Harrisonburg City Public Schools Open Enrollment 2014

1. Harrisonburg City Public Schools Open Enrollment 2014

2. Today’s Agenda • Welcome • Review Anthem Plan Effective 07/01/14 • What’s Staying the Same • Why & What’s Changing • Claim Examples • Q&A

3. Plan Overview WHAT’S STAYING THE SAME: KeyCare - Preferred Provider Organization (PPO) Plan • PCP not required • No referrals needed • No claim forms needed when using network providers • Very large network of providers available both in Virginia and throughout the U.S. • Out-of-network benefits available but at lower coverage levels • Dependents covered until the end of the month in which they reach age 26. • Annual eye exam - $15 copay (provided through Blue View Vision) • Out of pocket maximum (in-network)-$3,000/$6,000

4. Plan Overview WHY & WHAT’S CHANGING: • WHY CHANGE: • Health care costs are affected by: • Price inflation, utilization, legislation changes, new treatments, therapies and technologies • 8% is the national average rate increase… • If HCPS made NO changes, our rate increase would be: 22.3%...this is not sustainable • Solution: Change to a plan that is: • Considered a quality program in the market • Cost effective and sustainable

5. Plan Overview WHY & WHAT’S CHANGING: • WHAT’s CHANGING • Benefits – plan is changing to KeyCare 25 • Preventive services have been added as a result of the Affordable Care Act

6. Preventive Care • Preventive Care Services covered at 100% in-network with no member copay. • *Preventive care services are those services that meet the requirements of federal and state law, including certain screenings, immunizations and physician visits, and include such services as: • Well Baby Visit with associated immunizations and screenings • Well Woman Visit with associated gyn exam, pap smear, and mammogram. Medical and Pharmacy contraceptives, 1 breast pump purchase or rental per pregnancy when purchased from a participating Durable Medical Equipment provider. • Routine Physical with associated immunizations and screenings • Select OTC drugs with prescription from doctor (ex - iron supplements for children 0-12 months, aspirin for men age 45-79 and women age 55-79) • Screening related to tobacco use including tobacco cessation products with prescription from doctor • *During the course of a routine screening procedure, abnormalities or problems may be identified that require immediate intervention or additional diagnosis. If this occurs, and your provider performs additional necessary procedures, the service will be considered diagnostic and/or surgical, rather than screening, depending on the claim for the services submitted by your provider, which will result in a member cost share.

7. Benefits Overview-KeyCare 25

8. Benefits Overview-KeyCare 25 *Anthem bases claim payment on the amount the health care providers in our network agree to accept for their services. This is called “allowable charge”. Network providers cannot balance bill for the difference in what we pay and what they charge.

9. Benefits Overview-KeyCare 25

10. Benefits Overview-KeyCare 25 *Deductibles and out-of-pocket maximums do not cross accumulate between in-network and out of network. Anthem bases claim payment on the amount the health care providers in our network agree to accept for their services. This is called “allowable charge”. Non-Network providers can balance bill for the difference in what we pay and what they charge.

11. Benefits Overview

12. Meet Carol Lewis | Employee Only CoverageClaim Examples/Starting July 1, 2014

13. Meet Carol Lewis | Employee Only CoverageClaim Examples (continued) *For the remainder of 2014, Anthem pays 100% of any remaining medical charges. Carol continues to pay for any prescriptions and/or routine vision exam.

14. Meet Carol Lewis | Employee Only CoverageClaim Examples/Starting January 1, 2015

15. Questions