Public Employees Benefits Program. Open Enrollment. Plan Year 2018

Transcription

1 Public Employees Benefits Program Open Enrollment Plan Year 2018 Public Employees Benefits Program 901 S. Stewart Street, Suite 1001 Carson City, NV (775) (800)

2 We re in it together Today s Topics Overview of Open Enrollment Plan Design Changes Consumer Driven Health Plan (CDHP) CDHP/HMO Dental Plan Express Scripts (CDHP/PBM) Hometown Health Plan Northern NV HMO Health Plan of Nevada Southern NV HMO The Standard Page 2

3 We re in it together Participating Vendors Express Scripts Colonial Life Diversified Dental HealthScope Benefits Health Plan of Nevada/United Health Care Hometown Health Liberty Mutual Retired Public Employees of Nevada State of Nevada, Treasure s Office The Standard TIAA-CREF University of Nevada, Reno, School of Medicine VOYA Page 3

4 Open Enrollment: May 1 31, 2017 Complete changes: Online Portal at or Complete Open Enrollment Form Call PEBP at or to request a form Complete changes by May 31, 2017 We re in it together Form submissions must be postmarked by May 31, 2017 Page 4

5 We re in it together Allowable Changes Change health plan options Add or delete dependent(s) Decline coverage Enroll/Decline PEBP dental coverage (Medicare exchange retirees only) Voluntary Products You are NOT required to do anything if you wish to remain on the same plan and coverage tier Page 5

6 Plan Benefits and Enrollment We re in it together Web Portal for Online Enrollment Open Enrollment Guide Premium Rates Plan Documents Plan Contacts Provider Listings Page 6

7 We re in it together Required Documents if Adding Dependents Copies of documents due in the PEBP office by June 15, 2017 Spouse Certified marriage certificate Domestic partner Domestic partner certification issued by the Nevada Secretary of State s Office Child(ren) Natural children: birth certificate Stepchild: birth certificate and marriage certificate Domestic partner s child: birth cert/nv domestic partner cert Adopted child: adoption papers Permanent legal guardianship (child under 18): Legal guardianship papers signed by a judge Page 7

8 We re in it together Plan Design Changes for the Consumer Driven Health Plan (CDHP) Page 8

9 We re in it together Consumer Driven Health Plan (CDHP) Enhanced Primary Care Practice Reno & Carson area The University of Nevada, Reno School of Medicine offers a primary care practice plan for PEBP beginning July 1 st ~ This practice will grant you: Additional time with your doctor Same day appointments by simply calling the clinic by noon After hours access directly with the resident doctor Supervised by a faculty internist In-depth health evaluation Detailed report to help improve your health No additional cost Page 9

10 Consumer Driven Health Plan (CDHP) Diabetic Care Management (DCM) HealthScope Benefits effective May 1 st Opt-in program Actively engage in the program Two visits with a Primary Care Physician or Endocrinologist Adherence to medications Adherence to lab testing Yearly DCM Form submission Monthly RN calls no longer required We re in it together Page 10

11 Consumer Driven Health Plan (CDHP) Preventive Drug Benefit Express Scripts manages your prescription benefit Provides access to certain preventive medications without having to meet the deductible: Hypertension Asthma High cholesterol Subject to 20% coinsurance Coinsurance will apply to out-of-pocket maximum Only applies when using an in-network provider We re in it together Page 11

12 Consumer Driven Health Plan (CDHP) Annual Vision Exam $95 max benefit per annual exam $25 Copay No benefits for frames, lenses or contacts We re in it together Pre-Certification Expanded pre-certification requirement to include all outpatient surgeries performed in a surgery center or outpatient hospital setting *Full list of pre-certification requirements located in the Master Plan Document Page 12

13 We re in it together Consumer Driven Health Plan (CDHP) Medical Benefit ID Cards HealthScope Benefits will issue new Medical ID cards Aetna is replacing First Health Network National Preferred Provider Network available to participants in Nevada that are accessing services outside of Nevada Verify the information on the ID card is correct. If any discrepancies, contact HealthSCOPE Benefits (888) Page 13

14 We re in it together HSA/HRA Contributions State/Non State participant with coverage effective July 1, 2017 Base Contribution One-Time Additional Contribution Total Contribution for participant ONLY Participant Only Tier $700 Per Dependent (maximum 3 dependents) $200 $200 per primary participant** $900 after completion of Preventive Program ** amount provided after completion of a Preventive Program: 1. Annual Preventive Exam 2. Annual Preventive Lab Work 3. Annual Dental Exam 4. One Teeth Cleaning (of the available four per year) All four requirements are covered at 100% if in network providers are used. Participants enrolled on the CDHP on July 1, 2017 receive the Base Contribution. Enrollment in the CDHP on August 1, 2017 and later receive a pro-rated Base Contribution based on coverage effective date and the remaining months in the plan year. Page 14

15 We re in it together 2017 HSA Contribution Limits Increase PEBP + Employee contribution limit Family is defined as two or more covered individuals on your plan $1,000 Catch-up contribution limit for employees age 55 or older $3,400 $6,750 Individual Family Page 15

16 We re in it together Pre-Medicare Retirees Retirees Enrolled on the CDHP/HMO Plan Medicare Part B Premium Credit Increased from $ a month to $134 per month Page 16

17 We re in it together Northern Nevada Medical Plan Options Consumer Driven Health Plan with a: Health Savings Account (HSA); or Health Reimbursement Arrangement (HRA) Standard HMO - Hometown Health Plan Washoe, Carson, Douglas, Storey, Lyon, Churchill, Pershing, Humboldt, Mineral, Lander, Eureka, White Pine, Lincoln, Elko counties Alternative HMO - Hometown Health Plan Available to participants in Washoe, Carson, Douglas, Storey, Lyon, Churchill counties Page 17

18 PLAN DESIGN FEATURES Service Areas Northern Nevada Side by side HMO plan comparison STANDARD HMO PLAN (Hometown Health) IN-NETWORK Statewide ALTERNATE HMO PLAN (Hometown Health) IN-NETWORK Washoe, Carson, Douglas, Storey, Lyon and Churchill Counties Annual Deductible None None Medical Coinsurance N/A N/A Out-of-Pocket Maximum $7,150 Individual $7,150 Individual $14,300 Family $14,300 Family Primary Care Physician Referral Required No Yes Primary Care Office Visit $25 Copay $5 Copay Specialist Care Office Visit $45 Copay (no referral required) $25 Copay (referral required) Emergency Room Visit $300 Copay $1,000 Copay Urgent Care Visit $50 Copay $25 Copay In-Patient Hospital $500 per admission $1,000 per day not to exceed $3,000 per admission Outpatient Surgery $350 Copay $1,000 Copay Wellness/Prevention No Charge No Charge *Review the Open Enrollment Guide for out-of-network details

19 Northern Nevada Side by side HMO pharmacy plan comparison PLAN DESIGN FEATURES STANDARD HMO PLAN (Hometown Health) ALTERNATE HMO PLAN (Hometown Health) IN-NETWORK IN-NETWORK Generic $7 Copay $25 Copay Preferred Brand $40 Copay $50 Copay Non-Preferred $75 Copay $75 Copay Specialty 40% Coinsurance 40% Coinsurance Mail Order Pharmacy: Costco or PPS Option HometownRX Customer Service

20 We re in it together Southern Nevada Medical Plan Options Consumer Driven Health Plan with a: Health Savings Account (HSA); or Health Reimbursement Arrangement (HRA) Standard HMO Health Plan of Nevada Available to participants in Clark, Esmeralda, and Nye counties Alternative HMO - Health Plan of Nevada Available to participants in Clark, Esmeralda, and Nye counties Page 20

21 PLAN DESIGN FEATURES Southern Nevada Side by side HMO plan comparison STANDARD HMO PLAN (Health Plan of Nevada) IN-NETWORK ALTERNATE HMO PLAN (Health Plan of Nevada) IN-NETWORK Service Areas Statewide Available to participants in Clark, Esmeralda, and Nye counties Annual Deductible None None Medical Coinsurance N/A N/A Out-of-Pocket Maximum $7,150 Individual $7,150 Individual $14,300 Family $14,300 Family Primary Care Physician Referral Required No Yes Primary Care Office Visit $25 Copay $5 Copay Specialist Care Office Visit $45 Copay $25 Copay (no referral required) (referral required) Emergency Room Visit $300 Copay $1,000 Copay Urgent Care Visit $30 Copay $25 Copay In-Patient Hospital $500 per admit $1,000 per day not to exceed $3,000 per admission Outpatient Surgery $50 Copay $1,000 Copay Telemedicine $0 per visit $0 per visit Wellness/Prevention No charge No charge *Review the Open Enrollment Guide for out-of-network details

22 Southern Nevada Side by side HMO pharmacy plan comparison PLAN DESIGN FEATURES STANDARD HMO PLAN (Health Plan of Nevada) IN-NETWORK ALTERNATE HMO PLAN (Health Plan of Nevada) IN-NETWORK Generic $7 Copay $25 Copay Preferred Brand $40 Copay $50 Copay Non-Preferred $75 Copay $75 Copay Specialty 40% Coinsurance 40% Coinsurance Mail Order Pharmacy: Optum Rx 90 day supply can be cheaper than local, retail pharmacy Refer to the HPN Preferred Drug List to determine if eligible for mail order (877)

23 We re in it together Plan Design for the Consumer Driven Health Plan (CDHP) Page 23

24 Deductibles and Out-of-Pocket Maximums Consumer Driven Health Plan Deductible* In-Network Individual (self-only coverage): $1,500 Family Deductible: $3,000 Individual Family Member Deductible: $2,600 We re in it together Annual Out-of- Pocket Maximum* Coinsurance $3,900 Individual (self-only coverage) $7,800 Family $6,850 Individual Family Member (Family coverage) Plan pays 80% after deductible for most health care services: hospital inpatient stay, emergency room visit, urgent care, primary care visit, specialist visit, MRIs, CT scans, etc. *Separate deductibles for out-of-network *Separate out-of-pocket maximums for out-of-network $10,600 Individual / $21,200 Family The family deductible includes a $2,600 Individual Family Member Deductible (IFMD). The plan will pay benefits for one individual in the family once that person meets the $2,600 IFMD. The balance of the family deductible ($400) may be met by one or more remaining family member(s). Page 24

25 Consumer Driven Health Plan (CDHP) We re in it together Both medical and pharmacy expenses apply to annual deductible/out-of-pocket maximum Plan coupled with a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA) with PEBP contributions to help pay for out-of-pocket health care expenses Eligible wellness/preventive care benefits paid 100% when using in-network providers Page 25

26 PLAN DESIGN FEATURES Consumer Driven Health Plan IN-NETWORK OUT-OF-NETWORK Service Areas Global Global Annual Deductible $1,500 Individual $3,000 Family ($2,600 Individual Family Member Deductible) $1,500 Individual $3,000 Family ($2,600 Individual Family Member Deductible) Medical Coinsurance 20% after deductible 20% to 50% after deductible Out-of-Pocket Maximum Primary Care Physician Referral Required Primary Care Office Visit Specialist Care Office Visit Emergency Room Visit Urgent Care Visit In-Patient Hospital Outpatient Surgery Wellness/Prevention $3,900 Individual $7,800 Family ($6,850 Individual Family Member) N/A Deductible, then 20% coinsurance Deductible, then 20% coinsurance Deductible, then 20% coinsurance Deductible, then 20% coinsurance Deductible, then 20% coinsurance Deductible, then 20% coinsurance No charge for eligible wellness benefits provided in-network *Review the Open Enrollment Guide for further details $10,600 Individual $21,200 Family N/A 50% after deductible Subject to Usual and Customary Limits 50% after deductible Subject to Usual and Customary Limits 20% after deductible Subject to Usual and Customary Limits 50% after deductible Subject to Usual and Customary Limits 50% after deductible Subject to Usual and Customary Limits 50% after deductible Subject to Usual and Customary Limits N/A

27 Health Savings Account (HSA) We re in it together Tax-preferred savings account set up in conjunction with the Consumer Driven Health Plan PEBP and employees make tax-free contributions, then use the funds to pay for qualifying health care expenses Investment options available for balances exceeding $2,000 HSAs are owned by employees; funds carry over from year to year Must meet eligibility criteria to establish and contribute to HSAs Page 27

28 HSA Eligibility We re in it together To be eligible to establish and contribute to an HSA, you must meet the following criteria: You must be covered under the Consumer Driven Health Plan You are not covered by a non-irs qualified health plan, such as a spouse s PPO or HMO plan You are NOT enrolled in Medicare You are NOT enrolled in Tricare or Tricare for Life You or your spouse cannot be enrolled in a Medical Flexible Spending Account or HRA You are NOT retired Page 28

29 Health Reimbursement Arrangement (HRA) We re in it together HRAs are provided to retirees and employees that are ineligible for the HSA PEBP owned and funded account members use to pay or get reimbursed for qualifying health care expenses. Regulated by the IRS Participant contributions are not allowed Funds may be used for spouse s or child s qualifying health care expenses - if tax dependent PEBP contribution is tax-exempt Page 29

30 $49 $79 25m

31 We re in it together Flexible Spending Account (FSA) To participate in FSAs, State Active employees must submit a NEW election each plan year. PEBP offers three types of flexible spending accounts as follows: Health Care FSA Limited Purpose FSA (for dental and vision only) Dependent Care FSA Forms are available for download at Completed forms may be faxed to HealthSCOPE Benefits at or ed to PEBPFSA@HealthSCOPEBenefits.com by May 31, You will pay a small administration fee of $3.25 per month to participate in one or both (medical and/or dependent care) FSAs. Page 31

32 Dental Plan PPO and HMO Participants Voluntary for OneExchange Participants In-Network Out-of-Network Plan Year Maximum Benefit $1,500 $1,500 Plan Year Deductible (applies to basic and major services only) Preventive Services Oral examination, teeth cleaning (4/plan year), bitewing X-rays, (2/plan year) Benefits for preventive dental services do not apply to the annual maximum benefit Basic Services Full-mouth periodontal cleanings, fillings, extractions, root canals, full-mouth X-rays Major Services Bridges, crowns dentures, tooth implants $100 per person or $300 per family (3 or more) 100% of allowable fee schedule, no deductible 80% of allowable fee schedule, after deductible 50% of allowable fee schedule, after deductible $100 per person or $300 per family (3 or more) 80% of the in network provider fee schedule for the Las Vegas area, no deductible. For services outside of Nevada, the Plan will reimburse at the U & C rates. 50% of the in network provider fee schedule for the Las Vegas area, after deductible. For services outside of Nevada, the Plan will reimburse at the U & C rates. 50% of the in network provider fee schedule for the Las Vegas area, after deductible. For services outside of Nevada, the Plan will reimburse at the U & C rates. Under no circumstances will the combination of PPO and Non-PPO benefit payments exceed the plan year maximum benefit of $1,500.

33 Prescription Drug Program Plan Year: July 1, 2017 June 30, 2018 Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 33

34 About Express Scripts, Your Pharmacy Benefit Administrator Express Scripts is a leading pharmacy benefit manager (PBM) and administers Nevada Public Employees prescription drug benefit program As an Express Scripts member you have access to Home Delivery Services from the Express Scripts Pharmacy SM 60,000+ retail pharmacies across the United States Specialty drug program through Accredo Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 34

35 Your Plan s Drug Coverage Your plan covers a broad range of medications that fall into three categories Tier 1 - Generic medications May cost you less than plan-preferred medications Tier 2 - Plan-preferred medications A broad list that includes more than 1,800 brand-name drugs Tier 3 - Non-preferred medications Brand-name drugs that are not included on the plan-preferred list. You will pay 100% of the preferred contracted rate for these drugs. Your plan encourages you to choose plan-preferred generic and brand medications. Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 35

36 Prescription Costs Participating retail pharmacies Retail (30 or 90-day supply)* Express Scripts Home Delivery Mail Order (90-day supply) Deductible Out-of-Pocket Maximum Individual (self-only coverage): $1,500 Individual (family coverage): $2,600 Family: $3,000 In-Network: $3,900/individual (self-only coverage), $6,850/individual (family coverage), $7,800/family Out-of-Network: $10,600/individual, $21,200/family (Member cost is 100% up to out-of-pocket maximum) Preferred Generic & Brand 20% 20% Preventive Maintenance 20% (bypass deductible) 20% (bypass deductible) Non-Preferred Generic & Brand 100% *90-Day Retail Program available on maintenance medications *Specialty drugs are only available through Accredo Specialty Pharmacy Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 36

37 Preventive Medication Benefit In addition to eligible medications covered under the plan s wellness benefit (at $0 member cost in accordance with the Affordable Care Act), your plan is offering a number of additional preventive medications for just a coinsurance payment 20% coinsurance, bypass plan deductible Excluded: Brand drugs with generic equivalents, diabetes medications Example: Asthma/COPD, Diuretics, High Blood Pressure, Cholesterol Lowering To locate a list of commonly prescribed preventive medications: Prior to July 1: Visit Starting July 1: Log in at link located on bottom of home page under Benefit and account notifications or visit PEBP s website at Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 37

38 Accredo Specialty Pharmacy Specialty medications are infused, injectable or oral medications which: Are used to treat chronic and life-threatening conditions Are difficult to administer May cause adverse reactions Require temperature control or other special handling These medications must be filled through Accredo Specialty pharmacy Coinsurance amounts mirror those at retail (30 day supply) Contact Express Scripts members services for more information or to connect with a pharmacist Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 38

39 Diabetes Care Management Program Members can enroll in this program by contacting PEBP s third party administrator listed in the Participant Contact Guide Diabetic Supplies (ex: test strips, syringes, alcohol pads, lancets): receive up to a 90-day supply Mail order service through Express Scripts pharmacy only $5 copay applies (in-network) to each diabetic supply item. If cost is less than $25 patient will pay the cost of the supply. No cost for blood glucose monitors Plan-preferred diabetes medications (ex: insulin & Metformin) eligible for copayments at participating retail pharmacies for 30-day supply or through Express Script pharmacy for 90-day supply Retail fill greater than 30-day supply will charge 3x program 30-day supply copayment Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 39

40 Obesity and Overweight Care Management Members can opt-in to this program by contacting PEBP s third party administrator listed in the Participant Contact Guide Benefits payable by the wellness benefit do not apply to annual deductible or out-of-pocket In-network retail prescriptions (30-day supply) Generic: $5 Preferred Brand: $25 Non-preferred Brand: 100% copay Mail order services (90-day supply) Generic: $15 Preferred Brand: $75 Non-preferred Brand: 100% copay Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 40

41 Your Plan s Prescription Drug Coverage Your plan covers a broad range of medications. Some medications may not be covered by your plan unless you receive approval through a coverage review (prior authorization) Some covered medications may also have limits (for example, only for a certain amount or for certain uses) unless you receive approval through a review This review helps ensure a particular drug is being prescribed appropriately and in accordance with your plan s coverage The review uses plan rules that are based on FDA-approved prescribing and safety information, clinical guidelines, and uses that are considered reasonable, safe, and effective To learn more about your plan s drug coverage, log on to Express-Scripts.com or call Member Services Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 41

42 Making the Best Use of Your Benefit Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 42

43 Using Your Member ID Card at a Participating Retail Pharmacy Access to more than 60,000 pharmacies nationwide A retail pharmacy is a perfect choice for medications to treat an acute or temporary condition, such as antibiotics for an infection 90-Day Retail Program also available to receive maintenance medications at select retail pharmacies To locate a participating retail pharmacy NEW MEMBERS (prior to July 1): Select Find a local participating pharmacy at CURRENT MEMBERS: Go to Express-Scripts.com and select Locate a Pharmacy Or call Express Scripts Member Services (24 hours a day, 7 days a week) Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 43

44 Using Home Delivery Services from the Express Scripts Pharmacy SM A convenient and safe way to have certain medications delivered right to you The perfect choice for medications you take on an ongoing basis, such as those used to treat: Asthma High cholesterol Diabetes To learn more about how to use Home Delivery Services from the Express Scripts Pharmacy SM Go to Review your Welcome Package Call Express Scripts Member Services 24 hours a day, 7 days a week Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 44

45 Getting Started With Home Delivery From the Express Scripts Pharmacy Ask your doctor to write up to a 90-day prescription, with refills for up to one year as appropriate Option 1: Ask your doctor to send your prescription to Express Scripts via electronic-prescribing or fax Prescriptions are processed and delivered within 5 to 8 calendar days (after receipt of your prescription) Tip Mail-order forms can be printed from Option 2: Mail in your prescription Print a mail-order form Mail prescription and completed order form to the Express Scripts Pharmacy First-time orders will usually be delivered within 8 to 11 calendar days after we receive your order Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 45

46 Have a Question About a Medication? Ask a pharmacist You can contact one of our pharmacists for general counseling or a Specialist Pharmacist for complex concerns. Each Specialist Pharmacist has had specialized training in the medications used to treat a specific condition, such as: You can contact a Specialist Pharmacist 24/7 to ask questions about: To reach a pharmacist, call the Express Scripts Member Services number on your ID card High cholesterol High blood pressure Depression Diabetes Asthma Osteoporosis Cancer Drug interactions Side effects Risks and benefits of your medication The challenges of taking your medication as prescribed one of the best ways to help maintain or improve your health Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 46

47 Helpful Tools Available to You Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 47

48 Open Enrollment Website Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 48

49 View preferred versus non-preferred status Non-Preferred Brand Generic equiv. available Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 49

50 Manage Your Prescriptions at Express-Scripts.com At Express-Scripts.com you can log in and complete the one-time registration. You are then routed to the member website for a personalized, plan-specific experience. Open 24 hours a day, 7 days a week. Review your plan benefits and coverage Look up drug information Learn about opportunities to save Order refills Check on shipments Review your prescription history Look up health and wellness information Locate retail pharmacies in your network Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 50

51 Member Website Homepage Check order status View all prescriptions, order refills and renewals for yourself or the whole family View savings and transfer retail prescriptions to home delivery View plan balances Enroll in and manage automatic refills Receive medication-related alerts and take action View important Benefit and Account Notifications Navigate to any feature on the site Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 51

52 Price a Medication Accumulator Pricing Members can add drugs to a drug list for market basket pricing to assess the impact to pricing and their accumulator balances. Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 52

53 An App That Drives Better Decisions and Healthier Outcomes for Members on the Go Convenience Peace of Mind Simplicity Versatility Up-to-the-minute order status and a handy medicine cabinet lets members avoid trips to their local pharmacy Reminders and a drug interaction checker keep members traveling on the road to good health One swipe of the finger is all it takes to stay on track with medications Flexibility that fits their life, delivering personalized prescription information wherever and whenever they need it Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 53

54 We re Here to Help Answer Your Questions and Address Your Concerns New Members- visit the Express Scripts Open Enrollment Website Current Members- visit Express-Scripts.com Information you will need to complete registration can be found on your Member ID card Call the Member Services number at (855) Member services is available 24/7 Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 54

55 Thank You Confidential and Proprietary Information 2011 Express Scripts, Inc. All Rights Reserved 55

56 Hometown Health P u b l i c E m p l o y e e s B e n e f i t s P r o g r a m H M O O p t i o n s P r e s e n t a t i o n

57 Today s Presentation Hometown Health and Renown Introduction Standard HMO Plan Alternate HMO Plan Hometown Health Member Support Questions 57

58 About Hometown Health One of Nevada s largest health benefits organizations: 170,000+ total members served 800+ employer groups 235 employees $700M annual claim volume with cost savings focus Process over 150,000 claims monthly 90% of claims processed within 10 working days Overall, 99.3% of claims processed within 30 days 58

59 Hometown Health This year Hometown Health is proud offer two health plan options for State of Nevada Employees and Retirees 59

60 Standard HMO Plan Hometown Health Public Employees Benefits Program

61 PEBP Standard HMO Plan Highlights Open Access HMO - No referral required to see specialist Select any Primary Care Provider on the Hometown Health network No deductible for Medical or Pharmacy Statewide in-network coverage for members and dependents in Nevada 4- Tier Pharmacy Benefit including Diabetic Supplies Emergency coverage for members traveling outside the service area

62 Standard HMO Plan Medical Benefits Out of Pocket Maximum: Individual $7,150 Family $14,300 Office Visits: Primary Care Providers $25 Specialist $45 Preventive Care/Screenings $0 Laboratory General laboratory services $0 Ambulance: Ground $150 Air & Water $200 Urgent Care Center & Emergency Room: Urgent Care $50 Emergency Room $300 Includes all services and physician charges Copayment waived if admitted Hospitalization: Inpatient Care (per admission) $500 Outpatient Observation (4-48 hrs) $500 Outpatient Surgery (same day) $350 62

63 Standard HMO Plan Pharmacy Benefit Retail Pharmacy: Tier 1 Generic Drugs Tier 2 Preferred Brand Drugs Tier 3 Non-Preferred Drugs Tier 4 Special Pharmaceuticals $7/co-pay per script $40/co-pay per script $75/co-pay per script 40 % coinsurance Mail Order Pharmacy: Costco or PPS Option Savings: Pay two months of co-pay for three months of medication 63

64 Alternate HMO Plan Hometown Health Public Employees Benefits Program

65 PEBP Alternate HMO Plan Highlights Coverage only in Carson City, Churchill, Douglas, Lyon, Storey and Washoe counties Must select a Renown Primary Care Provider for all adult members Referral required to see specialist, except to for OBGYN or Pediatrics No deductible for Medical or Pharmacy 4- Tier Pharmacy Benefit including Diabetic Supplies Emergency coverage for members traveling outside the service area

66 Alternate HMO Plan Medical Benefits Out of Pocket Maximum: Individual $7,150 Family $14,300 Office Visits: Primary Care Providers $5 Specialist $25 Preventive Care/Screenings $0 Laboratory General laboratory services $0 Ambulance: Ground $150 Air & Water $200 Urgent Care Center & Emergency Room: Renown Virtual Visits $0 Urgent Care $25 Emergency Room $1000 Includes all services and physician charges Copayment waived if admitted Hospitalization: Inpatient Care $1000 Per day up to 3 days Outpatient Observation (4-48 hrs) $1000 Outpatient Surgery (same day) $

67 Alternate HMO Plan Pharmacy Benefit Retail Pharmacy: Tier 1 Generic Drugs Tier 2 Preferred Brand Drugs Tier 3 Non-Preferred Drugs Tier 4 Special Pharmaceuticals $25/co-pay per script $50/co-pay per script $75/co-pay per script 40 % coinsurance Mail Order Pharmacy: Costco or PPS Option Savings: Pay two months of co-pay for three months of medication

68 Vision Benefit Highlights Exam Frames Lenses Lens Options $15 copay in network $32 reimbursement out of network 35% off retail price $50 Single Vision $70 Bifocal $105 Trifocal $135 Progressive Varies, refer to plan documents Contact Lenses 15% off retail price-conventional No discount-disposable Laser Vision Correction 15% off Retail Price or 5% off promotional price Lasik or PRK from U.S. Laser Network Frequency Exam: Once every 12 months Lenses or Contacts: Unlimited Frame: Unlimited

69 My Benefits Coverage View current claims (EOB s) View, Print or Request New Member ID Card Check status of prior authorizations and referrals View pharmacy preferred drug list and compare pricing at local pharmacies

70 Hometown Health Smartphone App Download on iphone or Android: Hometown Health View/ /Fax Card to provider s office straight from your phone Dependent cards included Input Member ID and Year of Birth for PIN Code

71 Locate a Provider or Facility Locate a contracted provider or facility Filter by selecting the State of NV plan that you are enrolled in Locate specialist Locate Labs and imaging Use the link for PHCS Emergency Network

72 Convenience is the Best Medicine Virtual Visits: Connect with a provider through your smartphone, tablet or computer to be treated for a variety of common conditions and minor ailments. Enroll at renown.org/virtualvisits Virtual Check-In: Get in line at Renown Urgent Care from home, the office or even on-the-go. Receive text notifications to stay updated about estimated wait times and when you re next in line. MyChart: Securely manage your healthcare information online, 24/7. Schedule an appointment Get your test results faster Request prescription refills Keep track of your family s health Review immunization records View or download your Summary of Care document Logon at renown.org/mychart Check-in at renown.org/virtualcheckin

73 Contact Information Customer Service (775) or (800) Mail Order: Postal Prescription Services (PPS) (800) Mail Order: Costco (800) or Hometown RX (844) PEBP/Hometown Health Website

74 Questions? Hometown Health Public Employees Benefits Program

75 Plan Year 2018 Your Health Plan of Nevada Benefit Plans Southern Nevada Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth

76 You have two plans to choose from. Standard HMO (Preferred Plan Benefit Design) Alternate HMO Plan Benefit Design Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

77 What the two plans have in common. Both plans have no deductible for medical or pharmacy Both plans have a 4-tier pharmacy benefit Both plans are offered in Clark, Nye and Esmeralda counties Both plans offer the same provider network Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

78 What the two plans have in common. Both plans offer student coverage for eligible dependents enrolled in an accredited college, university or vocational school anywhere in the United States Both plans offer travel coverage for members and their dependents for certain covered services while traveling for business or pleasure in the United States Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

79 Here s a medical benefits snapshot. Standard HMO Plan Alternate HMO Plan Primary Care Provider Visit $25 $5 Specialist Visit $25 (with a referral) $45 (without a referral) $25 (referral required) Urgent Care Visit $30 $25 NowClinic Virtual Visit $15 $0 Emergency Room Visit $300 per visit waived if admitted $1,000 Hospital Admission $500 per admission $1,000 per day not to exceed $3,000 Outpatient Hospital Facility Services $50 per surgery $1,000 per surgery Lab $0 $0 Pharmacy Tiers 1-4 $7/$40/$75/40% $25/$50/$75/40% Form Nos. 17H_KN_SOL_HMO_5_SON, 17H_KN_SOL_HMO_25_DA_SON, 17H_KA_4T_RX74075_40SP_2_5X, 17H_KA_4T_RX255075_40SP_2_5X. These Plans include additional benefits, exclusions and limitations which are shown in the Health Plan of Nevada Evidence of Coverage, Attachment A Benefit Schedule, any other applicable Riders and the Summary of Benefits and Coverage. Copies of these documents are available upon request. Plan documents govern in resolving any benefit questions or payments. Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

80 Here s a vision benefits snapshot. Vision Plan Examination (one during 12 consecutive months) Lenses (one pair during 12 consecutive months) Frames (one pair during any 24 consecutive months) Medically Necessary Contact Lenses (one pair during any 12 consecutive months, in lieu of lenses and frames) Elective Contact Lenses (one pair during any 12 consecutive months, in lieu of lenses and frames) Plan Benefits $10 $10 $100 maximum allowance $250 maximum allowance $115 maximum allowance Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

81 Services available with both plans. Virtual Visits 24/7 Advice Nurse Online Member Center Local Customer Service Y O U Rally Wellness Care Coordination Mobile Medical Center Southwest Medical Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

82 Today s featured service: Virtual Visits See a provider from your smartphone, laptop, or tablet from the comfort of home. Available 24/7! No appointment needed! NowClinic virtual visits let Health Plan of Nevada members see a Southwest Medical or NowClinic provider ONLINE. Use this service for common care needs like allergies, pink eye, viral illnesses and more. No appointment needed, and most prescriptions can be sent to your chosen pharmacy. NowClinic is not intended to address emergency or life-threatening medical conditions. Please call 911 or go to the emergency room under those circumstances. Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

83 Getting care with Southwest Medical. Adult medicine Internal medicine Pediatrics OB/GYN Allergy Cardiology Endocrinology Gastroenterology Neurology Pain management Podiatry Rheumatology Urgent care Senior care Palliative care Hospice care Home health Pharmacy and home medical equipment Electronic medical records Patient portal My SMA app Urgent care home waiting room Convenient care home waiting room E-visits Telehealth 2 surgery centers 7 convenient cares 6 urgent cares (one open 24/7) 15 health care centers 2 SMA Lifestyle Centers 1 mobile medical center Group visits Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth

84 What plan is best for you? Do you have a specific doctor you are currently seeing that you want to continue to see? Do you or a covered family member see a specialist regularly? Do you or a covered family member live outside of Nevada or Health Plan of Nevada s covered service area? Do you find it helpful to have a PCP manage all your care, including referrals to specialists? Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

85 Questions? Let us help you understand your health plan options! Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

86 Plan Year 2018 Life and Disability Insurance Enrollment

87 (1) Member must be covered under a PEBP sponsored medical plan to be eligible for Life, Voluntary STD and LTD; Actives and Retirees cannot be insured under the Voluntary Life plan unless they are insured for Basic Life (2) To enroll in The Standard's Voluntary STD plan, the Active participant cannot be currently enrolled in another STD plan, such as Colonial or AFLAC.

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91 Access to a Personal Health Advocate is provided through an arrangement with Health Advocate, an independent organization not affiliated with The Standard or any other insurance or third party provider. The Health Advocacy Solution is not an insurance product. Health Advocate does not replace health insurance coverage, provide medical care or recommend treatment.

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93 We re in it together Thank you Page 94