The Local Choice Health Benefits Program

1. 1 The Local Choice Health Benefits Program 2005 Regional Meetings March 2005

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3. 3 What Else is New? COBRA/USERRA/HIPAA Updates Dependent Definitions GASB 45 Medicare D Alternate ID #s General Housekeeping

4. 4 CommonHealth Linda Sweeney Rose O’Toole Stacey Dorton

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14. 14 Anthem Blue Cross and Blue Shield Amy Feinman

15. 15 Anthem Cross and Blue ShieldThe Local Choice 2005/2006

16. 16 Anthem Blue Cross and Blue ShieldThe Local Choice 2005/2006 Look Back at 2004/2005 2005/2006 Changes 2005/2006 Plans

17. 17 Anthem Blue Cross and Blue ShieldThe Local Choice 2005/2006 Look Back at 2004/2005 10 new groups joined TLC 1 group left TLC Membership increased 4% Maintained a 13% trend factor Benefit analysis and plan changes

18. 18 Anthem Blue Cross and Blue ShieldThe Local Choice 2005/2006 2005/2006 Medical Plan Changes New four plan design No lifetime benefit maximum on any product All plans have the same coverage and exclusion base All plans have BlueCard All plans will have out of network coverage Copayments do not count towards the out of pocket calculation

19. 19 Anthem Blue Cross and Blue ShieldThe Local Choice 2005/2006 2005/2006 Medical Plan Changes Key Advantage Expanded is the only plan with vision coverage. (Vision benefits will continue to be on a 24 month basis. The 24 months begins the month you have your eye exam, or purchase frames, lens, or contact lenses.) This year only, because of the elimination of 4 plans, 4th quarter deductible carryover will apply for all plan changes.

20. 20 Anthem Blue Cross and Blue ShieldThe Local Choice 2005/2006 Really Good News New member handbooks will be published this year. They will have a standard format with inserts for plan specific coverage amounts.

21. 21 Anthem Blue Cross and Blue ShieldThe Local Choice 2005/2006 2005/2006 Plans Please refer to your comparison charts.

22. 22 Anthem Blue Cross and Blue ShieldThe Local Choice 2005/2006 Questions?

23. 23 ValueOptions Nathan Coley Joseph E. Chodkiewicz

24. 24 March 7, 2005

25. 25 ValueOptions Founded by a psychiatrist Clinically focused delivery system Over 25 years of EAP experience 84,000 provider locations- 23 million covered lives for managed care Virginia based employer

26. 26 ValueOptions Mental Illness/Substance Abuse and EAP Benefits Dedicated toll free number: 866-725-0602 Website: www.achievesolutions.net/tlc

27. 27 ValueOptions

28. 28 ValueOptions Employee Assistance Program Benefits Four sessions per problem per year with no cost to the member Everyone in the household is eligible Provides confidential, professional counseling, education and referral services

29. 29 ValueOptions EAP Offers help with a variety of issues: Marital and family problems Alcohol and /or drug abuse assessment Balancing work and family Work-related concerns Financial or legal issues (including mediation services) Grief and loss Personal growth and development

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31. 31 ValueOptions

32. 32 ValueOptions Mental Illness/Substance Abuse Call 866-725-0602 for pre-certification Certification is based on medical necessity Benefit coverage is based on provider status Out of Network benefit, when available, provides lower coverage and providers may balance bill the member

33. 33 ValueOptions Medical Necessity The service must be appropriate and essential for the evaluation and/or treatment of a mental disorder. The service must expect to improve a patient’s condition or level of functioning, and/or prevent regression. The service must meet national standard of practice. Medical Necessity Criteria can be found at our website: www.valueoptions.com

34. 34 ValueOptions As of June 30, 2005, The following plans are no longer offered: Cost Alliance Value Alliance KeyShare

35. 35 ValueOptions Beginning July 1, 2005 The TLC Program will offer 4 new plans: Key Advantage Expanded Key Advantage 200 Key Advantage 300 Key Advantage 500

36. 36 ValueOptions Questions???

37. 37 Thank you! www.valueoptions.com

38. 38 Medco Derek Fredenburg Robin Nieman

39. 39 The Local Choice Rx Benefit administered by Medco Presenter: Derek Fredenburg George Bognar

40. 40 New Copay Information

41. 41 Medco Customer Service for TLC 1-800-355-8279 Accessible 24 hours a day, seven days a week (except for Thanksgiving and Christmas) How can this help me? Ask a pharmacist…. Refill a prescription Order new mail order forms Locate a retail pharmacy Get a copay quote These are only some of things we can assist you with.

42. 42 Retail Pharmacy When you need a drug on a short term basis Over 50,000 stores in the network nationwide All major chains are in the network A retail copay is applied per 34 day supply of medication, up to a 102 day supply (3 month) with one prescription

43. 43 medco.com secure and convenient prescription management for members Award winning member website Verified Internet Pharmacy Practice Sites (VIPPS™) A Program of the National Association of Boards of Pharmacy What can I do? Refill medications by mail on line Get the status of a Mail Rx Order Copay quotes Ask a pharmacist Find a retail pharmacy Is my medication covered?

44. 44 Medco by Mail For prescription medications you use on a regular basis Dedicated primary mail pharmacy just for TLC and State employees – located on Richmond VA PO Box 35030 Richmond VA 23235-0030 Wilson Rx Award - Medco has re-earned the distinction of being named the nation's top-rated PBM and mail order pharmacy in the WilsonRx Pharmacy Benefit Satisfaction Report 2004. Safe, convenient, cost effective, and it is quick.

45. 45 Delta Dental of Virginia Duncan Sheils Matt Macdonald Terri Green

46. 46 Dental Benefit Solutions

47. 47 Discussion Points History of Dental Benefits Dental Plan Enrollment Costs and Trends Plan Changes for 2005 The Delta Difference

48. 48 Discussion Points History of Dental Benefits Dental Plan Enrollment Costs and Trends Plan Changes for 2005 The Delta Difference

49. 49 History of Dental Service Plans 1954 International Longshoreman’s Union and dental professionals create dental care program for Union’s children First not-for-profit dental service plan created, (Washington State Dental Service - now Delta Dental of Washington). 1955 Similar organizations created by dental societies in CA and OR. 1963 Aerojet-General Corp first large company to buy a dental program. 1966 ADA established the National Association of Dental Service Plans - forerunner of Delta Dental Plans Association. Organization’s main purpose to increase the availability of dental services to the public 1970s Commercial insurers enter dental marketplace

50. 50 Discussion Points History of Dental Benefits Dental Plan Enrollment Costs and Trends Plan Changes for 2005 The Delta Difference

51. 51 Current Dental Marketplace We will more than double the revenue size of the company by the end of 2008. Our annual surplus growth from overall operations will be targeted at 2.5% - 3.5% of premium income. Our surplus will exceed $50 million by year end 2008. Group dental service products sold under the Delta brand will be our primary business. We will position ourselves to develop out-of-state territories, but filling Virginia market opportunities will be primary. Strong networks and new business partnerships will play an important future role in our growth, project risk management, and profitability. We will insist that growth initiatives be self-sustaining and be consistent with our market, leadership and growth goals. We will position Delta to be the clear leader in the Virginia dental market and will be competitive in our chosen markets as perceived by key stakeholders. DDPV will engage all of its employees in the achievement of these objectives and will be viewed as an excellent, even exciting place to work and grow. Recognizing our mission statement, DDPV will also expand its oral health access and education programs within the Commonwealth of Virginia. We will more than double the revenue size of the company by the end of 2008. Our annual surplus growth from overall operations will be targeted at 2.5% - 3.5% of premium income. Our surplus will exceed $50 million by year end 2008. Group dental service products sold under the Delta brand will be our primary business. We will position ourselves to develop out-of-state territories, but filling Virginia market opportunities will be primary. Strong networks and new business partnerships will play an important future role in our growth, project risk management, and profitability. We will insist that growth initiatives be self-sustaining and be consistent with our market, leadership and growth goals. We will position Delta to be the clear leader in the Virginia dental market and will be competitive in our chosen markets as perceived by key stakeholders. DDPV will engage all of its employees in the achievement of these objectives and will be viewed as an excellent, even exciting place to work and grow. Recognizing our mission statement, DDPV will also expand its oral health access and education programs within the Commonwealth of Virginia.

52. 52 Delta Dental National Enrollment

53. 53 Competitive LandscapeNational Market Share

54. 54 Discussion Points History of Dental Benefits Dental Plan Enrollment Costs and Trends Plan Changes for 2005 The Delta Difference

55. 55 Current Dental MarketplaceTransition to PPO products PPO products are continuing to capture more than 50% of new covered lives DMO business continues to lag with a continued negative outlook for future sales We will more than double the revenue size of the company by the end of 2008. Our annual surplus growth from overall operations will be targeted at 2.5% - 3.5% of premium income. Our surplus will exceed $50 million by year end 2008. Group dental service products sold under the Delta brand will be our primary business. We will position ourselves to develop out-of-state territories, but filling Virginia market opportunities will be primary. Strong networks and new business partnerships will play an important future role in our growth, project risk management, and profitability. We will insist that growth initiatives be self-sustaining and be consistent with our market, leadership and growth goals. We will position Delta to be the clear leader in the Virginia dental market and will be competitive in our chosen markets as perceived by key stakeholders. DDPV will engage all of its employees in the achievement of these objectives and will be viewed as an excellent, even exciting place to work and grow. Recognizing our mission statement, DDPV will also expand its oral health access and education programs within the Commonwealth of Virginia. We will more than double the revenue size of the company by the end of 2008. Our annual surplus growth from overall operations will be targeted at 2.5% - 3.5% of premium income. Our surplus will exceed $50 million by year end 2008. Group dental service products sold under the Delta brand will be our primary business. We will position ourselves to develop out-of-state territories, but filling Virginia market opportunities will be primary. Strong networks and new business partnerships will play an important future role in our growth, project risk management, and profitability. We will insist that growth initiatives be self-sustaining and be consistent with our market, leadership and growth goals. We will position Delta to be the clear leader in the Virginia dental market and will be competitive in our chosen markets as perceived by key stakeholders. DDPV will engage all of its employees in the achievement of these objectives and will be viewed as an excellent, even exciting place to work and grow. Recognizing our mission statement, DDPV will also expand its oral health access and education programs within the Commonwealth of Virginia.

56. 56 Premium Trends

57. 57 Benefit Trends Composite fillings on posterior teeth Invisalign braces TMJ Cleanings-four/year (periodontal cleanings) Implants Consumer directed healthcare

58. 58 Discussion Points History of Dental Benefits Dental Plan Enrollment Costs and Trends Plan Changes for 2005 The Delta Difference

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60. 60 Discussion Points History of Dental Benefits Dental Plan Enrollment Costs and Trends Plan Changes for 2005 The Delta Difference

61. 61 Who Is Delta Dental? The largest and most experienced provider of group dental benefits nationally Delta Dental Plans Association 38 plans with a common mission & focus Shared national provider networks National Provider File

62. 62 Superior Networks and Access DeltaPremier Largest Network Available Anywhere! 136,500 dental offices 2675 Participating Premier Providers in Virginia (79% of all providers statewide) 29 million members 82% of TLC/School groups using a Premier provider 77% of TLC Government groups using a Premier provider 210 New Premier Providers since 4/1/04

63. 63 National Networks…With Local Control Seamless network of Delta Dental Plans across the country Recruitment and management of provider networks performed by local representatives Professional Relations staffs are well versed on concerns with specific offices or local dental societies - part of the community Delta Dental offers the best of both worlds Ability to offer national networks, while providing local support for providers

64. 64 State-of-the-Art Technology DCS2000® Claims System Single site for claims processing and customer service Designed specifically for dental claims Server-based, Windows technology Paperless processing

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66. 66 Internet Website: www.deltadentalva.com

67. 67 Making a Difference in the Community

68. 68 The Delta Difference! Total Focus on Dental Benefits Largest, Most Experienced Dental Benefits Carrier in the Nation Aggressive Cost Management Superior Network Access Proprietary DCS2000® Dental Claims System Community Involvement Satisfied Customers!

69. 69 Broader Plan Choices 25 or fewer - any one plan. 26 to 100 - any two plans, one of which may be the Regional HMO, if available 100+ - any two self funded plans plus the Regional HMO, if available

70. 70 Funding Requirements Full Time 80% of average single rate 20% of average dependent rate if less than 75% participation. Part Time 40% of average single rate 10% of average dependent rate if less than 75% participation

71. 71 TLC/DHRMFinancial Overview T.J. Clayton George Gibbs Walt Norman

72. 72 Renewal Requirements Data Sheet Memo of Understanding Group Profile Sheet

73. 73 COBRA Update Regulations finally final New Requirements Q/Bs to provide certain notices to plan (divorce, etc.) Notice of Unavailability Termination Notice Changes to Initial Notice, Election Notice Recommend sending new initial notice to all TLC will send materials prior to July 1, 2005 Our forms must be used TLC will allow 45-day grace period on COBRA premiums

74. 74 USERRA Uniformed Services Employment and Re-employment Relief Act requires all groups regardless of size to offer 24 months of Extended Coverage for Active Duty Military call ups.

75. 75 HIPAA All groups regardless of size must send certificates of creditable coverage to terminating participants MOU required With QME, TLC will allow Plan Change effective 7/1/2005 or later.

76. 76 Dependent Definition under WFTRA Spouse – Legally recognized in VA Children To end of year turning age 23 regardless of student status Lives at home or away at school Unmarried Receives over ½ of support from either or both parents (To be effective later in the year)

77. 77 GASB 45 Federal requirement that cost of retiree coverage be funded or carried as liability on books. Private sector requirement since early 1990s as FASB TLC will provide guidance and data but each group will be responsible for any required actuarial certification and/or filings

78. 78 Medicare D Still unclear Requires certification of creditable coverage TLC will initially let you know if creditable Awaiting further CMS guidance

79. 79 Alternate ID #s Effective 10/1/2005 TLC will issue alternate ID numbers to all covered employees Still 4 ID cards

80. 80 General Housekeeping Life Evac Air Ambulance now in network Reporting Medicare eligibility required New email and web addresses: www.thelocalchoice.virginia.gov walter.norman@dhrm.virginia.gov