YOUR 2017 BENEFITS UPDATE WHAT S CHANGING Open Enrollment 2017 Open Enrollment for your 2017 DTE Energy benefits starts Monday, Nov. 28 at 12:01 a.m. Eastern time and runs through Friday, Dec. 9 at 11:59 p.m., Eastern time. Your family s benefits coverage is one of the most important purchases you make each year. That s why we work hard to offer you access to a range of quality benefit options at affordable prices. Take time during Open Enrollment to be a smart shopper and choose the benefits that will best meet your needs for the coming year. Your first step review your current coverage and the options available to you for 2017. Then, use the tools and resources to help you make smart benefit decisions. Finally, take action by Friday, Dec. 9 before 11:59 p.m., Eastern time if you want to make changes for 2017, add or remove a dependent from coverage, contribute to a flexible spending account (FSA) or a Health Savings Account (HSA), if eligible, or buy vacation days, if eligible. Otherwise, no further action is required. Enroll on-the-go! You can access details about your current coverage including which plans you are enrolled in and the dependents you are covering online at ybr.com/dteenergy anytime, day or night. Best of all, you can review your benefits or enroll on your mobile device or tablet as well as your PC! Review this document to see what s changing for 2017. There are two ways to make changes: log on to the Your Benefits Resources Center website at ybr.com/dteenergy or call Your Benefits Resources Center at 1-866-899-4DTE (4383). You will receive a confirmation statement in the mail showing your 2017 coverage in late December. If you have an email address on file at ybr.com/dteenergy, you will also receive an Open Enrollment confirmation email immediately following your enrollment. Please be sure to review your confirmation carefully. 2017 Open Enrollment Is Nov. 28 Dec. 9, 2016 A-1 Non-Rep
What s Changing all changes effective Jan. 1, 2017 Medical Plan Changes All Medical Plans To comply with new Equal Employment Opportunity Commission (EEOC) regulations regarding wellness programs, the Standard plan options will be eliminated for 2017. The medical plan names have been changed, as follows: Current Plan Name Name in 2017 BCBSM Healthy Value CDHP BCBSM Healthy Living Incentives CDHP BCBSM Community Blue Healthy Living Incentives PPO BCN Healthy Blue Living HMO HAP Health Engagement HMO Priority Health HealthbyChoice Incentives HMO BCBS Value CDHP BCBS CDHP Community Blue PPO BCN HMO HAP HMO Priority Health HMO BCBS Value CDHP BCBS CDHP Community Blue PPO The Healthy Living Requirements have changed. See page 8 of this document and the enclosed Healthy Living Requirements document for more information. The BCBS Value CDHP medical plan is now subject to Healthy Living Requirements. No changes. New Out-of-Pocket Maximum Limits* (medical/prescription drug combined) In-Network Out-of-Network Single $4,000 $8,000 Family $8,000 $16,000 Changes to Prescription Drug Benefits Prescriptions Retail Generic 20% coinsurance; $5 min., $20 max. Preferred Brand 20% coinsurance; $25 min., $50 max. Non-Preferred Brand 20% coinsurance; $50 min., $100 max. Prescriptions Mail Order Generic 20% coinsurance; $10 min., $40 max. Preferred Brand 20% coinsurance; $50 min., $100 max. Non-Preferred Brand 20% coinsurance; $100 min., $200 max. Preferred Specialty (30-day supply) $100 Non-Preferred Specialty (30-day supply) $200 2
What s Changing ( continued) Medical Plan Changes ( continued) BCN HMO New Out-of-Pocket Maximum Limits* Single $4,000 Family $8,000 Changes to Specialty Drug Co-pays all changes effective Jan. 1, 2017 Preferred Specialty (30-day supply) Non-Preferred Specialty (30-day supply) $100 co-pay $200 co-pay HAP HMO New Out-of-Pocket Maximum Limits* Single $4,000 Family $8,000 Changes to Specialty Drug Co-pays Preferred Specialty (30-day supply) Non-Preferred Specialty (30-day supply) $100 co-pay $200 co-pay Priority Health HMO New Out-of-Pocket Maximum Limits* Single $4,000 Family $8,000 Changes to Specialty Drug Co-pays Preferred Specialty (30-day supply) Non-Preferred Specialty (30-day supply) $100 co-pay $200 co-pay Increased Health Savings Account (HSA) Limit for Individual Coverage (only applies to those enrolled in a Consumer Driven Health Plan) The single coverage amount that can be contributed to your account is increasing from $3,350 to $3,400 per year. The family coverage maximum amount will remain at $6,750 per year. These amounts include your contributions and DTE Energy employer contributions. 3
Medical Plan Summary Chart ( information purposes only) BCBS Value CDHP If available in your area. Plan Features In-Network Out-of-Network Deductible $4,000 single, $8,000 family $8,000 single, $16,000 family HSA Employer Contribution $0 single, $0 family Coinsurance (employee share) 20% 40% Primary Care Physician Specialist Emergency Room (waived if admitted) Urgent Care Out-of-Pocket Maximum* $6,550 single, $13,100 family $13,100 single, $26,200 family Prescriptions: Retail Generic Preferred Brand Non-Preferred Brand Prescriptions: Mail Order Generic Preferred Brand Non-Preferred Brand Preferred Specialty (30-day supply) Non-Preferred Specialty (30-day supply) Visit Your Benefits Resources Center at ybr.com/dteenergy to review the Summaries of Benefits and Coverage (SBCs) for more detailed information about what each plan covers. 4
Medical Plan Summary Chart ( information purposes only) ( continued) BCBS CDHP Plan Features In-Network Out-of-Network Deductible HSA Employer Contribution $1,500 single, $3,000 family $500 single, $1,000 family Coinsurance (employee share) 10% 30% Primary Care Physician Specialist Emergency Room (waived if admitted) Urgent Care Out-of-Pocket Maximum* $4,000 single, $8,000 family $8,000 single, $16,000 family Prescriptions: Retail Generic Preferred Brand Non-Preferred Brand Prescriptions: Mail Order Generic Preferred Brand Non-Preferred Brand Preferred Specialty (30-day supply) Non-Preferred Specialty (30-day supply) 5
Medical Plan Summary Chart ( information purposes only) ( continued) Community Blue PPO Plan Features In-Network Out-of-Network Deductible $750 single, $1,500 family $1,500 single, $3,000 family Coinsurance (employee share) 20% 40% Primary Care Physician Specialist Emergency Room (waived if admitted) Urgent Care Out-of-Pocket Maximum* $4,000 single, $8,000 family $8,000 single, $16,000 family Prescriptions: Retail Generic 20% coinsurance; $5 min., $20 max. Preferred Brand 20% coinsurance; $25 min., $50 max. Non-Preferred Brand 20% coinsurance; $50 min., $100 max. Prescriptions: Mail Order Generic 20% coinsurance; $10 min., $40 max. Preferred Brand 20% coinsurance; $50 min., $100 max. Non-Preferred Brand 20% coinsurance; $100 min., $200 max. Preferred Specialty (30-day supply) $100 Non-Preferred Specialty (30-day supply) $200 BCN HMO If available in your area; only covers in-network services. Plan Features Deductible $200 single, $400 family Coinsurance (employee share) N/A Primary Care Physician Co-pay $20 Specialist Co-pay $30 Emergency Room Co-pay (waived if admitted) $100 Urgent Care Co-pay $20 Out-of-Pocket Maximum* $4,000 single, $8,000 family Generic $10 Preferred Brand $30 Retail Prescriptions Non-Preferred Brand $60 Preferred Specialty $100 Non-Preferred Specialty $200 Generic $20 Preferred Brand $60 Mail Order Prescriptions Non-Preferred Brand $120 Preferred Specialty $100 for a 30-day supply Non-Preferred Specialty $200 for a 30-day supply 6
Medical Plan Summary Chart ( information purposes only) ( continued) HAP HMO If available in your area; only covers in-network services. Plan Features Deductible Coinsurance (employee share) $200 single, $400 family N/A Primary Care Physician Co-pay $20 Specialist Co-pay $30 Emergency Room Co-pay (waived if admitted) $100 Urgent Care Co-pay $30 Out-of-Pocket Maximum* Retail Prescriptions Mail Order Prescriptions $4,000 single, $8,000 family Generic $10 Preferred Brand $30 Non-Preferred Brand $60 Preferred Specialty $100 Non-Preferred Specialty $200 Generic $20 Preferred Brand $60 Non-Preferred Brand $120 Preferred Specialty $100 for a 30-day supply Non-Preferred Specialty $200 for a 30-day supply Priority Health HMO Limited to Grand Rapids, Muskegon, Ludington and Northern Michigan area; only covers in-network services. Plan Features Deductible Coinsurance (employee share) $200 single, $400 family N/A Primary Care Physician Co-pay $20 Specialist Co-pay $30 Emergency Room Co-pay (waived if admitted) $100 Urgent Care Co-pay $20 Out-of-Pocket Maximum* Retail Prescriptions Mail Order Prescriptions $4,000 single, $8,000 family Generic $10 Preferred Brand $30 Non-Preferred Brand $60 Preferred Specialty $100 Non-Preferred Specialty $200 Generic $20 Preferred Brand $60 Non-Preferred Brand $120 Preferred Specialty N/A retail only Non-Preferred Specialty N/A retail only 7
201 7 Healthy Living Requirements All medical plans, including the BCBS Value CDHP, are subject to Healthy Living Requirements. See the enclosed Healthy Living Requirements document for more information. If you have any questions about the Healthy Living Requirements, please contact RedBrick Health at 1-866-261-7144. If neither you nor your enrolled spouse completes the requirements by June 30, 2017, you will pay a Healthy Living Requirements (HLR) surcharge from August 1, 2017 through December 31, 2018, as follows: If Then your HLR surcharge is You and your spouse complete the requirements. $0 You complete the requirements, but your spouse doesn t complete the requirements. $46.15 per pay ($1,200 annually) You don t complete the requirements, but your spouse does complete the requirements. $46.15 per pay ($1,200 annually) Neither you nor your spouse completes the requirements $92.30 per pay ($2,400 annually) This is a Summary of Material Modifications to your 2017 benefit plans. These modifications are not currently reflected in the Summary Plan Description (SPD). It is intended to help you understand these changes so you and your family can take maximum advantage of your benefits. After reviewing this material, please file this document with your SPD. For Non-Represented Employees, nothing in this Summary of Material Modifications is intended to be interpreted as a promise or guarantee of future or continued benefits or employment or as stating provisions or terms of employment. DTE Energy and its subsidiaries and their Non-Represented Employees recognize their mutual right to end their employment relationship at any time and acknowledge that this relationship is one of employment at will. Except for the employment at will relationship, DTE Energy and its subsidiaries reserve the right to change (including, but not limited to, the right to amend, suspend or terminate) any employee pension or welfare benefit plan, policy or program, including those applicable to retirees, at its discretion, at any time without notice. The Senior Vice President of Human Resources is the only officer authorized to communicate such changes. Rights and benefits under the plans described in this Summary of Material Modifications are governed by legal documents, including the plan documents. These legal documents will control over any conflict with any information presented in this Summary of Material Modifications. If you elect medical coverage through DTE Energy, your medical and prescription drug claims information will be provided to our third-party wellness and health management vendors. Keep in mind, your information will only be used to assist these vendors in managing your health. Your specific health information will be held in confidence, and will not be accessible to DTE Energy, or any of its employees. If you opt out of wellness and health management programs, your medical and prescription drug claims information will continue to be sent to our third-party wellness and health management vendors. Your Benefits Resources is a trademark of Hewitt Associates LLC. 8