Employee Health Benefits 2012 Open-Enrollment. 2 Today’s Agenda Welcome & Introduction HealthAmerica Overview Network Accessibility Medical Benefits Overview.

Employee Health Benefits 2012 Open-Enrollment

2

Today’s Agenda

• Welcome & Introduction

• HealthAmerica Overview

• Network Accessibility

• Medical Benefits Overview

• Pharmacy Benefits/Administration

• Additional Member Benefits

• Enrollment Process

• Customer Service/Claims Administration

• Questions?

3

HealthAmerica Overview

• Subsidiary of Coventry Health Care, Inc.

• Deeply rooted in Pennsylvania since 1975

• Regional offices in Pittsburgh, Erie, Harrisburg & Plymouth Meeting

• Approximately 465,000 members

• Only carrier in PA with a statewide, seamless PPO network

• Access to national PPO network

• Strong financials

• Commitment to quality – NCQA – Excellent Accreditation– HEDIS – Leader in PA – US News & World Report Rankings

HealthAmerica at a Glance

5

Hallmarks

• One of the top health plans in the nation. Current commercial health plan ranking: 14 — the top six percent*

• Our Medicare plan is ranked 28 out of 183 Medicare plans evaluated nationwide**

• Excellent NCQA Accreditation for HMO, POS, and Medicare HMO

• HEDIS scores outperform statewide competitors and national averages in most categories

*NCQA’s Health Insurance Plan Rankings 2010-11 - Private**NCQA’s Health Insurance Plan Rankings 2010-11 - Medicare

6

• Dickinson College

• Carnegie Mellon University

• Delta Dental of PA

• Lancaster Schools Consortium

• Verizon Wireless

• Lycoming College

• Hanover Foods Corporation

• Ward Trucking

• General Electric

Major Accounts - Statewide

7

Network Accessibility

8

Best in Class Network Solution

• Pennsylvania provider network– Statewide network is directly contracted & proprietary– More than 250 hospitals and 49,000 providers*

• National network – More than 5,600 hospitals and

550,000 providers

*January 2011

9

Strong Local and Regional Network

10

PPO Nationwide Coverage (Coventry National Network)

Over 5,600 Hospitals and 550,000 Professional Providers

Coventry Health Plans

Coventry National Network

11

Transplant Centers of Excellence (Adult)

1. Allegheny General Hospital (Pittsburgh, PA)2. Cleveland Clinic (Cleveland, OH)3. Johns Hopkins Hospital (Baltimore, MD)4. Loyola University Medical Center (Maywood, IL)5. Medical College of Virginia Hospitals (Richmond, VA)6. Milton S. Hershey Medical Center (Hershey, PA)7. Northside Hospital (Atlanta, GA)8. St. Louis University Hospital (St. Louis, MO)9. Stanford University Hospital (Stanford, CA)

10. Tulane University Medical Center (New Orleans, LA)11. Tenet Health System-Memorial Medical Center & Lindy

Boggs Medical Center (New Orleans, LA)12. University of Alabama Health System (Birmingham, AL)13. University of Iowa Medical Center (Iowa City, IA)14. University of Kansas Medical Center (Westwood, KS)15. University of Pennsylvania (Philadelphia, PA)16. University of Virginia Health Sciences (Charlottesville, VA)

CHC Plan Location

12

1. Children’s Hospital Medical Center (Cincinnati, OH)2. Children’s Hospital (Pittsburgh, PA)3. Cleveland Clinic Foundation (Cleveland, OH)4. Johns Hopkins Hospital (Baltimore, MD)5. Lucile Salter Packard Children’s Hospital (Stanford, CA)

6. Medical College of Virginia Hospitals (Richmond, VA) 7. Milton S. Hershey Medical Center (Hershey, PA) 8. Tulane University Medical Center (New Orleans, LA) 9. University of Alabama Health System (Birmingham, AL)10. University of Virginia Health Sciences (Charlottesville, VA)

Transplant Centers of Excellence (Pediatric)

13

Medical Benefits Overview

• Increased mh/sa benefits.

• Enhanced benefits for autism spectrum disorders.

• Out-of-pocket maximum excludes deductible

• Benefits limits/maximums reset on 6/1; continued on a calendar year basis on 1/1/13.

• $25 inpatient copay included on mh/sa & SNF

• Addition of a $3.00 Tier 1A Rx copay

• Increased outpatient rehabilitation therapy visits

• Continuation of deductible carry over benefit

• Open access mh/sa benefits – no out-of-network

Benefit Plan Additions/Changes - 2012

1515

PPO Benefits Overview

Benefit CategoryPARTICIPATING

Choice 1NON-PARTICIPATING Out-

of-Network

Annual Deductible

$0 Single

$0 Family

$300 Single

$600 Family

OOP Maximum (excludes Deductible and Copays)

$0

$0

$2,000 Single

$4,000 Family

Coinsurance (after Deductible is met) 100% 80%

PCP/Specialist Office Visit $10 Copay80% Eligible Charges (after annual deductible)

Preventive CareWell Child, Adult Physical, Annual GYN Exam 100% or $10 Copay

80% Eligible Charges (after annual ded. or waived)

Emergency Room Copay$25 Copay (waived if admitted

$25 Copay (waived if admitted

Inpatient Hospital Care $25 copay (per admission )80% Eligible Charges (after annual deductible)

16

Emergency Care

• Worldwide ‘Emergency Care’ Coverage - $25 Copay (waived if admitted)

• Non-emergent use of the emergency room Exercise Good Judgment

• a medical emergency is defined as a sudden accident or medical condition that poses a significant jeopardy to your health, impairment to bodily functions, or serious dysfunction of any bodily organ or part if you do not seek immediate medical care.

• call your physician or HealthAmerica’s NurseLine if you are uncertain whether your symptoms warrant a visit to the emergency room.

• Ambulance Services – covered @ 100% (medically necessary)

17

Pharmacy Benefits Overview

18

Prescription Drug BenefitsRetail:

• $3 - Tier 1A Generic

• $10 – Tier 1 Generic

• 10% coinsurance (min. $20; max. $100) - Brand-Name

• 10% coinsurance (min. $40; max. $100 - Non-formulary

Mail Order:• $6 – Tier 1A Generic

• $20 - Tier 1 Generic

• $40 – Brand-Name• $80 – Non-formulary

(Limit of 90-day supply)

• “Freedom” Formulary – Refer to insert in your O/E packet – (take to your doctor’s office)

• Generic Substitution – (Restrictive Generic) If you elect a brand-name drug when your physician authorized a generic drug is available; you pay the Tier 2 cost PLUS ancillary charge (difference in price).

• Quantity limits may apply (QLL)• Tier 1A $3.00 Copay (select generics) -

90-day supply of maintenance meds. @ retail level

• Over-The-Counter drugs: Claritin, Prilosec OTC, Zaditor eye drops, Zyrtec, Allegra, etc. – $3 Copay with script from doctor.

• Copay per container at pharmacy

• Lifestyle Drugs (discounted) - weight loss and certain non-covered smoking cessation drugs.

• Diabetic meters - available at “no cost” (LifeScan Brand - J & J program)

19

Drug Formulary

• Drugs are removed generally only 1x time per year (effective January 1).

• Drugs can be added throughout the year (generally quarterly).

• Communication of changes: Members adversely impacted are sent notification

60 days in advance of changes.

Notify physicians annually during the month of December.

Annual changes posted on HealthAmerica website.

Note: Not all generic medications are covered at Tier 1 (lowest copay).

20

What Makes Us Different?

• Manage our own Formulary• Medco is our pharmacy benefits administrator• Promote select OTCs to lower costs• Targeted $0 “copay waiver” program• $3 Tier 1A • Freedom formulary • Flexible benefit packages

21

Member Education Resources

•Take formulary to every doctor visit– Ask for the evidence behind the choice

– Ask for the lowest copay drug that is safe & effective

– Use INDEPENDENT sources for information• Consumer Reports at www.CRBestBuyDrugs.org• MedlinePlus at www.medlineplus.gov• How to take drugs at www.safemedication.com• Summary comparisons of drugs by disease state at

www.effectivehealthcare.ahrq.gov

22

Additional Member Benefits

23

NurseLine – 24/7

•Registered Nurses•24 / 7•Sick or Injured•Health care questions•800# on all ID cards

24

Health Education Reimbursements(Learn & Earn Program)

• Group class format / behavior change

• 100% Reimbursement (80% completion)

Back Care

Cardiovascular Disease Prevention

Diabetes Education

Nutrition Education

Prenatal Education

Safety Education

Smoking Cessation

Stress Management

General Wellness

• $350/member/calendar year Weight Management

25

Digital Online Coaching

•Balance - weight management •Breathe - smoking cessation •Relax - stress management •Nourish – nutrition improvement •Move - physical activity •Achieve - cholesterol management •Control - blood pressure management •Overcoming Depression - depression management •Overcoming Insomnia - sleep improvement

26

WellBeing Member Discounts

• WellBeing– Fitness Facilities

• International Fitness Club Network

– Acupuncture– Massage Therapy

•Weight Watchers Online

•VisionOne Vision Discounts

•Lasik Vision Correction

– EyeMed– QualSight

27

Living Well - Member Magazine

• Up-to-date health information

• Updated health plan information

• Listing of resources and tools

• Articles available online for your employee newsletter

• Important contact information

• Distributed bi-annually

28

Enrollment Process

29

Completed Enrollment Forms due by: Monday, April 23rd!

■ Forms must be completed accurately with all required data.

■ Must provide real social security numbers and street addresses, no P.O. boxes

ID Cards will be mailed directly to your home.

Each member of the family receives own ID card.

Timeline

30

Enrollment Form

31

Sample ID Card

32

Customer Service &Website Resources

3333

Dedicated Customer Service Team

Strategic Customer Service• 1-800-252-5742

• www.healthamerica.cvty.com

MHNET (Behavioral Health)• 1-866-369-8362

Hours of operation:Monday -- Friday: 8:00 a.m. - 6:00 p.m.

Hours of operation:Monday -- Friday: 8:00 a.m. - 6:00 p.m.

34

Our Website –www.healthamerica.cvty.com

35

35

My Online Services Features

• View benefit information

• Check claim and referral status

• Print ID cards

• Manage HSA thru HealthEquity

• Review and print “EOB’s”

• View medical claims history

• View prescription claims history

• Access Medco to order prescriptions

• Review out of pocket and deductible accumulators

• Access Wellbeing to participate in online coaching programs or take HRA

• Establish a personal health record to print and share with providers

• Set and track personal health goals

My Online Services

3636

• Order an ID card• View & print temporary card• Locate a network provider• Change address• Request literature• View contact numbers• Review plan documents &

benefit usage

• Check claim status & lab tests• Check eligibility• Update your COB information• Send and receive secure

messages from customer service within 24 hours• Manage your personal

health with our wellness tools

-- Available 24/7 -- Web access via My Online Services

Online Customer Service

37

Questions?