THA Group, Inc. Medical Plan Review 2014. 2 Agenda THA Healthcare: Year In Review Health Insurance Offerings Health Care Reform Changes for 2014 Additional.

THA Group, Inc.

Medical Plan Review 2014

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Agenda

THA Healthcare: Year In Review Health Insurance Offerings Health Care Reform Changes for 2014 Additional Plan Changes THA Group Health Savings Account Prescription Updates Plan Reminders 2013 Premium Rebate Update PPC/Healthgram Other Benefits Questions

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THA Group Healthcare: 2013 Review

Our year-end projections indicate that health care costs will increase by about 13% in 2013 compared to 2012.

The average number of members covered by the plan increased from 68 to 79.

Network coverage was expanded for employees in South Carolina

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2013 Estimated Health Expenses Per Member

$8531

$449

THA portion EE only GOLD premium

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Health Insurance Plan Changes

You will continue to have 2 Consumer-Driven Plans from which to choose – The Healthy Return$ and Healthy Return$ GOLD Plans

In order to be eligible for the Healthy Return$ GOLD Plan, you must be tobacco free

Both plans will be partnered with a Health Savings Account (HSA) to offset deductible expenses

Premiums will increase, but the increase is well below the national average- Premiums will increase between 5% and 9% depending on your coverage category- THA Group will pay 95% of the premium costs for Employee only coverage

Deductibles and out of pocket maximums will also increase slightly

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Your Premium Cost in 2014Healthy Returns $1,600/$3,000 Deductible

EE Only EE Spouse EE Children EE Family

Employee monthly contribution $60.39 $457.89 $365.90 $603.36

THA Group per pay period contribution $27.87 $211.33 $168.88 $278.47

IHC/IH per pay period contribution $30.20 $228.95 $182.95 $301.68

ILAH per pay period contribution $13.94 $105.67 $84.44 $139.24

Healthy Returns Gold $3,000/$5,950 Deductible

EE Only EE Spouse EE Children EE Family

Employee monthly contribution $40.77 $349.82 $320.93 $519.75

THA Services per pay period contribution

$18.82 $161.46 $148.12 $239.88

IHC/IH per pay period contribution $20.39 $174.91 $160.47 $259.88

ILAH per pay period contribution $9.41 $80.73 $74.06 $119.94

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Plan Comparison – Employee Only Coverage

Employee only coverage Healthy Return$ Healthy Return$ GOLD

Embedded deductible N/A N/A

Preventive care covered at 100%

Deductible $1,600 $3,000

Employer payment to open HSA acct (one time only)

$100 $400

Employer Match (annual) $100 $400

Co-insurance after deductible

20% until $3,000 out of pocket is met (incl. deduc.)

None. Plan pays at 100% after deductible.

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Plan Comparison – Family Coverage

Family coverage Healthy Return$ Healthy Return$ GOLD

Embedded deductible NO YES

Preventive care covered at 100%

Deductible $3,000 $5,950($3,000 individual)

Employer payment to open HSA acct (one time only)

$100 $400

Employer Match (annual) $100 $400

Co-insurance after deductible

20% until $5,500 out of pocket is met (incl. deduc.)

None. Plan pays at 100% after deductible.

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Health Care Reform Changes for 2014

Due to Health Care Reform, the following changes will be implemented to the THA Group plan effective January 1st, 2014: Pre-existing condition limitations will no longer be

imposed. Coverage for approved clinical trials is now

included.

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Additional Plan Changes

Endovenous Ablation Therapy – vein stripping is a cosmetic procedure that will now be limited to $2500 per year.

Cochlear Implants will now be covered under the medical plan.

Therapy visits will be capped at 30 per year. East Georgia Regional Hospital will no longer be

considered in network.

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Health Care Reform & The Individual Mandate

In 2014, most individuals will be required to have health insurance.

If you choose not to enroll in some form of health insurance, you will be subject to a penalty on your taxes of $95 ($285 family max) or 1% of your family income.

Please note: As a THA employee, you will not be eligible for a subsidy because you have access to coverage through your employer.

Please see more details on the individual mandate in your enrollment packet.

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What is a Health Savings Account?

A Health Savings Account (HSA) is a special account owned by an individual and used to pay for current and future medical expenses

Employee HSA contributions are made on a pre-tax basis, which provides savings by reducing your taxable income

HSAs are used in conjunction with insurance that does not cover first dollar medical expenses (except for preventive)

HSA plan rules are dictated by the IRS

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HSA Contribution Rules

Contributions to the HSA can be made by the employer or the individual, or both If made by the employer, it is not taxable to the employee

(excluded from income and wages) Maximum amount that can be contributed in 2014

$3,300 (employee-only coverage) $6,550 (family coverage)

Individuals age 55 and older can make additional "catch-up" contributions to their HSA For 2014 - $1,000

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THA Group HSA Contributions

Healthy Return$ Plan - THA Group will provide a one-time contribution of $100 to open an HSA account (new participants only). THA will also match HSA contributions up to $100 annually

Healthy Return$ GOLD Plan - THA will provide $400 to start an HSA account (one-time contribution for new participants). THA will also match HSA contributions up to $400 annually

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Prescription Updates

Step Therapy Step Therapy will now be required for the following classes of

medications: Insomnia Agents, SSRIs, SNRIs, and Specialty Medications

If you are prescribed one of these classes of drugs, you will be required to try the more cost effective alternative before filling the brand name drug

Quantity Limits THA will adopt Envision Rx’s standard quantity limits on all

medications If you are affected by any of these prescription drug changes, Envision

will provide a member notification to your home.

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Prescription Updates

DON’T FORGET!90 day fills are required on maintenance medications. Make sure you ask your provider for a 90 day prescription.

Publix offers 7 antibiotics for free! Next time you need an antibiotic, please request one of the free Publix antibiotics to save money.

Publix also now offers lisinopril & metformin at no cost. Many other pharmacies offer discounted generic medications as well.

Shop around for your medications to see where you can get the best deal.

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Plan Reminders

Pre-certification is required for the following procedures: non-emergency hospital admissions (including observation) ambulatory surgery (outpatient surgery) dialysis inpatient care inpatient rehabilitation services chemotherapy/radiation therapy durable medical equipment (rental or purchase) prosthetics pain therapy (outpatient)

Precertification is required 7 days in advance of a non-emergent procedure. Please note that often the provider will certify for you but it is ultimately your responsibility to make sure it is done. Please contact Healthgram to make sure the pre-cert has been done. Failure to comply with these requirements will result in a 50% reduction in benefits.

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Plan Reminders

Urgent Care vs. Emergency Room Did you know that an Emergency Room

visit costs an average of $2,019 If you visit an Urgent Care, you will only

pay a fraction of the cost ($796 on avg.) Save time and money by visiting an Urgent

Care facility instead of the Emergency Room

If you are experiencing a true emergency, please go to the nearest facility.

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Plan Reminders

The Care Network The Care Network utilizes St. Joseph’s/Candler facilities and physicians. To find an in-network provider or facility, please visit

http://www.sjchs.org/body.cfm?id=30 This website can also be found on your ID card. Memorial Hospital facilities and physicians are NOT in-network. Staying in-network will provide

you with the best benefits for the money.

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Plan Reminders

In-Network Benefits

It is your responsibility to check that your providers are in-network This includes any referrals that your provider may make For example, if you visit Optim Health (formerly Southeastern Orthopedic)

providers and they refer you to their surgery center - the surgery center is not in your network and you will be responsible for 100% of the charges for those services

Common out of network facilities – labs, x-rays, scans, surgery centers

Important Tip: Be sure to ask your provider about the cost of additional procedures he or she may recommend during your visit – be a good consumer!

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Plan Reminders

Spousal Coverage

A covered Employee’s spouse, who is employed and eligible for coverage under his/her employer plan, must accept coverage under his/her employer plan in order to be eligible for coverage under the THA plan. If the spouse is not employed or their Employer does not provide coverage, the spouse will be considered an eligible dependent.

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Plan Reminders

Advantages of being a part of the Savannah Business Group & The Care Network include:

Free Car Seats for newborns at Candler Hospital Meal Tickets for family members Bearly Sick – child day care service

(912) 819-7382 Discounts at Lord’s Eye Center Nurse Call Center – 24 hours a day

Available 7 days a week (912) 813-3360

For those patients who are unable to keep their scheduled appointments due to transportation difficulties, the network will assist by arranging a taxi to transport the patient to their scheduled appointment. (Call Managed Care – 912 819 3332)

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2013 Health Premium Rebate Program

Last Year’s Promise: During the year, we tracked actual health plan cost against actuarial

cost. If actual cost for 2012 was less than actuarial cost, employees would

receive a premium rebate of up to 5% (based on percentage savings realized)

The Results: Costs through the first 3 quarters of 2012 were significantly lower

than previous years Unfortunately, as employees satisfied their deductibles, 4th quarter

expenses brought the total plan costs to a level that negated any rebate opportunities

Costs have continued to rise through 2013

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Health Care Cost Control: What You Can Do

Practice healthy habits - Get your preventive screenings- Maintain a healthy diet and exercise- Abstain from smoking; use alcohol in moderation, if at all

Use The Care Network whenever possible Avoid costly alternatives like ER visits Get prior authorization; when costs are high, work with

Healthgram to identify alternatives Be an advocate with your coworkers. We are all in this

together!

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PPC is now

Primary PhysicianCare changed their name to Healthgram on September 1, 2013.

They have not changed ownership, staff, or location, and your customer service contact information remains the same.

Please do not discard your current insurance card until you receive your new insurance card for 2014.

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View your medical claims onlinewww.healthgram.com

As part of their updated look and feel, Healthgram has launched a redesigned website as well as new Member Portals. You’ll notice a more user-friendly system that will save you valuable time.

For initial log-in, follow the prompts using your member ID number found on your ID card

View claims for you and your family You have access to your personal health

information, including screening results.

Access your deductible and out-of-pocket amounts to determine what you’ve met and how much you have left.

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SECURE & Password-Protectedwww.healthgram.com

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Online Member Portal

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Mobile Website

Access important health plan information and your personal health record, all from your web-capable mobile phone.

View claims, rx history, deductibles, ID card info, test results, blood pressure, medications, and search for providers.

Go to www.healthgram.com using your mobile phone.

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What about my other benefits?

All other benefits will renew as is for 2014 – Dental, Vision, Disability, Life and AD&D

Dental premiums will increase by 14.2% (part of increase is due to additional Healthcare Reform taxes); all others are unchanged for 2014

Flexible Spending Accounts (FSAs) are still available for child care and medical costs (for those who do not participate in THA Group’s health plan)- You must enroll every year to participate

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How do I complete my benefits enrollment?

Change forms are available for any adjustments you need to make to your current coverage

If you do not wish to add, drop, or change coverage, simply check the “No Change” box on the change form and return to Talent Management

All completed forms are due in Talent Management no later than December 13, 2013.

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Questions?