2014 Benefit Options Presentation

1. 2014 Benefit Options Presentation Plan Year January 1 through December 31, 2014 This publication is issued by the Office of Management and Enterprise Services as authorized by Title 62, Section 34. Copies have not been printed but are available through the agency website. This work is licensed under a Creative Attribution-NonCommercial-NoDerivs 3.0 Unported License. 2949

2. The Employee BenefitOptions Guide • How to access the Guide: • View the Guide on the EGID website at www.sib.ok.gov or www.healthchoiceok.com • Complete the online request to get one by mail • Contact your Insurance Coordinator • Contact EGID Member Services

3. Topics • 2014 Plan Changes • Health Plans • Dental Plans • Vision Plans • HealthChoice Life Insurance Plan • Eligibility

4. For More Information • 2014 Employee Benefit Options Guide • Frequently Asked Questions at www.sib.ok.gov or www.healthchoiceok.com • Plan websites and customer service representatives • Your Insurance Coordinator • EGID Member Services

5. Index • Click the links below to access a particular section of this presentation. • 2014 Plan Changes • HealthChoice Health Plans • HMO Health Plans • Dental Plans • Vision Plans • HealthChoice Life Insurance Plan • Eligibility

6. 2014 PLAN CHANGES

7. Eligibility Changes • Enrolling a newborn: • HealthChoice and HMO plan members must enroll the newborn for the month of birth if dependent coverage is desired • Premium for month of birth must be paid

8. HealthChoice Plan Changes • HealthChoice High and USA Plans • Calendar year out-of-pocket maximum is being increased to $3,300 for an individual/Network and $3,800 for an individual/non-Network • HealthChoice High Alternative Plan • Calendar year out-of-pocket maximum is being increased to $3,550 for an individual/Network and $4,050 for an individual/non-Network • Calendar year out-of-pocket maximum is being decreased to $8,400 for a family

9. HealthChoice Plan Changes • HealthChoice S-Account Plan • Copays for physician office visits for general practitioners, etc., and VA, Military and Indian Clinics is being reduced to $30 • Copay for specialist office visit will remain $50

10. HMO Plan Changes • CommunityCare HMO • Calendar year out-of-pocket is being increased to $4,000 for an individual and $8,000 for a family • Copay for hospital inpatient admission increased to $750 • Copay for hospital outpatient visit increased to $500 • Copay for mental health or substance abuse inpatient admission increased to $750 • No referral needed for most specialist visits • Visit state.ccok.com to view benefits, claims, EOBs, and more

11. HMO Plan Changes • GlobalHealth HMO • Copay for specialty scans will be $750 • Copay for outpatient visits in free-standing facility will be $250 and $750 in a hospital facility • Copay for emergency health care facility visit increased to $300 • Durable medical equipment – 20% coinsurance • Occupational or speech therapy and physical therapy/physical medicine limit: 60 combined inpatient and outpatient visits per acute illness or injury

12. Dental Plan Changes • HealthChoice Dental • 12-month waiting period will apply to all members, including those who had previous group dental coverage

13. Dental Plan Changes • CIGNA Dental • Cost for sealant increased to $17 per tooth • Cost for amalgam, one surface increased to $23 • Cost for a root canal, anterior, increased to $375 • Cost for periodontal/scaling/root planing, 1-3 teeth, increased to $75 • Out-of-pocket for children through 18 increased to $2,472 • Out-of-pocket for adults increased to $3,384

14. Dental Plan Changes • Delta Dental • Delta Dental Premier is now Delta Dental PPO Plus Premier

15. Vision Plan Changes • Primary Vision Care Services (PVCS) • Discounts offered through nJoy Vision, previously TLC, call PVCS for details • Vision Services Plan • $25 copay on contact lenses

16. HealthChoice Life Insurance Plan Changes • Dependent Life Insurance • Dependent life benefit for birth to 6 months of age is being eliminated • Dependent children eligible for Low, Standard, or Premier Option from live birth to age 26 • Return to Index

17. HEALTHCHOICEHEALTH PLANS

18. Click here to view HealthChoice plan changes • Available Plans • HealthChoice High • HealthChoice High Alternative • HealthChoice Basic • HealthChoice Basic Alternative • HealthChoice S-Account • HealthChoice USA • Using a HealthChoice Network Provider will lower your out-of-pocket costs.

19. HealthChoice Plan Changes • Tobacco-free Attestation • To remain enrolled in the HealthChoice High or Basic Plan, you must attest that you and your covered dependents are tobacco-free • Due to HealthChoice by Nov. 15, 2013 • The Attestation is available: • On the EGID website • Through a mobile app, or • By calling HealthChoice Member Services

20. HealthChoice Plan Changes • If you cannot complete the Attestation, you must either: • Enroll in the quit tobacco program AND complete three coaching calls, or • Provide a letter from your doctor indicating it is not medically advisable for you or your dependent to quit tobacco. • If you do not complete the Attestation or complete one of the reasonable alternatives as defined previously, you will be enrolled in the HealthChoice High Alternative or Basic Alternative Plan with a higher deductible and out-of-pocket maximum.

21. High • When using a Network Provider: • $30 copay for primary care office visits • $50 copay for specialist office visits • Annual deductible $500 for an individual or $1,500 for a family • Plan pays 80% and member pays 20% of Allowed Charges up to the out-of-pocket maximum of $3,300 for an individual or $8,400 for a family

22. High Alternative • When using a Network Provider: • Benefits the same as High Plan except deductible and out-of-pocket maximum • Annual deductible $750 for an individual or $2,250 for a family • Plan pays 80% and member pays 20% of Allowed Charges up to the out-of-pocket maximum of $3,550 for an individual or $8,400 for a family

23. Basic • When using a Network Provider: • Office visit copays do not apply • Plan pays first $500 then member pays next $500 as deductible; $1,000 deductible for a family of two or more • Plan then pays 50% until the out-of-pocket maximum is met; $5,500 for an individual or $11,000 for a family • Plan then pays 100% of Allowed Charges

24. Basic Alternative • When using a Network Provider: • Office visit copays do not apply • Plan pays first $250 then member pays next $750 as deductible; $1,500 deductible for a family of two or more • Plan then pays 50% until the out-of-pocket maximum is met; $5,750 for an individual or $11,500 for a family • Plan then pays 100% of Allowed Charges

25. S-Account • Plan designed for members with a Health Savings Account (HSA) • When using a Network Provider: • Combined $1,500 deductible for an individual and $3,000 for a family* • Entire deductible must be met before benefits are paid (including prescriptions) • $30/$50 copay for office visits • The calendar year out-of-pocket maximum is $3,000 for an individual or $6,000 for a family • *Individual deductible does not apply if two or more family members are covered.

26. USA • For members who live and work outside of Oklahoma and Arkansas for more than 90 consecutive days • Benefits are the same as the HealthChoice High Plan • Members have access to the USA Plan’s nationwide provider network

27. Network Pharmacy Benefits • Prescriptions can be filled at HealthChoice Network Pharmacies • Benefits are the same for all plans; S-Account members must meet the Plan deductible before benefits are paid • You are responsible for the cost difference when choosing a brand-name if a generic is available

28. Network Pharmacy Benefits • When purchasing up to a 30-day supply: • Generic – Up to $10 • Preferred brand-name – Up to $45 • Non-Preferred brand-name – Up to $75

29. Network Pharmacy Benefits • When purchasing up to a 90-day supply: • Generic – Up to $25 • Preferred brand-name – Up to $90 • Non-Preferred brand-name – Up to $150 • 90-day fill does not apply to medications with quantity or dosage limits

30. Network Pharmacy Benefits • Certain prescription tobacco cessation medications for a $0 copay • A calendar year pharmacy out-of-pocket maximum of $2,500/individual, $4,000/ family (does not apply to S-Account Plan) • Specialty medications must be purchased through Accredo Health, the HealthChoice specialty care, delivery service pharmacy • Return to Index

31. HMOPLANS

32. HMO Plans Click here to view HMO Plan Changes • You must live or work within the ZIP Code service area of the HMO • Copay system for services and supplies • Primary Care Physician (PCP) is required • Select your providers from the network designated by your plan for the State of Oklahoma You must select another provider within your HMO’s network in the event your provider leaves the network.

33. $35 office visit copay for PCP • $50 office visit copay for specialist • $750 copay for hospital and mental health or substance use disorder admission • $200 copay each emergency room visit • $50 copay for after-hours urgent care • Out-of-pocket maximum of $4,000 for an individual or $8,000 for a family

34. Pharmacy Benefits • 30-day supply per copay • $0 copay for select generics • Up to a $10 copay for formulary generic medications • Up to a $40 copay for formulary brand-name medications • Up to a $65 copay for all other medications • Some medications have quantity limits

35. $25/$50 office visit copay for PCP/specialist • $300 copay each emergency room visit • $25 copay for after-hours urgent care PCP; $50 copay for all others • $250 copay for free-standing outpatient facility or $750 for a hospital facility • No copay for x-ray and lab services • MRI, PET, CAT, or nuclear scan – copay of $250 for free-standing facility or $750 for hospital facility • Out-of-pocket maximum of $3,000 for an individual or $5,000 for a family

36. Pharmacy Benefits • 30-day supply per copay • $4 copay for select generics • Up to a $10 copay for formulary generic medications • Up to a $50 copay for formulary brand-name medications • Up to a $75 copay for all other medications • Some medications have quantity limits • Return to Index

37. DENTALPLANS

38. Dental Plans Available • Assurant Freedom Preferred • Assurant Heritage Plus with SBA (Prepaid) • Assurant Heritage Secure (Prepaid) • CIGNA Dental Care Plan (Prepaid) • Delta Dental PPO • Delta Dental PPO Plus Premier • Delta Dental PPO – Choice • HealthChoice Dental

39. Dental Benefits • All the dental plans have the same core benefits which are divided into four different classes: • Preventive Care includes cleanings, bitewing x-rays, and routine oral exams • Basic Care includes fillings, extractions, root canals, endodontics, and periodontics

40. Dental Benefits • Major Care includes dentures, bridgework, crowns, and implants • Orthodontic Care* is covered for members under age 19 and members age 19 or older with temporomandibular joint dysfunction (unless otherwise noted) *Assurant Freedom Preferred has a 12-month waiting period for orthodontic care; waived if proof of continuous dental insurance is provided. HealthChoice has a 12-month waiting period for orthodontic care.

41. Freedom Preferred Dental Plan • Preventive Care is covered at 100% • A $25 deductible applies to Basic and Major Care • After the deductible: • Basic Care is covered at 85% • Major Care is covered at 60% • Orthodontic Care under age 19 is covered at 60%; lifetime maximum benefit $2,000 • All other services have a combined $2,000 maximum annual benefit

42. Heritage Plus with SBA Dental Plan • No deductible or annual maximum for general dentist • You must select a Primary Care Dentist for each covered person • Preventive Care is covered at 100% • Copay schedule applies to other services • Orthodontic Care for children and adults • The Special Benefit Amendment provides an additional discount for network specialists

43. Heritage Secure Dental Plan • No deductible or annual maximum with general dentist • You must select a Primary Care Dentist for each covered person • Preventive Care is covered at 100% • Copay schedule applies to other services • Orthodontic Care for children and adults

44. Dental Care Plan • No deductible or maximum annual benefit • You must select a Primary Care Dentist for each covered person • After a $5 copay, routine cleanings, x-rays, and evaluations are covered at 100% • A copay schedule applies to other services, including specialist care • Orthodontic Care for children and adults

45. Delta Dental PPO • Preventive Care is covered at 100% • $25 annual deductible for Basic and Major Care • Basic Care is covered at 85% • Major Care is covered at 60% • Orthodontic Care for children and adults is covered at 60% with a$2,000 lifetime maximum benefit • $2,500 maximum annual benefit for other services

46. DeltaDental PPO Plus Premier • A $50 combined deductible applies to Diagnostic, Preventive, Basic, and Major Care • Preventive Care is covered at 100% • Basic Care is covered at 70% • Major Care is covered at 50% • Orthodontic Care for children and adults is covered at 60% with a lifetime maximum of $2,000 • $3,000 maximum annual benefit

47. Delta Dental PPO – Choice • You must select a Primary Care Dentist for each covered person • No deductible for Preventive or Basic Care • $100 deductible for Major Care • Copay schedule for all other services • Orthodontic Care for children and adults has a maximum lifetime benefit of $1,800 • $2,000 maximum annual benefit for Preventive, Basic, and Major Care

48. Dental • When using a Network Provider: • Preventive Care is covered at 100% • A $25 deductible applies to Basic and Major Care • Basic Care is covered at 85% • Major Care is covered at 60% • Orthodontic Care is covered at 50% —no lifetime maximum, 12-month waiting period applies • A $2,500 calendar year maximum applies to all other services • Return to Index

49. VISIONPLANS

50. Vision Plans Available • Humana CompBenefitsVisionCare Plan • Primary Vision Care Services (PVCS) • Superior Vision Plan • UnitedHealthcare Vision • Vision Service Plan (VSP)