1

Health

Wealth

Wellbeing

Health

Wealth

Wellbeing

2012: Enrollment Presentation

2

Costs of Healthcare

Effect of Trend on PEPY Costs

Annual Trend Rate Current 2012 2013 2014 2015 201610% 8,918$ 9,810$ 10,791$ 11,870$ 13,057$ 14,363$ 12% 8,918$ 9,988$ 11,187$ 12,530$ 14,033$ 15,717$ 14% 8,918$ 10,167$ 11,590$ 13,213$ 15,063$ 17,171$

Effect of Trend on Total Premium Costs

Annual Trend Rate Current 2012 2013 2014 2015 201610% 8,739,907$ 9,613,898$ 10,575,287$ 11,632,816$ 12,796,098$ 14,075,708$ 12% 8,739,907$ 9,788,696$ 10,963,339$ 12,278,940$ 13,752,413$ 15,402,702$ 14% 8,739,907$ 9,963,494$ 11,358,383$ 12,948,557$ 14,761,355$ 16,827,944$

$14,075,708

$15,402,702

$16,827,944

$8,000,000

$10,000,000

$12,000,000

$14,000,000

$16,000,000

$18,000,000

$20,000,000

Current 2012 2013 2014 2015 2016

U.S. Renal Care costs are expected to average $8,918 per employee per year in 2011. At this rate, our costs will almost double in the next 5 years. This is simply not sustainable.

3

Costs of Healthcare

Nearly 1 in 3 adults has high blood pressure and does not know it

Chronic diseases related to lifestyle or personal behavior account for 87% of total healthcare spending

Heart disease is the #1 killer in the United States Tobacco use continues to be the leading cause of

preventable death in the U.S. and can lead to serious illness, disability and decreased quality of life

An estimated 66% of U.S. adults are either overweight or obeseU.S. Renal Care is very interested in the health and well-

being of its employees which is why we are investing in programs to keep you healthy and better manage chronic

conditions.

4

What’s New in 2012?

General: Spouses who have access to employer sponsored group

coverage elsewhere are no longer allowed to participate in the USRC medical plans – regardless of the price or quality of the other coverage.

A spousal affidavit will be required to enroll a spouse in a USRC medical plan

USRC strives to keep healthcare costs as low as possible for its employees. Historically, spouses have accounted for 18% of our medical claims and

one-half of our large claims.

5

What’s New in 2012?

Medical: Greater emphasis on wellness and chronic condition

management A spousal affidavit will be required to enroll a spouse in a

USRC medical plan

Pharmacy Tobacco cessation drugs will be moved to Tier 1 of the

formularyUSRC will be launching additional wellness programs during 2012 so please watch your

mailbox!

6

Benefit Costs – Who Pays for What?

Benefit Who Pays? Premium Taxation

Medical U.S. Renal Care & You Pre-Tax

Dental U.S. Renal Care & You Pre-Tax

Vision You Pre-Tax

Basic Life Insurance U.S. Renal Care Pre-Tax*

Supplemental Life and AD&D Insurance

You Post-Tax

Employee Assistance Program U.S. Renal Care N/A

Short-Term Disability U.S. Renal Care & You EE Portion – Post-TaxUSRC Portion – Pre-Tax

Long-Term Disability U.S. Renal Care Pre-Tax

Flexible Spending Accounts You Pre-Tax

*Premium for coverage amounts over $50,000 are shown as imputed income on your W2

7

Medical Benefits

U.S. Renal Care will offer two medical plans through Aetna POS II – traditional network-based plan that allows members to choose

any healthcare provider POS II with Health Savings Account Plan – a high-deductible health plan

with the added benefit of a Health Savings Account (HSA)

Aetna Benefits POS IIIn Network

POS II w/ HSAIn Network

Annual Health Savings Account Single Family

N/AN/A

$500 $1,000

Annual Deductible Single Family

$1,000$3,000

$2,000 $4,000

Out-of-Pocket Maximum Single Family

$3,000$9,000

$4,000$8,000

Office Visit PCP Specialist

$30$40

80% after deductible80% after deductible

8

POS II Plan

A POS plan uses a network of providers A lower level of coverage is provided for care

received outside the network No “primary care physician” referral required to

visit specialist Copay and coinsurance This plan offers increased benefits but costs more

than the POS with HSA plan

9

POS II Plan – Consider This…

Of the employees currently enrolled in the POS II plan single coverage Only 31% have reached single deductible ($1,000) Only 39% have paid $500 or greater toward their

deductible 27% have paid less than $100 of the $1,000 deductible

Of the employees currently enrolled in the POS II plan family coverage Only 3 people have reached the family deductible

($3,000) Only 7% have paid $1,500 or greater toward their

deductible 42% have paid less than $100 of the $3,000 deductible

Fast Fact:

You should consider your annualized contributions when selecting the plan you enroll. If you are not meeting the deductible in the POS II plan, you may less out of pocket in the HSA plan.

*data thru September 30, 2011 in-network benefits only.

10

Medical Benefits - HSA Give employees access to a

fund they can use for their current or future healthcare expenses

Employees become better informed and more involved in making decisions about their own care

Employees will spend the money wisely

Unused money will rollover and grow over time

Money in your fund earns interest

Your account is portable – if you change health benefits, insurance plans or jobs, your HSA goes with you

Can be funded by the employer, employee or both

Federal government mandates the maximum amount that can be contributed each year

Money is put in fund pre-tax USRC funds:

$500 a year for individual; or $1,000 a year for family

You may contribute up to the 2012 maximum:

$3,100 individual; or $6,250 family

11

Medical Benefits - HSA

• Amount that needs to be satisfied before health coverage begins

• Protects you from high costs

• Coinsurance similar to traditional plans

• Out-of-pocket maximums are in place for added peace of mind

• Option to reimburse from this account

• Receive tax-free interest earnings while your money remains in your HSA

• If HSA funds are used for eligible expenses, then withdrawals are tax free.

Health Coverage

(ex. 80% In-Network)

HSA Fund ($500

Single / $1,000 Family)

AnnualDeductible

(ex: $2,000 Single / $4,000 Family) P

reven

tive C

are

As you go up the “stairs of the health care house,” you’ll incur expenses that go towards your deductible. Once you reach “upstairs,” or your deductible, then your 80% health coverage is applied. You can use your HSA to save tax dollars on medical expenses you incur. Money in your HSA can also be invested!

Preventive Care covered 100% (ex: Annual Physical)

12

Medical Plans Contributions

POS II POS II w/ HSA

Employee Bi-

Weekly Cost

USRC’s Bi-

Weekly Cost

Total Bi-Weekly

Cost

Employee Bi-

Weekly Cost

USRC’s Bi-

Weekly Cost

Total Bi-Weekly

Cost

Employee Only

$40.39 $201.08 $241.47 $29.76 $191.41 $221.18

Employee + Spouse

$140.55 $389.99 $530.53 $82.32 $403.62 $485.94

Employee + Child(ren)

$122.47 $371.24 $493.72 $72.40 $379.82 $452.22

Family $226.41 $556.31 $782.72 $127.71 $589.22 $716.94

Per Pay Period Contributions

13

Medical Plans Contributions

Plan Comparison Calculator

ExponentHR

Plan Information

Website Links

Select Calculator

14

Prescription Drugs

Prescription drug coverage is included with the medical plans offered

U.S. Renal Care encourages all employees to save money by selecting generics when available

76% of brand name drugs have a therapeutic generic equivalent▪ Generic medications are a safe and cost-effective alternative to brand-name

drugs ▪ Ask your doctor for a generic brand of the drug prescribed▪ If you must use a brand-name drug, ask your doctor for a drug that is a

preferred brand

Aetna Benefits POS IIIn Network

POS II w/ HSAIn Network

DeductibleRetail (30 Day Supply) Generic Brand Non Formulary

No Deductible

$15$35$50

After Deductible

$10$30$50

DeductibleMail (90 Day Supply) Generic Brand Non Formulary

No Deductible

$45$105$150

After Deductible

$20$60

$100

15

Medical Plans: Condition Management

The Aetna medical plans include access to Health Connections – a condition management program to help employees manage certain chronic conditions

The program provides access to a nurse who provides one-on-one education and support

Conditions include:

Vascular: Diabetes, congestive heart failure, coronary artery disease, hypertension, hyperlipidemia,

Pulmonary: Asthma, COPD

Cancer: Breast, lung, prostate, colorectal, lymphoma / leukemia

Gastrointestinal

Gastro esophageal reflux disease (GERD), peptic ulcer disease, chronic hepatitis, inflammatory bowel disease

Orthopedic / rheumatologic:

Osteoporosis, rheumatoid arthritis

Neurological Geriatrics, migraines, seizure disorders, Parkinson's

Other: Chronic Kidney disease, end stage renal, cystic fibrosis, HIV, chronic low back pain, sickle cell anemia, weight management

16

Dental Benefits

U.S. Renal Care offers two PPO dental benefit plans through Aetna The PPO buy-up plan includes adult and child orthodontia

Aetna Benefits PPO Basic PPO Buy-Up with Adult and Child Orthodontia

Annual Deductible (for Basic & Major)

Single Family

$50$150

$50$150

Services Diagnostic and Preventive Basic Major Orthodontia

100%80%50%

Not Covered

100%80%50%50%

Annual Maximum $1,500 $1,500

Orthodontia Lifetime Maximum Not Covered $1,500

Employee Contributions (Per Pay Period)

Employee Only Employee + Spouse Employee + Child(ren) Family

$6.12$12.25$13.78$19.91

$8.78$17.55$19.74$28.52

17

Vision Benefits

U.S. Renal Care offers a vision plan through VSP You pay 100% of the costs for vision care

VSP Benefits Vision PlanIn-Network

Frequency Limitations Eye Exams Lenses Frames Contact Lenses

1 per 12 Months1 per 24 Months1 per 24 Months1 per 24 Months

Eye Exam Copay $10

Materials Allowance Frames Contacts

$100 Allowance$115 Allowance

Employee Contributions (Per Pay Period)

Employee Only Employee + Spouse Employee + Child(ren) Family

$1.96$3.91$4.19$6.69

18

Disability Benefits

U.S. Renal Care offers short and long-term disability through MetLife

Short-term disability benefits are paid 50% by U.S. Renal Care and 50% by you

Long-term disability benefits are provided by U.S. Renal Care at no cost to you

MetLife Short Term Disability

Benefit Percentage 60%

Elimination Period (Accident & Sickness) 14 Days

Weekly Maximum $1,000

Benefit Duration 11 Weeks

Monthly Employee Contributions (Per $10 Weekly Benefit)

$0.123

MetLife Long Term Disability

Benefit Percentage 60%

Elimination Period 90 Days

Monthly Maximum $10,000

Employee Contributions None – Paid by U.S. Renal Care

19

Basic Life and AD&D Benefits

U.S. Renal Care offers Basic Life and Accidental Death and Dismemberment (AD&D) insurance through Prudential

Basic Life and AD&D benefits are provided by U.S. Renal Care at no cost to you

Prudential Basic Life and AD&D

Basic Life and AD&D Coverage

1 Times Annual Earnings

Maximum $300,000

Employee Contributions None – Paid by U.S. Renal Care

20

Supplemental Life and AD&D Benefits U.S. Renal Care offers Supplemental Life and Accidental Death and

Dismemberment (AD&D) insurance through Prudential Supplemental Life and AD&D benefits are paid for by you

Prudential Supplemental Life and AD&D

Supplemental Life Benefit Amount Employee Spouse Child(ren)

$10,000 Increments to a maximum of $300,000 or 5 times salary $5,000 Increments to a maximum of $150,000, not to exceed 50% of employee’s amount $1,000 increments to a maximum of $10,000 not to exceed 10% of employee’s amount*

Guarantee Issue Employee Spouse Child(ren)

Lesser of $100,000 or 3 times basic annual earnings $25,000 $10,000

Annual Enrollments Increases Employee Spouse Child(ren)

$10,000 Increments to a maximum of $40,000**All increases subject to EOIAll amount Guaranteed Issue

Supplemental AD&D Amount Employee Spouse Child(ren)

Same as Supplemental LifeVaries based on Employee amountVaries based on Employee amount

Employee Contributions Contributions are based on age. Please refer to benefits guide for pricing.*Amounts may be lower for children younger than 6 months.

**During the annual enrollment period, current employees who previously waived coverage or those currently enrolled may select/increase coverage as noted w/o EOI, up to the lifetime maximum without regard to the GI limit. Employees previously denied due to unsatisfactory EOI remain late entrants and EOI will be required from first dollar.

21

Flexible Spending Accounts

Flexible Spending Account (FSA) administration will be provided by Discovery Benefits

USRC offers two types of FSA accounts: Healthcare* & Dependent Care

Healthcare Flexible Spending Account

Dependent Care Flexible Spending Account

Annual Maximum $2,000 $5,000

Types of Expenses Medical, dental, vision copays and deductibles, hearing aides, eye glasses, contact lens

Day care, preschool, after school programs, elder care

*Participants enrolled in the POS w/ HSA plan are eligible to enroll in the Limited Health Care FSA which can be used once you meet that plan’s medical deductible.

REMEMBER: As part of Health Care Reform, over-the-counter medications (excluding insulin) purchased January 1, 2011 or after are ineligible for reimbursement under the Healthcare Spending Account unless

prescribed by your physician. Doctor’s prescription or letter of medical necessity must be submitted with itemized receipt at the time of the claim.

22

Employee Assistance Program (EAP)

U.S. Renal Care offers an Employee Assistance Program (EAP) through Prudential as part of the Basic Life offering

The program is available to all full-time employees and their family members at no cost

Services include: up to 3 telephonic calls per issue for: Personal Counseling: depression, marital and family conflicts, job

pressure, stress / anxiety, grief, loss, etc. Legal Guidance: divorce and family law, bankruptcy, criminal actions,

civil suits, real estate transactions, contracts, etc. Financial Advisors: saving for college, getting out of debt, retirement

planning, estate planning, tax questions, etc.

The EAP is 100% confidential. U.S. Renal Care will not receive any specific detail regarding who is accessing the program or why.

23

How You Can Manage Costs

Proactively manage your health If you have a chronic condition, enroll in the

Health Connections program Purchase generic drugs when possible Consider where you seek treatment

Event Average Cost

Primary care physician visit $117

Specialist (physician) visit $137

Urgent care* $164

Convenience care clinic visit** $74

Emergency room visit $798

Aetna Nurseline Free

* Urgent care clinics are care centers primarily used to treat patients who have an injury or illness that requires immediate care, but is not serious enough to warrant a visit to an emergency room. ** Convenience care clinics are health care clinics located in retail stores, supermarkets and pharmacies that treat uncomplicated minor illnesses and provide preventative health care services.

24

What To Do Next? Open Enrollment runs from 11/14/2011 – 11/28/2011

For additional information, please visit ExponentHR Choose the Benefits button Click on “2012 Benefits Guide” Print if desired

For detailed plan designs, please visit ExponentHR Choose the Benefits button Click on “Plan Information” Click on drop down and choose appropriate plan Print if desired

Enroll via ExponentHR Directions on page 15 of the Benefits Guide

See your Administrator or call the Benefits Department for more information

Visit AetnaNavigator.com for other tools to help manage your health

Drug & Hospital comparison tools Cost estimators Online health education tools

25

The information contained in this presentation is intended as an overview. If there are any differences between this information and the official Plan Documents, the Plan

Documents will govern.