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Your Guide to Health Care Benefits

Our Benefits Philosophy

• Deliver competitive benefits

• Offer value to you and your family

• Encourage you to make informed health care choices

• Help keep costs sustainable – for the company and you

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[Adjust as needed]

Health Care Reform Update

• Starting January 1, 2014, nearly everyone in the U.S. must have medical coverage or pay a penalty

• Your options for coverage:– Full time/part time employees (30+ hours/week) –[client name]’s

medical plan meets government affordability requirements • Not eligible for a government subsidy

– Part time employees (<30 hours/week) not eligible for coverage at [client name] – may need to look to the public marketplace

– Spouse’s medical plan– Your state’s Health Insurance Marketplace or “Exchange”– Private insurance companies– Medicaid, TEFRA and the Children’s Health Insurance Program

(if eligible)

Health Care Reform

What’s Coming Up• August 2013 – December 2013

– You may hear more about your Exchange options or get information from individual medical plan companies

• [October 1 – November 15, 2013]– [Client name] 2014 Open Enrollment

• October 2013 – March 2014– Exchange enrollment period for 2014 coverage

• January 1, 2014– Nearly everyone must be enrolled for health care coverage or

pay a penalty

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Your Medical Options

PPO

Health Savings Account (HSA)

Company Contributions

Your Contributions

CDHP + HSA

Medical Options:

Compare and Contrast PPO CDHP

Routine and preventive care?

100% covered in-network 100% covered in-network

Are there copays?

Only for doctor’s visits, specialists’ visits and ER

No copays

Pay the deductible first?

Yes, except for prescription drugs

Yes, but the HSA helps

Coinsurance? 75% in-network50% out-of-network

80% in-network60% out-of-network

Out-of-pocket maximums

Only for medical care;your prescription drug costs are

separate

Only for medical care;most of your prescription drug

costs are separate

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[update as needed]

Medical Options:

Compare and Contrast

PPO CDHPNetworks Cigna Healthcare Cigna Healthcare

What are the payroll deductions?

Lower deductibles; higher premiums

Higher deductibles; lower premiums

The most you’ll pay out-of-pocket in a year if you stay in the network?

For medical care onlyEmployee Only: $4,000Family: $12,000

You continue to pay your share of prescription drug costs

For medical care onlyEmployee Only: $4,000Family: $8,000

You continue to pay your share of prescription drug costs

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[update as needed]

Deductibles, Coinsurance and Out-of-Pocket Maximums

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PPO (in-network)

CDHP(in-network)

Deductible• Individual• Family

$750$2,250

$2,000$4,000

Your coinsurance (what you pay) 25% 20%

Out-of-pocket maximum• Individual• Family

$4,000$12,000

$4,000$8,000

After you reach out-of-pocket max, your coinsurance (what you pay)

0% 0%

[update as needed]

Deductible and Out-of-Pocket Maximum Work Differently:

If You Enroll Dependent(s)

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Two ways to meet the deductible (CDHP example) …Combined covered expenses

for entire family.

$4,000

Covered expenses for one family member, or …

• You must meet the family deductible before the plan begins to pay benefits for anything except preventive care

• You must meet the family out-of-pocket maximum before the plan pays 100%

$4,000

[update as needed]

CDHP with HSA: Working Together

Preventive care

Plan pays 100%

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Health Savings Account

Together, contributions from you and the Company can cover you deductible and coinsurance.

CDHP with HSA: Working Together

Preventive care

Plan pays 100%

Deductible

You pay 100%. Once

the deductible is met,

coinsurance kicks in

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CDHP with HSA: Working Together

Preventive care

Plan pays 100%

Coinsurance

You and the Company share a percentage of the costs until you meet the out-of-pocket maximum.

Deductible

You pay 100%. Once

the deductible is met,

coinsurance kicks in

Health Savings Account

Together, contributions from you and the Company can cover you deductible and coinsurance.

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Health Savings Account

Together, contributions from you and the Company can cover you deductible and coinsurance.

CDHP with HSA: Working Together

Preventive care

Plan pays 100%

Out-of-pocket maximum

Once you reach this, the plan pays 100% of

in-network costs.

Deductible

You pay 100%. Once

the deductible is met,

coinsurance kicks in

Coinsurance

You and the Company share a percentage of the costs until you meet the out-of-pocket maximum.

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Health Savings Account (HSA)

Available with the CDHP if you have no other medical coverage

Money goes in tax-free

Money comes out tax-free when you use it for qualified health care expenses

Unused HSA balance stays with you

Health Savings Account (HSA)

Company Contributions

Your Contributions

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Health Savings Accounts (HSAs):

We Get You Started

Based on your medical coverage level

CompanyContribution

Individual $500

Family $1,000

*The company does not make HSA contributions for highly-compensated employees.

HSA

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Health Savings Accounts (HSAs):

IRS Contributions Limitsfor Your HSA

HSA

When you … You and the Company can contribute up to a combined …

Enroll for Individual coverage

$3,300 per year

Enroll for Family coverage

$6,550 per year

Are age 55 or older

An extra $1,000 per year

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Health Savings Account: An Example

How Money Goes Into Your HSA

HSA$1,000

Provided for enrolling$500

You add$500

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Health Savings Account: An Example

How Money Comes Out

- $138 visit to your primary doctor- $30 for two prescriptions- $148 specialist visit

$316

$684 left

HSA$1,000

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Health Savings Account: An Example

Unused HSA Dollars Roll Over

2014: $684 remaining

2015:Start off with $684

Health Savings Account:

Consider Saving Enough to Cover Deductible

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In-Network Deductible

Company contribution

What you need to save

Individual Coverage $2,000 $500 $1,500 or $125/month

Family Coverage $4,000 $1,000 $3,000 or $250/month

[update as needed]

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Examples to Help You Choose

Example 1Single,

Generally healthy

Example 2Family

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CDHP

PPO

Care + Rx

PCP: $200

Prescription Drugs: $180

Total: $380

Teresa’s Out-of-Pocket

Health Care Costs

= $380

HSA Dollars

Company: $500

+

Teresa: $500

Total in HSA: $1,000

Out-of-Pocket(minus HSA dollars): $0

Carries forward$620 in HSA

Premium + HSA contributions: $X,XXX

Care + Rx

PCP: $50

Prescription Drugs: $180

Total: $230

Teresa’s Out-of-Pocket

Health Care Costs

= $230

Teresa – Generally healthy, single, in her late 20s

Here’s what Teresa anticipates her expenses to be in 2014, based on her care in 2013:

• 3 doctor visits – one preventive – and 12 prescriptions (at $15 each)

Premium: $X,XXX

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Tami and Sam – Family coverage

Here’s what Tami anticipates her expenses to be in 2014, based on her care in 2013:

• 8 doctor visits – 5 preventive – and 1 specialist, with 12 generic prescriptions (at $15 each) and 3 brand-name (at $35 each)

• 2 follow up specialist visits

Care + Rx

3 Doctor visits = $3001 Specialist visit = $200

Prescriptions drugs = $180Preferred brand prescriptions = $105

2 Follow-up specialist visits = $400

Total: $1,185

Tami’s Out-of-Pocket

Health Care Costs

= $1,185

HSA Dollars

Company: $1,000+

Tami: $400

Total in HSA: $1,400

Out-of-Pocket(minus HSA dollars): $0

Carries forward$215 in HAS

Premium + HSA contributions: $X,XXX

Tami’s Out-of-Pocket

Health Care Costs

= $5,10 Premium: $X,XXX

Care + Rx

3 Doctor visits = $751 Specialist visit = $50

Prescriptions drugs = $180Preferred brand prescriptions = $105

2 Follow-up specialist visits = $100

Total: $510

CDHP

PPO

Prescription Drug Coverage

• You receive prescription drug coverage when you enroll in either medical plan

• Generic: $15 copay

• Brand-name formulary: $35 copay

• Brand-name non-formulary: $50 copay– For 30-day supplies when you visit retail pharmacy

• 90-day supplies available through mail-order

• CDHP offers preventive prescription drugs covered at 100%

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Dental OverviewIn-network

Plan year deductible• Individual• Family

$50$150

Plan year maximum• Individual $1,500

Preventive• Exam• Cleanings• X-rays

100 %

Basic• Fillings• Endodontics • Periodontics

80% after deductible

Major• Crowns/Bridges 50% after deductible

Orthodontia (Children under 19)

Up to $1,250 lifetime maximum benefit

Vision Overview In-network

Deductible $25

Eye exam (every 12 months)

Covered at 100% up to $125 after deductible

Frames(every 12 months)

Covered at 100% up to $125 after deductible

Contact lenses One pair every 12 months in lieu of

eyeglasses

NO changes to Dental benefits

NO changes to Vision benefits

[update or delete]

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Consider Your Choices

Enroll for medical

coverage?

Consider your likely health care

needs, other available

coverage, cost

Which medical

plan?

Consider your estimated total cost

If you enroll in the CDHP - how much to

additionally contribute to your HSA?

Consider what it would take to meet the deductible

Factor in employer contributions and your own

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Three Simple Steps to Enroll

Verify your dependents

Submit the

needed documents within

31 days of enrolling a new

dependent

Complete your screenings and

health assessment

Online health assessment available

starting October 1

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Enroll for 2014 benefits

Everyone must make an election – visit the

Employee Portal to enroll from

Oct. 1 – Nov. 15