Welcome Iowa Bankers Benefit Plan

1. WelcomeIowa Bankers Benefit Plan Administered by Iowa Bankers Insurance & Services, Inc.

2. 30th Anniversary • Iowa Bankers Benefit Plan • Established in 1978 through the Employees Retirement Income Security Act (ERISA) • Organized as a tax exempt trust under Section 501.C.9 of the Internal Revenue Code • Do not pay income tax on trust income if we stay within safe harbor limits

3. Iowa Bankers Benefit Plan • Classifed as a Multiple Employer Welfare Arrangement (MEWA) • Definition – Arrangement providing health and welfare benefits to two or more unrelated employers. MEWAS are designed to give small employers access to low cost health coverage on terms similar to those available for large employers. MEWA’s are most often found among employer groups belonging to a common trade or industry association. i.e. Iowa Bankers Association

4. Iowa Bankers Benefit Plan • 1980 – 2000 – States receive the right to regulate MEWA’s. 1983 ERISA amended. • Several MEWA’s in other states become insolvent. • Iowa Bankers Benefit Plan in 1997 work’s with Iowa legislature to pass a bill authorizing MEWA’s to operate in Iowa for limited period of time. • In 2003, Iowa Bankers Benefit Plan is granted Certificate of Authority to operate a MEWA in state of Iowa subject to annual renewal requirements.

5. Iowa Bankers Benefit Plan • Today IBBP is the largest non-public employee trust in the state of Iowa. We presently insure approximately 11,000 employees and more than 27,000 total lives. Over 95% of the banks chartered in the state of Iowa participate in the Plan.

6. IBIS and the Iowa Bankers Benefit Plan • IBIS is fiduciary administrator of the Benefit Plan. Administrative decisions made by: • IBBP Trustees • IBIS Directors • IBIS Management

7. IBIS – Fiduciary AdministratorServices Provided: • Accounting • Asset Management • Billing and Premium Collection • Claims Auditing • Customer Service – Claims Monitoring • Benefit Plan Design • Plan Management including contracting claims administrator • Compliance with State and Federal Regulations. • (TEFRA, ERISA, COBRA, Filing Form 5500)

8. 2006 Administrative Expense Ratio • 2006 Total Premiums $89,322,482 • Wellmark Administrative Fees -$4,108,329 • Plus IBIS Administrative Expense -$4,342,745 • Other Expense - Audit Expense -$21,290, Legal Expense - $15,635,Misc $39,842 • Total Administrative Expense $8,435,810 or • 9.5% Administrative Expense Ratio

9. Comparison of Administrative ExpenseIowa IBBP

10. September 2007 Financials Revenue • Premium Contributions $66,079,695 • Interest Income $ 622,578 • Total Revenue $66,707,273 Expenses • Claims Paid $55,376,284 • Other Trust Expenses $ 5,948,264 • Total Expense $61,324,548 Net Increase* $ 5,377,725 * Direct Addition to our Trust Reserve

12. Iowa Bankers Benefit PlanOctober 2007

13. Overview of Presentation • Detailed information on claims paid by the Plan • Wellness – member health support • Changes to our website • Answer questions on our move from 2 tier to 4 tier premium rating

15. The Plan paid $16.7 million dollars in inpatient claims. The top three diagnosis categories are: Muscular/Skeletal cases accounted for 17% of covered charges –osteoarthritis, disc and back problems top diagnoses Obstetrical cases accounted for 15.7% of covered charges – newborns and normal deliveries were the most costly diagnoses Heart/Vessels cases accounted for 15.5% - chronic heart disease, brain hemorrhage, and arrhythmias the top diagnoses Overall, covered inpatient charges per member increased less than 1% Top Diagnoses -Inpatient

16. The Plan paid $18.8 million dollars in outpatient claims. The top three diagnosis categories are: Bones, muscles, ligament conditions accounted for 15% of covered charges – knees, disc and back problems top diagnoses Digestive conditions accounted for 10.4% of covered charges – gall bladder, esophagus, and appendicitis were the most costly diagnoses Benign/cancerous tumor cases accounted for 10.3% - breast, prostate, and benign digestive tumors the top diagnoses Overall, covered outpatient charges per member increased 6%. Top Diagnoses - Outpatient

17. The Plan paid $17.8 million dollars for office visits. The top three diagnosis categories are: Bones/muscle/ligaments conditions accounted for 13% of covered charges – disorders of joints, backs, and sprains top diagnoses Preventive care - Routine/diagnostic diagnoses accounted for 10% of covered charges –general exam, well-child care and special cancer screening tests were the most costly diagnoses Benign/cancerous tumor cases accounted for 9.5.% - breast, colon, and prostate the top diagnoses Overall, covered office visit charges per member increased 4.1% Top Diagnosis – Office Visits

18. Drugs • Pharmacy Claims paid were $10,295,534 – slightly lower than the previous year • Generic utilization – 52.8% • Top drug classes – cholesterol-reducing 13%, antidepressants 9.7%, Proton Pump Inhibitors 7.5% • 26% of our members had no prescriptions • 36% of our members has less than $100 in prescriptions • 10% had prescriptions in excess of $1,000 and accounted for 42% of all prescriptions filled and 66% of all prescription dollars paid.

19. Dental IBBP was billed $8,906,647 in dental claims – Paid $5,539,920 43.5% of paid claims were for preventive and diagnostic procedures 80.6 % of those members who purchase dental coverage use it 94.1% of members receive their coverage in-network

20. Plan Overall • Health care claims per member decreased by 1% • Pharmacy claims increased by 2% • Overall, total claims paid decreased by 0 .7%, well below the expected rate

21. Member Health Support Our goal is to • Better support our members in their relationship with their physician • Seen as adding value • Result in better health outcomes • Optimize benefit cost

22. Iowa Bankers Health Continuum-2006

23. Member Health Support • Preventive Care – Annual physical, well child checks – 10% of total office charges • Disease management – COPD, asthma, heart failure, coronary heart disease, diabetes – very successful • Pharmacy Management – mandatory generic fill, step therapy, cost management • Case management • Pregnancy program – Better Beginnings

24. Prenatal Program • Current Better Beginnings Program – low enrollment - less than 14% of eligible members have enrolled • 2005 – highest number of high risk pregnancies/ neonatal claims • $1.4 million claim paid on one baby • One of the top three diagnoses paid for by the Plan

25. Program Goals Pregnancy Care • Voluntary program • Support clinician’s care plan • Prolong pregnancy and reduce antenatal hospitalizations • Improve normal birth weight rates • Improve quality of life for mother, newborn and family • Reduce health care cost • Mailed Graduation Gift

26. Pregnancy Care Intervention Highlights • Assessment results shared with member and clinician • Assessment results determine if member participates in low risk track or high risk track • High risk members receive primary nurse case manager and ongoing telephonic support • Risk level assessment at program admission and mid-pregnancy

27. Whole Health Dimensions

30. What type of information can be accessed off the IBBP/Wellmark BC/BS website? • IBBP Summary Plan Descriptions • Enrollment Guides • HSA Calculator • Provider Directories (Doctor or Hospital) • Blue Card( outside of Iowa) providers • Disease management information • Healthy Living/Decision Counts • Myhealth@wellmark.com – member access to on-line EOB’s • WebMD

31. Coming to our website in 2008 • On line Health risk assessments • Additional web based educational materials • More to come!

32. IBBP change from 2 tier premium rating to 4 tier premium rating effective 1-1-2008 • Employee • Employee and spouse • Employee plus child(ren) • Family

33. Questions? • Eligibility • Qualifying events • Certificates of Creditable Coverage • COBRA • Identification Cards

34. Administration • New Health/Dental Application • New Change Form • Life/Disability Form • Instruction Sheet in Packet

35. Employee BenefitWorkshop - 2007 Sponsored by: Iowa Bankers Insurance and Services

36. Iowa Bankers Insurance and Services, Inc • VISION STATEMENT: • Be the leader in providing resources and expertise to empower the financial services industry. • MISSION STATEMENT: • Contribute to the success of our customers and shareholders by providing superior products and service at a competitive price.

37. What Iowa Banks are offering. • There are 417 chartered banks in the State of Iowa. • Just over half of the banks in the state offer the 105 (HRA), the 125(FSA), or both. • 3850 employees in the 105 • 2525 employees in the 125 • Total of 6375 in the two plans • Do you?

38. Topics of Discussion • Review of Forms/Reports for 2008 • Review of Web Tools • Section 125 Summary of Regulation changes • Section 125 Enhancements for 2008 • High Deductible Health Plans and Health Savings Accounts

39. Review of Forms/Reports • See handouts where necessary

40. Direct Deposit Notification- 125 • See handouts: • Look at claim # (same as Wellmark #) • Plan is listed • Plan year listed • Service date: from – to • Requested amount • Amount paid • Notes: reason for denial or non-payment • Year to date history at the bottom

41. 125 Claim Denial Codes • 1. IBIS will receive and process the claims electronically. • 2. This claim was paid on __________________ • 3. Not a covered item______________________ • 4. Additional informational needed_____________ • 5. No coverage at time of service • 6. Other_____________________________

42. Claim processed in error • For 105 and 125 plans, the following will occur. • Wellmark may reprocess a claim due to an error. • This may cause an overpayment to the employee from either/ both the 105 and 125 plans. • Letter will be sent to the employee and HR person within 30 days of event. • Follow-up letter sent at 90 day interval • IBIS will request a correction debit to the employees account, you must notify us which date to do the reversal. • See sample letters attached.

43. Direct Deposit Notification- 105 • See handouts • Plan limits listed at the top right • Participant • ICN # (same as Wellmark claims #) • Billed amount/Provider savings/Wellmark paid • Deductible: applied to the employee 105 level • Co-insurance credited to the employee level • Employees responsibility • Employer Paid • Year to date totals by insured

44. 2008 Forms • Employee Election Form • Employee Change of Status Form • Coordination of Benefits Form • Company Data Gathering Form • Please refer to handouts

45. Must be returned by 11-30

49. Return ASAP— Deadline 11-30

50. Review of Web Site • Where to find forms • Where to find reports • Where to find PowerPoint presentations