1 10/1/19 Open Enrollment - PowerPoint Presentation

1. 110/1/19 Open EnrollmentJune 11, 2019 Through August 31,2019June 2019 MeetingsProprietary + Confidential

2. Who is Optima Health?Virginia-based, not-for-profit health plan; owned by Sentara Healthcare, consistently ranked as one of Modern Healthcare’s top ten Integrated Delivery Systems Offering plans in Hampton Roads for 30 years, in Central VA since 2005, and in Roanoke/Lynchburg region since 2011Covering 500,000+ commercial and government program membersHighest-ranked health plan serving central/eastern Virginia by NCQAMarket leader in integrated Consumer Directed Health Plan solutions (HSA, HRA)Consistently exceeds industry standards for claims accuracy, speed of answer, first call resolution, member and provider satisfaction2Proprietary + Confidential

3. 98% of physicians in Hampton Roads / NE North Carolina100% of inpatient facilitiesAll Sentara, Riverside, and Bon Secours facilities, Chesapeake RegionalLevel 1 Trauma Center (Sentara Norfolk General)Pediatric specialty hospital (Children’s Hospital of the King’s Daughters)Three teaching facilities for tertiary care:Virginia Commonwealth University - RichmondUniversity of Virginia - CharlottesvilleDuke University – DurhamOptima Health Network OverviewProprietary + Confidential3

4. Provider Network PenetrationUpdated January 2019Vantage HMO/POS NetworkPlus PPO NetworkLocationHospitalsPhysiciansHospitalsPhysiciansHampton Roads100%98%100%98%Richmond100%96%100%96%Charlottesville100%98%100%98%Harrisonburg100%98%100%98%Roanoke100%96%100%96%Lynchburg100%95%100%95%Winchester100%99%100%99%4All Optima Health networks include Duke University Hospitals and their affiliated physiciansProprietary + Confidential

5. Features in Your PlanNo Pre-existing Condition exclusions or waiting periodsNo cost for preventive services, including annual vision examPCP relationships will be established, to help manage your care, but….No referrals required to see a specialist (“open access”)After Hours Nurse – Toll Free number on ID cardEmergency Travel Assistance includedConvenience & Savings with MDLIVE telehealthEmployee Assistance Plan built inPharmacy and Medical Transition wellness services5Proprietary + Confidential

6. BenefitPOSPOS 500/20/20%HMOVantage 500/20/20%HMO HSAEquity Vantage 3000/0%ReferralsNo Referrals are requiredNo Referrals are requiredNo Referrals are requiredAnnual Deductible$500 per Person$1,000 per Family$500 per Person$1,500 per Family$3,000 per Person$6,000 per FamilyAnnual Maximum Out of Pocket (MOOP)$3,000 per Person$6,000 per Family$4,500 per Person$9,000 per Family$5,000 per Person$10,000 per FamilyOON Coinsurance40% CoinsuranceADNo Out-of-Network CoverageNo Out-of-Network CoveragePCP$20$200% CoinsuranceADMDLIVE Virtual Visits$20$20$39Specialist$40$400% CoinsuranceADMaternity$350 Global Copayment$450 Global Copayment0% CoinsuranceADInpatient Hosp20% CoinsuranceAD20% CoinsuranceAD0% CoinsuranceADOP Surgery20% CoinsuranceAD20% CoinsuranceAD0% CoinsuranceADUrgent Care$40$400% CoinsuranceADEmergency Room20% CoinsuranceAD20% CoinsuranceAD0% CoinsuranceADRetail Pharmacy Tier 1Tier 2Tier 3Tier 4$150 / $300 Rx Ded$15BD $60AD $80AD20% (up to $250 max) AD$150 / $300 Rx Ded$15BD $60AD $80AD20% (up to $250 max) ADPreventive Drugs @ 100%$15AD $60AD $80AD20% (up to $250 max) ADMail Order Rx$38/$150/$200$38/$150/$200$38/$150/$200Benefit Summaries6Proprietary + Confidential

7. Premium Rate Summary (24 months) 7

8. MDLIVE = Telehealth servicesAffordable (cost = PCP copay or $39)24/7/365 Anytime, Anywhere consultations Online with webcam, telephone, or secure email with Board Certified physicians MDLIVE physicians can diagnose, treat, and call in prescriptions for routine medical conditionsRegister for MDLIVE by going to optimahealth.comFor added convenience, register all family members up front so that the account/profile is set up and ready to use when neededAccess MDLIVE via Optimahealth.comProvides medical excuse notes for work and/or schoolSee Benefit Information Guide (BIG) for more details8Proprietary + Confidential

9. Equity Vantage Preventive Rx BenefitEquity Vantage plan members are eligible to receive medications that are considered by Optima Health to be preventive at $0 copaymentExamples:Montelukast Sodium for members with allergies or asthmaMetoprolol Succinate ER for members with high blood pressurePlease note:If a generic equivalent drug is available, the brand-name drug is excluded from this benefitYou or your doctor may be asked to prove that the drug is used for prevention9Proprietary + Confidential

10. OptumRx Mail Order Home DeliveryMail order home delivery from OptumRx is a convenient and cost-effective way to receive maintenance or long-term medicationsHave your doctor write a mail order prescription; write your member ID number, name, and DOB on back*Complete a New Prescription Mail-In Order Form and mail along with prescription and copayment to OptumRxFor refills, you can request via Optimahealth.com, by calling OptumRx, or by mail using the provided medication refill slip*Doctors can also place prescriptions over the phone or by fax directly to OptumRx; they must provide required member information10Proprietary + Confidential

11. 11Additional Pharmacy NotesStandard/Closed FormularyDrugs must be on the Formulary to be coveredA number of high-cost brand name drugs with proven alternatives are not includedBrand Buy-UpMember pays difference between cost of generic and cost of brand, if generic is available but brand is obtained Specialty Pharmacy: Our specialty pharmacy is Proprium. They will fill all specialty prescriptions, via delivery to your home or physician’s office. Your retail pharmacist will alert you if your prescription must be filled by Proprium. Contact Proprium at 855-553-3568. Compare Drug Costs for a chance to save! At optimahealth.com – find drug prices and see alternatives to share with doctorProprietary + Confidential

12. Provides estimates for over 500 procedures and servicesCompares providers and facilitiesUses real-time benefit information, deductible, and out-of-pocket maximum balances to calculate estimateProvides HSA balances Provides estimates of annual treatment costs by conditionsEstimates are based on claims dataTreatment Cost CalculatorImproving Transparency for Members12Proprietary + Confidential

13. Winning with an Optima Health HSA Plan Experienced market leaderNo implementation or administration fees Paperless for ease of administrationDirect claim feed from Optima to HealthEquityOnline Employee Portal Permanent online database of eligible expensesEasily pay providers for balance due or reimburse yourself Wide breadth of investment options through low-cost Vanguard mutual fundsNo transaction costs for tradesEasily transfer account balances and contributions from previous HSA24/7 US-based call center for questions, assistance, tax adviceEducation available through:Pamphlets/BooksWebinars/videos HSA Contribution Calculator13Proprietary + Confidential

14. For Vantage HMO and POS subscribersAvailable to dependent children living out of the service areaProvides in-network coverage for use of PHCS providersMust complete a confirmation document each yearOut-of-Area Dependent Program 14Proprietary + Confidential

15. Optima EAPHelpful, flexible, and easy to use resources that can assist with:Addressing life’s challengesSolving problemsTackling work-related issuesHealth Plan includes 3 visits/virtual visits per new incident per person per yearIncludes all enrolled employees AND household family members of enrolled employeesNo cost for EAP visitsConfidential15Proprietary + Confidential

16. Optima Health Mobile AppMembers can safely and securely access important health information whenever and wherever they need it.Improved Access to Care with the touch of a screenFind doctors and urgent care centersShop for health plansDigital EngagementSecurely view benefit informationView and email member ID cardsReal-time access to deductibles, balances, and claimsView user profile and update email addressAccess Optima Health contact informationFuture enhancements and features to come16Proprietary + Confidential

17. 17Staying HealthyAward Winning Signature Programs Healthy Habits/Healthy YouGuided MeditationTai Chi Qigong ShibashiEating for LifeTobacco CessationWalkabout with Healthy Edge Free PedometerCall 1-800-SENTARA – No chargeHealth and Wellness ServicesGetting Started (No Charge)Personal Health AssessmentsOnline; ConfidentialHow do I stack up? What are my risks? How can I address them?Coaching – with Digital Health Assistant (telephonic option)Robust Tools and TrackersProprietary + Confidential

18. Gym Network 360 Discount ProgramEffective April 2018, we have partnered with GlobalFit to provide a new discount programMember discounts on fitness facilities, at-home exercise programs, nutrition, weight loss, and healthy-eating programs5-20% off retail rates at over 9,500 fitness facilities and programs24 Hour Fitness, Anytime Fitness, Curves, Gold’s Gym, etc.18Proprietary + Confidential

19. Emergency Travel AssistanceWhen you are over 100 Miles from Home - Anywhere in the World Complements Health Plan Benefits, for travelersMedical Consultation, Evaluation, and ReferralCoordination between the health plan, attending physician/facility, and family membersAvailable 24/7, 365 days per yearOffers global access to Western-style health careCoordinates logistics of care and repatriation of a seriously ill or injured memberPays for full cost of evacuation (or return of remains)Medical or non-medical escort if necessaryForeign Hospital Admission AssistanceAdvance of funds / guaranteed accessSeparate ID card will come with regular Optima ID card19Proprietary + Confidential

20. New Member ChecklistThis new checklist is designed to help navigate new enrollees to the services and tools available on Optimhealth.comGetting registered Complete Personal Health AssessmentRegister with MDLIVEAccess HSA InformationTransition of care information20Proprietary + Confidential

21. Easy to UseQuestions? Better Health A Great Value21Proprietary + Confidential10/1/19 Open EnrollmentJune 11, 2019 Through August 31,2019