Weber State University

1. Weber State University Open Enrollment 2014

2. HEALTHCARE REFORM Preventive Health Benefits Routine Services Contracted Provider Some are age specific Deductible does not apply Women’s Health Removal of waiting periods for adults

3. BENEFIT CHANGES Combined Benefit Summary and Master Policy Sleep Studies require a preauthorization Home sleep studies do not Dental accidents are payable under the medical benefit Autism Treatment Programs - Specific Ages – specific disorder – Separate from Medical benefits Traditional and Star plans

4. CHANGES - REMINDERS Tax on Healthy Utah Rebates Paying the member out-of-network Medical, DME or Labs services from a non-contracted provider. Does not hold any contract with PEHP in Utah Preferred Drug list adjusted to keep up with market. PEHP follows FDA-indicated guidelines. This includes pain management medications Enhanced Pharmacy Benefits for diabetics Traditional and Star plans

5. PROVIDER NETWORKS

6. TRADITIONAL PLANS

7. SUPPLEMENTAL RX Applies to traditional plans only $2,000 per individual Applies to: Preferred Generic, Preferred Brand Name and Specialty drugs obtained through the pharmacy. Does not apply to: Non-preferred drugs and the cost difference between a generic drug and brand-name drug when a substitutable generic is available.

8. PHARMACY BENEFITS Generic Benefit Substitution - All medical plans If a brand-name drug is dispensed when a preferred generic can be substituted; You pay the generic copayment plus the difference in cost between the generic and brand – name drug.

9. Pharmacy Benefits 30 day supply at retail pharmacy

10. PHARMACY Benefits Mail Order Maintenance Medications Only

11. SPECIALTY PHARMACY All Plans/Retail Pharmacy or Accredo Note: TRADITIONAL PLANS Tier B are NON-PREFERRED SPECIALTY MEDICATIONS – They do not apply to the $2,000 pharmacy out-of-pocket maximum

12. PEHP FLEX$ Federal Program allows you to use pre-tax dollars for your out of pocket medical, dental, and vision costs The money you elect is deducted from each paycheck throughout the year, before taxes You never pay taxes on the deductions List of qualified expenses at pehp.org or irs.gov

13. PEHP FLEX Eligibility You and your spouse Children of the participant can remain covered up to Dec. 31 of the calendar year they turn age 26 even if they are married and whether or not they are dependents for tax purposes. 2014 Flexible Spending limit $2,500

14. PEHP FLEX$ Runs on the WSU’s fiscal year • July 1, 2014 – June 30, 2015 IRS allowed grace period • Claims must be incurred before September 15, 2015 • Verification or receipts to PEHP before September 30, 2015 Minimum amount of $130 Maximum amount of $2,500

15. FLEX$ ELIGIBLE EXPENSES VISION • Exams • Eyeglasses • Reading Glasses • Contact Lenses • Lens Care Supplies • LASIK Surgery DENTAL • Bridges • Cleaning • Crowns • X-Ray • Dentures • Extraction • Fluoride • TMJ • Oral Surgery • Orthodontics

16. FLEX$ ELIGIBLE EXPENSES • Radium Therapy • Psychotherapy • Routine Physical Exam • Fist Aid Kits • Orthotics • Oxygen equipment • Thermometers • Wheelchairs • Physical & Speech Therapy • Acupuncture • Alcohol & Drug Treatment • Band-aids • Chiropractor • Copays/deductibles • Diabetic Supplies • Hearing Aides & Batteries • Insulin Treatments • Infertility Treatment

17. FLEX$ ELIGIBLE EXPENSES Some expenses are eligible with a note from your doctor explaining medical necessity: Depression medication Massage Therapy Vitamins Hormone Therapy Sleep Aids

18. OVER-THE-COUNTER DRUGS Effective 1/1/2011 Over-the-counter drugs and medicines require a prescription from your doctor, or a note of medical necessity. Some of these are: Acid Controllers Allergy, cough, cold and flu Pain Reliever Digestive Aid and Stomach Remedies Pay with your own funds and send a copy of the receipt with a copy of the prescription from your provider to PEHP with a claim form.

19. FLEX$ Spending Advantages Flex$ dollars/health are available immediately The money you elect is deducted from each paycheck throughout the year, before taxes MasterCard You can track you balance online

20. FLEX$ Benefit Card Now functions as credit and a debit card. Accepted at most places that take Mastercard You can swipe the card at participating vendors OR you can copy and send your receipts to PEHP for reimbursement Save your receipts Only charge qualified Expenses You must re-enroll every year.

21. FLEX Dependent Day-Care Automatic Reimbursement & Direct Deposit Separate from your Flex$ Medical Deduction $5,000 limit per household Must be incurred to allow you and your spouse to work or look for work Dollars become available to you as they are deducted from your paycheck Care can be provided by a day care, nanny, or relative

22. FLEX$ SPENDING WARNINGS USE IT OR LOSE IT Designated Amount CANNOTbe changed without qualifying event, such as: Birth, Death, Marriage, divorce, Employment Change, or Adoption KEEP ALL YOUR RECEIPTS

23. ADDITIONAL BENEFITS • Visit www.pehpplus.com for discounts on things not covered by the health plan WeeCare • Pre-natal program for expecting parents Out of Area Network Card • Receive contracted benefits if you travel within the United States

24. Life Assistance Counseling NO copay for the Preferred, Summit, and Advantage Partnership between PEHP and Blomquist Hale Consulting One-on-one Counseling for life problems • Anxiety or depression • Relationship Difficulties • Work Related Stress • Family Problems • Alcohol / Drug Problems No limit on number of visits Patient will be seen until patient has tools to resolve issues on their own

25. Life Assistance Counseling Not available for complex issues that need ongoing care from a Mental Health Provider • Bipolar Disorder • Multiple Personalities • Manic Depressive Disorder Patient may go directly to the traditional Mental Health Benefit as offered by their Medical plan and pay all required co-pays Patient may be referred by the Life Assistance Counselor into the Mental Health Benefit and pay all required co-pays

26. PLAN REMINDERS Select a plan that meets your needs Pre-authorize inpatient hospital and mental health services (call PEHP) Call to verify benefits /preauthorization Visit www.pehp.org for plan information Enroll on-line at www.pehp.org at my Brief overview. See the master policy for more detailed information

27. PEHP On-Line Enrollment You DO NOT NEED TO RE-ENROLL If you are NOT changing plans or adding or deleting dependents USE PEHP’s on-line enrollment if you are MAKING CHANGES TO YOUR PLAN. You are required to re-enroll in flex each year. If you waived coverage, a new employee or Early Retiree, you will need to complete an enrollment form. Open Enrollment is April 7th through May 15th Brief overview. See the master policy for more detailed information

28. WWW.PEHP.ORG myPEHP • Claim status and dates • Benefit Summaries • Master policies • Cost Calculator • Provider Lists • Preferred Drug List • WeeCare • Healthy Utah and more Brief overview. See the master policy for more detailed information

29. CONTACT INFORMATON Customer Service 801-366-7555 1-800-765-7347