OPERS Health Care Update 2011: Challenges & Opportunities

1. 2011 Health Care Update Jason Davis OPERS Devon Hooper OPERS

2. Health Care Challenges & Opportunities • Baby Boomers’ Retiring • Retirees Living Longer • Benefits Perception (a.k.a. “Pension Envy”) • Economy and Budget • Increasing Cost of Health Care • Solvency of Medicare and Social Security • National Health Care Reform

3. Present & Future of OPERS Health Care • Although Ohio law does not mandate health care coverage, OPERS understands the importance of health care coverage to our benefit recipients • As of 12/31/09, HCPP 1.0 & 2.0 have had an impact of $1.8 billion on the health care fund • $11.4 billion in health care fund as of 12/31/09 • OPERS spent $1.5 billion in 2009 on health care claims for our retirees & dependents • OPERS is currently planning for future changes aiming to improve solvency of health care fund

4. Eligible Dependent Guidelines in 2011 • Your Legal Spouse - Spouses under age 55 will pay full premium cost - Once covered spouse reaches age 55 OPERS will again subsidize portion of premium cost • Your biological and/or legally adopted children: - Under age 26 with no other qualifications • Grandchildren, only if legally adopted or with a court order pursuant to the Ohio Revised Code See page 14 of 2011 Health Care Coverage Guide

5. Dependent Coverage • You may add coverage for a dependent during Open Enrollment or within 60 days of a qualifying event such as: - Involuntary loss of health insurance - Marriage - Birth of a child • You may drop coverage for a dependent at any time See page 14 of 2011 Health Care Coverage Guide

6. 2011 Medical Mutual Plan • Medical Mutual administers plan for all Non-Medicare participants (under 65) & Medicare retirees or spouses in a “split family” • Non-Medicare participants have lower out of pocket costs by using network providers (PPO) • Medical Mutual has largest provider network of any insurer in Ohio • Enhanced plan level • Intermediate plan level • Basic plan level See pages 4 - 6 of 2011 Health Care Coverage Guide

7. 2011 Non-Medicare Medical Mutual Plan Highlights 2011

8. 2011 Non-Medicare Prescription Coverage • Administered by Express Scripts See page 7 of 2011 Health Care Coverage Guide • 30-day supply at retail pharmacy • 90-day supply through Express Scripts mail order • Our formulary is a preferred list of medications • Formulary brands & generics have lowest copays • Cost savings through mail order

10. Medicare & Your Health Coverage • Medicare A is hospitalization coverage - 40 credits required by Social Security but you may qualify through a spouse • Medicare B is medical coverage - Everyone is eligible, usually at age 65 - Enrollment is required when first eligible - Medicare proof must be submitted to OPERS • OPERS will reimburse a retiree’s Medicare B premium up to $96.40 See pages 14 - 15 of 2011 Health Care Guide

11. Medicare & Your Health Coverage • Medicare C is Medicare Advantage Plans that administer Medicare through insurance companies - OPERS has enrolled our Medicare eligible participants in Humana Medicare Advantage Plan • Medicare D is prescription coverage through Medicare & administered by insurance companies - OPERS has enrolled our Medicare eligible participants in Medicare D Plan through Express Scripts

12. 2011 Humana Medicare Advantage Plan • Retirees and covered spouses with Medicare A & B or Medicare B only who live in the U.S. and not covering children are enrolled • Claims are sent directly to Humana for processing & are not sent to Medicare • Member must meet annual deductible of $250 before most services are paid at 96% or higher • Provider must accept Medicare & Humana card • Diabetic testing supplies covered at 100% See pages 1 & 2 of 2011 Health Care Guide

13. 2011 Humana Medicare Advantage Plan Highlights

14. 2011 OPERS Medicare Part D Drug Plan • Administered by Express Scripts See page 3 of 2011 Health Care Coverage Guide • 90-day supply at Medicare approved pharmacy • 90-day supply through Express Scripts mail order • Zostavax vaccine for Shingles covered • 100% coverage for all diabetic medications • Copays for Medicare retirees will remain the same

15. 2011 OPERS Medicare Part D Drug Plan

16. 2011 Optional Coverage • MetLife Dental • High Option • Low Option • Aetna Vision • High Option • Low Option • Prudential Long Term Care • Coverage includes custodial nursing home care & home health care • Coverage is subject medical underwriting See pages 9 – 12 of 2011 Health Care Guide See page 17 of 2011 Health Care Guide

17. 2011 Preventive Coverage • One routine physical exam covered at 100% • Preventive services include PAP, PSA, EKG, Colonoscopy, Mammogram, Bone Density Test • Most preventive services covered once per calendar year at 100% of UCR including associated lab work • Preventive services must have a routine diagnosis to be paid at 100% of UCR • Preventive services will not be subject to coinsurance or deductible

18. OPERS Wellness Programs $50 deposit in RMA for each of the following with a maximum of $100 per year: • Complete a Health Assessment questionnaire • Have an annual physical exam • Complete a Lifestyle Coaching Program • Participate in a Disease Management Program for those with certain chronic conditions See page 18 of 2011 Health Care Coverage Guide

19. Retiree Medical Account • The incentive earned will be placed into the retiree’s RMA • An RMA will automatically be created by OPERS • The RMA can be used for additional/future health care expenditures • It is not taxable • Can be rolled over from year to year • Currently earns interest • Administered by Aetna See page 19 of 2011 Health Care Coverage Guide

20. What Can You Do? Stay Informed: • OPERS website • OPERS newsletters • Ongoing OPERS & vendor communications Educate your physician about your coverage: • Provide physician with Express Scripts formulary • Inform physician about 100% preventive coverage

21. Important Phone Numbers • Humana Prudential LTC - 1-877-890-4777 - 1-877-893-3367 • Medical Mutual MetLife Dental - 1-877-520-6728 - 1-888-262-4874 • Express Scripts Aetna Vision - 1-800-789-7416 - 1-866-591-1913 • Aetna RMA OPERS - 1-888-672-9136 1-800-222-7377