EASTERN MICHIGAN UNIVERSITY 2014 HEALTH CARE OPTIONS

1. EASTERN MICHIGAN UNIVERSITY2014 HEALTH CARE OPTIONS

2. Introduction Who you are

3. About Your Medical Coverage • 100% Preventive Care Benefits - Based on age & gender - No deductibles or copays apply if rendered in-network and doctor codes as preventive (annual physical or annual screening) - Not covered out of network; exceptions for mammograms and colonoscopy

4. Available Options • Community Blue PPO – Option 5 • Simply Blue HSA • Blue Care Network Healthy Blue Living

5. ACA Mandated Benefits The following are applicable to all Large groups: • Coverage of routine care for participants in certain clinical trials • Preventive drug coverage with no cost share that includes (all must be prescribed by a physician): • Coverage for select smoking cessation drugs • Aspirin for women ages 55 to 79 years when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage • Aspirin for men ages 45 to 79 years when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage • Folic acid for women planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400 to 800 µg) • Oral fluoride supplementation at currently recommended doses to preschool children older than age 6 months whose primary water source is deficient in fluoride • Routine iron supplementation for asymptomatic children ages 6 to 12 months who are at increased risk for iron deficiency anemia • Over the counter female contraceptive medications only when prescribed by a physician

6. Deductible, Copays & Maximums

7. Community Blue PPO/HSA Option • Who is eligible? - Must be enrolled in a qualifying High Deductible Health Plan (HDHP) - Deductibles at least $1,250 individual/$2,500 family - Not covered under any other health insurance (unless it is another HDHP) - Not enrolled in Medicare - Not receiving any VA benefit - Subscriber cannot be eligible to be claimed as a dependent on another person’s tax return and must be over 18 years old

8. What is an HSA? • Similar to checking account for health expenses - You own your HSA funds that are deposited into your “Health Equity” account - Debit card to pay for qualified medical expenses - HSA funds can be used for: - Deductibles, copays and coinsurance for medical, Rx, vision and dental plans - COBRA premiums - Health insurance premiums while receiving unemployment - Medicare Part A and B premiums - Qualified long term care

9. Who is Health Equity? • A FDIC full-service financial institution • Leader in • HSA, HRA and FSA administration • Free investment options through Charles Schwab • 24/7 customer service available

10. HSA Tax Advantages • All contributions are pre-tax • All funds grow tax free in bank account • Funds are not taxed when you use money to pay for a qualified medical expense – there is a 20% penalty if money is spent on a non-qualified expense prior to age 65 SAVE YOUR RECEIPTS

11. Blue Care Network – Healthy Blue Living • Health Maintenance Organization (HMO) • High performance network that encourages a health lifestyle • Comprehensive network of providers • Two levels of benefits - Enhanced - Standard • Must select a primary care physician (PCP) from the Focus Network

12. Enhanced and Standard Benefits • HMO participants are eligible for 2 benefit levels with cost sharing options - Enhanced – has lower deductible and copayments - Standard – has higher deductible and copayments • You are automatically enrolled in the enhanced benefit for the first 90 days of coverage at the initial enrollment • To qualify to remain in the enhanced plan you and your enrolled spouse must do the following: • Complete an online Health Risk Assessment (HRA) • Receive a physical exam and have your physician complete a qualification form - There are 6 Wellness Targets that will be measured

13. Wellness Targets for Enhanced Benefit Level

14. Selecting a PCP in the HMO • Employees residing in one of the 7 identified southeast counties must select a PCP from the PCP Focus Network: Macomb Washtenaw Oakland Monroe Saint Clair Wayne Livingston • Members residing outside of these 7 counties will select a PCP from BCN’s existing network • Network includes all BCN contracted hospitals and specialists • Members that do not select a PCP upon enrollment will be assigned to a Focus PCP • Visit www.mibcn.com to view network providers

15. About the BCBSM Pharmacy Cost Control Measures for PPO and PPO/HSA

16. Cost Savings Programs for Pharmacy Benefits • EMU/Snow Pharmacy Discount Program - Lower Generic Copay @ Snow Pharmacy - $3 copay for 30 day generic - $7 copay for 90 day generic • BCBSM Pharmacy Cost Savings Programs - Mandatory Maximum Allowable Cost (MMAC) - Pharmacy Initiatives

17. About Your RX Coverage

18. Mandatory Maximum Allowable Cost (MMAC) * When a generic equivalent is available for a brand-name drug and the brand-name drug is purchased, the member is responsible for the difference in cost between the brand-name drug and the MAC price, in addition to the applicable brand-name copayment, regardless of whether the doctor indicates DAW or not

19. How MMAC Works

20. BCBSM Pharmacy Initiatives • Dose Optimization • Brand-to-Alternate Generic Interchange • Generic Copay Waiver • Quantity Limits • Off Label/High-Cost Specialty Review • Preferred Therapy Details posted on the EMU Benefits website under Prescription Drugs