CoverageFirst ® PPO The easy first step toward consumer choice plans. Now with more options for your smaller clients! April 2005 GHC-17612 4/05.

CoverageFirst® PPOThe easy first step toward consumer choice plans. Now with more options for your smaller clients!

April 2005

GHC-17612 4/05

The Easy First Step Toward Consumer-Choice Plans

A simple solution-no complicated banking arrangements

All the benefits of a full PPO plus an up-front allowance

Motivates employees to use their benefits wisely - and to consider costs

Guides employees in becominginformed consumers of health care

A Quick Review• CoverageFirst is a PPO plan that can help

members save money. Members change their behavior by becoming more involved in their health spending decisions.

• Unique four-phase design:– Annual allowance of $500 per member

promotes consumerism: member must manage allowance up-front before paying toward deductible

– Annual deductible after eligible expenses total $500

– Coinsurance goes into effect after member meets the deductible

– Safety net ensures 100% coverage for all eligible expenses after the member reaches the out-of-pocket maximum

CoverageFirst: How it works

that applies after a member spends the allowance for the year.

in which CoverageFirst pays all or most additional eligible medical expenses until the member satisfies the annual out-of-pocket maximum

CoverageFirst 100/70 plan – new options (for 2-50 case size)

Current Additional options

Deductible $2,500$3,000/$4,000/$5,000

Copayment $25 $40 – office visit – office visit $100 – ER

$50 – outpatient facility

CoverageFirst 80/60 plan – new options (for 2-50 case size)

Current Additional options

Deductible $1,000 $1,500/$2,000/$2,500/$3,000/$4,000/$5,000

Copayment $25 – $40 – office visitoffice visit $100 – ER

$50 – outpatient facility

Out-of-pocket $2,000 $3,000/$4,000 (Available with allMaximum deductible options)

Rate reduction!For groups with 2-50 employees,

CoverageFirst 100/70 plan rates

will be reduced by 7.5 percent

Reduced rates start with 4/1/05 effective dates

Lower rates are available on our new product options

Rate reduction helps nudge your clients toward consumer-choice plans

Humana’s Consumer Choice Continuum Today

CoverageFirst

New Options Benefit AllowanceFully insured fund

SmartExpressCoins PPO w/ PCA

Employer Funded

Traditional Products

PPO, HMO

Consumer Choice Continuum

Health SavingsAccount

Employee Funded

• Introduces the concept of consumer choice• Appropriate for groups at any point on the continuum• Good strategy for employers: Offer CoverageFirst at a low employee premium as a dual choice strategy to encourage high participation. Consider adding “buy-up” options to encourage engagement.

Dual Choice Strategy

$500 $625

$375 $375

$125 $250

Example

Standard copayment plan 90/60 with $500 deductible

With a dual choice strategy, the employer can encourage consumer engagement by contributing at the same level for both plans.

Premium

Employer contribution

Employee contribution

Example

CoverageFirst 80/60 with $1,500 deductible

Dual Choice

Wrap-up

CoverageFirst PPO – an easy first step for employers not ready to dive into more complicated consumer-choice plans

Broad choice of deductible and copayment options

Changes employees’ behaviors and attitudes about health care costs – spending allowance encourages planning, cost-comparing, and budgeting

For 2-50 groups, reduced ratesfor 100/70 plans with 4/1/05 effective dates

Great option for dual-choice strategy

Thanks for your interest in the“new and improved” CoverageFirst PPO plan!

What else would you like to know about CoverageFirst?