GROUPS SIZED Plan Overview

Transcription

1 GROUPS SIZED Plan Overview

2 Select the Plan That s Right for Your Business Many things are factored into selecting the right health benefits for your business plan designs, networks, customer service, member extras and, of course, cost. We ve taken into consideration all of your needs, and we feel confident that we have the right plan for your business. This guide provides an overview of health plans available to meet your business and employee needs for benefits effective Jan. 1,

3 Why Choose Providence? Here are five great reasons to partner with Providence Health Plan. We help you manage costs. For the past six years, our trend has been consistently below market 7.6 percent trend in January With a large product portfolio, nearly limitless plan design options and a broad provider network, choice and options are yours. We have one of the nation s best pharmacy utilization rates 91 percent for generic utilization. We re recognized for reducing unnecessary emergency room visits nearly 40 percent reduction over the last 10 years. We are integrated. We offer a cohesive approach to member and patient care founded on the Providence Mission and core values of respect, compassion, justice, excellence and stewardship. Electronic systems keep members, physicians and the health plan connected, making it easy to share information. For example: ProvRN nurses electronically notify providers after a member s ProvRN call. Health express providers electronically share the after-visit summary with physicians. We are innovative. Health express, our Web-based health care service, delivers high-quality care on demand and is ranked 4.8 out of five stars for patient satisfaction. Our unique partnerships with northwest businesses and Providence Health & Services achieve optimal health and cost savings. Our joint care packages, which offer bundled payments, improve patient experiences, coordinate care and ultimately lower costs without compromising quality. We are good at what we do, and we re recognized by our peers. The National Committee for Quality Assurance has awarded Providence Health Plan an accreditation status of Commendable for its 97% Oregon Commercial PPO plans. This signifies Providence Health Plan s service and clinical quality meet or exceed NCQA s rigorous requirements for consumer protection and quality improvement. For 10 years in a row, Portland Business Journal has recognized us as one of Oregon s most admired companies. We provide accurate and timely claims processing. We accurately processed 97 percent of all claims within 30 days in 2014, 2013 and We care. We live the Providence Mission every time we talk with a member, ensuring each person is cared for in the most genuine, compassionate way. Last year Providence outreach programs supported five community priorities: 1. Preventive and primary care needs 2. Mental health and substance use 3. Chronic conditions and disease management 4. Oral health 5. Basic needs, such as hunger, housing and transportation 3

4 What really matters? It s what s in it for YOU... Your health care dollars are invested wisely. You ll benefit from our relationship with Providence Health & Services, making sure you have access to high-quality care in a convenient and compassionate way. You ll share in our commitment to the Triple Aim as we work to provide improved health, the best care experience and affordable services. You ll be given free tools, resources and support to achieve your health goals. You ll be treated with dignity and respect because we take time to listen and learn about your needs. You ll have fewer hassles because we do things right the first time. You ll find what you need and, if you don t, we ll help until you do. Who is Providence Health Plan? Providence Health Plan is part of Providence Health & Services, an integrated delivery system that has been caring for Northwest communities for nearly 160 years. We offer health insurance for commercial groups, Medicare, Medicaid, individuals and families, and we serve more than 500,000 members nationwide. Compassionate and innovative care along with unique partnerships with physicians, hospitals and pharmacies help us achieve the Triple Aim: Improved health Best care experience Affordability 4

5 What you get with Providence? Exclusive health improvement resources Healthy employees make for a healthy business. Providence is home to FitTogether, a comprehensive suite of health management solutions. It offers a unique blend of medical management, health improvement and workforce wellness to support members specific health needs. Health Management Consultants. We offer the expertise of our health management consultants to design tailored wellness campaigns with aggregate reports available if more than 50 members participate in campaigns. Work site wellness challenges. Members can participate in work site wellness challenges with various health focuses. Choose from nutrition, weight management or health improvement topics that bring people together and encourage them to use tools and resources for better health. Customized solutions. All Providence work site challenges are customizable. Add participation incentives and weekly challenge support activities to encourage challenge engagement. Health coaching. Members can receive 12 one-on-one health coaching sessions each calendar year at no cost. The programs are designed to help members lose weight, improve diet, manage stress, exercise, stop using tobacco or just feel better every day. Care management. Members partner with registered nurses to improve health outcomes. When health improves, costs typically go down. Our nurse care coordinators provide education and support for a broad spectrum of health conditions, discuss treatment options, review medications and address lifestyle modifications. On-demand health and wellness resources. Our secure member website, myprovidence.com, provides a complete source for health, wellness and benefits information. Wellness Central, Providence s integrated online health and wellness hub, available through myprovidence, helps members move from a vision of health to an actionable plan for health. Take advantage of the personal health assessment, health trackers, health education resources and much more. 5

6 Extras for employees You and your employees get more value from your health care dollar with Providence. Our extra values and discounts help your employees stay active and healthy and save money. ProvRN Get free medical advice 24 hours a day, seven days a week. Members speak with a registered nurse who can answer health questions and determine the type of care needed. (Not available for residents of California.) or TTY: 711 LifeBalance Program Members enjoy savings on health club memberships, fitness classes, massage therapy, weight loss programs, and recreational, cultural and wellness events, including family activities, movies, travel and more TruVision Members save on contact lenses, which will be mailed to their home, and on LASIK (laser vision correction) Visionworks Members enjoy discounts on vision exams, eyeglass frames and lenses at Oregon and southwest Washington locations ChooseHealthy Members save on acupuncture, chiropractic care, massage therapy and dietitian services with discounted rates available from ChooseHealthy providers Health education classes Members can sign up for free or discounted Providence Health & Services classes, including weight management, childbirth preparation, yoga, smoking cessation and more TruHearing Members receive discounted hearing aids. A discount is also available to members parents and grandparents who are not enrolled with Providence Health Plan

7 Selling areas Find the right plan for your business. Open Option, Core Advantages, Personal Option and HSA Qualified Plans are available statewide and in southwest Washington. Businesses located anywhere in Oregon and southwest Washington can partner with Providence Health Plan for their employees health coverage. Most plans including Open Option, Core Advantages, Personal Option and HSA Qualified plans are available statewide in Oregon and in Clark, Skamania and Klickitat counties in Washington. Providence Choice is available throughout most of Oregon and in select Washington state counties. Providence Choice plan utilizes a medical home model for care. Medical homes are available in most counties in Oregon and select counties in southwest Washington. Please refer to the Providence networks section for a description of Providence Choice and to see a map of where medical homes are located in Oregon and southwest Washington. Choice network: select counties in Oregon and southwest Washington: Baker Benton Clackamas Clark (WA) Clatsop Coos Crook Curry Deschutes Douglas Hood River Jackson Josephine Klamath Lane Lincoln Linn Malheur Marion Multnomah Polk Umatilla Union Wallowa Washington Yamhill Providence Connect is available in Multnomah, Clackamas and Washington county in Oregon. Connect plans combine a medical home model of care with a tailored provider network to achieve substantial premium savings. Available in Multnomah, Clackamas and Washington counties in Oregon, Connect Plan serves employees who work or reside in one of these counties. For the most up-to-date list of providers in any PHP network, visit our provider directory at 7

8 Networks Ensuring access to high-quality health care while controlling costs that s been a shared goal for several years and likely a shared goal for many more to come. Whatever your cost management strategy, Providence Health Plan is taking steps to help manage costs that translate into savings for your business. We ve created a range of networks that allow you to select what fits your budget and employee needs while still providing access to providers your employees know and trust. Providence Signature Network The Providence EPO Network has a new name: The Providence Signature Network. Select a plan that features the Providence Signature Network, and your employees can access the broadest selection of health care providers with in-network benefits. Featuring nearly 1 million providers nationwide including more than 10,000 specialists throughout Oregon and southwest Washington the Providence Signature Network is available to members enrolled in an Open Option, Core Advantages, Personal Option or HSA Qualified plan. Enrolled employees get exceptional care from Providence providers and affiliated providers in and outside of the Northwest. Consider a plan with this network if you have employees who work outside of Oregon. Signature network: nationwide Providence Choice Network With the Providence Choice Network, members choose a medical home from more than 235 primary care clinics in most counties in Oregon and select counties in southwest Washington. Clinics in the Choice network are recognized by the Oregon Health Authority as Patient-Centered Primary Care Homes based on access, coordination, quality and cost measures. Choice network: select counties in Oregon and southwest Washington: Baker Benton Clackamas Clark (WA) Clatsop Coos Crook Curry Deschutes Douglas Hood River Jackson Josephine Klamath Lane Lincoln Linn Malheur Marion Multnomah Polk Umatilla Union Walla Walla (WA) Wallowa Washington Yamhill Providence Connect Network With the Portland-area Providence Connect Network, members choose a medical home from more than 65 primary care clinics in Multnomah, Washington and Clackamas counties. As with the Choice network, participating clinics partner with Providence to improve the quality of care and reduce medical costs. Connect network: Clackamas, Multnomah and Washington counties in Oregon 8 All Providence networks offer access to Providence physicians, specialists and other caregivers. We also partner with individual providers and provider groups outside of the Providence family. Your employees can choose from a range of health care experts to best meet their health needs.

9 Plan comparison The information in this guide is intended to provide an overview of the plans available to Oregon and southwest Washington employers with 51 or more employees. For specific plan details, please refer to the plan s benefit summary. Some benefit limitations and exclusions apply. For a complete list of benefits and exclusions, please see the plan contract documents. Plan features Open Option Core Advantages Personal Option HSA Qualified Choice Connect Provider Network Network name Signature Signature Signature Signature Choice Connect Broad PPO-style network Local medical home model Specialist referrals required Benefits Combined in- and out-of-network deductibles and out-of-pocket maximums Deductible applies to out-of-pocket maximum Most preventive care covered in full Deductible waived for personal physician/provider and specialist visits Deductible waived for Health express visits Deductible waived for urgent care visits Deductible waived for emergency services for emergency medical conditions Specialist visit copay same as personal physician/provider office visit copay Deductible waived for in-network lab and X-ray Diagnostic lab and X-ray covered in full for first $500 of in-network services Deductible waived for in-network high-tech imaging services Alternative care provider office visit copay same as personal physician/ provider office visit copay* Higher cost shares for select services Health and Wellness Program ProvRN free medical advice line Disease management for chronic conditions Telephonic health coaching LifeBalance discount program Integrated HSA, HRA and FSA administration Option to pair with an integrated vendor, Health Equity HRA and/or FSA Option to pair with an integrated vendor, HealthEquity HSA 9 *Chiropractic manipulation and acupuncture services covered only if a separate rider is purchased.

10 Open Option Plans Open Option plans provide a premier level of coverage with full access to the Providence Signature network and non-network providers. These plans are easy to use and offer predictable costs for members. Plan features Specialist visits without a referral Predictable out-of-pocket costs through upfront coverage and low copay and coinsurance options Plan designs with combined or separate in- and out-of-network deductible and out-of-pocket maximums In-network deductible waived for many services, including office visits, health exams, diagnostic services, women s health services, routine immunization and maternity prenatal care Deductible applied to out-of-pocket maximum Includes coverage for Health express, our Web-based health care service offering convenient, on-demand visits on your smartphone, tablet or computer without an appointment Plan network Providence Signature Network: A national network with nearly 1 million providers nationwide, with Providence facilities, affiliated provider groups and individual providers Plan selling area Business must be located in Oregon or in Clark, Skamania or Klickitat counties in Washington state. Benefit design options Copay Options Out-of-Pocket Max* Deductible* 10 $10 $15 $20 $25 $35 Coinsurance Options 10% / 20% 20% / 30% 20% / 40% 30% / 50% $2,000 $2,500 $3,000 $3,500 $4,000 $5,000 $6,850 $250 $500 $750 $1,000 $1,500 $2,000 $2,500 $3,000 $5,000 * Individual amounts are shown. The family out-of-pocket maximum and family deductible are two times the individual amounts.

11 Open Option Plans: Benefit Highlights No deductible needs to be met prior to receiving this benefit. $ Copay applies % Coinsurance applies In-network copay or coinsurance* Out-of-network copay or coinsurance* Preventive Care Services What the member pays: Periodic health exams and well-baby care Covered in full % Routine immunizations and shots Covered in full % Colonoscopy (age 50+) Covered in full % Gynecologic exams; Pap tests Covered in full % Mammograms Covered in full % Tobacco cessation, counseling/classes and deterrent medications Covered in full Not covered Physician/Provider Services Office visits $/visit % Health express $/visit Not covered Office visits to alternative care providers (does not include chiropractic manipulation or acupuncture services) $/visit % Allergy shots, serums, infusions, injectable medications % % Inpatient hospital visits % % Surgery, anesthesia % % Diagnostic Services X-ray and lab services % % High-tech imaging services (such as PET, CT or MRI scans) % % Sleep studies % % Emergency and Urgent Care Services Emergency services (for emergency medical conditions only; if admitted to the hospital, all services are subject to inpatient benefits) $250 $250 Urgent care services (non-life-threatening illness/minor injury) $/visit % Emergency medical transport (air or ground) % % Hospital Services Inpatient/observation care % % Rehabilitative care (limited to 30 days per calendar year) % % Skilled nursing facility (limited to 60 days per calendar year) % % Outpatient Services Outpatient surgery, dialysis, infusion, chemo and radiation therapy % % Outpatient rehabilitative services: physical, occupational or speech therapy (limited to 30 visits per calendar year) % % Maternity Services Prenatal office visits Covered in full % Delivery and postnatal services 10x OV/delivery % Inpatient hospital/facility services % % Routine newborn nursery care % % * After deductible where no checkmark is indicated 11

12 Core Advantages Plans With a Core Advantages plan, members enjoy robust benefits and first-dollar coverage for certain preventive and frequently used services with some upfront premium savings. Plan features Specialist visits without a referral Predictable out-of-pocket costs through upfront coverage and low copay and coinsurance options Plan designs with combined or separate in- and out-of-network deductible and out-of-pocket maximums In-network deductible waived for many services, including office visits, health exams, diagnostic services, women s health services, routine immunization and maternity prenatal care In-network X-ray and lab services covered in full for the first $500 in a calendar year Cost-sharing differential for services provided by specialists versus personal physician/provider, meaning out-of-pocket costs are higher for specialist visits, keeping premiums manageable Deductible applied to out-of-pocket maximum Includes coverage for Health express, our Webbased health care service offering convenient on-demand visits on your smartphone, tablet or computer without an appointment Plan network Providence Signature Network: A national network with nearly 1 million providers nationwide, with Providence facilities, affiliated provider groups and individual providers Plan selling area Business must be located in Oregon or in Clark, Skamania or Klickitat counties in Washington state. Benefit design options Copays Out-of-Pocket Max* Deductible* $10/$20 $15/$25 $20/$30 $25/$35 $35/$45 Coinsurance 10% / 20% 20% / 30% 20% / 40% 20% / 50% 30% / 50% $3,500 $4,000 $5,000 $6,850 $250 $500 $750 $1,000 $1,500 $2,000 $2,500 $3,000 $5, * Individual amounts are shown. The family out-of-pocket maximum and family deductible are two times the individual amounts.

13 Core Advantages Plans: Benefit Highlights No deductible needs to be met prior to receiving this benefit. $ Copay applies % Coinsurance applies Preventive Care Services In-network copay or coinsurance* What the member pays: Out-of-network copay or coinsurance* Periodic health exams and well-baby care Covered in full % Routine immunizations and shots Covered in full % Colonoscopy (age 50+) Covered in full % Gynecologic exams; Pap tests Covered in full % Mammograms Covered in full % Tobacco cessation, counseling/classes and deterrent medications Covered in full Not covered Physician/Provider Services Office visits to personal physician/provider $/visit % Office visits to specialists $/visit % Health express $/visit Not covered Office visits to alternative care providers (does not include chiropractic manipulation or acupuncture services) $/visit % Allergy shots, serums, infusions, injectable medications % % Inpatient hospital visits % % Surgery, anesthesia % % Diagnostic Services X-ray and lab services (Covered in full for the first $500 of in-network services in a calendar year) % % High-tech imaging services (such as PET, CT or MRI scans) % % Sleep studies % % Emergency and Urgent Care Services Emergency services (for emergency medical conditions only; if admitted to the hospital, all services are subject to inpatient benefits) $250 $250 Urgent care services (non-life-threatening illness/minor injury) $ specialist OV/visit % Emergency medical transport (air or ground) % % Hospital Services Inpatient/observation care % % Rehabilitative care (limited to 30 days per calendar year) % % Skilled nursing facility (limited to 60 days per calendar year) % % Outpatient Services Outpatient surgery, dialysis, infusion, chemo and radiation therapy % % Outpatient rehabilitative services: physical, occupational or speech therapy (limited to 30 visits per calendar year) % % Maternity Services Prenatal office visits Covered in full % Delivery and postnatal services % % Inpatient hospital/facility services % % Routine newborn nursery care % % * After deductible where no checkmark is indicated 13

14 Personal Option Plans With a Personal Option plan, members get excellent coverage and predictable costs along with premium savings based on coverage specifically with in-network providers in our Providence Signature Network. Plan features Specialist visits without a referral Deductible waived for many services, including office visits, health exams, diagnostic services, women s health services, routine immunizations and maternity prenatal care Deductible applied to out-of-pocket maximum Includes coverage for Health express, our Web-based health care service offering convenient on-demand visits on your smartphone, tablet or computer without an appointment Plan network Providence Signature Network: A national network with nearly 1 million providers nationwide, with Providence facilities, affiliated provider groups and individual providers Plan selling area Your business must be located in Oregon or in Clark, Skamania or Klickitat counties in Washington state. Benefit design options Copays Out-of-Pocket Max* Deductible* 14 $10 $15 $20 $25 $35 $2,000 $2,500 $3,000 $3,500 $4,000 $5,000 $250 $500 $750 $1,000 $1,500 $2,000 $5,500 $2,500 Coinsurance $6,850 $3,000 $5,000 10% 20% 30% 40% * Individual amounts are shown. The family out-of-pocket maximum and family deductible are two times the individual amounts.

15 Personal Option Plans: Benefit Highlights No deductible needs to be met prior to receiving this benefit. $ Copay applies % Coinsurance applies Preventive Care Services Periodic health exams and well-baby care Routine immunizations and shots Colonoscopy (age 50+) Gynecologic exams; Pap tests Mammograms Tobacco cessation, counseling/classes and deterrent medications In-network copay or coinsurance* What the member pays: Covered in full Covered in full Covered in full Covered in full Covered in full Covered in full Physician/Provider Services Office visits $/visit Health express $/visit Office visits to alternative care providers (does not include chiropractic manipulation or acupuncture services) $/visit Allergy shots, serums, infusions, injectable medications % Inpatient hospital visits % Surgery, anesthesia % Diagnostic Services X-ray and lab services % High-tech imaging services (such as PET, CT or MRI scans) % Sleep studies % Emergency and Urgent Care Services Emergency services (for emergency medical conditions only; if admitted to the hospital, all services are subject to inpatient benefits) $250 Urgent care services (non-life-threatening illness/minor injury) $/visit Emergency medical transport (air or ground) % Hospital Services Inpatient/observation care % Rehabilitative care (limited to 30 days per calendar year) % Skilled nursing facility (limited to 60 days per calendar year) % Outpatient Services Outpatient surgery, dialysis, infusion, chemo and radiation therapy % Outpatient rehabilitative services: physical, occupational or speech therapy (limited to 30 visits per calendar year) % Maternity Services Prenatal office visits Covered in full Delivery and postnatal services 10x OV/delivery Inpatient hospital/facility services % Routine newborn nursery care % * After deductible where no checkmark is indicated 15

16 HSA Qualified Plans These high-deductible health plans give members affordable coverage and the flexibility to choose any provider. They also help members save for future health care needs via a tax-advantaged health savings account. Members can keep this account even if they change employers. Plan features Provider choice in and out of the Providence Signature network Specialist visits without a referral Most visits subject to the deductible, helping manage premiums Plan designs with combined or separate in- and out-of-network deductible and out-of-pocket maximums In-network preventive care covered in full before the deductible Includes coverage for Health express, our Webbased health care service offering convenient on-demand visits on your smartphone, tablet or computer without an appointment Integrated health savings account administered through HealthEquity, simplifying employee account setup and contributions (please see page 28 for information about integrated accounts) A seamless member experience for tracking and paying HSA qualified plan expenses through integrated claims processing, available with HealthEquity Plan network Providence Signature Network: A national network with nearly 1 million providers nationwide, with Providence facilities, affiliated provider groups and individual providers Plan selling area Your business must be located in Oregon or in Clark, Skamania or Klickitat counties in Washington state. Benefit design options Coinsurance Out-of-Pocket Max* Deductible* 20% / 40% 50% / 50% $3,500 $4,000 $5,500 $6,550 $1,500 $2,500 $3,000 $3,500 $5,000 $6,550 * Individual amounts are shown. The family out-of-pocket maximum and family deductible are two times the individual amounts. 16

17 HSA Qualified Plans: Benefit Highlights No deductible needs to be met before receiving this benefit % Coinsurance applies Preventive Care In-network coinsurance* What the member pays: Out-of-network coinsurance* Periodic health exams and well-baby care Covered in full % Routine immunizations and shots Covered in full % Colonoscopy (age 50+) Covered in full % Gynecologic exams; Pap tests Covered in full % Mammograms Covered in full % Tobacco cessation, counseling/classes and deterrent medications Covered in full Not covered Physician/Provider Services Office visits to primary physician/provider % % Health express % % Office visits to specialist % % Office visits to alternative care providers (does not include chiropractic manipulation or acupuncture services) % % Allergy shots, serums, infusions, injectable medications % % Inpatient hospital visits % % Surgery, anesthesia % % Prescription Drugs (up to a 30-day supply/retail and preferred retail pharmacies; 90-day supply/mail-order and preferred retail pharmacies) Preventive generic and brand-name drugs under ACA Covered in full Not covered Generic and brand-name drugs % Not covered Compounded drugs % Not covered Diagnostic Services X-ray and lab services % % High-tech imaging services (such as PET, CT or MRI scans) % % Sleep studies % % Emergency and Urgent Services Emergency services (for emergency medical conditions only; if admitted to the hospital, all services are subject to inpatient benefits) % % Urgent care services (non-life-threatening illness/minor injury) % % Emergency medical transportation (air or ground) % % Hospital Services Inpatient/observation care % % Rehabilitative care (limited to 30 days per calendar year) % % Skilled nursing facility (limited to 60 days per calendar year) % % Outpatient Services Outpatient surgery, dialysis, infusion, chemo and radiation therapy % % Outpatient rehabilitative services: physical, occupational or speech therapy (limited to 30 visits per calendar year) % % Maternity Services Prenatal care Covered in full % Delivery and postnatal services % % Inpatient hospital/facility services % % Routine newborn nursery care % % *After deductible where no checkmark is indicated 17

18 Providence Choice Plans Choice plans use a collaborative medical home model that provides members a team of health professionals dedicated to their overall well-being. Members select a medical home from the Providence Choice Network at the time of enrollment. The medical home team then works collaboratively to support all aspects of a member s health, from wellness and prevention to active management of chronic conditions. Plan features More than 235 medical homes in Oregon and southwest Washington that provide a patient-focused, coordinated care experience Access to a broad network of specialists and facilities via referral from the medical home in order to receive coverage at the in-network level Deductible waived for many services, including office visits, health exams, diagnostic services, women s health services, routine immunizations and maternity prenatal care Higher cost shares for selected services, such as knee and hip replacement, sleep studies and sinus surgery Separate deductibles and out-of-pocket maximums in- and out-of-network Includes coverage for Health express, our Webbased health care service offering convenient on-demand visits on your smartphone, tablet or computer without an appointment Plan network Providence Choice Network: More than 235 medical home clinics in Oregon and southwest Washington designated as medical homes provide a patient-focused, coordinated care experience. For a complete list of available medical homes and providers by location, visit Plan selling area Providence Choice Plans are available in select counties within Oregon and southwest Washington. Providence Choice plans use a medical home model to provide care. Recognized medical homes are not available in all Oregon and southwest Washington counties. To ensure coverage for members outside the Choice Network service area, a Choice plan must be paired with another Providence health plan that uses the Providence Signature Network (such as an Open Option, Core Advantages, Personal Option or HSA Qualified plan). Benefit design options Copays $10/$20 Out-of-Pocket Max* Deductible* $15/$30 $20/$40 $25/$50 $30/$60 $35/$70 $2,000 $2,500 $3,000 $3,500 $4,000 $250 $500 $750 $1,000 $1, Coinsurance 10% / 30% 20% / 30% 20% / 40% $5,000 $5,500 $6,850 $2,000 $2,500 $3,000 $3,500 30% / 50% * There are separate out-of-pocket maximums for in-network and out-of-network expenses, and separate in-network and out-of-network deductibles. Out-of-network values = 2x the in-network values. There are separate deductibles and out-of-pocket maximums for in-network and out-ofnetwork services. Out-of-network values = 2x the in-network values.

19 Choice Plans: Benefit Highlights No deductible needs to be met before receiving this benefit $ Copay applies % Coinsurance applies In-network copay or coinsurance from your medical home with a referral* Out-of-network copay or coinsurance from a non-network provider or without a referral* Preventive Care What the member pays: Periodic health exams and well-baby care Covered in full % Routine immunizations and shots Covered in full % Colonoscopy (age 50+) Covered in full % Gynecologic exams; Pap tests Covered in full % Mammograms Covered in full % Tobacco cessation, counseling/classes and deterrent medications Covered in full Not covered Physician/Provider Services Office visits to primary physician/provider $ / visit % Health express $ / visit % Office visits to specialist $ / visit [2x PPP OV] % Office visits to alternative care providers (does not include chiropractic manipulation or acupuncture services) $ / visit % Allergy shots, serums, infusions, injectable medications % % Inpatient hospital visits % % Surgery; anesthesia % % Diagnostic Services X-ray and lab services % % High-tech imaging services (such as PET, CT or MRI scans) % % Emergency and Urgent Services Emergency services (for emergency medical conditions only; if admitted to the hospital, all services are subject to inpatient benefits) $250 $250 Urgent care services (non-life-threatening illness/minor injury) $(specialist OV) / visit % Emergency medical transportation (air or ground) % % Hospital Services Inpatient/observation care % % Rehabilitative care (limited to 30 days per calendar year) % % Skilled nursing facility (limited to 60 days per calendar year) % % Outpatient Services Outpatient surgery, dialysis, infusion, chemo and radiation therapy % % Outpatient rehabilitative services: physical, occupational or speech therapy (limited to 30 visits per calendar year) % % Maternity Services Prenatal office visits Covered in full % Delivery and postnatal services % % Inpatient hospital/facility services % % Routine newborn nursery care % % * After deductible where no checkmark is indicated 19

20 Connect Plans Connect plans combine a medical home model of care with a tailored provider network to achieve substantial premium savings. Members select a medical home from our Portland metro-area Providence Connect Network. The medical home model provides a team of health professionals dedicated to the member s overall well-being. Medical home team members work collaboratively to support all aspects of a member s health, from wellness and prevention to active management of chronic conditions. Plan features Some of the lowest premiums of any Providence plan for groups sized 100-plus More than 65 medical home clinics in the Portland metro area Access to specialists and facilities with referral from the medical home with coverage at the in-network level Deductible waived for many services, including office visits, health exams, diagnostic services, women s health services, routine immunizations and maternity prenatal care Higher cost shares for select services, such as knee and hip replacement, sleep studies and sinus surgery Separate deductibles and out-of-pocket maximums in- and out-of-network Includes coverage for Health express, our Webbased health care service offering convenient on-demand visits on your smartphone, tablet or computer without an appointment Plan network Providence Connect Network: A Portland-area network of more than 65 primary care clinics in Multnomah, Washington and Clackamas counties designated as medical homes. For a complete list of available medical homes and providers by location, visit Plan selling area To be eligible for a Connect plan, your business must be located in Washington, Multnomah or Clackamas counties in Oregon. To ensure coverage for members outside the Connect Network selling/ service area, a Connect plan must be paired with another Providence health plan that uses the Providence Signature network (Open Option, Core Advantages, Personal Option or HSA Qualified plans). Benefit design options Copays $10 / $20 Out-of-Pocket Max* Deductible* $15 / $30 $20 / $40 $25 / $50 $30 / $60 $35 / $70 $2,000 $2,500 $3,000 $3,500 $4,000 No deductible $250 $500 $750 $1, Coinsurance 10% / 30% 20% / 30% 20% / 40% 30% / 50% $5,000 $5,500 $6,850 $1,500 $2,000 $2,500 $3,000 $3,500 * Individual amounts are shown. The family out-of-pocket maximum and family deductible are two times the individual amounts. There are separate deductibles and out-of-pocket maximums for in-network and out-ofnetwork services. Out-of-network values = 2x the in-network values.

21 Connect Plans: Benefit Highlights No deductible needs to be met before receiving this benefit $ Copay applies % Coinsurance applies Preventive Care In-network copay or coinsurance from your medical home with a referral What the member pays: Out-of-network copay or coinsurance from a non-network provider or without a referral Periodic health exams and well-baby care Covered in full % Routine immunizations and shots Covered in full % Colonoscopy (age 50+) Covered in full % Gynecologic exams; Pap tests Covered in full % Mammograms Covered in full % Tobacco cessation, counseling/classes and deterrent medications Covered in full Not covered Physician/Provider Services Office visits to primary physician/provider $ / visit % Health express $ / visit % Office visits to specialist $ / visit [2x PPP OV] % Office visits to alternative care providers (does not include chiropractic manipulation or acupuncture services) $ / visit % Allergy shots, serums, infusions, injectable medications % % Inpatient hospital visits % % Surgery, anesthesia % % Diagnostic Services X-ray and lab services % % High-tech imaging services (such as PET, CT or MRI scans) % % Emergency and Urgent Services Emergency services (for emergency medical conditions only; if admitted to the hospital, all services are subject to inpatient benefits) $250 $250 Urgent care services (non-life-threatening illness/minor injury) $(specialist OV) / visit % Emergency medical transportation (air or ground) % % Hospital Services Inpatient/observation care % % Rehabilitative care (30 days per calendar year) % % Skilled nursing facility (60 days per calendar year) % % Outpatient Services Outpatient surgery, dialysis, infusion, chemo and radiation therapy % % Outpatient rehabilitative services: physical, occupational or speech therapy (limited to 30 visits per calendar year) % % Maternity Services Prenatal office visits Covered in full % Delivery and postnatal services primary care provider or certified nurse midwife 10% less than plan coinsurance Delivery and postnatal services OB-GYN % % Inpatient hospital/facility services % % Routine newborn nursery care % % * After deductible where no checkmark is indicated % 21

22 Pharmacy Benefit Plans Providence Health Plan offers a number of pharmacy benefit plans with two different broad formulary options to supplement your employee medical plan coverage. All plans include: Preventive prescription medications covered in full on ACA preventive prescriptions Access to more than 26,000 participating pharmacies Access to a 90-day pharmacy transition period for most prescriptions that normally require prior authorization for newly enrolled members New for 2016: 5-tier pharmacy plans: Prescription cost-shares do not apply to the medical deductible, but do go toward the medical plan out-of-pocket maximum Coverage for preventive, preferred generic, generic, preferred brand-name and brandname, specialty and compound medication No separate out-of-pocket maximum Care management for members with chronic conditions, including support for medication adherence, help identifying harmful drug interactions and help identifying opportunities to reduce health care costs 90-day supply of maintenance medication through the preferred retail or mail-order service for two times the cost of a 30-day supply at a retail pharmacy RX 0/10/15/20/50 RX 0/15/20/30/50 RX 0/15/20/45/50 RX 0/20/25/40/50 RX 0/25/30/50/50 Retail** Preferred retail / Mail order Retail** Preferred retail / Mail order Retail** Preferred retail / Mail order Retail** Preferred retail / Mail order Retail** Preferred retail / Mail order 5-tier Pharmacy Plans 1. ACA preventive $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 2. Preferred generic $10 $20 $15 $30 $15 $30 $20 $40 $25 $50 3. Generic $15 $30 $20 $40 $20 $40 $25 $50 $30 $60 4. Preferred brand-name $20 $40 $30 $60 $45 $90 $40 $80 $50 $ Brand-name, specialty and compound drugs Brand-name 50% to $100 50% to $200 50% to $100 50% to $200 50% to $100 50% to $200 50% to $100 50% to $200 50% to $100 50% to $200 Specialty* and compound drugs (limited to a 30- day supply) 50% to $100 50% to $100 50% to $100 50% to $100 50% to $ * Specialty prescription drugs are not available with the mail-order/maintenance benefit, are limited to a 30-day supply, and must be obtained through the Providence Health Plan participating specialty pharmacy. **90-day supplies of maintenance medication can only be obtained through a preferred retail pharmacy or the mail-order service.

23 Two-tier prescription drug plans Our integrated standard prescription drug plans include a robust formulary, support for retail and mail-order fulfillment, and multiple cost-sharing options. Plan feature Preventive prescription medications covered in full on ACA preventive prescription medication Two-tier pharmacy copays start as low as $10 for a 30-day supply of generic medications. RXtra plans are available with many different copay levels. RXtra plans allow members to purchase up to a 90-day supply of each prescription maintenance medication at one time for the cost of two copays through preferred retail and mail-order services. Specialty prescription drug benefits are obtained through Providence Health Plan participating specialty pharmacies. They are not available with the mail-order/maintenance service or through preferred retail pharmacies, and are limited to a 30-day supply. Participating/Preferred Retail 30-day supply Copays/Coinsurance Mail-Order/Preferred Retail 90-day supply maintenance prescriptions Copays/Coinsurance RXtra Available* Generic Brand Generic Brand Rx $10/$20 $10 $20 $30 $60 Y Rx $10/$30 $10 $30 $30 $90 Y Rx $10/50% $10 $50 $30 $50 Y** Rx $15/$30 $15 $30 $45 $90 Y Rx $15/$45 $15 $45 $45 $135 Y Rx $15/50% $15 or 50%, whichever is greater 45 or 50%, whichever is greater Y*** Rx $15/$60 $15 $60 $45 $180 Y Rx $15/$75 $15 $75 $45 $225 Y Rx $20/$40 $20 $40 $60 $120 N * RXtra plans provide standard 30-day prescriptions and allow members to purchase up to a 90-day supply of each prescription medication at one time through a preferred retail or mail-order pharmacy for the cost of two copays. For example, if a 30-day supply of a generic drug has a copay of $10, a 90-day supply of that same medication would, under RXtra, have a copay of $20 instead of $30. ** For the RXtra $10/50% plan, the copay for a 90-day supply of generic drugs is $20 or 50% for the brand drugs. *** For the RXtra $15/50% plan, the copay for a 90-day supply of both generic and brand drugs is $30 or 50%, whichever is greater. 23

24 Providence Dental plans Providence Dental Plans provide comprehensive benefits that help promote good health, and are available when paired with a Providence medical plan. With Providence Dental, members have access to more than 2,000 in-network dental provider listings in Oregon and southwest Washington and more than 280,000 in-network provider listings nationwide. Searching for a dentist is easy; visit Plan features Eight dental plan options (four plans with orthodontia coverage and four without) Plus Plans available each offering an orthodontia benefit with a $1,500 lifetime maximum Robust coverage for services received both in and outside the network Access to our national network of dental providers with over 280,000 dentist listings No waiting periods Dental Plans: Benefit highlights Essential, Classic and Premium Dental Plans Services on the following plans Essential Dental, Classic Dental and Premium Dental are reimbursed according to the Maximum Allowable Charge (MAC) the negotiated fee the plan pays to providers. Balance billing may apply for out-of-network services. No deductible for in- and out-of-network diagnostic and preventive services In-network diagnostic and preventive services covered in full Diagnostic and preventive services do not apply toward calendar year benefit maximum Calendar year costs Essential Dental Classic Dental Premium Dental Common deductible (per person) Common deductible (per family) $50 $50 $50 $150 $150 $150 Benefit maximum $1,000 $1,500 $2,000 Covered services You pay In-network In-network In-network Out-ofnetwork Out-ofnetwork Out-ofnetwork Preventive and diagnostic care (routine exams, cleanings, bitewing X-rays, topical fluoride for age 16 and younger)* $0; services covered in full 10% $0; services covered in full 10% $0; services covered in full 10% Basic care (restorative fillings and extractions) Endodontics, periodontics, oral surgery, including root canals Major care (crowns, dentures, bridge work) 20% 30% 20% 30% 20% 30% 20% 30% 20% 30% 20% 30% 50% 60% 50% 60% 50% 60% 24 Orthodontics optional $1,500 lifetime maximum benefit available on Essential Plus, Classic Plus or Premium Plus plans Reimbursement MAC** MAC** MAC** MAC** MAC** MAC** * Services do not apply to member s calendar year benefit maximum. **MAC is Maximum Allowable Charge by the provider. Balance billing may apply for out-of-network services.

25 Classic Access Dental Plans The following plan Classic Access Dental reimburses in-network services according to the Maximum Allowable Charge (MAC). Out-of-network services are reimbursed according to UCR what is usual, customary and reasonable within a region. Calendar year costs Classic Access Dental Common deductible (per person) $50 Common deductible (per family) $150 Benefit maximum $1,500 Covered services You pay Preventive and diagnostic care (routine exams, cleanings, bitewing X-rays, topical fluoride for age 16 and younger)* In-network Covered in full Out-of-network Covered in full Basic care (restorative fillings and extractions) Endodontics, periodontics, oral surgery, including root canals Major care (crowns, dentures, bridge work) Orthodontics optional 20% 20% 20% 20% 50% 50% $1,500 lifetime maximum benefit available on Classic Access Plus Reimbursement (OON) MAC** 90% of UCR * Services do not apply to member s calendar year benefit maximum. **MAC is Maximum Allowable Charge by the provider. 25

26 Vision plans Providence offers vision benefits through Vision Service Plan (VSP), the largest nonprofit vision benefits and services company in the U.S. The VSP Choice Network gives members access to 50,000 highly skilled providers in more than 48,000 locations nationwide. Plan features No deductible An annual eye exam from participating providers after a low copay Basic lenses for adults covered in full $130 allowance toward frames or contacts* Progressive lenses are available with a $50 copay Full coverage for eye exam, lens and frames for children up to age 19 every 12 months with no copay** No referral required (out-of-pocket costs generally will be less with an in-network provider) Discounts on additional exams, extra features and options, such as lens tinting and nonprescription sunglasses No referral required (out-of-pocket costs will be less with an in-network provider) Discounts on additional exams, extra features and options, such as lens tinting and hardware, and nonprescription sunglasses Vision Plans: Benefit highlights Vision Plan Exam Frequency Lens Frequency Frame Frequency Exam Copay Adult Frame or Contact Lens Allowance Vision Exam 12 months N/A N/A $10 N/A Vision Basic 12 months 24 months 24 months $10 $130 Vision Basic featuring Otis and Piper Eyewear 12 months 24 months 24 months $10 $130 Vision Plus 12 months 12 months 24 months $10 $130 Vision Plus featuring Otis and Piper Eyewear 12 months 12 months 24 months $10 $130 Vision Premium 12 months 12 months 12 months $10 $ Vision Premium featuring Otis and Piper Eyewear 12 months 12 months 12 months $10 $130 * Except for the Vision Exam plan, which does not cover frames or lenses ** Any frame from Otis and Piper Eyewear or the equivalent value can be applied toward any other frame.

27 Chiropractic manipulation and acupuncture plans with massage therapy option available Complementary and alternative medicine is enjoying growing popularity among consumers and greater clinical support by care providers. These treatments are valued for their ability to quickly provide therapeutic benefits for members. Providence offers two types of plans with benefit design options: Chiropractic Manipulation and Acupuncture plans (CHA) Chiropractic Manipulation and Acupuncture Plus plans (CHA Plus) Our standard CHA plans provide benefits for medically necessary chiropractic and acupuncture services from in-network licensed providers. Our CHA Plus plans offer the same benefits from any licensed providers. For additional premium, massage therapy benefits can be added to any plan. Plan features No provider referral is required No deductible needs to be met Copays do not apply toward the medical plan out-of-pocket maximum (except for on an HSA Qualified plan) Benefit design options Standard CHA and CHA Plus plan options are available with the following copay and benefit combinations: Copays Maximum calendar year benefit (per member) $15 $500 $25 $1,000 $1,500 27

28 Integrated HSA, HRA or FSA An integrated HSA, HRA or FSA can lower members costs and support their choice and flexibility, and employers can benefit from tax advantages. These plans also encourage members to be more judicious with their health care dollars and make more informed health care decisions. Providence Health Plan partners with HealthEquity to provide best-in-class health care accounts delivered seamlessly with our health plans at a competitive price. Through a partnership with HealthEquity, the nation s oldest and largest dedicated health savings trustee, Providence makes integrated HSA, HRA or FSA easy with: Live 24/7 customer service The ability to pay providers and view claims and payment information online, anytime, anywhere Integrated plan setup, enrollment, claims administration and billing so that health plan and member health care accounts are set up in one place A fully equipped employer portal that lets you manage contributions, view reporting and upload contribution information A free HealthEquity mobile app that gives members on-the-go access to account balances and Claims history and the ability to send payments and reimbursements, initiate and document claims, and manage debit card transactions Account type Employee account activation and setup Monthly administration Employer plan setup and annual plan maintenance fee (payable to HealthEquity) Health Savings Account Free $2.70 per account (included in Providence invoice) Free Health Reimbursement Arrangement Free $3.45 per account (included in Providence invoice) $250 - $500 Flexible Spending Account Free $3.45 per account (paid to HealthEquity) $250 - $500 Limited Purpose Flexible Spending Account Free $1.95 per account (paid to HealthEquity) Free 28