Agenda

1. Embracing a Healthy Lifestyle through the State Health PlanNew Plan Options and Incentives for 2014

2. Agenda • Why are we Making Changes for 2014? • New Plan Options for 2014 • Introducing New Wellness Incentives • Open Enrollment for 2014 • Additional Resources

3. Why Are We Making Changes for 2014? • The State Health Plan is providing more choice for members. The Treasurer conducted a listening tour across the state last year and the Plan has conducted various focus groups and surveys and the message has been clear, members have stated that they want more options. • Many of the changes and new choices are designed to encourage members to become more engaged in their health and take steps to live a healthier life. • The Plan also believes an engaged membership will help ensure that the State Health Plan remains financially stable in the years ahead.

4. Health Plan Options for 2014 Enhanced 80/20 Plan NEW: Consumer-Directed Health Plan (CDHP) with HRA Traditional 70/30 Plan • The current Standard 80/20 Plan with a new name to match the new features • $0 ACA Preventive Services • $0 ACA Preventive Medications • New Wellness Incentives • Reduced medical copay opportunities • A new health plan option • A high-deductible medical plan • A Health Reimbursement Account (HRA) to help offset the deductible • 85/15 Coinsurance • $0 ACA Preventive Services • $0 ACA Preventive Medications • CDHP Preventive Medication List ($0 deductible) • New wellness incentives • Additional HRA funds for visiting certain providers • The current Basic 70/30 Plan with a new name • No incentives available • No $0 ACA Preventive Services • No $0 ACA Preventive Medications Open Enrollment will be conducted October 1 – 31, 2013. You must complete enrollment—otherwise, you and your covered family members will be enrolled in the Traditional 70/30 Plan effective January 1, 2014.

5. A New Focus On Wellness Enhanced 80/20 Plan NEW: Consumer-Directed Health Plan (CDHP) with HRA Traditional 70/30 Plan • Wellness premium credits when: • Subscriber completes a Health Assessment • Subscriber attests for him/herself and spouse (if applicable) to not smoking...or to being in a smoking cessation program • Selecting a Primary Care Provider (PCP) for self and all dependents • Additional wellness incentives • $15 copay reduction for utilizing the PCP (or someone in that practice) listed on the ID card • $10 specialist copay reduction for utilizing a Blue Options Designated Specialist • $0 inpatient hospital copay for utilizing a Blue Options Designated Hospital • Wellness premium credits when: • Subscriber completes a Health Assessment • Subscriber attests for him/herself and spouse (if applicable) to not smoking...or to being in a smoking cessation program • Selecting a Primary Care Provider (PCP) for self and dependents • Additional wellness incentives • $15 added to the HRA when the PCP (or someone in that practice) listed on the ID card is seen • $10 added to the HRA when a Blue Options Designated Specialist is seen • $50 added to the HRA when a Blue Options Designated Hospital is utilized for inpatient services • No incentives available • No $0 ACA Preventive Services • No $0 ACA Preventive Medications

6. Wellness Premium Credits

7. Who can be a Primary Care Provider? • A Primary Care Provider can practice: • General / Family Medicine • Internal Medicine • Pediatrics, or • Obstetrics and Gynecology • A Primary Care Provider can be: • Licensed Nurse Practitioners • Physician’s Assistants • Specialty Providers cannot be selected as a PCP.

8. What Is a Blue Options Designated Provider? • Blue Options Designated providers meet BCBSNC criteria for: • Delivering quality health outcomes • Cost effectiveness • Accessibility by members • The Blue Options Designated provider network includes hospitals and certain types of specialists: • General Surgery • Ob-Gyn • Gastroenterology • Orthopedics • Cardiology • Neurology To find a Designated Blue Options provider, members may go online to www.shpnc.org and click on Member Services, then on “Find a Doctor or Facility” or call 888-234-2416

9. The Enhanced 80/20 Plan • An enhanced version of the current Standard 80/20 Plan, except • New name – The Enhanced 80/20 Plan • New incentives to encourage members to manage their health and lower their health care costs • Preventive Care – There will be no copays on Affordable Care Act (ACA ) preventive services or preventive medications. • Primary Care Provider (PCP) – To receive a $15 PCP copay reduction, a PCP must be selected by Oct. 31, 2013. • If the selected PCP is not available at the time of the appointment, the member may visit any provider in the same practice and still receive the copay reduction • If a member wants to change PCPs, they can go to their enrollment portal and select a new PCP. A new ID card with the PCP’s information will be mailed to the member. The PCP change must be made before visiting the new PCP. • Providers* - When a specialist or hospital is needed, members have the option to select a Blue Options Designated Provider: • Specialists – To receive a $10 Specialist copay reduction, choose a Blue Options Designated provider • Hospitals – To avoid a $233 Inpatient Hospital copay, select a Blue Options Designated Hospital *Members may visit any provider in the BCBSNC Blue Options network and be considered “in-network”. The additional rewards are tied to the incentives outlined above and throughout this presentation.

10. Lower Your Premiums with Wellness Premium Credits—The Enhanced 80/20 Plan

11. Lower Your Health Care Costs with Wellness Incentives—The Enhanced 80/20 Plan

12. ACA Preventive Medications You must have a Prescription for these medication to have them covered at 100%

13. Enhanced 80/20 Plan Highlights in 2014

14. The Consumer-Directed Health Plan (CDHP) with HRA   High-Deductible Health Plan Health Reimbursement Account (HRA) A different kind of health plan with two components • Covers the same services as other Plan options through the same PPO network • The deductible is higher than other Plan options, but the coinsurance is lower • In-network: $1,500 Individual/$4,500 Family • Out-of-Network: $3,000 Individual/ $9,000 Family • After the deductible is met, the member only pays the 15% coinsurance • The deductible applies to both Pharmacy and Medical expenses • If the member reaches his or her deductible and coinsurance out-of-pocket maximum, the Plan pays 100% of the covered expenses for the rest of the benefit year (medical and pharmacy) • The Plan funds the members’ Health Reimbursement Accounts (HRA) annually • HRA funding is based on the number of family members covered • $500 for employee/retiree only • $1,000 for employee/retiree + 1 $1,500 for employee/retiree + 2 or more dependents • HRA funds are used to pay a portion of the members’ deductibles & coinsurance • Once the HRA is depleted, the member must pay the remaining deductible & coinsurance • Incentives available to add value to HRA • Unused HRA funds are available the following year

15. The Consumer-Directed Health Plan (CDHP) • A High Deductible Health Plan is exactly what it says – A plan with a high front-end deductible. • After meeting the deductible the member pays a 15% coinsurance on all in-network medical and pharmacy benefits except ACA preventive services and ACA preventative medications, which are covered at 100%. • The pharmacy and medical deductible and out-of-pockets are shared. • An additional CDHP preventive medication list is covered with no deductible meaning the member is subject to 15% of eligible expense only.

16. Consumer Directed Health Plan (CDHP): Pharmacy Benefits The Deductible Does Not Apply to Every Medication • Under the Affordable Care Act, many ACA preventive medications are paid at 100% • Medications on the CDHP Preventive medication are subject to 15% coinsurance with no deductible. Example of medications include those used to treat heart disease or stroke, asthma, and diabetes. These 2 different medication lists will be posted online at www.shpnc.org.

17. How The HRA Helps The Member Meet Their Deductible Coverage Type HRA Pays Total Deductible You Pay Employee Only First $500 Remaining Deductible $1,000 $1,500 In-Network $3,000 Out-of-Network Remaining Deductible $2,500 Employee + One Family Member First $1,000 Remaining Deductible $2,000 $3,000* In-Network $6,000 Remaining Deductible $5,000 Out-of-Network Employee + Two or more Family Members First $1,500 Remaining Deductible $3,000 $4,500* In-Network $9,000 Remaining Deductible $7,500 Out-of-Network *The HRA is a pooled account and is available to whichever family member needs it first. It is possible for one family member to use all the funds before another family member has a claim.

18. How the Consumer-Directed Health Plan with HRA Works #1 #6 #2 #3 #5 To monitor HRA balance and claim’s payments, members may go online to www.shpnc.org and click on My Member Services. #4

19. Lower Premiums with Wellness Premium Credits—CDHP

20. Lower Member Health Care Costs with Wellness Incentives—CDHP

21. CDHP Highlights in 2014

22. The Traditional 70/30 Plan • Traditional 70/30 Plan – The new name for the current 70/30 Basic Plan; there are no changes to the Plan’s benefits for 2014 • Copays and Deductibles – The copays and deductibles on the Traditional 70/30 PPO plan are the same as they are today on the 70/30 Basic Plan. There will be no opportunities for copay reductions on the Traditional 70/30 Plan. • Network Services – Members may visit any provider, but they will pay less when they go to a BCBSNC network provider • Preventive Services – Copays still apply to preventive services.

23. Traditional 70/30 Plan Benefit Highlights

24. Monthly Premiums—Enhanced 80/20 Plan *Assumes completion of three wellness activities

25. Monthly Premiums—CDHP *Assumes completion of three wellness activities

26. Monthly Premiums—Traditional 70/30Plan Reminder: Wellness premium credits are not offered under the Traditional Plan.

27. Completing Open Enrollment • Action must be taken during Open Enrollment—October 1–31, 2013: • Choose a health plan • Decide whom to cover • Complete wellness activities • Remember, NC Flex Benefits enrollment in Oct. as well. • Online enrollment only – through the eEnroll or BEACON platform, depending on your agency • Choices are effective from January 1, 2014 through December 31, 2014 If you do not complete your enrollment by October 31, 2013, you, and any currently covered family members will be enrolled in the Traditional 70/30 Plan effective Jan. 1, 2014.

28. Enrollment Instructions BEACON • Employee Self Service (ESS), available on the BEACON website at https://mybeacon.nc.gov. Select the “My Benefits” link to begin enrollment. • For instructions, click on the “Read Before Beginning Online Enrollment” link. • Members without ESS access may contact BEST Shared Services at 919-707-0707 (in Raleigh) or 866-622-3784 (statewide) to complete enrollment by phone. eEnroll • All changes need to be done through the eEnroll system by logging in to the system at https:// shp-login.hrintouch.com to enroll. For assistance in navigating eEnrollmembers can call Benefitfocus Customer Service at 855-859-0966.

29. Resources for Members • Please READ your mail! • There will be 4 mailers sent to you to assist you in your decision. • SHP Website • There will be 4 instructional videos posted to the Plan’s website. • Premium Rate Calculator tool available online in September • Enrollment tour will be conducted across the state in October, more information will be included in one of your mailers • Sign up for our monthly electronic newsletter, Member Focus, which can be done by visiting the Plan’s website

30. Important Numbers • ELIGIBILITY AND ENROLLMENT for eEnroll Agencies 855-859-0966 • BEST SHARED SERVICES: BEACON919-707-0707 • BLUE CROSS AND BLUE SHIELD OF NC (BENEFITS, CLAIMS and HRA) 888-234-2416 • EXPRESS SCRIPTS (PHARMACY QUESTIONS for Active/Non-Medicare Retirees)800-336-5933

31. Thank you!