriate plans – This option is enabled based on the account setup for this employer. If available, the user may enter annual contributions or premiums for their benefit plan. This amount is then included in the total annual out-of-pocket expense. Each plan a user is eligible for will be represented under Plan Name and allow for entry of an amount representing their annual contribution.

46. Step Three: View Assumptions (continued) ④Enter previous year HRA rollover – This text box allows a user to include any eligible rollover dollars from the previous year’s HRA balance. ⑤ Enter previous year HSA rollover – This text box allows a user to include any eligible rollover dollars from the previous year’s HSA balance. This function can also be used to model Employer funded HSA dollars.

47. Step Four: Add Spouse Plan From the results page, users may also enter one or more spouse or other plans for comparison. 2 1