State Employee Health plan

1. State Employee Health plan Open Enrollment for Plan Year 2013

2. Health Care Commission (HCC) • No employee & employer rate increases • No plan design changes for Plans A and B • Autism Spectrum Disorder Pilot • Benefit will be continued for 2013

3. Other HCC Action • Plan Design Changes for Plan C • Lower premium • Deductible • Single $2,500/ Family $5,000 • Single family member only has to meet the single deductible • Network services for medical & pharmacy have 0% member Coinsurance • State HSA Funding Increased • Maximum of $1,500 for single & $2,250 for family • State pays HSA funding in a lump sum • All HSA accounts will be with US Bank

4. Changes Due to Health Reform • Preventive Care Coverage for Contraception • Medical coverage for implantable & injectable contraceptives • Medical coverage for sterilization • Pharmacy coverage for prescription birth control products • Must be on the Preferred Drug List • Does not include over the counter items • Preventive Care Coverage for Breastfeeding • Includes counseling and equipment rental

5. New Documents required by PPACA • Summary of Benefits & Coverage (SBC) • www.kdheks.gov/hcf/sehp/SBC.htm • Uniform Glossary of Health Coverage & Medical Terms* • www.kdheks.gov/hcf/sehp/download/UniformGlossaryofHealthCoverageMedicalTerms.pdf * Note: This is not specific to the SEHP Coverage

6. Selecting Your Health Plan • Pick a plan design (A, B or C) • Which plan design provides the coverage you and your family need? • What is the total plan cost? What is the member contribution? • Premiums + Deductible & Coinsurance = ? • Review the Provider Networks • Each of the medical plans uses a different provider network

7. 2013 SEHP Medical Plans • All are Preferred Provider Organizations (PPOs) • Plans A, B and C all use the same provider networks & same basic coverages • Claims paid based on the network status • Network Providers accept the plan allowance as payment in full • Non Network Providers can balance bill • All plans include preventive care

8. Covered Preventive Care

9. Deductible • A set amount of eligible expenses a covered person must pay out of their own pocket before the health plan will begin paying on their claims. • Network and Non Network Deductibles accumulate separately. • Deductible and “Not Covered” do not mean the same thing.

10. Deductible Example * Members on Plan C have a Health Savings Account that could be used to pay this deductible amount.

11. Coinsurance • A cost sharing formula for health care services • Coinsurance is expressed as a percentage of the allowed charge that will be paid by the member and the balance paid by the Plan • You must meet the deductible before coinsurance is applied

12. Coinsurance Example

14. Quest Diagnostics • Statewide & nationwide preferred lab vendor • 100% coverage for eligible outpatient lab tests • For non-emergency outpatient lab work only • Testing must be performed and billed by Quest • Available on Plans A and B only • Your Doctor can draw the sample - or- • Visit Quest’s website for collection sites • Online appointment scheduling available • Use Your Quest ID card or medical ID card www.labcard.com

15. Stormont-Vail HealthCare • Stormont-Vail HealthCare is the regional • preferred lab vendor in NE Kansas • 100% coverage for eligible outpatient lab • tests • All Plan A and B members may use the • Stormont-Vail draw site locations • Labs drawn at other Cotton-O’Neil locations • may be included if by network providers • Show your medical ID Card to access benefit

16. Plans A & B Drug Benefit Generic Drugs • 20% Coinsurance Preferred Brand • 35% Coinsurance Non Preferred Brand • 60% Coinsurance Special Case Medications • 25% to a max of $75 per 30-day supply • Coinsurance Maximum is $2,580 per person for Generic, Preferred Brand & Special Case medications. Up to a sixty (60) day supply of most drugs available www2.caremark.com/kse

17. Generic Launches • 2013 • Reclast1st Qtr • Zomig 2nd Qtr • Zomig ZMT 2nd Qtr • Advicor 2nd Qtr • Niaspan 3rd Qtr • Aciphex4th Qtr • Cymbalta 4th Qtr 2012 Actos 3rd Qtr Diovan 3rd Qtr Singulair 3rd Qtr Maxalt 4th Qtr Maxalt MLT 4th Qtr Tricor 4th Qtr Requip XL 4th Qtr www2.caremark.com/kse

18. Plan C • Network Coverage for Medical & Pharmacy • $2,500/$5,000 Deductible • 0% Coinsurance • $2,500/$5,000 Total Deductible & Coinsurance • Preventive Care Services paid at 100% • Non Network Coverage • $2,500/$5,000 Deductible • 20% Coinsurance • $4,000/$8,000 Total Deductible & Coinsurance • Preventive Care is not covered • Does not include dental or optional vision plan

19. Plan C Drug Plan • Same Preferred Drug List as Plans A & B • Covered drugs are subject to the Network Plan C deductible • After the deductible, the plan pays covered prescription drugs at 100% • 100% coverage for contraceptives on the PDL • Discount Tier drugs are not covered drugs • Only eligible for Caremark’s negotiated discount • Plan C is a creditable drug plan

20. Plan C - At a Glance

21. What is a Health Saving Account? • An employee-owned bank account for saving money to pay for current or future medical expenses for members enrolled in a qualified high deductible health plan • Unspent HSA funds roll over and accumulate year to year and can be invested • Portable - The account and the money belong to you

22. HSA Eligibility Requirements • The following members are not eligible for an HSA: • Enrolled in Medicare • Receiving Social Security benefits • Enrolled in TRICARE or TRICARE for Life • Enrolled with the Veteran’s Administration (VA) and/or have received VA medical services within a three-month period immediately preceding their enrollment in Plan C • Covered as a dependent under another plan that isn’t a QHDHP • Can be claimed as a dependent on another individual’s tax return (e.g., Parents) • Spouse has Health Care Flexible Spending Account See page 12 of the OE Book

23. State Increases HSA Funding • State will pay HSA contribution as a lump sum • Payment date depends on HCFSA: • Account funded in January if no HCFSA in 2012 or if all money has been used by 12/31/12 • Account funded after March 15, 2013, if enrolled in HCFSA in 2012 and you have funds during the grace period

24. HSA Contributions • HSA Contributions are governed by the Internal Revenue Service (IRS). • Eligibility criteria for HSA is on Page 12 of the Open Enrollment Book • Minimum contribution of $25 semi-monthly by the employee is required • Contributions may be made with pre- or post-tax funds. • HSA Contribution amounts can be changed anytime during the year. • Members over age 55 can contribute additional funds to “catch up”

25. HSA Enrollment is Easy • All Plan C options will have the same HSA vendor: • US Bank • A file with the members who enroll in Plan C will be sent by SEHP to US Bank • Employees receive “welcome” notification via email • Letter if no email • Employee completes online enrollment process • Must accept the Terms and Conditions • Order additional cards for dependents • Select account beneficiaries • Online Tools to manage your account

26. Using Your HSA Funds • Use your HSA Bank Card at a Pharmacy • Fill a prescription • Swipe your HSA Bank Card for payment • Save a copy of receipt for your records • Use your HSA Bank Card for Medical Services • Health plan adjudicates claim & sends you an Explanation of Benefits (EOB) • Pay the provider using your HSA Bank Card • Save a copy of the bill or EOB for your records

27. Additional Ways to Pay with Your HSA • You Pay the Provider through Bill Pay • You go online and use Bill Pay to issue payment to the provider of service • Reimburse yourself for expenses paid out of your pocket • With Bill Pay you can send a direct deposit reimbursement to your checking or savings account for health care services

28. Dental Coverage • Plan pays in full for 2 exams & cleanings • $50 Plan Deductible max of 3 per family • Implant Coverage • 50% Coinsurance to a max of $1,250 per year • Benefit subject to annual benefit max • Annual benefit maximum • $1,700 per person per year • $1,000 Lifetime Orthodontic benefit

29. Dental Benefit

30. Basic Vision Plan • $25 Materials Copay then: • 100% single vision, standard bifocal, trifocal lenticular lenses • Up to $100 frame allowance • Elective Contact lens allowance $150 • Office visit subject to $50 Copay • Contact Lens Fitting Fee subject to $35 Copay

31. Enhanced Vision Plan Includes Basic benefits plus… • Frame allowance of up to $150 • Contact Lens Fitting Fee subject to $35 Copay • High index or Poly-carbonate lenses up to $116 • Progressive lenses up to $165 • Scratch and UV coating

32. Flexible Spending Accounts • Health Care Flexible Spending Account • For Plan A and B members only • Limited to $2,500 • Debit Card available • Limited FSA for Plan C members • Dental and vision expenses only • Cannot be used for medical expenses • Dependent Care Flexible Spending Account • For child care expenses • Limited to $5,000 www.asiflex.com

33. HealthQuest (HQ) Rewards • Requirements for 2014 incentive discount • Complete the health assessment • Earn 20 additional credits • HQ Rewards deadline is July 31, 2013 • Non Tobacco usage is worth 10 credits • Certification is now online at: www.kansashealthquest.com • You may complete the certification anytime before the deadline. • Tobacco cessation program is no longer required for tobacco users.

34. Open Enrollment • Enroll online: • Make health plan selections • Add/drop dependents • Dependent documentation required by October 31. • Enroll in Flexible Spending Accounts • Apply for HealthyKIDS • Families at 250% of poverty level • State pays 90% of children’s premium • Enroll at:https://khap.kdhe.state.ks.us/hkapplication/ • Coverage effective January 1, 2013

35. Identification Cards • Coventry/PHS and UHC Plan C are issuing new ID cards • Delta Dental is issuing new ID cards • Plans A and B, BCBS Plan C, Lab, Vision & Drug are not issuing new cards unless the member makes a plan/coverage change

36. Resources • Review the Open Enrollment (OE) booklet • ?’s: Call the health plan customer service • Phone numbers in the front of the OE booklet • Visit www.kdheks.gov/hcf/sehp.htm • Benefit descriptions, Provider directories, & Preferred drug list available • Information on the HSA and FSA accounts • Summary of Benefits & Coverage (SBC) • Email ?’s to SEHP:benefits@kdheks.gov

37. Benefit Decision Making Tools • Two tools are available at: www.kdheks.gov/hcf/sehp/default.htm • SEHP Tool • US Bank Plan Comparison Tool • There is a Payroll Calculation tool available at http://www.kansas.gov/employee/

38. Questions?