GROUPS SIZED Plan Overview

Transcription

1 GROUPS SIZED Plan Overview

2 WHY CHOOSE 600,000 + MEMBERS 30% MEMBER GROWTH YEARS OF CARE PROVIDENCE HEALTH PLAN? As part of Providence Health & Services, we are proud to help lead the transformation of health care into a consumer-centric, innovative industry. It also makes us well-positioned to provide our partners and consumers with ideal cost structures, operational excellence, better outcomes and responsive approaches to integrated care delivery. FOR PRODUCERS Financially strong and highest quality FOR EMPLOYERS Healthy employees and affordable care FOR MEMBERS Easy access to care and resources LARGEST CARRIER IN THE STATE 2016 Oregon Market Share Top 7 BEST NEGOTIATED RATES for Providence providers and facilities MANY WAYS TO GET CARE Express Care, ProvRN, health coaches and more 9 % 5 % 5 % 19% NUMBER 1 MARKET SHARE IN OREGON 12 % Q % 13 % n PROVIDENCE n Kaiser n Regence n Moda n United Healthcare n PacificSource n Health Net FINANCIAL RESERVES far exceed regulatory requirement PERFORMANCE METRICS 93.7% first call resolution rate BEST IN REGION FOR MANAGING 5 CHRONIC DISEASES* 1500% 1000% 500% % % % Minimum requirement 2015 Our risk-based capital is 4x requirement set by the Oregon Division of Financial Regulation. 95.8% of total clean claims processed within 30 days 97.2% overall processing accuracy 99.8% financial payment accuracy LifeBalance activities and discounts 2 HIGHEST RATED PPO PLANS CMS awarded Providence Medicare Advantage a 4.5 star rating for TH PERCENTILE HEDIS SCORES in key areas such as diabetes care myprovidence Easy access to personal health information anywhere

3 Our promise: Great care and coverage As part of Providence Health & Services, we offer: Dedication to our Mission to serve all Focus on the total well-being of each person Reach beyond our doors to help all people live healthier lives For producers Employers can have confidence knowing members receive the most appropriate care within a connected system. We offer: Breadth of plans to help manage costs (PPO, medical home and HSA plans with integrated tax-advantaged savings accounts) Trends that are below market, keeping plans competitively priced A best-in-class sales team, so working with us is easy Financial stability, with reserves that well exceed regulatory requirements set by the Oregon Division of Financial Regulation Resources that drive improvements in cost, satisfaction and quality An integrated health system that provides the convergence of care and coverage Recognized efficiency and accuracy in claims resolution Quality overall, including recognition from the National Committee for Quality Assurance who awarded us Commendable accreditation status for commercial plans For employers We help keep employees engaged and healthy while managing costs. We offer: Emphasis on preventive, whole-person care On-site flu-shot clinics Certified RN case managers trained in disease management and behavior change Education to increase medication adherence A one-stop shop, including pharmacy, vision, dental and alternative care For members Members stay healthy and engaged with access to convenient tools, innovative programs and multiple ways to access care. We offer: Health coaching to support healthy lifestyles Health express, a telehealth program for members, that s ranked 4.8 out of five stars for patient satisfaction ProvRN, offering 24/7 health advice from a registered nurse Express Care clinics with same-day local care Vision and hearing discounts Lowest-in-region rate of adverse medical events associated with poor control of disease for commercial members ( )* 38% decrease to inpatient hospitalizations and ER visits for members with chronic disease ( )* LifeBalance program, offering discounts for healthy activities myprovidence, a secure, personal way to manage all aspects of care FitTogether wellness program and engaging newsletters Tobacco cessation programs, and more * Data from the Disease Management Purchasing Consortium 3

4 What you get with Providence 4 New for 2017: Personal physician/provider phone and video visits are now in full for all plans. (Deductible applies for HSA plans.) Providence Essential Dental, a new, lower-cost dental plan, is added. The six-month exclusion for elective procedures has been eliminated. The HSA plans formulary includes some preventive medications that are exempt from the deductible, with the member paying the applicable tier cost share. The prescription drug formulary tiers have been changed to help keep the coverage affordable. See page 21 for details. Choice plans will no longer be available. Robust plan choices You can choose from a wide variety of plan types with a range of deductibles to meet the needs of your business. Bundled benefits include pediatric dental, vision and pharmacy Coverage for vision, pharmacy services and pediatric dental is included in every plan: We offer a pediatric dental plan that is compliant with the Affordable Care Act.* Vision coverage for adults and children is offered through the VSP Choice network.* Members have access to preferred retail and mail-order pharmacy options. Most plans include coverage for chiropractic manipulation and acupuncture.* * available with Standard plans Exclusive health improvement resources With FitTogether members can take multiple paths to better health with various programs and services, including: ProvRN, free health advice 24/7 from a registered nurse Tobacco cessation programs that help tobacco users quit for good Award-winning case and disease management nurse care coordinators who provide education and support for members with chronic conditions Health and wellness classes that help members manage stress, achieve a healthy weight, begin a yoga practice and more An award-winning newsletter packed with health and wellness information from our own medical experts Two innovative tools to maintain and improve health myprovidence, our secure member portal and complete source for health, wellness and benefits information, enables members to: Get a baseline of their overall health with a personal health assessment Search our online directory to find in-network providers, review their claims history and calculate how much of their deductible they ve met Manage their health costs with our treatment cost calculator and online bill pay options Live healthier lives with Wellness Central, an integrated health and wellness hub that offers a personalized dashboard, health trackers and assessments, a library of health and wellness videos and articles, meal plans and medication information MyChart is a secure website for contacting the Providence Medical Group family of clinics to: Schedule appointments online health care providers Pay bills online Access lab and other test results e: myprovidence and MyChart are separate sites with different logins and passwords.

5 Health-enhancing extras for added fitness and fun All members enjoy savings on: Exclusive discounts through LifeBalance to recreation options, such as popular family attractions, zoos and amusement parks; hundreds of fitness facilities throughout Oregon; and local events Board-certified LASIK vision correction or custom LASIK through our partner, TruVision Hearing aids (up to off the average retail price) through our partner, TruHearing Services for a fit business and a healthy workforce In addition to medical plans, Providence offers buy-up services that give you everything you need to build a comprehensive benefits program customized to your objectives: An employee assistance program designed to help employees resolve issues affecting work and family life through comprehensive counseling and referrals to community resources Simplified integration of health saving accounts, health reimbursement accounts and flexible spending accounts with Providence Health Plan through our partner, HealthEquity Best Fit defined contribution When you choose the defined contribution option with Providence Health Plan, you re able to offer your employees a choice of two or three plans instead of just one. The advantages of a Best Fit option for the employer include: Eliminating the burden of having to choose one plan that satisfies all employees Better prediction and control of insurance costs, regardless of fluctuations in insurance rates and employee census Greater employee satisfaction with benefit choices The advantages of a Best Fit option for employees include: Greater control, involvement and choice in benefit selection The ability to stretch benefit dollars by choosing lower-priced options Greater satisfaction with coverage that they ve chosen to best meet their needs The plans you choose must meet a few guidelines: Groups with one to four benefit-eligible subscribers can offer up to two plans. Groups with five or more benefit-eligible subscribers can offer up to three plans. The employer contribution must be at least 50 percent of the employeeonly rate for the lowest-cost plan. If you offer Connect plans, you also must offer at least one option that includes the Signature Network (Total Enhanced, Total, Balance, Standard or HSA Qualified). 5

6 Networks and selling areas Keeping comprehensive care and cost management top of mind, Providence offers plans with broad or tailored networks. Our networks offer access to Providence physicians and specialists, as well as individual providers and provider groups outside of the Providence health system. Providence Signature Network The Providence Signature Network offers the broadest selection of in-network health care providers. Unlike other carriers, we give members who live or travel outside of Oregon access to our entire national provider network rather than being assigned to a specific network in their region. Plans with this network are a great fit for organizations that have employees who work outside of Oregon. Providers: nearly 1 million providers nationwide Specialists: more than 350,000 specialists nationwide Plans with the Signature Network: Total Enhanced, Total, Balance, HSA Qualified and Standard Selling area: statewide in Oregon Network area Selling area Providence Connect Network With the Portland-area Providence Connect Network, members choose a medical home from more than 70 primary care clinics in Clackamas, Multnomah and Washington counties. Participating clinics partner with Providence to improve the quality of care and reduce medical costs. Members get access to Connect network specialists via referral from their medical home. Clinics: more than 70 medical homes Specialists: by referral Plans with the Connect Network: Connect Selling area: Clackamas, Multnomah and Washington counties Network and selling area 6 For a listing of providers for any of these networks, visit ProvidenceHealthPlan.com/findaprovider.

7 Plan comparison Plan Features Total Enhanced Total Balance HSA Qualified Connect Standard Gold & Silver Standard Bronze Provider network Broad PPO-style network Local medical home model No in-network referrals required Benefits Combined in-network and out-ofnetwork deductibles and out-ofpocket maximums Deductible applies to out-of-pocket maximum ACA preventive care in full Deductible waived for personal physician/provider and specialist visits Deductible waived for urgent care visits Deductible waived for lab and X-ray * * Deductible waived for generic drugs Deductible waived for preferred brand name drugs * * Coverage for chiropractic manipulation and acupuncture Pediatric dental (Medical deductible and out-of-pocket maximums apply) Adult vision exams Adult vision hardware Higher cost shares for select services Health and wellness program ProvRN free 24/7 nurse line Disease management for chronic conditions LifeBalance recreational discount program Health coaching (12 sessions/year) Integrated HSA, HRA and FSA account administration Can be paired with an integrated HealthEquity HRA and/or FSA Can be paired with an integrated HealthEquity HSA *Gold and Silver plans only The plan information listed in this booklet is intended to provide an overview only. Please refer to a benefit summary for specific details. Some benefit limitations and exclusions apply to our plans. For a complete listing of benefits and exclusions, please see the plan contract documents. 7

8 Total Enhanced plans With the most robust level of coverage, Total Enhanced plans offer best-in-class benefits with full access to the Providence Signature Network for the ultimate flexibility. Total Enhanced plans offer: Rich benefits with platinum, gold and silver options The greatest cost predictability with low copays and deductible-waived benefits Copays starting as low as $10, deductibles as low as $250 and out-of-pocket maximums as low as $2,500 Deductibles waived for doctor and specialist visits; ER and urgent care; lab and X-ray services; and chiropractic manipulation and acupuncture A combined deductible and out-of-pocket maximum Deductible waived on all five pharmacy tiers Lowest prescription drug copays and best adult vision coverage, including annual exams, lenses and hardware Provider choice in or out of the Providence Signature Network Pediatric dental coverage Up to 15 combined chiropractic manipulation and acupuncture visits per year Providence Signature Network: A network with nearly 1 million providers nationwide, including Providence facilities, affiliated provider groups and individual providers Six plans available Deductible (in-/out-of-network) Out-of-pocket maximum (in-/out-of-network) Total Enhanced 250 Platinum $250 $2,500 Total Enhanced 500 Platinum $500 $2,500 Total Enhanced 1000 Gold $1,000 $4,000 Total Enhanced 1500 Gold $1,500 $4,000 Total Enhanced 2500 Gold $2,500 $4,000 Total Enhanced 5000 Silver $5,000 $7,150 8

9 Total Enhanced plans Network Referral required for in-network benefits After meeting the deductible, the member pays the following amounts for services. The deductible does not apply to some services. These are marked with Providence Signature Network No Preventive Care Periodic health exams and well-baby care (from any provider licensed to perform the service) In-network full Out-of-network 30% to 40% Maternity prenatal care full 30% to 40% Gynecological exams; Pap tests full 30% to 40% Mammograms full 30% to 40% Routine immunizations and shots full 30% to 40% Colorectal cancer screenings (preventive, age 50 and over) full 30% to 40% Office Visits for Medical Services Personal physician/provider $10 to $35 30% to 40% Alternative care provider $10 to $35 30% to 40% Specialist $25 to $65 30% to 40% Personal physician/provider visits by phone or video, including Providence Health express full Hospital Services Inpatient hospital services and maternity care 10% to 30% 30% to 40% Emergency/Urgent Care Emergency services $250 then 10% to 30% $250 then 10% to 30% Urgent care services $25 to $65 30% to 40% Outpatient Diagnostic Services X-ray and lab services 10% to 30% 30% to 40% High-tech imaging services (such as PET, CT, MRI) 10% to 30% 30% to 40% Other Services Outpatient surgery at a hospital-based facility or ASC 10% to 30% 30% to 40% Chiropractic manipulation and acupuncture (limited to 15 visits combined per calendar year); does not apply to out-of-pocket maximum $25 Prescription Drugs Preferred generic $10 to $15 Non-preferred generic $15 to $20 Preferred brand name $25 to $60 Non-preferred brand name 30% to 40% Specialty Pediatric Vision Services (children aged 18 years and younger) Routine eye exams (limited to one exam per calendar year) full Vision hardware (frames, lenses, contact lenses); limits apply full Adult Vision Services Routine eye exams (limited to one exam per calendar year) $30 Vision hardware (frames, lenses, contact lenses); limits apply Pediatric Dental Services (children aged 18 years and younger) Preventive services (routine exams, cleanings, bitewing X-rays, topical fluoride, space maintainers) full 30% Basic services (restorative fillings) 70% Major services (oral surgery, endodontics, periodontics, crowns, and denture and bridge work) 70% 9

10 Total plans Choose a Total plan for a mix of rich benefits and the flexibility of the national Signature network. These affordable plans are a great choice for many types of companies. Total plans offer: Rich benefits with gold and silver options Low copays and deductible-waived benefits for cost predictability Copays starting at $10, deductibles as low as $1,000 and out-of-pocket maximums from $4,000 Deductibles waived for doctor and specialist visits; urgent care; lab and X-ray services; all drug tiers except Specialty; and chiropractic manipulation and acupuncture A combined deductible and out-of-pocket maximum Provider choice in or out of the Providence Signature Network Pediatric dental coverage Adult vision coverage (exams and hardware) Up to 10 combined chiropractic manipulation and acupuncture visits per year Providence Signature Network: A network with nearly 1 million providers nationwide, including Providence facilities, affiliated provider groups and individual providers Four plans available Deductible (in-/out-of-network) Out-of-pocket maximum (in-/out-of-network) Total 1000 Gold $1,000 $4,000 Total 2000 Gold $2,000 $4,000 Total 3500 Silver $3,500 $7,150 Total 5000 Silver $5,000 $7,150 10

11 Total plans Network Referral required for in-network benefits Providence Signature Network No After meeting the deductible, the member pays the following amounts for services. The deductible does not apply to some services. These are marked with Preventive Care Periodic health exams and well-baby care (from any provider licensed to perform the service) In-network full Out-of-network 40% Maternity prenatal care full 40% Gynecological exams; Pap tests full 40% Mammograms full 40% Routine immunizations and shots full 40% Colorectal cancer screenings (preventive, age 50 and over) full 40% Office Visits for Medical Services Personal physician/provider $25 to $35 40% Alternative care provider $25 to $35 40% Specialist $45 to $65 40% Personal physician/provider visits by phone or video, including Providence Health express full Hospital Services Inpatient hospital services and maternity care 20% to 30% 40% Emergency/Urgent Care Emergency services $250 then 20% to 30% $250 then 20% to 30% Urgent care services $45 to $65 40% Outpatient Diagnostic Services X-ray and lab services 20% to 30% 40% High-tech imaging services (such as PET, CT, MRI) 20% to 30% 40% Other Services Outpatient surgery at a hospital-based facility or ASC 20% to 30% 40% Chiropractic manipulation and acupuncture (limited to 10 visits combined per calendar year); does not apply to out-of-pocket maximum $25 Prescription Drugs Preferred generic $10 to $15 Non-preferred generic $20 Preferred brand name $45 to $60 Non-preferred brand name 40% to Specialty Pediatric Vision Services (children aged 18 years and younger) Routine eye exams (limited to one exam per calendar year) full Vision hardware (frames, lenses, contact lenses); limits apply full Adult Vision Services Routine eye exams (limited to one exam per calendar year) $30 Vision hardware (frames, lenses, contact lenses); limits apply Pediatric Dental Services (children aged 18 years and younger) Preventive services (routine exams, cleanings, bitewing X-rays, topical fluoride, space maintainers) full 30% Basic services (restorative fillings) 70% Major services (oral surgery, endodontics, periodontics, crowns, and denture and bridge work) 70% 11

12 Balance plans Our Balance plans offer a harmonious mix of cost-saving features and coverage for the services members use the most. With excellent benefits at an affordable premium, this classic plan design is straightforward and flexible. Balance plans offer: A variety of deductible options and out-ofpocket maximums so you can select the plan and price point that fits within your budget Separate deductibles and out-of-pocket maximums, in and out of the network Deductibles waived for doctor and specialist visits, urgent care, chiropractic manipulation and acupuncture Deductibles waived in Gold and Silver plans for lab and X-ray, and all drug tiers except Specialty Provider choice in or out of the Providence Signature Network Pediatric dental coverage Adult vision coverage (exams and hardware) Up to 10 combined chiropractic manipulation and acupuncture visits per year Providence Signature Network: A network with nearly 1 million providers nationwide, including Providence facilities, affiliated provider groups and individual providers Six plans available Deductible (in-/out-of-network) Out-of-pocket maximum (in-/out-of-network) Balance 750 Gold $750/$1,500 $4,700/$9,400 Balance 1500 Gold $1,500/$3,000 $4,700/$9,400 Balance 2500 Silver $2,500/$5,000 $7,150/$14,300 Balance 3500 Silver $3,500/$7,000 $7,150/$14,300 Balance 5500 Silver $5,500/$11,000 $7,150/$14,300 Balance 7150 Bronze $7,150/$14,300 $7,150/$14,300 12

13 Balance plans Network Referral required for in-network benefits Providence Signature Network No After meeting the deductible, the member pays the following amounts for services. The deductible does not apply to some services. These are marked with Preventive Care Periodic health exams and well-baby care (from any provider licensed to perform the service) In-network full Out-of-network Maternity prenatal care full Gynecological exams; Pap tests full Mammograms full Routine immunizations and shots full Colorectal cancer screenings (preventive, age 50 and over) full Office Visits for Medical Services Personal physician/provider $25 to $65 Alternative care provider $25 to $65 Specialist $50 to $125 Personal physician/provider visits by phone or video, including Providence Health express full Hospital Services Inpatient hospital services and maternity care 20% to 30%* * Emergency/Urgent Care Emergency services $250 then 20% to 30%* $250 then 20% to 30%* Urgent care services $50 to $125 Outpatient Diagnostic Services X-ray and lab services 20% to 30%* * High-tech imaging services (such as PET, CT, MRI) 20% to 30%* * Other Services Outpatient surgery at a hospital-based facility or ASC 20% to 30%* * Chiropractic manipulation and acupuncture (limited to 10 visits combined per calendar year); does not apply to out-of-pocket maximum $25 Prescription Drugs Preferred generic $15 to $30 Non-preferred generic $20 to $55 Preferred brand name $50 to $75* Non-preferred brand name * Specialty * Pediatric Vision Services (children aged 18 years and younger) Routine eye exams (limited to one exam per calendar year) full Vision hardware (frames, lenses, contact lenses); limits apply full Adult Vision Services Routine eye exams (limited to one exam per calendar year) $30 Vision hardware (frames, lenses, contact lenses); limits apply Pediatric Dental Services (children aged 18 years and younger) Preventive services (routine exams, cleanings, bitewing X-rays, topical fluoride, space maintainers) full 30% Basic services (restorative fillings) * 70%* Major services (oral surgery, endodontics, periodontics, crowns, and denture and bridge work) * 70%* 13 * For the Balance 7150 Bronze plan only: The deductible applies to this benefit. Therefore, because the deductible is equal to the out-of-pocket maximum, the benefit is in full after the deductible is paid.

14 HSA Qualified plans These lower-premium, high-deductible health plans give members affordable coverage and the flexibility to choose any provider in the Signature network. 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. HSA Qualified plans offer: Provider choice in or out of the Providence Signature Network Lower premiums with most services subject to the deductible Separate deductibles and out-of-pocket maximums, in and out of the network In-network preventive care services that are before the deductible Integrated health savings account administration, available through HealthEquity, to simplify employee account setup and contributions A seamless member experience for tracking and paying HSA qualified plan expenses through integrated claims processing, available with HealthEquity A formulary that includes some preventive medications that are exempt from the deductible, with the member paying the applicable tier cost share Pediatric dental coverage Adult vision coverage (exams only) Up to 10 combined chiropractic manipulation and acupuncture visits per year Providence Signature Network: A network with nearly 1 million providers nationwide, including Providence facilities, affiliated provider groups and individual providers Six plans available Deductible (in-/out-of-network) Out-of-pocket maximum (in-/out-of-network) HSA Qualified 1500 Silver $1,500/$3,000 $5,500/$11,000 HSA Qualified 2500 Silver $2,500/$5,000 $5,500/$11,000 HSA Qualified 3000 Silver $3,000/$6,000 $5,500/$11,000 HSA Qualified 4500 Bronze $4,500/$9,000 $6,550/$13, HSA Qualified 5500 Bronze $5,500/$11,000 $6,550/$13,100 HSA Qualified 6550 Bronze* $6,550/$13,100 $6,550/$13,100 If any dependents are enrolled in addition to the subscriber, the in-network per person annual cost-sharing limit is $7,150.

15 HSA Qualified plans* Network Referral required for in-network benefits Providence Signature Network No After meeting the deductible, the member pays the following amounts for services. The deductible does not apply to some services. These are marked with In-network Out-of-network Preventive Care Periodic health exams and well-baby care (from any provider licensed to perform the service) full Maternity prenatal care full Gynecological exams; Pap tests full Mammograms full Routine immunizations and shots full Colorectal cancer screenings (preventive, age 50 and over) full Office Visits for Medical Services Personal physician/provider 20% to Alternative care provider 20% to Specialist 20% to Personal physician/provider visits by phone or video, including Providence Health express Hospital Services full after the deductible Inpatient hospital services and maternity care 20% to Emergency/Urgent Care Emergency services 20% to Urgent care services 20% to Outpatient Diagnostic Services X-ray and lab services 20% to High-tech imaging services (such as PET, CT, MRI) 20% to Other Services Outpatient surgery at a hospital-based facility or ASC 20% to Chiropractic manipulation and acupuncture (limited to 10 visits combined per calendar year); does not apply to out-of-pocket maximum $25 Prescription Drugs Preferred generic 20% to Non-preferred generic 20% to Preferred brand name 20% to Non-preferred brand name 20% to Specialty 20% to Pediatric Vision Services (children aged 18 years and younger) Routine eye exams (limited to one exam per calendar year) full Vision hardware (frames, lenses, contact lenses); limits apply full Adult Vision Services Routine eye exams (limited to one exam per calendar year) $25 Vision hardware (frames, lenses, contact lenses); limits apply Pediatric Dental Services (children aged 18 years and younger) Diagnostic and preventive services (routine exams, cleanings, bitewing X-rays, topical fluoride, space maintainers) full 30% Basic services (restorative fillings) 70% Major services (oral surgery, endodontics, periodontics, crowns, and denture and bridge work) 70% 15 * For the HSA Qualified 6550 Bronze plan, most benefits do not have a cost share after the deductible is met, because the deductible is equal to the out-of-pocket maximum. Please refer to a benefit summary for details.

16 Connect plans Connect plans combine a medical home model of care with a tailored provider network to achieve substantial premium savings. Members choose 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. Connect plans offer: Some of the lowest premiums of any Providence small group plan More than 70 medical home clinics in the Portland metro area Access to Connect network specialists and facilities via referral from the medical home in order to receive coverage at the in-network level Deductibles waived for doctor and specialist visits, urgent care, chiropractic manipulation and acupuncture Deductibles waived in Gold and Silver plans for lab and X-ray, and all drug tiers except Specialty Higher cost shares for select services, such as knee and hip replacement, and sinus surgery Separate deductibles and out-of-pocket maximums in and out of the network Pediatric dental coverage Adult vision coverage (exams only) Up to 10 combined chiropractic manipulation and acupuncture visits per year (out-ofpocket maximum doesn t apply) To be eligible for a Connect plan, your business must be located in Clackamas, Multnomah or Washington counties in Oregon. To ensure coverage for members outside the Connect Network selling/service area, a Connect plan must be paired with another Providence plan that uses the Providence Signature network (Total Enhanced, Total, Balance, HSA Qualified and Standard plans). Providence Connect Network: A Portlandarea network of more than 70 primary care clinics in Clackamas, Multnomah and Washington counties designated as medical homes For a complete list of available medical homes and providers by location, visit ProvidenceHealthPlan.com/findaprovider. Six plans available Deductible (in-/out-of-network) Out-of-pocket maximum (in-/out-of-network) Connect 750 Gold $750/$1,500 $4,700/$9,400 Connect 1500 Gold $1,500/$3,000 $4,700/$9,400 Connect 2500 Silver $2,500/$5,000 $7,150/$14,300 Connect 3500 Silver $3,500/$7,000 $7,150/$14, Connect 5500 Silver $5,500/$11,000 $7,150/$14,300 Connect 7150 Bronze $7,150/$14,300 $7,150/$14,300

17 Connect plans Network Referral required for in-network benefits Providence Connect Network Yes After meeting the deductible, the member pays the following amounts for services. The deductible does not apply to some services. These are marked with In-network Out-of-network Preventive Care Periodic health exams and well-baby care (from any provider licensed to perform the service) full Maternity prenatal care full Gynecological exams; Pap tests full Mammograms full Routine immunizations and shots full Colorectal cancer screenings (preventive, age 50 and over) full Office Visits for Medical Services Personal physician/provider $25 to $65 Alternative care provider $25 to $65 Specialist $50 to $125 Personal physician/provider visits by phone or video, including Providence Health express full Hospital Services Inpatient hospital services and maternity care 20% to 30%* * Emergency/Urgent Care Emergency services $250 then 20% to 30%* $250 then 20% to 30%* Urgent care services $50 to $125 Outpatient Diagnostic Services X-ray and lab services 20% to 30%* * High-tech imaging services (such as PET, CT, MRI) 20% to 30%* * Other Services Outpatient surgery at a hospital-based facility or ASC 20% to 30%* * Chiropractic manipulation and acupuncture (limited to 10 visits combined per calendar year); does not apply to out-of-pocket maximum $25 Prescription Drugs Preferred generic $15 to $30 Non-preferred generic $50 to $55 Preferred brand name $50 to $75* Non-preferred brand name * Specialty * Pediatric Vision Services (children aged 18 years and younger) Routine eye exams (limited to one exam per calendar year) full Vision hardware (frames, lenses, contact lenses); limits apply full Adult Vision Services Routine eye exams (limited to one exam per calendar year) $25 Vision hardware (frames, lenses, contact lenses); limits apply Pediatric Dental Services (children aged 18 years and younger) Preventive services (routine exams, cleanings, bitewing X-rays, topical fluoride, space maintainers) full 30% Basic services (restorative fillings) * 70%* Major services (oral surgery, endodontics, periodontics, crowns, and denture and bridge work) * 70%* 17 * For the Connect 7150 Bronze plan only: The deductible applies to this benefit. Therefore, because the deductible is equal to the out-of-pocket maximum, the benefit is in full after the deductible is paid.

18 Standard plans Standard plans can be purchased through the federal government s Small Business Health Options Program (SHOP) Marketplace and in the private market. Choose from gold, silver and bronze plans with deductibles ranging from $1,000 to $7,150. Standard plans offer: Separate deductibles and out-of-pocket maximums in and out of the network Copays starting as low as $20 and deductibles as low as $1,000 Provider choice in or out of the Providence Signature Network Eligible Oregon employers may purchase a SHOPcertified plan and take advantage of the IRS Small Business Health Care Tax Credit for Our Standard plans are all certified for SHOP. Dental plans are not available when purchasing plans through the SHOP marketplace. To find out more, visit ProvidenceHealthPlan.com. e: Standard plans do not include chiropractic manipulation, acupuncture, adult routine vision exams and vision hardware, or pediatric dental services. Providence Signature Network: A network with nearly 1 million providers nationwide, including Providence facilities, affiliated provider groups and individual providers Three plans available Deductible (in-/out-of-network) Out-of-pocket maximum (in-/out-of-network) Providence Oregon Standard Gold Plan $1,000/$2,000 $6,850/$13,700 Providence Oregon Standard Silver Plan $2,500/$5,000 $6,850/$13,700 Providence Oregon Standard Bronze Plan* $7,150/$14,300 $7,150/$14,300 18

19 Standard plans Providence Oregon Standard Gold Providence Oregon Standard Silver Providence Oregon Standard Bronze After meeting the deductible, the member pays the following amounts for services. The deductible does not apply to some services. These are marked with Network In-network Out-ofnetwork In-network Out-ofnetwork In-network Providence Signature Network Out-ofnetwork Referral required for in-network benefits Preventive Care Periodic health exams and well-baby care (from any provider licensed to perform the service) Maternity prenatal care Gynecological exams; Pap tests Mammograms Routine immunizations and shots Colorectal cancer screenings (preventive, age 50 and over) Office Visits for Medical Services No Personal physician/provider $20 $35 $70 Alternative care provider $40 $70 $115 Specialist $40 $70 $115 Personal physician/provider visits by phone or video, including Providence Health express Hospital Services Inpatient hospital services and maternity care 20% 30% full after the deductible full after the deductible full after the deductible full after the deductible full after the deductible Emergency/Urgent Care Emergency services 20% 10% 30% 30% full after the full after the deductible deductible Urgent care services $60 $70 $100 full after the deductible Outpatient Diagnostic Services X-ray and lab services 20% 30% full after the full after the deductible deductible High-tech imaging services (such as PET, CT, MRI) 20% 30% full after the full after the deductible deductible (continued) 19

20 Standard plans (continued) Providence Oregon Standard Gold Providence Oregon Standard Silver Providence Oregon Standard Bronze After meeting the deductible, the member pays the following amounts for services. The deductible does not apply to some services. These are marked with In-network Out-ofnetwork In-network Out-ofnetwork In-network Out-ofnetwork Other Services Outpatient surgery at a hospital-based facility or ASC 20% 30% Chiropractic manipulation and acupuncture Prescription Drugs Generic Preferred brand name Non-preferred brand name Specialty $10 $30 Pediatric Vision Services (children aged 18 years and younger) Routine eye exams (limited to one exam per calendar year) Vision hardware (frames, lenses, contact lenses); limits apply Adult Vision Services full full $15 $50 full full Pediatric Dental Services (children aged 18 years and younger) full after the deductible $35 full after the deductible full after the deductible full after the deductible full full full after the deductible 20

21 Pharmacy benefits Coverage for prescription drugs is included in all of our plans. Providence Health Plan is actively taking steps to mitigate the impact of increasing drug costs, while ensuring members continue to have access to safe, effective and affordable medications. One way to help keep premiums affordable is through the structure of our pharmacy benefits. These plans help to balance costs while providing the following benefits: A 90-day supply of maintenance medication through mail-order or preferred retail pharmacies; for a list of pharmacies, visit ProvidenceHealthPlan.com/pharmacylist Different copays for preferred and non-preferred generic and brand-name drugs to provide the best cost for the most commonly used medications Coverage for very high-cost specialty medications at member responsibility ($500 script cap Oregon Standard Gold plan) With a Providence plan, members get: Access to a 90-day pharmacy transition period for most prescriptions that normally require prior authorization for newly enrolled members 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 Access to Providence Health Plan s designated pharmacy network, as published in our pharmacy directory The pharmacy tier structure for all plans except Oregon Standard Plans is: Preferred generic Non-preferred generic Preferred brand name Non-preferred brand name Specialty Oregon Standard plans have a fourtier pharmacy structure: Generic Preferred brand name Non-preferred brand name Specialty Five-tier structure, drug usage and costs A formulary is a list of medications that are by the plan. The description below outlines what each formulary tier means and includes a range of member cost shares for a 30-day supply from a preferred pharmacy, depending on the plan selected. Tier/Category Tier description and drug usage Cost shares Preferred generic Non-preferred generic Preferred brand name Non-preferred brand name Specialty The most frequently prescribed generic drugs that treat common conditions; 60 percent of drugs used are in this tier Generic drugs with higher costs than preferred generics; about 23 percent of drugs used are in this tier The lowest-cost brand-name drugs; about 4 percent of drugs used are in this tier The highest-cost brand-name drugs; about 4 percent of drugs used are in this tier Very high-cost drugs that require special monitoring and/or handling; only 0.5 percent of drugs used are in this tier $10 to $30, 20% to for HSA plans $15 to $55, 20% to for HSA plans $25 to $75, 20% to for HSA plans 20% to For HSA plans only: The HSA Formulary includes safe harbor preventive medications that are exempt from the deductible, with the member paying the applicable cost share. The safe harbor drug list is made up of medications that Providence Health Plan has selected, with the guidance of our Clinical Pharmacy Division. These are first-line medications that may prevent the onset of a disease or condition when taken by a person who has developed risk factors for the disease or condition that has not yet manifested itself or has not become clinically apparent, or may prevent the recurrence of a disease or condition from which a person has re. See a benefit summary for specific copay/coinsurance information for a specific plan. Find the tiers of specific drugs by looking in the plan s formulary at ProvidenceHealthPlan.com/SGformulary. 21

22 Integrated HSA, HRA and FSA Providence Health Plan partners with HealthEquity to bring you best-in-class health care accounts delivered seamlessly with our health plans at a competitive price. With an integrated HSA, HRA or FSA, you can lower your employees costs and support their choice and flexibility, and you can benefit from tax advantages. These plans also encourage employees to be more judicious with their health care dollars and make more-informed health care decisions. Through a partnership with HealthEquity, the nation s oldest and largest dedicated health savings trustee, Providence makes integrated HRA, HSA and FSA easy with: In-person, 24/7 customer service The ability to pay providers and to view claims and payment information online anytime, anywhere Integrated plan setup, enrollment, claims administration and billing so that health plan and employee health care accounts are set up in one place A fully equipped employer portal that lets you manage contributions, view reports and upload contribution information A free HealthEquity mobile app that gives members on-the-go access to account balances and claims history, 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 (paid directly to HealthEquity) Health Savings Account (HSA) Free $2.70 per account (paid as part of Providence bill) Free Health Reimbursement Arrangement (HRA) Free $3.45 per account (paid directly to HealthEquity) $ Flexible Spending Account (FSA) Free $3.45 per account (paid directly to HealthEquity) $ Limited Purpose Flexible Spending Account (LPFSA) Free $1.95 per account (paid directly to HealthEquity) Free 22 To learn more about HealthEquity and for access to employer and employee demos, go to HealthEquity.com/providence.

23 Optional dental plans Providence dental plans provide comprehensive benefits that help promote good health. Through the plan, you have access to more than 2,300 in-network dental provider listings in Oregon and southwest Washington and more than 270,000 in-network provider listings nationwide. Search for a dentist at ProvidenceHealthPlan.com/findaprovider. With Providence dental plans, you get: Three dental plan choices to meet your employees needs and your budget Robust coverage for services received both in and outside the network No waiting periods In-network diagnostic and preventive care services, such as exams, cleanings and X-rays in full Coverage for more extensive services, such as root canals, crowns, bridges and dentures Diagnostic and preventive services do not count toward the annual maximum. A dental plan must be paired with a PHP medical plan, and medical and dental enrollment must match. After meeting the deductible, the member pays the following amounts for services. The deductible does not apply to some services. These are marked with Providence Essential Providence Essential Access Providence Advantage Access Coverage Type Innetwork Out-ofnetwork Innetwork Out-ofnetwork Innetwork Out-ofnetwork Network Providence All other providers Providence All other providers Providence All other providers Deductible $50 $50 $25 Annual maximum $1,000 $1,000 $1,500 Waiting period None None None Diagnostic and preventive services (includes routine exams, cleanings, bitewing X-rays, topical fluoride (age 16 and younger), space maintainers) full 10% full 10% full full Basic services (includes restorative fillings, oral surgery, endodontics, periodontics) Major services (includes crowns, dentures, bridge work) 20% 30% 20% 30% 20% 20% 60% Out-of-network** MAC* 2017 Rates UCR 90th percentile UCR 90th percentile Subscriber only $26.18 $31.32 $34.84 Subscriber and spouse $52.37 $62.65 $69.68 Subscriber and child(ren) $43.12 $51.19 $55.86 Subscriber, spouse and child(ren) $70.77 $84.21 $92.40 Orthodontics/orthodontia are not available. *Maximum allowable charge by the provider **Balance billing may apply for out-of-network services 23

24 Important contact information Resource Find it here 2017 small group benefit summaries ProvidenceHealthPlan.com/2017plansummaries Providence Dental Employer training and forums Employer website HealthEquity Health and wellness for members myprovidence Pharmacy resources Producer compensation, news and notices Producer training and forums Producer website Providence Employee Assistance Program Providence Health Coaching Provider directory ProvidenceHealthPlan.com/smallgroupdental ProvidenceHealthPlan.com/employerCE ProvidenceHealthPlan.com/employers HealthEquity.com/providence ProvidenceHealthPlan.com/findyourfit myprovidence.com ProvidenceHealthPlan.com/pharmacy ProvidenceHealthPlan.com/producernotices ProvidenceHealthPlan.com/producerCE ProvidenceHealthPlan.com/producers ProvidenceHealthPlan.com/eap ProvidenceHealthPlan.com/healthcoach ProvidenceHealthPlan.com/findaprovider Dedicated customer service resources or , TTY: 711 Monday Friday, 8 a.m. to 5 p.m. Sales or ProvidenceHealthPlan.com Our Mission As people of Providence, we reveal God s love for all, especially the poor and vulnerable, through our compassionate service. Our Core Values Respect, Compassion, Justice, Excellence, Stewardship Providence Health & Services, a not-for-profit health system, is an equal opportunity organization in the provision of health care services and employment opportunities Providence Health Plan. All rights reserved. HP SGP-020 8/16