1. State of Maine Employee Health & Benefits Insurance Update Revised 02/06/20131

2. What we’ll cover today... Explain how your health plan works Help you maximize your health benefits Provide overview of resources available to you Answer your questions 2

3. Who does what….. State Employee Health Commission 24 members Employees & Retirees Labor/management Design plan features Set premium rates Contract with vendors Aetna Third-party administrator (TPA) Process medical claims Maintain a network of doctors & hospitals Care management Division of Employee Health & Benefits Administrative support to the Health Commission Process benefit applications Maintain payroll records for insurance premiums for State employees 3

4. Point of Service Plan: “Self-Insured ” Health Plan Employee Paid Premiums Employer Paid Premiums Medical Providers Copays, Deductibles & Coinsurance Premiums are collected from plan participants, the State of Maine and ancillary employer groups. Those funds are used to pay for services provided by doctors, hospitals, prescriptions, etc. 4

5. Where does flat funding come from? Why is it important? The Point of Service (POS) health plan was flat funded as part of the budget passed by the State of Maine Legislature for fiscal years 2012 and 2013 The funding for the POS plan cannot exceed the premium rates in effect for fiscal year 2011 Premium rates must remain the same for both the employees/retirees and the employer paid premiums (e.g. State of Maine); the two primary funding sources to pay for medical claims 5

6. Types of medical expenses you pay for and those you don’t…. Office visit Prescription Emergency room visit MRI, CT scan Copay (flat dollar amount) Lab work X-ray Procedure Surgery Deductible (owed before plan covers) Lab work X-ray Procedure Surgery Coinsurance (percentage after deductible) Provided at no cost to you Routine physical exams Immunizations Routine gynecological exams Routine mammograms Routine eye exams Colonoscopies no copay | no deductible | no coinsurance Refer to your Benefit Overview for out-of-network coverage. See appendix for more information 6

7. Types of providers Preferred Providers Referred Providers Non-Participating Providers Primary care doctors Hospitals Primary care doctors Hospitals Pharmacies Specialists Primary care doctors Hospitals Pharmacies Specialists 7

8. Maximize the Benefits of Your Health Plan Choose a primary care doctor (“PCP”) Get a referral from your selected PCP Specialty services Tests Procedures Preferred providers Highest level of benefit Least out of pocket expense 8

9. What to do if you receive a denial of your claim…. You have options! Carefully review your explanation of benefits Call Aetna Member Services to review your claim with you (1-855-850-0039) Aetna appeal process Appeal to the State Employee Health Commission Independent external review administered by the Maine Bureau of Insurance (1-800-300-5000) 9

10. Resources to Assist You Aetna Member Services 1-855-850-0039 www.AetnaStateOfMaine.com Aetna Navigator DocFind Division of Employee Health & Benefits (207) 287-6780 or 1-800-422-4503 www.maine.gov/deh Maine Bureau of Insurance 1-800-300-5000 www.maine.gov/pfr/insurance/index.shtml 10

11. Thank you for attending! Questions? 11

12. Appendix 12

13. What is driving the increase in plan expenses? FY2012 (7/1/11-6/30/12): 6% increase or an extra $13.4 million in plan expenses (medical claims) FY2013 (7/1/12-6/30/13): 10% projected increase or an extra $22 million in plan expenses The FY13 10% increase is a direct result of: Cost of medical care is going up Hospital in-patient services up 14.4% Hospital out-patient services up 7.8% Increased utilization Up 3.5% 13

14. Copay, Deductible & Coinsurance Defined Copay: A flat dollar amount paid for certain health expenses Deductible: The amount you pay before the health plan provides coverage Coinsurance: A shared expense between you and the health plan *Deductible + Coinsurance = Calendar year out-of- pocket maximum limit 14

15. Co-pay Amounts Co-pay amounts will remain the same Primary Care office visit $0 or $20 Specialist office visit $25 Prescription Drug Copays 30-day supply - $10/$30/$45/$50 90-day supply - $15/$45/$70/$75 Generic/Name-brand formulary/Non-formulary/Lifestyle Emergency Room $100 & Walk-In Clinic $25 Advanced Imaging $50 15

16. Summary of Plan Design Changes: Comparison 8/1/11 to 7/1/12 Tier 1 Preferred Level Tier 2 Referred Level Tier 3 Self-Referred 8/1/11 7/1/12 Deductible Individual Family $0 $300 $600 $200 $400 $1,500 $3,000 $300 $600 $2,500 $5,000 Coinsurance Member Plan 5% 95% 5% 95% 15% 85% 20% 80% 25% 75% 40% 60% Out-of-Pocket Max Individual Family $500 $1,000 $1,100 $2,200 $1,000 $2,000 $3,000 $6,000 $2,100 $4,200 $5,000 $10,000 Any amount paid towards your 2012 deductible or coinsurance through June 30 th will be applied to the new limits for July 1 st. 16

17. Aetna’s On-Line Tools Customized website for the State of Maine “Express Lane” www.AetnaStateOfMaine.com www.AetnaStateOfMaine.com Find a Provider Benefit Overview Discount Programs (Fitness, weight management, vision, hearing, etc) Secure member website – Aetna Navigator Look up a claim Order/print an ID card Keep track of health care costs Change your primary care doctor Aetna Mobile Mobile web App for Android & iPhone 17

18. Includes all types of providers – PCP’s, specialists, hospitals, walk-in clinics, etc. Participates with Aetna Preferred status (based on results from the Maine Health Management Coalition) See www.GetBetterMaine.org for more informationwww.GetBetterMaine.org Find out additional information about your Doctor…certification status, language spoken, handicap access, accepting new patients, etc. Aetna DocFind 18

19. Division of Employee Health & Benefits: 1-800-422-4503 Each of you have access to a designated Benefits Specialist: Our Specialists can assist you with questions regarding eligibility, payroll deductions for premiums and general plan guidance. (Reminder: The best resource for questions regarding medical claims is Aetna Member Services 1-855- 850-0039.) If your last name begins with…. Your Benefits Specialist is…. Contact Information A – DOTDoris PietroskiDoris.pietroski@maine.gov DOU – KZJune SoucyJune.soucy@maine.gov LA – PLErica OuelletteErica.ouellette@maine.gov PO – ZEmily CharltonEmily.charlton@maine.gov www.maine.gov/deh 19

20. Additional Resources www.GetBetterMaine.org – the Maine doctor and hospital ratings www.GetBetterMaine.org www.leapfroggroup.org/cp - hospital safety scores www.leapfroggroup.org/cp www.maine.online.Staywell.com – Your personal wellness program www.maine.online.Staywell.com 20