Office of Group Benefits

Office of Group Benefits
Annual Enrollment 2012 FOR ACTIVE EMPLOYEES & RETIREES WITHOUT MEDICARE

Welcome This presentation is a summary of information and does not purport to present complete details of all plan options offered by the Office of Group Benefits. For complete information on each plan option, individuals should read plan documents carefully and also consult other OGB and plan administrators’ publications.

Welcome This presentation will cover: Ways to Save Eligibility
Overview of Health Plans Life Insurance Flexible Benefits

Office of Group Benefits
OGB serves state agencies, universities and school boards Prescription Drug Benefits 21.9% Administrative Costs 3.5% Mental Health Benefits 1% Medical Benefits 71.4% Life Insurance 2.2% OGB’s administrative costs are only 3.5% of total costs (June 30, 2011)

Annual Enrollment Timeline
Annual Enrollment ends Deadline for employees to submit health plan enrollment forms to HR (if changing plans) Annual Enrollment begins January 1 November 4 October 3 Flexible Benefits Annual Enrollment ends Deadline for employees to submit Flexible Benefits forms to HR (may be earlier for some agencies) 2012 plan year begins

Ways to Save

Your Health: Our Premium Priority 7 Ways to Save
1 Choose the right health plan for you Out-of-state coverage differs by plan Out-of-state dependent? Job transfer? Travel? Are your providers in the plan’s network? All plans accessible through OGB website 2 Stay in your health plan’s provider network Avoid balance billing 3 Request generic drugs Same active ingredients and big savings Preferred drug list at

Your Health: Our Priority 7 Ways to Save
4 Get preventive (wellness) exams Prevention Early diagnosis 5 Use Flexible Benefits (active employees) Pre-tax deduction saves money More take-home pay 6 Sign up for Diabetic Sense program (PPO & HMO plans) Get test supplies free Free glucometer Provided by Catalyst Rx through Liberty Sign up for Living Well Louisiana program (PPO & HMO plans) Access to health coaches 24 hours a day, 7 days a week Prescription drug incentive for active LWL participants Lower co-pays 7

Prescription Cost Comparison
Brand-Name Drug Average Cost per Prescription * Approved Generic Alternative Average Cost per Prescription * Ambien insomnia $ zolpidem $ Imitrex migraines 342.63 sumatriptan 66.85 Neurontin seizures 231.48 gabapentin 21.54 Flomax prostate hyperplasia 143.47 tamsulosin 42.06 Effexor XR depression 198.93 venlafaxine XR 129.85 Valtrex anti-viral 268.43 valacyclovir 149.43 Ultram ER pain 260.89 tramadol ER 138.33 Wellbutrin XL depression 258.79 bupriopion XL 61.16 Lamictal seizures 404.79 lamotrigine 24.26 Prozac depression 320.23 fluoxetine 12.39 Topamax seizures 422.89 topiramate 31.06 Zocor cholesterol 147.35 simvastatin 9.59 Pravachol cholesterol 147.95 pravastatin 12. 20 Paxil depression 140.85 paroxetine 13.68 * Average costs as of utilization; subject to change Source: Catalyst Rx

Health Management Program
Living Well Louisiana Health Management Program For PPO and HMO Plans Free health management program for active employees, retired employees without Medicare and rehired retirees without Medicare who are diagnosed with 1 or more of these 5 ongoing health conditions: Diabetes Heart disease Heart failure Asthma Chronic obstructive pulmonary disease (COPD) Living Well Louisiana is not available to individuals who have Medicare as primary coverage

Living Well Louisiana Health Management Program For PPO and HMO Plans Once enrolled, you have access to... Health coaches – 24 hours a day, 7 days a week Online health information and resources Reduced co-payments to eligible LWL participants for prescription drugs used to treat these 5 chronic conditions When Medicare Part A and/or B become primary, you are no longer eligible for LWL program

Living Well Louisiana Health Management Program For PPO and HMO Plans Active participation requires: Initial assessment by phone Follow-up contacts by phone, mail or Ongoing relationship with LWL health coaches (contact at least once every 3 months) If plan member fails to maintain contact with health coaches, or if Medicare becomes plan member’s primary health coverage, participant is no longer eligible to participate in LWL program or receive reduced co-pay on applicable prescription drugs

Premium Cost-Saving Strategies
Married Couples If both are state or school employees... Both eligible? May save if split coverage

Eligibility

Eligibility – Same for All Plans
Full-Time Employees and Dependents Legal spouse Louisiana does not recognize same-sex marriages regardless of other states’ laws Children up to age 26 – regardless of child’s student, marital or tax status No one can be enrolled simultaneously as both an employee and a dependent in OGB health plans or life insurance No dependent can be covered by more than one employee Dependent verification required

Eligibility – Children
Natural child of you or your legal spouse Legally adopted child Child placed in home for adoption Child in home under legal guardianship or custody Grandchild dependent on you whose parent is your covered dependent

Dependent Verification
Plan member must provide proof of the legal relationship of each dependent within 30 days of date of application for coverage Proof: Official documents Marriage certificate Birth certificate Other court records or legal documents

Eligibility Change – Newborns
Effective July 1, 2011, OGB must receive child’s birth certificate within 6 months of birth Birth letter will suffice for first 6 months only – if received within 30 days of DOB OGB will send reminder letter 90 days after birth date

Over-Age Dependents Covered child under age 26 who is or becomes incapable of self-sustaining employment is eligible to continue coverage as an overage dependent OGB must receive required medical records before dependent reaches age 26 Definition of incapacity broadened – now includes both mental and physical incapacity

Pre-Existing Condition Limitation for New Hires and Late Applicants
Must complete enrollment form (GB-01) within 30 days for new dependent … otherwise, pre-existing condition limitation (PEC) applies If diagnosed or treated within 6 months prior to enrollment date, condition is pre-existing ... no benefits are payable for that condition in first 12 months of coverage PEC limitation does not apply to anyone under age 19 May be exempt from pre-existing condition limitation if continuously covered without 63-day break in coverage prior to enrollment date

Retirement Coverage must be in effect prior to retirement date
Participation schedule applies to... Employees who joined an OGB health plan on or after January 1, 2002 Dependents who joined an OGB health plan on or after July 1, 2002 Prior OGB health plan coverage as a spouse qualifies in computing years of participation

Retiree Participation Schedule
Years of OGB Health Plan Participation State Premium Subsidy % Less than 10 years 19% 10 years or more, but less than 15 years 38% 15 years or more, but less than 20 years 56% 20 years or more 75% Schedule not affected when you change OGB health plans

Medicare and OGB Coverage
If you reached age 65 on or after July 1, 2005, AND are retired AND are eligible for Medicare Part A premium-free, then… You MUST enroll in Medicare Part B to receive OGB health plan benefits for medical expenses covered by Medicare Part B You must submit Social Security verification to OGB: If eligible – submit copy of Medicare card If not eligible – submit letter from Social Security This also applies to your covered spouse If you are not yet retired, this will apply when you retire

Overview of Health Plans

(Statewide – must choose
OGB Health Plans for 2012 PPO (Statewide) Administered by OGB HMO (Nationwide) Blue Cross and Blue Shield of La. Medical Home HMO (Statewide – must choose PCP in Region 9) Fully insured by Vantage Health Plan CDHP-HSA * UnitedHealthcare Regional HMO (Regions 6, 7, 8 & 9) * CDHP-HSA plan is not available to retirees; other plans are available to all employees and retirees

Key Points Can change health plans during Annual Enrollment
Compare costs, benefits and restrictions when choosing a plan Active employees and retirees who choose to keep same plan do not have to fill out a form Active employees who want to change plans must notify your HR office

Key Points Retirees who want to change plans must…
Fill out an OGB enrollment form … or Write a letter to OGB that includes: Your plan choice Your name and address Your date of birth Your daytime phone number Sign form or letter and mail it to ... OGB Eligibility Division P.O. Box 66678 Baton Rouge, LA 70896 ... or visit any OGB Agency Services office

Plan Member Out-of-Pocket Expenses
In-Network PPO HMO Medical Home HMO CDHP-HSA Regional HMO Coverage Area All regions Nationwide Statewide *** PCP must be in Region 9 (northeast LA) Regions 6, 7, 8 & 9 *** (Baton Rouge, Alexandria, Shreveport & Monroe) Administrator OGB Blue Cross Vantage Health Plan UnitedHealthcare Lifetime Maximum Unlimited Deductible $500 active $300 retiree 3-person maximum None $1,250 employee $2,500 employee + 1 $3,000 family Out-of-Pocket Maximum $1,000 per person ** $1,000 per person $3,000 per family No maximum $2,000 per person $1,000 per person $3,000 per family Hospital 10% of contracted rate* Pre-certification required $100 per day $300 maximum per admission 20% of Doctor Visits No referral required Co-pay $15 PCP $25 specialist Co-pay $10 PCP Referral required for most specialists; PCP required (primary care & specialty care) * Subject to plan year deductible and/or applicable co-insurance ** Active employees and retirees without Medicare *** Active employees and retirees without Medicare

In-Network PPO HMO Medical Home HMO CDHP-HSA Regional HMO Referrals None required Required for all specialists except OB/GYN; 1 routine eye exam every year Required for most specialists Maternity Doctor Visits 10% of contracted rate * $90 co-pay (first visit only) $10 co-pay 20% of contracted rate * No referral required MRI or CAT Scans *** $50 co-pay Sonograms *** $25 co-pay Chemotherapy Radiation Therapy *** $15 co-pay $25 co-pay per treatment Routine Mammograms ** 0% of contracted rate $0 co-pay 100% covered Member pays $0 Routine PSAs ** Cardiac Rehabilitation *** contracted rate * Complete within 6 months $15/$25 co-pay 20% co-insurance Pre-authorization required Up to 18 visits in 6-week period Emergency Care $150 deductible $100 co-pay 20% of contracted rate* * Subject to plan year deductible and/or co-insurance * * Age and time restrictions may apply *** Prior authorization may be required

Out-of-Network Providers PPO HMO Medical Home HMO CDHP-HSA** Regional HMO Louisiana resident 30% of fee schedule * $1,000 deductible per person; $3,000 maximum per family 30% of reasonable and customary charge * Emergencies covered worldwide; all other services require prior plan approval fee schedule * 30% of Vantage allowable after separate $1,000 deductible * Out-of-state resident 10% of Same as Louisiana resident * Same as Louisiana resident Same as Louisiana resident * * Plan member owes deductible, co-pay, co-insurance and balance of billed charges ** No out-of-pocket maximum for non-network providers

Mental Health & Substance Abuse Treatment Benefit
PPO ValueOptions HMO Medical Home HMO Vantage Health Plan CDHP-HSA OptumHealth Regional HMO Inpatient 2 Member pays 10% of contracted rate 1 $100 co-payment; $300 maximum per admission $100 co-payment per day; $300 maximum 20% of Outpatient $25 office visit co-payment 100% after $25 co-payment per office visit 2 co-payment 2 1 Subject to plan year deductible and/or co-insurance 2 Pre-authorization required

Prescription Drug Benefit PPO and HMO (Administered by Catalyst Rx)
Prescription Drug Benefit In-Network Plan Member Out-of-Pocket Expense Generic drug & brand-name drug with no generic available: Plan member pays 50% of cost Maximum $50 per 31-day fill After $1,200 per person per plan year, plan member pays co-pay of $15 for brand-name drug, $0 for generic drug Brand-name drug with FDA-approved generic available: Plan member pays cost difference between brand-name drug and generic, plus 50% of brand-name drug cost Cost not applied to $1,200 out-of-pocket maximum Formulary Open * Mail Order Program Same as above * OGB’s open formulary means EVERY FDA-approved prescription drug is covered by PPO and HMO health plans

Prescription Drug Benefit Regional HMO (Administered by VHP’s Catalyst Rx)
Prescription Drug Benefit In-Network Plan Member Out-of-Pocket Expense Generic drug & brand-name drug with no generic available: Plan member pays 50% of cost Maximum $50 per 30-day fill After $1,200 per person per plan year, plan member pays co-pay of $15 for brand-name drug, $0 for generic drug Brand-name drug with FDA-approved generic available: Plan member pays cost difference between brand-name drug and generic, plus 50% of brand-name drug cost Cost not applied to $1,200 out-of-pocket maximum Formulary Closed with exceptions * Mail Order Program 30-day supply – 1 co-pay 60-day supply – 2 co-pays 90-day supply – 3 co-pays * Prescription drugs not on Vantage’s formulary list may be available at higher out-of-pocket cost

Prescription Drug Benefit Medical Home HMO (Administered by VHP’s Catalyst Rx)
Prescription Drug Benefit In-Network Plan Member Out-of-Pocket Expense Per 30-day fill Generic drugs – $5 co-pay Preferred brand drugs – $30 co-pay Non-preferred brand drugs – $50 co-pay Specialty drugs – 20% co-insurance Formulary Closed with exceptions * Mail Order Program 30-day supply – 1 co-pay 60-day supply – 2 co-pays 90-day supply – 3 co-pays * Vantage Health Plan’s open formulary means prescription drugs not on the Vantage formulary list may be available at higher out-of-pocket expense

Prescription Drug Benefit CDHP-HSA (Administered by UHC’s PrescriptionSolutions)
Prescription Drug Benefit In-Network Plan Member Out-of-Pocket Expense Per 31-day fill Generic drugs – $10 co-pay Preferred brand drugs – $25 co-pay Non-preferred brand drugs – $50 co-pay Specialty drugs – $50 co-pay Prescription drugs subject to deductible except maintenance drugs Formulary Open Mail Order Program Same as above for 90-day supply Maintenance drugs not subject to deductible (See myuhc.com for list of maintenance drugs)

Life Insurance

Life Insurance Prudential Insurance Co. of America
Group term life insurance policy State pays half of premium for employees and retirees Employee pays full premium for dependent life insurance 25% reduction in coverage and appropriate reduction in premiums on July 1 after plan member reaches age and age 70

Premiums for Dependent Life
Life Insurance Basic Plan Option I Option II Employee $5,000 Spouse $1,000 $2,000 Each Child $ 500 Employee Premiums Schedule in Helpful Information Book Premiums for Dependent Life Employee Pays $0.88/mo $1.76/mo

Life Insurance Basic Plus Supplemental Plan Option I Option II
Employee Schedule to maximum of $50,000 (amount based on employee’s annual salary) Same Spouse $2,000 $4,000 Each Child $1,000 Employee Premiums Schedule in Helpful Information Book Premiums for Dependent Life Employee Pays $1.76/mo $3.52/mo

Life Insurance Accidental Death and Dismemberment (AD&D) benefits available to all active and retired employees covered under Basic or Basic Plus plan Retirees over age 70 not eligible for AD&D ALL inquiries and changes in life insurance must be made through your agency’s HR office

Sources of Information
OGB website with links to all health plans….. OGB (PPO)… Blue Cross and Blue Shield of La. (HMO)… Vantage Health Plan (Medical Home & Regional HMO)… UnitedHealthcare (CDHP-HSA)… Catalyst Rx… Living Well Louisiana Program… Diabetic Sense Program… ValueOptions… DataPath Administrative Services…

Flexible Benefits 2012 Plan Year January 1, 2012 – December 31, 2012

Flexible Benefits Options – Why Enroll?
Flexible Benefits Plan Reduce taxes Easy to participate Increase spendable income

Flexible Benefits – More Take-Home Pay
Premium Conversion Option (no fee) Set aside eligible payroll deductions for health care premiums Eligible premium deductions automatically continue in Premium Conversion from year to year unless you request to drop out during Annual Enrollment Health Savings Account Set aside money from paycheck for out-of-pocket medical expenses MUST RE-ENROLL EACH YEAR during Annual Enrollment Must participate in OGB Consumer Driven Health Plan (CDHP) General-Purpose (Health Care) FSA ($36/plan year) Set aside $600 - $5,000 (per plan year) from your paycheck for eligible out-of- pocket medical expenses Limited-Purpose (Dental & Vision) FSA Set aside $600 - $5,000 (per plan year) from your paycheck for eligible out-of-pocket dental and vision expenses only Dependent Care FSA Set aside money from your paycheck for dependent care expenses while you work

Premium Conversion

More Take-Home Pay – Example
Premium Conversion Option Category Participant Non-Participant Monthly Taxable Salary $3,000 Pre-Tax Premium (Employee + spouse) * - $420 $0 Taxable Income $2,580 Federal Taxes (25%) - $645 - $750 After-Tax Premium Spendable Income $1,935 $1,830 * Employee + spouse is health plan premium for employee and spouse $105 monthly savings x 12 months = $1,260 yearly savings

Premium Conversion (Free Participation)
Eligible Payroll Deductions OGB health plan premium OGB life insurance premium (Prudential) Employee portion only Some miscellaneous/statewide insurance premiums Cancer insurance deduction* Dental insurance deduction Hospital indemnity insurance deduction Intensive care insurance deduction Vision insurance deduction * Policy cannot have a cash value or a return-of-premium rider

Health Savings Account (HSA)

OGB Health Savings Account (HSA)
You cannot participate in OGB HSA option if you have: General-Purpose (Health Care) FSA – or your spouse has General-Purpose (Health Care) FSA Medical coverage under a non-CDHP TRICARE or TRICARE for Life coverage Used any VA benefits within previous 3 months Medicare Part A or Part B coverage You must participate in OGB Consumer Driven Health Plan (CDHP) to participate in Health Savings Account (HSA) option

You can use your HSA to pay these eligible expenses: Office visits (including deductibles and co-insurance) Chiropractic services Prescription drugs Over-the-counter medications with a prescription Dental expenses Eye glasses, contact lenses and solutions Eye surgery (including Lasik) Lab fees COBRA, Medicare and qualified long-term care premiums

State will make initial $100 deposit in your HSA State will match your additional HSA contributions, dollar-for-dollar, up to $400 – if made through an IRS Section 125 cafeteria plan via payroll deduction Reimbursement limited to current account balance Total contribution limits for calendar year: $3,100 (individual coverage) $6,250 (employee plus 1 or family coverage) Can add $1,000 more if you are over age 55

Health Savings Account (HSA) – Contribution Amount Changes
Requested changes in your contribution amount during the plan year will take effect as follows: A change request received on or before the 15th of the month will be effective on the 1st of the next month A change request received after the 15th of the month will be effective on the 1st of the following month

IRS “use-or-lose” rule does not apply Funds can roll over from one plan year to the next Money in your HSA grows tax-free If you change health plans or jobs, or you retire, HSA is yours to keep From age 65 on, you can use your HSA dollars for any health care or non-health care expense with no penalty Decrease your taxable income Use tax-deferred dollars to pay health care costs for family household members NOT on your health plan

UnitedHealthcare Consumer Driven Health Plan (CDHP) with HSA Option
UnitedHealthcare Consumer Driven Health Plan (CDHP) with Health Savings Account (HSA) option CDHP premium must be paid through an IRS Section 125 cafeteria plan (i.e. OGB’s Premium Conversion option) Health Savings Account (HSA) eligibility Current participants in General-Purpose (Health Care) FSA must have $0 balance on or before… December 31 to be HSA-eligible on January 1; or March 15 to be HSA-eligible on April 1

Flexible Spending Arrangements (FSAs)

FSA Participation Employees can participate in these Flexible Spending Arrangements: General-Purpose (Health Care) FSA Limited-Purpose (Dental & Vision) FSA Dependent Care FSA Even if they are... Not enrolled in Premium Conversion option Not enrolled in an OGB health plan

Eligibility and Enrollment Rules
General-Purpose FSA and Limited-Purpose FSA Must be active, full-time employee (as defined by employer) in a participating payroll system Must be continuously employed as active, full-time employee for at least 12 consecutive months from January 1, 2011, through December 31, 2011 Can enroll during Annual Enrollment or after you experience an IRS qualifying event Must re-enroll each year to continue participation

General-Purpose FSA General-Purpose Flexible Spending Arrangement
Minimum amount $600; maximum amount $5,000 Can be used for medical expenses – for you, your spouse and your eligible dependents Health coverage-related expenses – deductibles and co-pays Medications – both prescription drugs and prescribed over-the-counter drugs

GPFSA – Yearly Savings (Example)
Category Participant Non-Participant Monthly Taxable Salary $2,000.00 Monthly Deduction General-Purpose FSA - $150.00 Monthly Administrative Fee General-Purpose FSA - $3.00 Monthly Taxable Income $1,847.00 Taxes (20%) $369.40 $400.00 After-Tax (Out-of-Pocket) Health Care Expenses - $150.00 SPENDABLE INCOME $1,477.60 $1,450.00 $27.60 Monthly Savings x 12 = $ Yearly Savings

Limited-Purpose FSA Limited-Purpose (Dental & Vision) Flexible Spending Arrangement Minimum amount $600; maximum amount $5,000 Can be used only for dental and vision medical expenses Can be used in conjunction with a Health Savings Account Cannot participate in both General-Purpose (Health Care) Flexible Spending Arrangement (GPFSA) and Limited-Purpose Flexible Spending Arrangement (LPFSA)

Reminder – Dependent Coverage Rule
Reimbursement of eligible out-of-pocket medical expenses for children up to age 27 through: General-Purpose (Health Care) FSA or Limited-Purpose (Dental & Vision) FSA

Dependent Care FSA For eligible dependent care expenses while you work
Signing up for DCFSA Recurring Expense Service reduces submissions of DCFSA claims Reimbursement limited to current amount in account Must re-enroll each year to continue participation Minimum annual amount is $600 Must file an IRS Form 2441

DCFSA – Remaining Balance
After termination of employment, employee can use remaining balance in Dependent Care FSA while looking for work Claim reimbursement request must be submitted by April 29

Dependent Care FSA – Contributions
Parental/Tax Status Maximum Amount Allowed Dependents Single Parent or Married Filing Separately $2,500 Child age 12 or younger Older dependent incapable of self-care Single Head of Household $5,000 Married Filing Jointly Spouse incapable of self-care Note: DCFSA is good for employees who earn $25,000 or above

Easy Participation … FSA Card
mySource FSA card can be used to pay providers who accept MasterCard for eligible expenses… General-Purpose (Health Care) FSA Limited-Purpose (Dental and Vision) FSA Dependent Care FSA Full amount of General-Purpose (Health Care) FSA funds available immediately (interest-free loan) Full amount of Limited-Purpose (Dental and Vision) FSA funds available immediately (interest-free loan) Dependent Care FSA funds available upon deposit

Easy Participation … FSA Card
Fax receipts within 2 weeks upon request No receipts needed for: Hospitals Physician providers Dental providers Vision providers Doctors’ prescriptions and receipts needed for reimbursement of FSA-eligible over-the-counter drugs and medicines at: Albertsons CVS Pharmacy Kroger Sam’s Club Sav-A-Center SuperFresh Target Walgreens Walmart Winn-Dixie drugstore.com IPS

Grace Period and Run-Out Period
January 1, 2013 – March 15, 2013 Can incur eligible expenses during this period to be paid with money remaining in FSA from the immediately preceding plan year Run-Out Period March 16, 2013 – April 29, 2013 Must receive claims from the immediately preceding plan year for reimbursement

Flexible Benefits – Key Facts
No fee for Premium Conversion option or Health Savings Account option Administrative fee ($36 per account per year) – applies to: General-Purpose (Health Care) FSA Limited-Purpose (Dental and Vision) FSA Dependent Care FSA “Use or lose” rule applies to all FSAs – but not to HSA Flexible Benefits elections locked in for plan year – except in case of qualifying event as defined by IRS

Flexible Benefits Annual Enrollment Period
October 3 – November 4, 2011 May vary by agency – check with your agency’s HR office

DataPath Administrative Services
Phone (toll-free): Fax: Website:

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