2019 State Health P l an Open Enro l l m ent T rai n - PowerPoint Presentation

2019 State Health Plan Open Enrollment Training for Health Benefit Representatives Open Enr o l l ment D a tes: S e pt. 2 9 -Oct. 31, 2018

What We Will Cove r TodayNew State Health Plan WebsiteOverview of C h a n g e sPlan OptionsPremiumsEnrollment Process Overview 2

Introducing the State Hea lth Plan’s New WebsiteThe new website has a new look and feel and is NOW m obile res p on s ive!Changes to note:Name change of eEnroll to eBenefitsNC Health Smart transit i on to Health and Wellness 3

Become a State Health Plan We need your help in communicating this initia tive to y o u r employees!4

New Ex planation of Benefits (EOB) Coming Soon!Current EOBNew & Improved EOB T he se ne w and easier to read EOBs will belaunched in Aug ust (dra f t version shown).

New St ate Health Plan Member ID Cards for 2019Current ID CardNew & Improved ID C a rd A ll members will be receiving new ID cards this year. T h ey will b e mailed in l a te N o v em b er / ear l y De c em b e r .

Enrollment Overview7

Open Enrollment, Changes & Dependent Eligibility ReminderOpen Enrollment is the time to add and drop dependents as well as review and change plans. Outside of Open Enrollment, there must be a qualifying event to add or drop dependents and those changes must be made within 30 days of the event.It is essential that dependent verification documentation is maintained on all dependents. (e.g., birth certificate, marriage certificate, court orders). Refer to list on Plan’s website.

Enrollment SiteEnrollment site: https://hr.unca.edu/benefits-enrollmentSign-On: Your username and password will be the same information you use to access your UNC Asheville computer/email or OnePort login.All Changes are Effective January 1, 2019

Insurance Terminology Q. What is a Deductible?A deductible is a specified amount that you must pay before the insurance company will pay anything toward a claim.Q. What is a Copay? A copay is a fixed amount, typically paid at time of service or for prescription costs, in addition to what the insurance pays.Q. What is Coinsurance?Coinsurance is the percentage you pay after the deductible is met. (i.e. for the 80/20 Plan, you pay 20% insurance pays 80%.) Q. What is a Coinsurance Maximum?Coinsurance maximum is the total amount of coinsurance that a member is obliged to pay before the health plan begins paying 100% of covered medical expenses per benefit period. The deductible is not included in this total, the deductible is in addition to. Q. What is an Out of Pocket Max?The most you will have to pay for covered medical expenses in a plan year through deductible and coinsurance before your insurance plan begins to pay 100 percent of covered medical expenses.Q. What is a PPO?A preferred provider organization (PPO) is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients Q. What is a Flexible Spending Account (FSA)? A Flexible Spending Account allows you to set aside a portion of earnings, on a pre-tax basis, to pay for qualified expenses such as medical, dental, and dependent care. UNC Asheville offers 2 types of Flexible Spending Accounts: Health Care FSA Dependent Day Care FSA

Action Required!ALL non -Medicare primary members will be moved to the 70/30 Plan e f fe ctive Jan. 1, 2019.Subscribers will see this cha nge when t hey log in to eB enefi t s in Octo b e r . Sub s c r i b e r s MUST ta k e ac t i o n t o en r o l l in t h e 80/20 Plan and reduce their premium in either the 70/30 or 80/20 Plan.Failure to take action by Oct. 31st will result in:Remaining on the 70/30 Plan for 2019Paying more for subscriber-only premium for failure to complete the tobacco attestation. 11

Plan Options The State H e a l th Plan will continue to offer two plan options to active em ploy e e s a nd non-Med icare retir e es for 2 0 1 9 : 80/20 Plan Members pay a 2 0 % coinsurance for eligible i n - net w ork s er vic e s. For some services (i.e., office visits, urgent care or emergency room visits), members pay a copay. Affordable Care Act (ACA) Preventive Services performed by an in-network provider are covered at 100% by the Plan, at no cost to the member.70/30 PlanServices are subject to deductible and coinsurance maximum. Members pay 30% coinsurance for eligible in-network expenses. Similar to the 80/20, members pay a copay for some services (i.e., o f fice visits, urgent care or emergency room visits). What is different on the 70/30 plan is that members also pay a copay for preventive office services. The deductible and coinsurance would apply to preventive services, like colonoscopies, performed in an outpatient setting.Members can reduce their employee premium by completing the tobacco attestation in both plans! 12

Tobacco Attestation ChangeBy comple ting the tobacco attestation, employees can reduce employee-only premium by $60 on both the 80/20 & 70/30 plans. N e w attestation language and required activity:Employee must re-attest to no t being a tob acc o user or agr ee to v i sit a CVS M inute Clinic f or at lea s t one tobacco c e s s ation c o un s eling se s sion within 90 da y s of Open Enrollment or risk losing their credit.New hires enrolling during OE will be prompted to answer the tobacco attestation for 2018 and 2019 benefit year. While they need to answer the question twice, they can satisfy the requirement by completing either the QuitlineNC (2018) or the Minute Clinic (2019) tobacco cessation program.Subscribers enrolled through the Retirement Systems that select the 70/30 P l an do NOT need to complete the tobacco attestation.13

How the CVS Minute Clinic Tobacco Cessation Program Works14During enrollment on the tobacco attestation sc reen, employee s e lects “I AM a tobacco user, BUT I agree to visit a CVS Minu te Clin ic for at least one tob acco cess a tion co u ns e l i ng sess i on w ith i n 90 d a y s after the last d a y of Op e n E n ro l lm e nt or from your initial hire date.”Employee will then receive a letter which will include a CVS Minute Clinic Tobacco Attestation Voucher that will cover an initial visit (a $45 savings) + one follow-up (a $35 savings) visit for face-to-face tobacco cessation counseling.Employee will need to bring the voucher to each session and present their State Health Plan ID c a rd in order for the visit to be covered at 100% by the Plan (no charge to the member).The initial visit is the only requirement to keep the premium credit.This will replace the QuitlineNC multi-call program enrollment requirement for the 2019 Plan bene fit y e a r . For su b scri b ers th a t w o u ld l i ke to uti l ize the V ou c he r Pr og r a m after J an . 1 , 2019 , th e y w i l l nee d to c a ll C V S C a r e m a rk a t 888 - 321 -3 1 24 a n d a v o uc h er w i l l be mai l ed to th e m.

CVS Minute Clinic Tobacco Attestation VoucherFor locations and hours visit ww w .cvs.co m / m inuteclinic15

Tobacco Attestation Savings 15 8 0 /20 Plan 7 0 /30 Plan T otal emp l o y e e -o n l y mo n thly pr e mi u m w ith o ut cre d it $ 1 10 $85 A t test to bei n g tob a cc o -free OR agree to visit a CVS Minute Clinic for at least one tobacco cessation counseling session, if a tobacco user.$60$60TOTAL employee-only monthly premium with credit$50$25

162019 ChangesIndividual In -Network Benefit Design70/30 Plan (no changes)2018 80/20 Plan 2019 80/20 Plan D eductible$1,080$1,250 $1 ,250 C o i nsurance Percenta g e 30% 20% 20% P re v e n t i v e C o v era g e C ost- S h a r i ng A p p li es 100% 100% M e d i cal OOP M ax P harmacy OOP Max Medical Coinsurance Max Overall OOP MaxNA$3,360$4,388N/A$4,350$2,500N/A$6,850NAN/A N/A$4,890PCP Copay$40$10 (selected PCP)/$25 (non) $ 1 0 (se l ected P C P)/$25 (non)Chiro/Therapies$72$52$52Specialist Copay$94$45 Designated/$85 (non)$80Inpatient Hospital$337, then Ded/Coins.$0 or $450 , th e n D e d / C o i ns. $ 3 0 0 , th e n D e d / C oins. Outpat i e n t H os p i tal D e d / C o i ns. D e d / C o i ns. D e d / C o i ns. E R C o p ay $ 3 3 7 , th e n D e d / C o i n s . $300 , th e n D e d / C o i n s . $300 , th e n D e d / C o i n s . U r g e n t C are $100 $70 $70 D rugs T i er 1 T i er 2 T i er 3 T i er 4 T i er 5 T i er 6 $16 $47 $74 10 % up to $ 1 00 2 5 % up to $ 1 03 2 5 % up to $ 1 33 $5 $30 D e d / C o i ns. $100 $250 D e d / C o i ns. $5 $30 D e d / C o i ns. $100 $250 D e d / C o i ns. P re f er r ed Di a b etic S u p p li es* (e.g. T e s t Str i p s , Lan c et s , S y ringe s , Needle s ) P ref e rred D i a b et i c S u p p l y brand i s On e To u c h $10 $5 * N o n -prefer r ed Di a b et i c $5 S u p pli es w il l be pr i c e d at T i er 3

80/20 Plan Wellness Incentive18 Additional Wellness ActivityReduced CopayVisit the Primary Care Provider ( PCP) listed on your ID card or another provider in the same practice.$10 copay The B l ue Options Designated Provider Program will not be o f fered in 2019.

Pharmacy Benefit RemindersCVS Caremark is the Pharmacy Benefits Manager for the State Health Plan. Remember that the Plan c o ntinues to maintain a customized closed formulary, or drug list.The formulary is upda ted on a quar terly ba sis and members sh ould always review it to see if t here ha v e been any coverage changes to the i r pre s cribed medi c ations. An exception pro c e s s is available to providers who believe that, based on medical necessity, it is in the members’ best interest to remain on the excluded drug(s).Excluded drugs approved for coverage through the exceptions process will be at the tier 3 or tier 6 member copay level.Closed Formulary – In a “closed” formular y , cert a in dr u gs are excluded.19

20Pharmacy Benefit Reminders The Plan continues to receive feedback/complaints from emplo y ees t h at don’t understand the impact of the 80/20 Plan’s deductible /coinsur ance desi g n for Tie r 3 and T i e r 6 medi c ations. T i e r 3 a n d T i e r 6 m e d i c a ti on s d o no t have a defined copay, but are subject to a deductible/coinsurance. This means that employees will have to pay the full cost of the medication until they meet their deductible. Once they meet their deductible, they will be responsible for the 20% coinsurance amount until they reach the ou t-of-po c k e t ma x im u m. Medications that are subject to coinsurance in most cases will result in higher out-of-pocket costs to members.As a reminder, if an exception is approved for an excluded drug, it is only approved for coverage at the Tier 3 or T i e r 6 member copay l e v el. Indi v idual In - Net w ork Benefit De s ign 70/30 Plan 80/20 Plan D ru g s T i er 1 T i er 2 T ier 3 T i er 4 T i er 5 T ier 6 $16 $47 $74 10 % up to $ 1 00 2 5 % up to $ 1 03 2 5 % up to $ 1 33 $5 $30 D e d / C oins. $100 $250 D e d / C oins. P re f er r ed Di a b etic S u p p li es* (e.g. T e s t Str i p s , Lan c et s , S y ringe s , Needle s ). P ref e rred D i a b et i c S u p p l y brand i s On e To u c h $10 $5

Prem ium Rates21

222019 Premium Rates (80/20 & 70/30 Pl an)*Assumes completion of tobacco attestation. The em p l o ye e -only premium will be $60 higher per month if the tob acco attestat io n is not com pleted . N O T E: 70/30 Plan f o r retire e - onl y c o vera g e remai n s p remi u m free. Mo n th l y Pr e mium R a tes2019 Rates *80/20 PlanSubscriber Only$50.00Subscriber + Child(ren)$305.00Subscriber + Spouse$700.00Subscriber + Family$720.0070/30 PlanSubscrib er Only $2 5 .00 S u bscr i b er + Child(ren)$218.00Subscriber + Spouse$590.00Subscriber + Family$598.00

Employer Contributions23 The State Budget provides an increase of 4% in the monthly employer contributions: Acti v e E mployer Contribution Rate: $518.64Medicare Primary Employer Contribution Rate: $403.06N on-Permanent Full-time Emplo y er Rate (HDHP): $141 .75 As a reminde r , the c u r r ent monthly employer c o ntribution rate for a c ti v e employees is $49 8 .6 8 . 2019 rate sheets will be available on the Plan's website soon.The monthly employer contributions above will be effective January 1, 2019, which means they should be reflected in December's payroll deductions.

Extended Call Center HoursTh e Eligibility and Enrollment Support Center will have extended hours:Monday – Frida y , 8:00 a.m. – 10:00 p.m.Saturday 8:00 a.m. – Noon.Encourage your employ ees not to w a it until the last minute! Longer hold times oc c ur the f irst and last we e k of Op e n Enr o llment. 855 - 85 9 - 0966 24

Important Points to Reinforce for Members Members need to SAVE their choi ces at the end of theenrollment process.Many members overlook this vital, final step and therefore fail to complete enrollment! A l l enrollment choices w ill be d i spl a yed for confirmati o n – but the member is n ’t fin i sh e d yet! Members t hen n eed to scroll do w n and click S A VE to record their enrol l ment choices. Otherwise, it will be as if they never enrolled.Printing out their confirmation statement is alsorecommended!The choices you pickWill NOT stickUnless you SAVE them With a CLICK! 25

Dependent Eligibility Reminder26 Open Enrollment is the time to add/drop dependents and/or change plansOutside of OE, there must be a QLE to add/drop dependentsWithin 30 days of t he event Depend ent verification documentation is required for all dependents. It is the HBR’s responsibility to ensure the proper documentation is uploaded for all new dependents, including dependents added during OE: F u ll list of req uired d oc um e n t s on t he P l a n ’ s we bsite Documents s h ou l d be uploa d ed and stored on eBe n e f itsContact HBR Support at Benefitfocus or your Account Managerfor help

NC Flex Supplemental Benefits

ww w.shpnc.org www.nctreasurer.com Thank Y ou! T h is presentation is for gener al inf ormat io n purposes onl y. If i t c on f lic t s w i t h fed e r al o r s t a t e l aw, St a t e H e a lt h P l an policy or your benefits booklet, those sources will control. Please be advised that while we make every effort to ensure that the information we provide is up to date, it may not be updated in time to reflect a recent change in law or policy . To ensu r e t he accuracy of, and to prevent the undue reliance on, this information, we advise that the content of this material, in its entirety, or any portion thereof, should not be reproduced or broadca s t w i t h o u t t h e e xp r e ss w ri tt e n p e r m i s sio n o f t h e S t a t e H e a lt h P l a n .