State Employee Health Plan

1
State Employee Health Plan

• Non State Group
• Open Enrollment 2010

2
Changes for 2010

• Medical Plans
• Plan changes for Plan A
• Deductible increased to 150/300
• Coinsurance maximum increased to 1,200/2,400
• Quest LabCard added
• No plan changes for Plan B and Plan C
• Prescription Drug Plan
• Adding Performance Drug List
• Dental Plan
• Deductible increased to 50/150
• New value-based plan design

3
Medical Plan Options
4
Medical Plan

• Standardized Plan designs
• All plans include preventive care
• Not all services are covered
• Review the benefit description
• Questions - contact plans customer service
• Differences
• Provider networks
• All plans are Preferred Provider Organizations
  (PPO)
• Rates
• Additional services/discounts offered on Medical
  Plans websites

5
Selecting a Medical Plan

• Pick a plan design (Plan A, B or C)
• Review the Provider Networks
• ? Each of the medical plans uses a
  different provider network
• Review the other services each medical plan
  offers
• 4. Review the premiums

6
PPO Providers

• Claims paid based on the network status
• Network providers accept the plan allowance
• Non Network Providers can balance bill
• Non Network Providers may work at Network
  Facilities - examples
• Pathologists
• Emergency Room Providers
• Anesthesiologists
• Radiologists
• Laboratory Technicians

7
(No Transcript)
8
Primary Care Providers
? Primary Care Providers (PCPs) are defined as

• General practice
• Family practice
• Geriatrics

• Internal medicine
• Physician extenders
• Pediatrics

• ? Use a network provider
• ? Referrals not required by the medical plan

9
Preventive Care

• Physical Exams
• Well Woman
• Well Man
• Well Baby
• Well Child
• Immunizations
• Over age 60 shingles vaccine
• Flu shots

• Vision Exam
• Hearing Exam
• Bone Density Screening
• Mammogram
• Colonoscopy

10
Plan A Network Providers

• Preventive Care Covered at 100
• Office Visit Copays
• 20 for Primary Care Office Visits
• 40 for Specialist Office Visits
• 150/300 Deductible
• 20 Coinsurance
• Coinsurance Max 1,200/2,400
• Quest LabCard Benefit

11
Quest LabCard

• Optional benefit
• You will need to request tests are sent to Quest
  or..
• Use a Quest collection site
• The decision is up to you and your provider
• 100 coverage of eligible outpatient lab tests
• Saves you and the plan money
• For non-emergency outpatient lab work only
• Testing must be performed and billed by Quest
• You will receive a Quest ID card
• Quest logo will also be on your medical card

12
Plan B Network Providers

• Preventive Care Covered at 100
• Primary Care Office Visits
• 20 Adult Copay
• 10 Children age 18 and under Copay
• Specialist Office Visits
• 40 Adult Copay
• 25 Children age 18 and under Copay
• No Deductible
• 30 Coinsurance
• Coinsurance maximum 2,200/4,400
• Quest LabCard benefit

13
Quest Lab Card Savings
Charges on a typical lab claim for CBC, Lipid
Panel, TSH Basic Metabolic Panel

• Current Lab Fees
• Billed 194.83
• Allowed 155.86
• Coinsurance 80
• Plan pays 124.69
• Member pays 31.17

• LabCard Fees
• Total Charges 35.33
• Coinsurance 100
• Plan Pays 35.33
• Member Pays 0

Plan saves 89.36 and Employee saves 31.17
Source Quest Diagnostics, Inc.
14
Plans A B - Non Network Providers

• 500/1,500 Deductible
• 50 Coinsurance
• Coinsurance Max 3,650/7,300
• Preventive care not covered

15
Drug Plan

• Generic Drugs
• 20 Coinsurance
• Preferred Brand
• 35 Coinsurance
• Special Case Medications
• 75 per 30-day supply
• Non Preferred Brand
• 60 Coinsurance
• Discount Tier
• 100 Member responsibility

16
Drug Plan

• Print out the PDL and take it with you
• Preferred Drug List (PDL) available on website
• PDL is updated quarterly
• Talk to your doctor about prescription drug
  options
• Using Generics will save you money
• Specialty, Special Case and injectables lists
• on the website
• www.khpa.ks.gov
• www2.caremark.com/kse/

17
Performance Drug List

• Three drug classes of Performance Drug List
• ACE/ARBs Blood pressure lowering
• HMGs Cholesterol lowering
• PPIs Stomach acid reducers
• Must try a Generic before using a Non Preferred
  Brand Name Drug
• Claim system will review members history
• Generic and Preferred Brands not effected
• Those using a Non Preferred drug will be notified
  by Caremark

18
Performance Drug List
Blood Pressure Lowering

• Preferred ACE/ARBs

• Non Preferred ARBs

• Generic
• benazepril benazepril HCT
• captopril captopril HCT
• enlapril enlapril HCT
• fosinopril fosinopril HCT
• lisinopril lisinopril HCT
• moexipril moexipril HCT
• quinapril quinapril HCT
• ramipril
• trandolapril
• Preferred Brands
• Benicar Benicar HCT
• Micardis Micardis HCT

• Diovan Diovan HCT
• Teveten Teveten HCT
• Tekturna Tekturna HCT
• Angiotensin Converting Enzyme Inhibitors (ACEs)
• Angiotensin II Receptor Antagonists (ARBs)
• Direct Renin Inhibitors Combinations

19
Performance Drug List
Cholesterol Lowering Agents
HMG-CoA Reductase Inhibitors (HMGs or
Statins)/Combinations

• Preferred HMGs

• Non Preferred HMGs

• Generic
• simvastatin
• pravastatin
• lovastatin
• Preferred Brands
• Lipitor
• Crestor

• Vytorin
• Lescol
• Lescol XL
• Altoprev
• Pravachol
• Zocor

20
Performance Drug List
Stomach Acid Reducers
Proton Pump Inhibitors (PPIs)

• Preferred PPIs

• Non Preferred PPIs

• Generic
• omeprazole
• pantoprazole
• Preferred Brands
• Prevacid
• Nexium

• Aciphex
• Prilosec

21
Home Delivery
Medical Plan

• Convenient and easy
• Timing of orders
• New orders process within 10-14 days
• Reorders process in 5-7 days
• Up to a 60-day supply available
• Same Coinsurance requirements
• Convenient re-orders
• Online _at_ Caremark.com
• Phone [phone]

22
Projected Generic Launches

• 4th Qtr. 2009
• Prevacid
• Pulmicort Inhalation Suspension
• Valtrex

• 1st 2nd Qtr. 2010
• Arimidex
• Flomax 24 hour ER
• Hyzaar
• Effexor XR

• 3rd 4th Qtr. 2010
• Aricept
• Cozaar
• Namenda

http//www.khpa.ks.gov/sehp/2009_providers.html
23
Specialty Biotech Drugs
Medical Plan

• Designed for conditions that are difficult to
  treat with traditional therapy
• Treatments for cancer, MS, hemophilia, hepatitis
  C, rheumatoid arthritis and growth hormone
• Self-administered drugs for home use
• Overnight shipping
• Available only at Caremark Specialty Pharmacy
• Call Caremark Connect 1.800.237.2767
• Coordinates patient care with provider
• List of Specialty Biotech drugs available

http//www.khpa.ks.gov/sehp/2009_providers.html
24
Plan C QHDHP w/ HSA

• QHDHP is the medical drug plan
• HSA is the health savings account
• You are not eligible to enroll for an HSA if
• Anyone covered by Medicare
• Covered by another health plan that is not a
  QHDHP
• Covered by a health care flexible spending
  account
• Covered by TRICARE or TRICARE For Life
• Eligible to receive VA medical services

25
Plan C - QHDHP

• Network Provider Coverage
• 1,500/3,000 Deductible
• 20 Coinsurance
• 3,000/6,000 Out-of-Pocket Maximum
• Preventive Care Services paid at 100
• Non Network Provider Coverage
• 2,000/4,000 Deductible
• 50 Coinsurance
• 3,650/7,300 Out-of-Pocket Maximum
• Preventive Care is not covered

26
Plan C QHDHP Drug Plan

• Drugs are subject to the Deductible then
• Generic 10 Copayment
• Preferred Brand 30 Copayment
• Non Preferred Brand 55 Copayment
• Copayment is per 31-day supply
• Generic Incentive Provision
• Uses Caremark Preferred Drug List, Performance
  Drug list and Specialty Pharmacy
• Not creditable drug coverage for Medicare

27
Plan C Health Savings Account (HSA)

• Employer contribution to your HSA
• 75.00 per pay month for single
• 112.50 per pay month for family
• Member contribution to HSA
• Require contribution of 50 per month
• HSA bank depends on medical plan vendor selected
• http//www.khpa.ks.gov/SEHBP/benlink.htm
• HSA funds can be used to pay
• Deductible, Coinsurance, Copayments

28
Dental Coverage

• You have access to two PPO provider networks
• Delta Dental PPO
• Delta Dental Premier
• Plan Deductible
• Applies to Basic Major Restorative Care
• 50 per person, 150 per family
• Orthodontic benefit
• 1,000 per person per lifetime
• Annual benefit maximum
• 1,700 per person per year

29
Dental Preventive Care

• Covered in full
• Prophylaxis/cleanings twice per year.
• Oral examinations twice per year.
• Bitewing x-rays
• adults 1 x a year
• children under 18 - 2 x a year
• Full mouth x-rays once each five (5) years.
• Limited coverage for children only
• Sealants
• Space maintainers
• Topical fluoride

30
Dental Restorative Services

• Basic Restorative
• Regular restorative dentistry fillings
• Oral surgery
• Endodontics root canals
• Periodontics treatment of gum bone disease
• Additional Diagnostic X-Rays
• Major Restorative
• Special restorative dentistry crowns
• Prosthodontics bridges, implants, dentures
• TMJ Treatment Requires prior authorization
• Restorative care is subject to a 50 deductible

31
Value Based Plan DesignBasic Benefit

• If You have NOT had one preventive or office
  visit for cleaning or exam of the teeth in the
  preceding 12-month period

32
Enhanced Benefit

• If You have had at least one preventive or office
  visit for cleaning or exam of the teeth in the
  preceding 12-month period

33
Basic Vision Plan

• Exams subject to 50 Copay
• 25 Materials Copay then
• 100 single-vision, standard bifocal, trifocal
  lenticular lenses
• Up to 100 allowance for frames
• Elective Contact lens allowance 150
• Home delivery SVcontacts.com

34
Enhanced Vision Plan

• Includes Basic Plan Coverage PLUS
• Progressive lenses up to 165
• High index lenses or Poly-carbonate lenses up to
  116
• Scratch and UV coating
• Contact Lens Fitting Fee
• Subject to 35 Copay
• Limited Coverage
• Enhanced benefits not available from Non Network
  Providers

35
Non Tobacco Users Discount

• You must complete enrollment form and declare
  tobacco status to get the discount!
• 40 discount per month
• Must be a non tobacco user
• - or -
• Tobacco users agreeing to enroll in the
  HealthQuest tobacco control program beginning
  1/1/10

36
Tobacco Control Program

• Enroll in the tobacco control program between
  1/1/2010 and 1/31/2010 
• Complete an assessment with a Quit Coach by
  1/31/2010 
• Complete a minimum of four remaining telephone
  discussions with a Quit Coach by 5/31/2010
• Call the toll free number from 7 AM 2 AM any
  time you need to speak with a Quit Coach.
• Quit for Life will notify the SEHP once you have
  completed and you will receive a congratulatory
  letter from the SEHP. Additionally, employees
  will be requested to complete a survey to give
  their feedback on the program.

37
Paying the Base Rate in 2010

• The following will NOT be receiving the discount
• Elects not to disclose Tobacco status
• Tobacco users not enrolled in the tobacco control
  program
• Failed to enroll and declare tobacco status
• Members who enroll but fail to complete the
  tobacco control course within the required
  timeline will be notified of the loss of the non
  tobacco discount
• Every 6.5 seconds someone around the world dies
  from tobacco use. In fact, it is the only legal
  consumer product that kills when used as
  intended. Tobacco use is the second leading cause
  of death around the globe it causes more death
  globally than AIDS, illegal drugs, motor vehicle
  accidents, murder, and suicide combined.
• Source National Business Group on Health
  Tobacco the Business of Quitting

38
Resources

• Review the Open Enrollment (OE) booklet
• Call the health plan customer service
• Phone number in the front of the OE booklet
• Visit the KHPA website http//www.khpa.ks.gov/SEH
  P/Active.htm
• Benefit descriptions available
• Caremark PDL
• Provider listings
• Information on HSA accounts
• Email ?s to SEHP benefits_at_khpa.ks.gov

39
HealthQuest

• Health Screenings Online Health Assessment
• 50 gift card for completion
• Health Coaching
• Online Wellness Newsletter
• HealthQuest Website and Blog
• Wellness Presentations
• LIFELINE Employee Assistance Program
• 1-800-284-7575
• 24/7 support
• Confidential, personal counseling referrals
• http//www.khpa.ks.gov/healthquest/default.htm

40
Annual Open Enrollment

• October 1 October 31, 2009
• Enroll Using enrollment form
• Declare tobacco status
• Make changes
• Add/drop dependents
• Paper enrollment forms required
• New employees hired after September 10, 2009
• Coverage effective January 1, 2010

41
Required Documentation

• If you are adding a dependent, documentation of
  eligibility is required
• Birth certificates
• Marriage licenses
• Affidavit of common law marriage
• Social Security numbers for all covered members
• Documentation must accompany enrollment form
• If documentation is not received dependents will
  not be added to your plan for 2010

42
Identification Cards

• Make sure your address is up-to-date
• Plan A members will get new health plan id card
• All Plan A members will get a LabCard id card
• Delta Dental will be issuing everyone new id
  cards
• New cards for new/changed memberships only
• Superior Vision
• Caremark
• Plans B and C
• If you lose your card, call the health plan

43
Open Enrollment Checklist

• Enrollment Use enrollment form
• Must declare tobacco status
• Review health plan selections

44
Questions?
45
(No Transcript)