State of Maine POS Benefit Changes

1. State of Maine POS Benefit Changes Effective July 1, 2012 Introduction & housekeeping items (restrooms, cell phones, etc)Introduction & housekeeping items (restrooms, cell phones, etc)

2. Objectives for today…. Outline the benefit changes for the POS plan Introduce new partners & programs Answer your questions During today’s session we will review…..During today’s session we will review…..

3. Background – State Employee Health Commission 24-member labor/management group serves as plan trustees Plan participants – forest ranger, highway supervisor, corrections officer, retirees, classroom instructors Committed to value-based benefits – incentives to choose high-quality, safe, more effective care About 7 years ago the commission adopted a goal to move towards value-based benefits design.About 7 years ago the commission adopted a goal to move towards value-based benefits design.

4. Why the changes to the plan? Self-insured plan defined Plan expenses are paid by our employer The State of Maine Ancillary employer groups (e.g. Maine Turnpike, Maine Community College System, etc.) Flat funding Fiscal Year 2011 plan expenses = $222.6 million; benchmark for flat funding Premiums must remain the same FY2012 (current): 6% increase or $13.4 million FY2013 (July 1, 2012): 10% projected increase or $22 million Non-Medicare group expanding. In recent years we’ve seen cuts in $5M-$7M Anthem is just our Third Party Administrator; we assume the risk. Plan expenses consist of about 96% in claims & 4% in administration Non-Medicare group expanding. In recent years we’ve seen cuts in $5M-$7M Anthem is just our Third Party Administrator; we assume the risk. Plan expenses consist of about 96% in claims & 4% in administration

5. What is driving the increase? The FY13 10% increase is a direct result of: Provider price inflation Hospital in-patient services up 14.4% Hospital out-patient services up 7.8% Increased utilization Up 3.5%

6. Good News/Bad News Good News No premium increase Co-pay amounts will remain the same Bad News – plan expenses will have to be reduced in order to achieve flat funding Reduction in expenses = adjustments within the benefit design.Reduction in expenses = adjustments within the benefit design.

7. How Do We Get There? A series of options were considered Two objectives were required by SEHC: Introduce savings consistent with value-based benefits Limit members’ out-of-pocket expense as much as possible

8. Key Terms Revisited Deductible – The amount you have to pay before your health benefits kick in Copayment – The set dollar amount you are required to pay for certain services (office visits, emergency room, etc.) Coinsurance – After the deductible, the percentage you are required to pay for services (example: 5% of hospital care) Out-of-pocket limit – The maximum amount of deductible and coinsurance that you may pay in a calendar year. Copayments are not included.

9. Plan Design Changes July 1, 2012 Hospital benefits Any amount paid towards your 2012 deductible or coinsurance bill be applied to the above.

10. Co-pay Amounts Co-pay amounts will remain the same Primary Care office visit $0 or $20 Specialist office visit $25 Prescription Drug Copays 30-day supply - $10/$30/$45/$50 90-day supply - $15/$45/$70/$75 Generic/Name-brand formulary/Non-formulary/Lifestyle Emergency Room $100 & Walk-In Clinic $25 Advanced Imaging $50

11. Achieving Flat Funding Estimated Benefit Savings Hospital $18.4M Prescription Drugs (MaineMeds) $3.6M Total $22M

12. Preferred Hospital Methodology Scoring Values Explained

13. Preferred Hospitals What’s changing How score is determined (a minimum score of 70 is still required) List updated once per year Based on most recent data available April 1st Effective date of new list will be July 1st We will send you the new list as soon as it is available.

14. New Weighting Effective care (quality) = 30% Safe (patient safety) = 30% Patient satisfaction = 10% Comparative cost = 30% Results for effective care, safety & satisfaction can still be found at www.getbettermaine.org The cost category/data is not included in the coalition’s site. The cost category/data is not included in the coalition’s site.

16. Scoring Values For Effective care, Safe care, and Patient Satisfaction Low (below national average) = 1 Good (reflects average) = 2 Better (better than national average) = 3 Best (top 10% of nation’s hospitals) = 4

17. Comparative Cost:Small Maine Hospitals Hospitals with 75 or more beds. Vertical line at 0% is the State average. Average payments from commercial payers for their population for same services & procedures. Compare TAMC to SMMC. The plan cannot sustain this level of expenses. Our plan members are paying almost 50% more at TAMC than SMMC. We need to start to push the hospitals to control costs while still providing high quality health care. Potential market-share loss as we saw in the other three categories. Shifting the challenge of cost & efficiency to hospital administrators.Hospitals with 75 or more beds. Vertical line at 0% is the State average. Average payments from commercial payers for their population for same services & procedures. Compare TAMC to SMMC. The plan cannot sustain this level of expenses. Our plan members are paying almost 50% more at TAMC than SMMC. We need to start to push the hospitals to control costs while still providing high quality health care. Potential market-share loss as we saw in the other three categories. Shifting the challenge of cost & efficiency to hospital administrators.

18. Comparative Cost: Large Maine Hospitals Consistent for the last 5 or 6 years (this is 2009 data). Encourage participants to go to high quality, efficient hospitals. Economic pressure from members could reduce market share; get hospitals’ attention and to start to seriously look at reducing costs.Consistent for the last 5 or 6 years (this is 2009 data). Encourage participants to go to high quality, efficient hospitals. Economic pressure from members could reduce market share; get hospitals’ attention and to start to seriously look at reducing costs.

19. Scoring Values – Comparative Costs 8% or greater above the state average = 0 Between 4% and 7.9% above the state average = 1 Between state average and 3.9% above state average = 2 Below state average to 4.9% below state average = 3 5% or greater below state average = 4

20. Challenges Ahead SEHC continues to be engaged in several pilot projects with health systems and hospitals to improve care, enhance patient experience and reduce costs This is where the changes in delivery of care and the payment system have to be transformed SEHC members are participating in the evenings on their own time to advance better quality and more efficient care

21. Health Credit Premium Program For active State of Maine employees If you completed the Health Risk Assessment (HRA) last year you will continue to pay the same premium you do today; you will continue to receive the 5% discount. If you did not complete the HRA last year you will not have to continue paying the extra 5% towards your premium effective with your first check in July. Notices will be sent out by the end of July regarding the program requirements for this year. Statutory Reference: MRS Title 5, 285, 7-A

22. StayWell Health Management New in 2012 Their mission To help people achieve optimal health through solutions that set the standard for quality, effectiveness and value. Program Offerings: Health Risk Assessment Health Coaching Programs Disease Management Programs StayWell Online On-site Health Screenings 15 locations in the State of Maine 22

23. StayWell Health Management Programs Health Risk Assessment A 15-20 minute questionnaire covering topics such as nutrition, stress and physical activity Provides a snapshot of your current health and offers suggestions to inspire your future health goals Health Coaching and Disease Management Connect one on one with a health coach who provides encouragement, tips and ideas to help you reach your overall health goals Programs offered via phone, through the mail or online StayWell Online Access to your Health Risk Assessment Provide interactive tools to set goals, monitor your program progress and access to the latest health information 23 Mention our mutual clients Strategy: Comprehensive wellness is our singular focus. Solid, consistent ownership. 31 years working with large employers in the US market. Simply put, our mission is to improve health and avoid progression into costly disease states which will positively impact your health care cost trend and improve overall productivity. StayWell Health Management is a division of The StayWell Company, which is a wholly owned subsidiary of MediMedia USA, a financially strong parent company. Our division of MediMedia, The StayWell Company, is comprised of other focused business units including, StayWell Custom Communications, Krames Health and Safety Education, (85% of hospitals), Consumer Health Publishing Group-Harvard Health Newsletters, American Red Cross Publishing, and several smaller groups, which were brought together through strategic “best-in-class” acquisitions. The combined strengths of our sister companies’ health content resources and StayWell Health Management’s leadership in providing integrated health management programs, allows us to deliver virtually an endless array of products and services to meet client needs. Our Organization December 31, 2009 - StayWell acquired LifeMasters Supported Care assets, adding disease management to our portfolio of population health management solutions StayWell brings over 30 years of experience delivering comprehensive wellness programs LifeMasters brings over 15 years of specialized experience with clinical depth in core conditions Both are recognized for scientifically-tested programs Our Clients Long-term partnerships, representing employers, union groups, health plans and government entities of all sizes and industries with very diverse needs Our People & Locations We employ a highly experienced, multidisciplinary team of credentialed health and business professionals, many recognized as industry though leaders Call centers in Albuquerque, Indianapolis, St. PaulMention our mutual clients Strategy: Comprehensive wellness is our singular focus. Solid, consistent ownership. 31 years working with large employers in the US market. Simply put, our mission is to improve health and avoid progression into costly disease states which will positively impact your health care cost trend and improve overall productivity. StayWell Health Management is a division of The StayWell Company, which is a wholly owned subsidiary of MediMedia USA, a financially strong parent company. Our division of MediMedia, The StayWell Company, is comprised of other focused business units including, StayWell Custom Communications, Krames Health and Safety Education, (85% of hospitals), Consumer Health Publishing Group-Harvard Health Newsletters, American Red Cross Publishing, and several smaller groups, which were brought together through strategic “best-in-class” acquisitions. The combined strengths of our sister companies’ health content resources and StayWell Health Management’s leadership in providing integrated health management programs, allows us to deliver virtually an endless array of products and services to meet client needs. Our Organization December 31, 2009 - StayWell acquired LifeMasters Supported Care assets, adding disease management to our portfolio of population health management solutions StayWell brings over 30 years of experience delivering comprehensive wellness programs LifeMasters brings over 15 years of specialized experience with clinical depth in core conditions Both are recognized for scientifically-tested programs Our Clients Long-term partnerships, representing employers, union groups, health plans and government entities of all sizes and industries with very diverse needs Our People & Locations We employ a highly experienced, multidisciplinary team of credentialed health and business professionals, many recognized as industry though leaders Call centers in Albuquerque, Indianapolis, St. Paul

24. Expert Medical Opinion Program Program Highlights Access to the world’s medical experts* Free 100% Confidential Open to any and all conditions and treatments Advance Medical 1-888-218-0992 www.advance-medical.com/maine (*EMO physicians are not a substitute for your current provider)

25. Anthem Vision is now “Blue View Vision” Plan enhancements at no cost Retinal eye imaging Standard lenses with factory scratch coating Discounts on Transitions, premium progressive lenses and anti-reflective coatings Open enrollment – May/June 2013

26. MaineMeds: A new voluntary prescription drug program Program Overview 90-day prescription Brand name medications Review list of eligible medications Enrollment

27. MaineMeds (continued) Program Advantages Cost = FREE! Convenience of home delivery No shipping & handling costs

28. MaineMeds (continued) How to Enroll Complete enrollment form Ask your doctor for a new prescription for each medication 3-month supply with 3 refills Fax or mail form and prescription(s) to MaineMeds

29. Member Services Toll Free Number Nurseline Toll Free Number Welcome Guide ExpressLane Navigator DocFind Thank you for your time today, my name is ____________ and I am here today to review some of the tools that the State of Maine Employee Benefits team has worked with us on to help you with your health and heath plan benefits. We take our member satisfaction very seriously at Aetna. Our goal is to provide you the best member experience we can. We hope that you will share any concerns with us, and we hope that you will share your positive expeiriences as well. We want to hear from you especially during this time with any concerns that you may have, so to make this as easy as possible please see the attached member inquiry form in your hand outs. If you have any specific questions related to yourself or a covered family member, please give us some general information on this from and hand it to myself or Heather after the meeting and we will get back to you within two business days. On this first slide we have a list of Tools and Resources that I would like to briefly review with you. Next slide please.Thank you for your time today, my name is ____________ and I am here today to review some of the tools that the State of Maine Employee Benefits team has worked with us on to help you with your health and heath plan benefits. We take our member satisfaction very seriously at Aetna. Our goal is to provide you the best member experience we can. We hope that you will share any concerns with us, and we hope that you will share your positive expeiriences as well. We want to hear from you especially during this time with any concerns that you may have, so to make this as easy as possible please see the attached member inquiry form in your hand outs. If you have any specific questions related to yourself or a covered family member, please give us some general information on this from and hand it to myself or Heather after the meeting and we will get back to you within two business days. On this first slide we have a list of Tools and Resources that I would like to briefly review with you. Next slide please.

30. Member Services Toll Free Number 1-855-850-0039 Call between 8 & 6 Local time for questions on benefits, claims, or anything else you need assistance with…we are here to help! Nurseline Toll Free Number 1-800-424-4047 Call anytime to talk to a Nurse Our Member Services Team is available to you from 8AM to 6 PM local time. The Member Services Toll Free number can be found on the back of your ID card which you will get at your home address by the end of June. If you have questions prior to the July 1 effective date you can contact either the Employee Benefits Division or you can use the Member Services number, we will be ready for your calls on May 1st. Member Services will help you with claim questions, benefit questions, provider questions, anything you need, just call! Ever wake up in the middle of the night and wondering about something your doctor has said to you at an appointment earlier in the day….or have a child with a temperature, but you don’t want to bother your doctor at 2AM? Call Nurseline for some peace of mind. You can talk to a Nurse anytime 24 hours a day, 7 days a week. This service will be available to you starting on 7/1.Our Member Services Team is available to you from 8AM to 6 PM local time. The Member Services Toll Free number can be found on the back of your ID card which you will get at your home address by the end of June. If you have questions prior to the July 1 effective date you can contact either the Employee Benefits Division or you can use the Member Services number, we will be ready for your calls on May 1st. Member Services will help you with claim questions, benefit questions, provider questions, anything you need, just call! Ever wake up in the middle of the night and wondering about something your doctor has said to you at an appointment earlier in the day….or have a child with a temperature, but you don’t want to bother your doctor at 2AM? Call Nurseline for some peace of mind. You can talk to a Nurse anytime 24 hours a day, 7 days a week. This service will be available to you starting on 7/1.

31. Coming to your home mail box A Reference guide listing Online tools Programs Handy list of contact numbers A diagram of your ID Card Keep this document for reference If you have not already received the Welcome Guide, you will be getting this in your mail at home in the very near future. The Welcome Guide is a joint effort between the State of Maine Employee Benefits Division and your Aetna Account team to provide you with a resource to have on hand to review tools, programs and contact numbers that are offered with Aetna. Keep this to use as a reference guide.If you have not already received the Welcome Guide, you will be getting this in your mail at home in the very near future. The Welcome Guide is a joint effort between the State of Maine Employee Benefits Division and your Aetna Account team to provide you with a resource to have on hand to review tools, programs and contact numbers that are offered with Aetna. Keep this to use as a reference guide.

32. Customized Web Site for State of Maine Members Access to Resources in one place Aetna Navigator DocFind Benefit Summaries Frequently Asked Questions…and more! ExpressLane is another joint effort by the State of Maine Employee Benefits Division and Aetna to provide you to easy access to resources and tools. ExpressLane is a website that provides quick access to details on your health benefits as well as resources for your health. Go to the ExpressLane website to find your benefit summaries, Links to Navigator and DocFind (which I will review with you in a minute), Frequently Asked questions, Forms and Rx Information. ExpressLane is another joint effort by the State of Maine Employee Benefits Division and Aetna to provide you to easy access to resources and tools. ExpressLane is a website that provides quick access to details on your health benefits as well as resources for your health. Go to the ExpressLane website to find your benefit summaries, Links to Navigator and DocFind (which I will review with you in a minute), Frequently Asked questions, Forms and Rx Information.

33. Manage your health & your benefits on this secure site any time Access Aetna Navigator thru ExpressLane Use Navigator to: View your claims Order a replacement ID card or print a temporary card Use the “Ask Ann” feature to get what you need fast! Aetna Navigator is another website that provides you everything you need to manage you r health and health benefits. Navigator is a secure site and you will need to register to start using the site. You can access Navigator by going to ExpressLane. Navigator is your tool to look at claims information, to print a temporary ID card or to order a replacement card. You can also check on your deductibles, get forms or estimate the cost of care. There is a lot of information offered thru Navigator and a GREAT tool to help you find what you are looking for is “Ask Ann.” “Ask Ann” is the Navigator virtual assistant. You will see her picture in the Welcome Guide and when you log into Navigator. To use her, just type in a question and she will type an answer for you AND bring you to the page that your information is on. If you have your computer volume turned up then you will hear Ann’s voice responding as well as seeing the typed information. Don’t you wish every website came with a virtual assistant??!? Aetna Navigator is another website that provides you everything you need to manage you r health and health benefits. Navigator is a secure site and you will need to register to start using the site. You can access Navigator by going to ExpressLane. Navigator is your tool to look at claims information, to print a temporary ID card or to order a replacement card. You can also check on your deductibles, get forms or estimate the cost of care. There is a lot of information offered thru Navigator and a GREAT tool to help you find what you are looking for is “Ask Ann.” “Ask Ann” is the Navigator virtual assistant. You will see her picture in the Welcome Guide and when you log into Navigator. To use her, just type in a question and she will type an answer for you AND bring you to the page that your information is on. If you have your computer volume turned up then you will hear Ann’s voice responding as well as seeing the typed information. Don’t you wish every website came with a virtual assistant??!?

34. Find out if your Doctor is in the Network Find out information about your Doctor… Certification Status Other Information (language spoken, handicap access) You can get to DocFind from the ExpressLane at www.AetnaStateofMaine.com Picking an in-network doctor is important to get the most for your benefit buck. DocFind has been customized for the State of Maine to show Doctors in the Preferred State of Maine Network which is your best choice to maximize your out of pocket expenses. DocFind will also show you the Aetna network as well as out of Network providers. There is additional information on DocFind to help you select the provider that is right for you, including what language the provider speaks and if they have handicap access. You can get to DocFind and many other helpful tools and resources by going to ExpressLane at www.AetnaStateofMaine.com I appreciate your time today. I’d like to remind you that if you do have any questions or have any benefit related issues you would like to discuss, please fill out the member inquiry form and hand it to Heather or I as you leave today. A customer service advocate will get back to you within 48 hours. Again, many thanks for your time we look forward to being of service to you! Picking an in-network doctor is important to get the most for your benefit buck. DocFind has been customized for the State of Maine to show Doctors in the Preferred State of Maine Network which is your best choice to maximize your out of pocket expenses. DocFind will also show you the Aetna network as well as out of Network providers. There is additional information on DocFind to help you select the provider that is right for you, including what language the provider speaks and if they have handicap access. You can get to DocFind and many other helpful tools and resources by going to ExpressLane at www.AetnaStateofMaine.com I appreciate your time today. I’d like to remind you that if you do have any questions or have any benefit related issues you would like to discuss, please fill out the member inquiry form and hand it to Heather or I as you leave today. A customer service advocate will get back to you within 48 hours. Again, many thanks for your time we look forward to being of service to you!

35. Questions? Aetna Member Services Employee Health & Benefits (207)287-6780 www.maine.gov/beh