Roswell Independent School District 1

 (a)NMPSIA doesn’t care about its members  (b) NMPSIA loathes 89% member satisfaction  (c) NMPSIA staff pocketed the extra millions  (d) Bernie Madoff made us do it  (e) NMPSIA’s reserves are depleted & claim costs are up 2

 Self – Insured Coverage  Excess Fund Balance went from $25 million on April 30, 2008 to negative $2 million on March 30, 2009  No Premium Increases allowed in FY10 legislative budget process 3

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Blue Cross Medical:No Change Presbyterian Medical:No Change UCCI Dental:No Change Davis Vision:No Change The Standard Life:No Change The Standard Disability:No Change 5

6 JULY 1 ST PLAN CURRENT PLAN

 New Introduction (Executive Director’s Letter)  New Employer Plan Matrix  Expanded Rules and Regulations Summary  New Summary of Benefits High & Low Options  New Prescription Drug Summary  New Davis Vision Summary 7

 Copay - The predictable fixed dollar amounts you pay for certain services.  Deductible - The amount you pay for health care before the PPO begins to pay  Coinsurance - The percentage of covered charges you pay after you meet the deductible  Out-of-Pocket Maximum – The maximum amount you pay for covered services in a calendar year. (Charges above the maximum allowable fees do not apply to the out-of-pocket maximum.) 8

$300 Deductible Plan pays 80% of next $12,500* (Member pays 20% or $2,500 ) $2,800 Out of Pocket met ($300 + $2,500) Plan pays 100% for rest of calendar year *This amount may be less if copays were also paid

Benefits What You Pay Preferred ProviderNonpreferred Provider High OptionLow OptionHigh OptionLow Option PPP Office Visit (Deductible waived) $20$25 30% (after deductible) 50% (after deductible) Specialist Visit (Deductible waived) $30$35 30% (after deductible) 50% (after deductible) Preventive Services (PAP test, cholesterol test, immunizations, etc.) (Deductible waived) $0 30%50% Lab, X-Ray, and Pathology 20%25%30%50% High-Tech Radiology (MRIs, PET Scans, CT Scans) 20%25%30%50% Surgery, Outpatient $150 copay per occurrence + 20% 25%30%50% Inpatient Hospital/ Facility Services $500 copay per admission + 20% 25%30%50% Ambulance – emergency (Copay per trip) $3025%$3025% Emergency Room 20%25%20%25% Urgent Care Facility (Deductible waived) $50 30%25%

Copays DON’T go in the deductible bucket Neither do non-allowed charges Deductible, coinsurance, and copays go in the out-of-pocket bucket  Deductible Bucket  Out of Pocket Bucket 11

Charges which are:  Not Covered, or  In Excess of Plan’s Allowable Amount when going out of network (balance billing) 12

Applies to Out of Network Charges Charge $1,000 Allowed $ 800 Balance $ 200 $200 does not go to deductible. Member is 100% responsible for this amount 13

An example of what the member’s responsibility could be for a medical office visit including lab and radiological services once the deductible has been met. BilledAllowablePlan Pays You Pay (In-Network)Notes Office Visit$300.00$73.00$53.00$20.00 Copayment (Deductible waived and not applied to deductible). Venipuncture $3.00$ Coinsurance after deductible is met. Urinalysis$4.00$ Complete Blood Count $70.00 $56.00$14.00 Radiologic Exam/Chest X-ray $39.00$31.20 $7.80 Grand Totals$300.00$189.00$145.80$43.20 Note: Your OOP includes co-pays, deductibles and coinsurance. *Please note that this is set up as an example and actual payments will vary.

A member obtains a routine physical and associated testing. Later in the year, the member suffers an injury requiring an emergency room visit. The member also sees their PPP, which includes associated lab test and a high- tech radiology test (MRI). These tests show a need for surgery, a brief hospitalization, and short-term physical therapy. BilledAllowablePlan Pays You Pay (In-Network)Notes Wellness Visit $300.00$ $0.00 The plan pays 100% of preventive care. ER Visit $7,000.00$1,700.00$ Deductible $ Coinsurance $1,120.00$ Total you pay for the ER facility. PPP Visit $190.00$90.00$70.00$20.00 Copayment. Follow up from ER service. Lab/X-Ray $250.00$175.00$140.00$35.00 Coinsurance MRI $2,300.00$1,500.00$1,200.00$ Total you pay for MRI. Out of Pocket So Far $ Hospitalization $40,000.00$28,000.00$26,135.00$1, $500 Copay plus Coinsurance Physical Therapy (x5) $2,000.00$ $0.00 You have satisfied your out-of-pocket max. The plan now picks you up at 100%. Grand Totals$52,040.00$32,165.00$29,365.00$2, Note: Your OOPM includes the deductible, copayments and coinsurance amounts. *Please note that this is set up as an example and actual payments will vary.

 Drug Firms' Spending on Consumer Ads Fell 8% in '08, a Rare Marketing Pullback - - spending on such ads reached a high of $4.8 billion in 2007, compared with less than $1 billion in 1997  Third tier (non-formulary) still covered, but member will pay 70% of discounted price  Formulary at nmpsia.com or catalystrx.com 16

Lunesta or Ambien CR for insomnia 70% of Discounted Price is $54. Member pays $54. Generic for Ambien (zolpidem tartrate) another sleep aid, would cost member $2. 17

Celebrex$48 naproxen $2 Vytorin$70 Zetia + simvastatin$35 Cozaar$35 Diovan$17 Aciphex$116 omeprazole $2 18

 Occupational Eyeware option (safety or VDT glasses)  Contact lens discount of 15% for amounts over allowable  Lens 123 offers 50% savings on replacement contact lenses 19

 Any More Questions?  Comments?  Thanks! 20