Your Plan for Better Health Open Enrollment 2017 October 1 17, - PowerPoint PPT Presentation

Your Plan for Better Health Open Enrollment 2017 October 1 – 17, 2016 Online Enrollment October 1 – 17, 2016

Important Dates • Open Enrollment Deadline for ALL plans is October 17, 11:59 PM • Changes effective January 1, 2017

Health Plan’s Five Guiding Principles 1. Finding the best care for our employees, retirees and their families 2. Better monitoring our employees’ health in order to reduce emergency room visits and inpatient days 3. Finding physicians that take personal responsibility for the care of their patients 4. Improving the health of our employees, retirees and families 5. Maintaining a sustainable health plan by reducing the growing cost of health care

Changes for 2017

Medical Basic Plan • Out of Pocket Maximum increase to $5,000/$10,000 • Emergency Room copay increase to $350 – Alternatives to the ER • Virtual Visits • USMD • Urgent Care • Convenience Care Clinics Basic and Consumer Choice Plan • No out of network labs covered – Preferred Lab is LabCorps

Prescription Drug Plan • New specialty pharmacy tier – 20% after deductible – Max $200/script for Basic Plan members • Mandatory Generic Medications – Physician Letter of Necessity to receive brand name • ALL maintenance medications - RX90 Program – 90 day fill at Walgreens or Envision Mail Order – First two 30 day fills will be covered • Medications available OTC no longer covered – Includes brands like Nexium and Claritin

Prescription Drug Plan • Introduction of step therapy for 11 medication classes – Those currently affected will receive letters – Examples: • Anti-depressants (Brintellix) • Statins (Crestor, Lipitor, Vytorin) • Proton Pump Inhibitor (Zegrid) • Selective Serotonin Reuptake Inhibitor and Serotonin Norepinephrine Reuptake Inhibitor (Viibryd, Cymbalta) • Insomnia (Ambien, Lunesta)

Introducing SurgeryPlus

Conside r ing Sur ge r y? Conside r Sur ge r yPlus. Is yo ur Sur ge o n bo ar d-c e r tifie d? Do e s yo ur Sur ge o n have any malpr ac tic e c laims o r sanc tio ns? Ho w many pr o c e dur e s has yo ur Sur ge o n pe r fo r me d? Will yo ur sur gic al fac ility me e t the highe st quality me tr ic s? Ho w muc h will yo ur sur ge r y c o st yo u?

Hig h Qua lity Rigorous Screening Industry Insight Your Surgeon Matters John Hopkins 2/ 3 o f surg e o ns invo lve d in a surg ic a l mista ke ha ve b e e n c ite d in mor e than one se par ate malpr ac tic e r e por t in the pa st Soc ie ty of Ac tuar ie s E stima te 1.5 million me dic al s annually with a n e r r or a sso c ia te d c o st o f $19 b illio n Har var d Me dic al Sc hool Whe n a priva te ly-insure d pa tie nt suffe rs a t le a st o ne c o mplic a tio n, the hospital make s 330% mor e pr ofit 1 Ba se d up o n Me d ic a re fe e fo r se rvic e d a ta o b ta ine d b y the no np ro fit Co nsume rs‘ Che c kb o o k/ Ce nte r fo r the Stud y o f Se rvic e s

Gre a t E xpe rie nc e Schedules Coordinates Follows Up Locates Books appointments & Bundles Service Providers Ensures Complete Identifies manages logistics & Transfers Medical Records Member Satisfaction Surgeon of Excellence SurgeryPlus’ Customer Satisfaction 1 Net Promoter 61 Score 22 63 88 1 Ba se d 2015 Surg e ryPlus NPS re sults

L ow Costs Ma rke t Pric e Compa rison Wha t you Pa y T o ta l K ne e Re pla c e me nt I nsura nc e vs Surg e ryPlus Basic EPO Deductible $950 $950 $37,362 National SurgeryPlus Coinsurance $4,050 $0 What You Pay $5,000 $950 $24,551 Savings $4,050 $20,445 $15,690 $13,535 Consumer Choice $9,116 $8,268 Deductible $1,500 $1,500 $4,817 $3,673 $1,976 Coinsurance $4,750 $0 What You Pay $6,250 $1,500 Knee Laparoscopic Shoulder Gallbladder Carpal Tunnel Replacement Sleeve Arthroscopy Removal Release Savings $4,750 Gastrectomy

Most Common Pr oc e dur e s Ove r Hundre ds o f No n-E me rg e nt Pro c e dure s a re Co ve re d Kne e : Spine : Ge ne r al Sur ge r y: – K ne e Re pla c e me nt – L a mine c to my / L a mino to my – Ga llbladde r Re mo val – K ne e Re pla c e me nt Re visio n – AL IF / PL IF / ACDF – He rnia Re pa ir – K ne e Arthro sc o py – 360 Spina l F usio n – T hyro ide c to my – ACL / MCL / PCL Re pa ir – Artific ia l Disk Ge nitour inar y: Hip: Wr ist & E lbow: – Hyste re c to my – Hip Re pla c e me nt – E lb o w Re pla c e me nt – T ub a l L ig a tio n – Hip Re pla c e me nt Re visio n – E lb o w F usio n – Bla dde r Re pa ir – Hip Arthro sc o py – Wrist F usio n – Wrist Re pla c e me nt Shoulde r : – Ca rpa l T unne l Re le a se – Sho ulde r Re pla c e me nt – Sho ulde r Arthro sc o py F oot & Ankle : – Ro ta to r Cuff Re pa ir – Bunio ne c to my – Bic e p T e ndo n Re pa ir – Ha mme r T o e Re pa ir – Ankle Arthro sc o py – Ankle Re pla c e me nt T o le a rn mo re , c a ll the City o f F o rt Wo rth’ s de dic a te d line a t 1- 855- 200- 9508 o r visit www.MySur ge r yPlus.c om/ CF W

Overview of Current Benefits

Medical Plans Basic Plan Consumer Choice Plan Premium (Tier 1) Premium (Tier 1) In-Network Provider In-Network Provider Up to maximum allowable by IRS: $3,400 Health Savings Fund (Employee Account) N/A N/A individual and $6,750 family $1000 additional catch up for ages 55 & older Annual Deductible (Individual/Family) $950/$1,900 $1,500/$3,000 Annual Coinsurance Out-of-Pocket-Max $5,000/$10,000 $6,250/$10,125 Physician Services Office Visits PCP $45 $25 35% after deductible 15% after deductible Office Visits at USMD PCP $10 N/A 15% after deductible N/A Office Visits Specialist $55 $35 35% after deductible 15% after deductible Virtual Visits $40 N/A 35% after deductible N/A Preventive Office Visits Annual Exams: Wellness covered at 100% by plan, deductible At USMD provider $0 N/A waived OB-GYN, well child care, mammogram, PSA $0 $0 Hospital Services In Patient 20% after deductible N/A 20% after deductible N/A SurgeryPlus 0% after deductible N/A $0 after deductible N/A

Physic ia n Ne two rk Se nio rCa re Ho spita ls Ca nc e r Ce nte rs Dia g no stic Se rvic e s City of Fort Worth – Open Enrollment Employee Meetings Brent Russell, Director of Provider Services

CareToday

Physic ia n Ne two rk Se nio rCa re Ho spita ls Ca nc e r Ce nte rs Dia g no stic Se rvic e s Numbers to know Need a PCP? 817.514.5277 CareToday 817.566.7466

Airrosti • Rapid recovery clinic for musculoskeletal injuries • Visits are a $15 copay for the Basic Plan or a 15% coinsurance (after the deductible) on the Consumer Choice Plan

HEALTHCARE STARTS WITH COMPASS. 20

How compass takes care of you UNDERSTAND YOUR BENEFITS FIND A GREAT DOCTOR Receive guidance in understanding your Find the best doctors, dentists & eye-care benefits throughout the year. professionals in your area and network that meet your preferences & healthcare needs. SAVE MONEY ON MEDICAL CARE PAY LESS FOR PRESCRIPTIONS Get price comparisons before receiving care. Let Compass compare medication prices and Depending on doctor, hospital or facility, costs can explore lower cost options for you. vary by hundreds or thousands of dollars—even in- network. GET HELP WITH MEDICAL BILLS Have your medical bills reviewed to make sure you are not overcharged. 21 Confidential and Proprietary – Intended for Compass Customers Only

WELCOME TO HEALTHCARE—SIMPLIFIED. Healthcare Redefined. BEATRIZ BYERS HEALTH PRO CONSULTANT CFW@compassphs.com 855-769-4377 Monday through Friday 8AM – 6PM Central 1 3 Moved recently or looking for a new Tired of overpaying for brand-name provider? We’ll find great doctors, dentists prescriptions? Let Compass research the and eye care professionals for you and your most cost-effective options for the family. prescriptions you’re taking. 2 4 Upcoming medical procedure? We’ll Wondering if a medical bill is correct? We’ll estimate your out-of-pocket cost to ensure make sure you’re not overbilled. you pay a fair price. 22 Confidential and Proprietary – Intended for Compass Customers Only