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Independent School District #492 Austin Public Schools

March 1, 2012 Health Insurance Plan

2/21/2012

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•The Austin Public School health plan went out for bid for coverage effective 3/1/2012

•Why – Renewal from UMR (TPA -Third Party Administrator) was not affordable

•Recommendation to change TPA’s to CCStpa based on capabilities and cost

•Management & Insurance Committee recommended changes in carriers at renewal time

•Board of Directors approved recommended changes

Benefits effective March 1, 2012

Austin Independent School District #4922012 Benefit Plan Comparison (In-Network)

Benefit 250/500 Plan 1200/2400 Plan

Lifetime Maximum Unlimited Unlimited

Deductible $250 Single / $500 Family $1,200 Single / $2,400 Family

Coinsurance Percentage 80/20% 80/20%

Out of Pocket Maximum (OOPM) $2,500 Single / $5,000 Family $2,500 Single / $5,000 Family

Hospital Inpatient 80% after deductible to OOPM, then 100%. 80% after deductible to OOPM, then 100%.

Hospital Outpatient 80% after deductible to OOPM, then 100%. 80% after deductible to OOPM, then 100%.

Emergency Room Services 80% after deductible to OOPM, then 100%. 80% after deductible to OOPM, then 100%.

Inpatient Physician Visits 80% after deductible to OOPM, then 100%. 80% after deductible to OOPM, then 100%.

Inpatient Maternity Services 80% 80%

Prenatal Care 80% 80%

Well Baby Care Visit Maximum: 100% 100%

Birth to 12 Months 100%, no visit limitation 100%, no visit limitation

12 Months to 24 Months 100%, no visit limitation 100%, no visit limitation

24 Months to age 6 100%, no visit limitation 100%, no visit limitation

Immunizations (up to age 18) 100% 100%

Outpatient Diagnostic Testing, X-ray & Lab Services

80% after deductible to OOPM, then 100%. 80% after deductible to OOPM, then 100%.

Physician Office Visit 80% after deductible to OOPM, then 100%. 80% after deductible to OOPM, then 100%.

Preventive Care 100% Full Preventive Care 100% Full Preventive Care

Benefit 250/500 Plan 1200/2400 Plan

Mental Health – Inpatient 80% after deductible to OOPM, then 100%. 80% after deductible to OOPM, then 100%.

Mental Health – Outpatient 80% after deductible to OOPM, then 100%. 80% after deductible to OOPM, then 100%.

Chemical Dependency – Inpatient 80% after deductible to OOPM, then 100%. 80% after deductible to OOPM, then 100%.

Chemical Dependency – Outpatient 80% after deductible to OOPM, then 100%. 80% after deductible to OOPM, then 100%.

Organ Transplants (performed at an Organ Transplant Network Facility)

80% after deductible to OOPM, then 100%. 80% after deductible to OOPM, then 100%.

Organ Transplants - Performed at any other Facility

80% after deductible to OOPM, then 100%. 80% after deductible to OOPM, then 100%.

Durable Medical Equipment 80% after deductible to OOPM, then 100%. 80% after deductible to OOPM, then 100%.

All other Eligible Expenses 80% after deductible to OOPM, then 100%. 80% after deductible to OOPM, then 100%.

Prescription Drugs – You pay:

$0 Generic Copay

80% after deductible to OOPM, then 100%.$35 Formulary Copay

$50 Non-Formulary Copay

Prescription Drug Out-of-Pocket Maximum Limit

$1,000 Single Included in medical deductible and out-of-pocket maximum limit$2,000 Family

NOTE: This is only a summary of your group health and dental benefits. All Benefits are subject to the detailed description of your coverage’s, exclusions, conditions and limitations listed in your benefit plan booklets. If this outline and your benefit plan booklet conflict, the benefit plan booklet prevails.

Austin Independent School District #4922012 Benefit Plan Comparison (In-Network)

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CCStpa: The right partner for you

• Founded in 1982 — 30 years experience• Purchased by Blue Cross Blue Shield of

Minnesota in 1985• Headquartered in Eagan• Outstanding service and responsiveness

of a top notch TPA– dedicated claims, service, and account

management to Austin Public Schools

• Integrated resources and industry expertise of a large health plan– Compliance, Contracts, Legal departments

Large provider network means access to your choice of care

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CCStpa, not your average tpa.

• Access to Minnesota’s broadest network – Access to virtually all doctors, hospitals and

other health care providers in the state– Strong negotiations produce deep discounts

• Relationships with national networks ensure access and savings anywhere in the country for people traveling or dependants residing outside of MN.– PHCS

Services and support that help you manage your health

Customer service and connections • Check claims status, order ID

cards, view membership, view benefits, print forms, search for providers

• Answers benefits coverage and other questions

• Provides information about available services and tools

• May connect you to a nurse or other health specialists

Coordinated, personalized support for you

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Were here to help

• Customer Service (651)-662-5425 or (866) 356-2425– Monday – Thursday 8a.m.– 5p.m. Friday 9a.m. -5p.m.

• Find a doctor online: − Go to www.ccstpa.com− Click on member tab− Click on “Find a doctor”− Choose the EPNI network to match network listed on ID card,

or the PHCS travel network when traveling

• Check drug list online: − Go to www.ccstpa.com− Click on member tab− Click on “prescription drugs”− Click on “myprime.com”

More support for your health

• Health Assessment and Online Coaching• Stop-Smoking Support• CCS Member Center• Online Wellness Center

– General health information– Tips for nutrition, fitness, safety, etc.– Stay on track with health goals

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Prescription drugs

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Prime Therapeutics and CCStpa

• Prime Therapeutics network of pharmacies includes over 60,000 pharmacies nationwide.

• Cub, CVS, Target, Walgreens, Walmart• Independent and local drug stores

• Access information at:• www.myprime.com • 1-800-509-0545

• Prime Therapeutics telephone number is located on the back of your ID card

2012 Prescription drug benefit250/500 Plan

*For eligible drugs available at participating 90dayRx pharmacies.

RetailPharmacy

90dayRx*Retail Pick-up or Home Delivery

Days Supply 31 days 90 days

Generic $0 copay $0 copay

Preferred Brand (Formulary)

$35 copay $70 copay

Non-Preferred Brand(Non-formulary)

$50 copay $100 copay

Separate Drug -

out-of-pocket maximum

$1,000 Individual

$2,000 Family

2012 Prescription drug benefit 1200/2400 plan Member cost-share after deductible is met

RetailPharmacy

90dayRx* Retail Pick-up orHome Delivery

Days Supply 31 days 90 days

Generic 80% After Deductible

Preferred Brand (Formulary)

80% After Deductible

Non-Preferred Brand(Non-formulary)

80% After Deductible

*For eligible drugs available at participating 90dayRx pharmacies.

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Ask for generics and saveGenerics work the same as brand name drugs, but cost less

Brand name$120

Generic equivalent Co-pay$xx

$xx Brand name co-pay

Generic equivalent$20

Member cost

Actual Cost

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Order 90-day supplies*

* For eligible drugs available at participating 90dayRx pharmacies.

90dayRx program:• Home delivery or

pharmacy pick-up

• Less expensive

• More convenient

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Specialty Rx

• Available for specific chronic conditions

• Often the prescriptions require special handling

• Order from a specialty network pharmacy– Fairview Specialty Pharmacy, LLC*

1-800-595-7140(612) 672-5262 faxwww.fairviewspecialtyrx.org

− Triessent1-888-216-67101-866-203-6010 fax

• Contact customer service with questions regarding Specialty Rx

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Step Therapy

• Step Therapy is based on FDA guidelines, clinical evidence and research to ensure you are taking the most appropriate medication

• Physicians and pharmacists review medications to determine which is appropriate and lower-cost alternative medications

• Previously qualified Step Therapy participants will be grandfathered and will not have to re-qualify

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Questions?