Genesee County 1 Findings and Recommendations Regarding Retiree - - PowerPoint PPT Presentation

Genesee County

Findings and Recommendations Regarding Retiree Medical Benefits February 19, 2020

1

AGENDA

Process Findings Recommendations Proposed Project Process and Timing Appendix Pre and Post-65 Costs and Enrollment Current Plan Designs Factors that Impact Cost of Retiree Medical Plans

2

Process

Retained to evaluate existing retiree medical benefit plans in terms of:

• Plan design
• Plan funding
• Costs
• Contributions

Purpose is to determine if there are:

• Better, more efficient methods to deliver the benefits at lower costs to

both the County and its retirees, and

• Create greater sustainability of retiree medical benefit plans

3

Process

Data provided by the County, broker, and carriers to understand:

• Plan enrollment – data in today’s report is based on master list from the

County,

• Plan designs,
• Rates/premium equivalent rates and carrier enrollment summaries, and
• Retiree contributions

Collected information from County’s legal counsel regarding status

• f bargaining requirements

Over 100 variations by retiree group in terms of potential to change one or more of the following:

• Plan administrator (Blue Cross or HAP)
• Plan financing method (insured or self-insured)
• Plan design (24 different retiree plan designs between the two

administrators)

4

5

Findings

Groups # of Subscribers Premium Equivalence Contributions Net Expense Pre-65 Retirees 319 $7,147,318.04 $123,825.48 $7,023,492.56 Post 65 Retirees 718 $7,427,634.93 $80,710.56 $7,346,924.37

Pre-65 Retirees account for 319 former employees

• Represents an annual gross spend (using accrual rates) of $7.023 million
• Retiree contributions are about 1.7% of premiums

For Post-65 retirees, the story is similar

• 718 covered retirees
• Annual post-65 retiree medical spend is $7.35 million
• Contributions are 1.1% of premiums

All retirees, pre and post, have been accounted for and reconciled between the Master List and billing statement with the vendors

Findings

The County operates 24 different pre and post-65 retiree medical plans through two different carriers/administrators

• Blue Cross plans are self-insured
• HAP plans are fully-insured

100+ permutations of plan offerings – all permutations are based

• n the time of retirement of the retiree

The chart below illustrates the number of plans, to whom they apply, and a general comment on cost efficiency of the platform

6

Ty Type pe o

• f Pl

f Plan Pr Pre-65 65 Post st-65 65 Effic fficie iency o

• f Pl

Plan Pu Purchasin ing Comprehensive Major Medical 11 11 No pre-65 cost effectiveness; Modest for Post 65 – design limits apply to both pre and post PPO 4 4 Modest cost effectiveness – design limits HMO 3 3 Modest cost effectiveness – design limits Hybrid – Comp MM/PPO 4 4 Low cost effectiveness for pre-65, Modest for Post 65 – design limits MAPD 2 Good effectiveness – completely unleveraged

Findings

As currently structured, the County’s plans are not sustainable The Comprehensive Major Medical plan for pre-65 retirees delivers excellent benefits but on a cost basis that is 15% to 25% above market norms if purchased through PPOs and HMOs In addition:

• Levels of benefits shift virtually all of the medical inflationary (trend) costs

to the County

• Retiree contributions are slightly over 1% in total

7

Findings

Comprehensive Major Medical for post-65 is not as problematic as it is for the pre-65 cohort since reimbursement is based on Medicare PPO, Hybrid, and Limited MAPD plans are problematic due to design structure as noted previously Having multiple vendors on different financing platforms limits/eliminates any purchasing leverage that could be available to the County

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Recommendation

Comprehensive approach to consolidate the County’s purchasing for Actives and Retirees

• At this time leave active plan designs alone, but include them in a

consolidated purchasing effort to deliver:

• Lower costs
• Easier administration
• Opportunity to deal with carrier imposed administrative limitations affecting

pre-65 retirees with post-65 dependents, post-65 retirees with pre-65 dependents (split contracts)

• Provide multiple (not more than three options each) for pre-65 and post

65 plans

Range of costs savings estimated at:

9

Retire iree C Class Estimated L Low

• w S

Sav avin ings Range e Estimated H Hig igh S Sav avin ings Ran ange Pre-65 retirees $700,000 $1,000,000 Post -65 retirees $1,850,000 $2,600,000 Total $2,550,000 $3,600,000

Project Process and Timing

Week 1 through 3: Complete data collection – historical claims, enrollment, fixed costs, shock claims, etc. Week 2 through 5: Draft Vendor RFP complete with all historical data, proposal specifications, response timing, etc. Week 4 through 12: Manage Vendor questions, responses, begin analytics Week 10 through 16: Complete analysis of all vendor responses, prepare and present findings to County Week 14 through 24: Decision making process Week 23 through 40: Implementation, communications, open enrollment

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11

Appendix

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Pre-65 Retiree Costs and Enrollment

• Of the 319 pre-65 retirees, 304 either
• Allow a plan change, or
• May allow a plan change
• Note, plan changes have been taking place each year as

new medical technologies, clinical treatments, and pharmacy therapies replace old clinical approaches

Change Carrier? Change Funding? Change Plan? # of Subscribers Premium Equivalence Contributions Net Expense Maybe Maybe Maybe 2 $38,863 $0 $38,863 Maybe Maybe Yes 22 $424,176 $3,311 $420,866 Maybe No Maybe 5 $84,761 $1,741 $83,019 No No Maybe 2 $55,404 $0 $55,404 No No Yes 1 $11,624 $0 $11,624 Yes Maybe Yes 43 $1,037,662 $6,579 $1,031,082 Yes No Yes 2 $38,790 $0 $38,790 Yes Yes No 15 $377,424 $0 $377,424 Yes Yes Yes 218 $4,912,535 $110,491 $4,802,044 9 $166,079 $1,704 $164,375 319 $7,147,318 $123,825 $7,023,493 Totals Blanks

13

Post-65 Retiree Costs and Enrollment

• Of the 718 post-65 retirees, 707 either
• Allow a plan change, or
• May allow a plan change
• Note, plan changes have been taking place each year as

new medical technologies, clinical treatments, and pharmacy therapies replace old clinical approaches

Change Carrier? Change Funding? Change Plan? # of Subscribers Premium Equivalence Contributions Net Expense Maybe Maybe Maybe 24 $229,819 $0 $229,819 Maybe Maybe Yes 110 $1,128,244 $0 $1,128,244 Maybe No Maybe 110 $1,052,750 $0 $1,052,750 No No Maybe 28 $262,137 $310 $261,828 No No Yes 12 $162,288 $0 $162,288 Yes Maybe Yes 46 $535,387 $903 $534,484 Yes No Yes 22 $216,542 $4,888 $211,654 Yes Yes No 11 $141,832 $0 $141,832 Yes Yes Yes 287 $3,005,754 $70,095 $2,935,658 68 $692,882 $4,514 $688,367 718 $7,427,635 $80,711 $7,346,924 Totals Blanks

Current Medical Plan Designs

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• Plans are administered by
• Blue Cross Blue Shield of MI – all are self-insured
• Health Alliance Plan (HAP) – all are fully insured
• HAP also includes a post 65 retiree medical design that is a

Medicare Advantage Part D plan (MAPD) – by definition, fully insured

• The MAPD plan is a plan available only to participants in

Medicare

• Combines Medicare Part A (hospital), Part B (professional),

and supplemental benefits to both Part A, B, and all covered retail prescription drug benefits

Current Medical Plan Designs

15

• General commentary
• For the Pre-65 population, a significant portion of the population are enrolled

in Comprehensive Major Medical plans

• Such plans carry with it a claims cost reimbursement rate that can be

anywhere from approximately 5% to 40% above the normal reimbursement levels for typical PPO providers

• This means that simply moving this group of retirees into a PPO plan

structure will produce a reduction in costs of 12% to 30% overall, without any change to the benefit level itself

• For the post 65 population, the situation is very similar in that the same plans

are generally available, with the exception of the two MAPD plans offered by HAP

• The difference is, that for those retirees post-65 are covered primary

by Medicare, Medicare reimbursements rates dictate how claims will be paid by the plan

• As such, for the Medicare population, cost savings due to

reimbursements based on plan type, e.g. Comp Major Med, PPO, or HMO do not drive a much cost savings

• All claims for this group are reimbursed at Medicare levels

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BCBSM & HAP Plans - Actives

• Up

Upda dated 02/ 02/18/ 18/202 020 to refle lect ct a actual B l BCBS S ben enef efits

• This simply provides

the benefit summary for the Active employees

• While our report is

focused on retirees, it is important to have a reference point to the active plan

• We may find that a

strategy for cost reduction, where allowed, could be to replicate the active plan

Medical 019 1000, 1002 1000, 1002 Actives Actives Actives BCBSM HAP HMO HAP PPO In-Network Out-of-Network In-Network In-Network Out-of-Network Deductible Single $250 $500 $250 $250 $500 Family $500 $1,000 $500 $500 $1,000 Coinsurance Inpatient 80% 60% 80% 80% 60% Outpatient 80% 60% 80% 80% 60% Coinsurance Max Single $750 $1,500 N/A N/A N/A Family $1,500 $3,000 N/A N/A N/A Out-of-Pocket Max Single $6,350 $12,700 $1,000 $1,000 $2,000 Family $12,700 $25,400 $2,000 $2,000 $4,000 Visits PCP Office $20 copay Not covered $15 copay $20 copay 60% coinsurance after ded Specialist Office $20 copay Not covered $15 copay $20 copay 60% coinsurance after ded Urgent Care $20 copay Not covered $30 copay $30 copay $30 copay ER $150 copay $150 copay $100 copay $150 copay $150 copay PRESCRIPTION DRUG Retail Generic $5 $5 $5 Brand Formulary $20 $20 $20 Brand Non-formulary $40 $40 $40

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BCBSM Plans – Retirees

Medical 002 003 004 Retirees Retirees Retirees BCBSM BCBSM BCBSM Comp/Major Medical Comp/Major Medical Comp/Major Medical Deductible Single $100 $50 $50 Family $200 $100 $100 Coinsurance Inpatient 90% 90% 90% Outpatient 90% 90% 90% Coinsurance Max Single N/A N/A N/A Family N/A N/A N/A Out-of-Pocket Max Single $1,100 $1,050 $1,050 Family $1,200 $1,100 $1,100 Visits PCP Office 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded Specialist Office 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded Urgent Care 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded ER 100% 100% 100% PRESCRIPTION DRUG Retail Generic $5 $2 $2 Brand Formulary $5 $2 $2 Brand Non-formulary $5 $2 $2

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BCBSM Plans – Retirees

Medical 005 006 007 Retirees Retirees Retirees BCBSM BCBSM BCBSM BCBSM BCBSM Comp/Major Medical In-Network Out-of- Network In-Network Out-of- Network Deductible Single $100 $0 $1,000 $0 $1,000 Family $200 $0 $2,000 $0 $2,000 Coinsurance Inpatient 90% 100% 60% 100% 60% Outpatient 90% 100% 60% 100% 60% Coinsurance Max Single N/A N/A N/A N/A N/A Family N/A N/A N/A N/A N/A Out-of-Pocket Max Single $1,100 $600 $4,000 $600 $4,000 Family $1,200 $1,200 $8,000 $1,200 $8,000 Visits PCP Office 90% coinsurance after ded $15 copay Not covered $15 copay Not covered Specialist Office 90% coinsurance after ded $15 copay Not covered $15 copay Not covered Urgent Care 90% coinsurance after ded $15 copay Not covered $15 copay Not covered ER 100% $75 copay $75 copay $75 copay $75 copay PRESCRIPTION DRUG Retail Generic $5 $5 $5 Brand Formulary $5 $5 $15 Brand Non-formulary $10 $25 $25

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BCBSM Plans - Retirees

Medical 008 009 010 Retirees Retirees Retirees BCBSM BCBSM BCBSM Comp/Major Medical Comp/Major Medical Comp/Major Medical Deductible Single $100 $100 $100 Family $200 $200 $200 Coinsurance Inpatient 90% 90% 90% Outpatient 90% 90% 90% Coinsurance Max Single N/A N/A N/A Family N/A N/A N/A Out-of-Pocket Max Single $1,100 $1,100 $1,100 Family $1,200 $1,200 $1,200 Visits PCP Office 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded Specialist Office 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded Urgent Care 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded ER 100% 100% 100% PRESCRIPTION DRUG Retail Generic $5 $5 $5 Brand Formulary $15 $5 $5 Brand Non-formulary $25 $5 $5

20

BCBSM Plans - Retirees

Medical 011 012 013 Retirees Retirees Retirees BCBSM BCBSM BCBSM Comp/Major Medical Comp/Major Medical Comp/Major Medical Deductible Single $100 $100 $100 Family $200 $200 $200 Coinsurance Inpatient 90% 90% 90% Outpatient 90% 90% 90% Coinsurance Max Single N/A N/A N/A Family N/A N/A N/A Out-of-Pocket Max Single $1,100 $1,100 $1,100 Family $1,200 $1,200 $1,200 Visits PCP Office 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded Specialist Office 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded Urgent Care 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded ER 100% 100% 100% PRESCRIPTION DRUG Retail Generic $5 $5 $5 Brand Formulary $5 $5 $5 Brand Non-formulary $5 $5 $10

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BCBSM Plans - Retirees

Medical 015 016 Retirees Retirees BCBSM BCBSM BCBSM BCBSM In-Network Out-of-Network In-Network Out-of-Network Deductible Single $100 $100 $100 $100 Family $200 $200 $200 $200 Coinsurance Inpatient 90% 90% + 15% approved amount 90% 90% + 15% approved amount Outpatient 90% 90% + 15% approved amount 90% 90% + 15% approved amount Coinsurance Max Single N/A N/A N/A N/A Family N/A N/A N/A N/A Out-of-Pocket Max Single $1,100 $1,100 $1,100 $1,100 Family $1,200 $1,200 $1,200 $1,200 Visits (Ded does not apply) (Ded does not apply) PCP Office 100% 90% after ded + 15% approved amount 100% 90% after ded + 15% approved amount Specialist Office 100% 90% after ded + 15% approved amount 100% 90% after ded + 15% approved amount Urgent Care 100% Not Covered 100% Not Covered ER 100% 100% 100% 100% PRESCRIPTION DRUG Retail Generic $5 $5 Brand Formulary $5 $5 Brand Non-formulary $5 $5

22

BCBSM Plans - Retirees

Medical 017 018 Retirees Retirees BCBSM BCBSM BCBSM BCBSM In-Network Out-of-Network In-Network Out-of-Network Deductible Single $100 $100 $100 $100 Family $200 $200 $200 $200 Coinsurance Inpatient 90% 90% + 15% approved amount 90% 90% + 15% approved amount Outpatient 90% 90% + 15% approved amount 90% 90% + 15% approved amount Coinsurance Max Single N/A N/A N/A N/A Family N/A N/A N/A N/A Out-of-Pocket Max Single $1,100 $1,100 $1,100 $1,100 Family $1,200 $1,200 $1,200 $1,200 Visits (Ded does not apply) (Ded does not apply) PCP Office 100% 90% after ded + 15% approved amount 100% 90% after ded + 15% approved amount Specialist Office 100% 90% after ded + 15% approved amount 100% 90% after ded + 15% approved amount Urgent Care 100% Not Covered 100% Not Covered ER 100% 100% 100% 100% PRESCRIPTION DRUG Retail Generic $5 $5 Brand Formulary $5 $5 Brand Non-formulary $5 $10

23

BCBSM Plans - Retirees

Medical 021 022 Retirees Retirees BCBSM BCBSM BCBSM In-Network Out-of-Network In-Network Deductible Single $250 $500 $50 Family $500 $1,000 $100 Coinsurance Inpatient 80% 60% 90% Outpatient 80% 60% 90% Coinsurance Max Single $750 $1,500 N/A Family $1,500 $3,000 N/A Out-of-Pocket Max Single $6,350 $12,700 $1,050 Family $12,700 $25,400 $1,100 Visits PCP Office $20 copay Not covered 90% coinsurance after ded Specialist Office $20 copay Not covered 90% coinsurance after ded Urgent Care $20 copay Not covered 90% coinsurance after ded ER $150 copay $150 copay 90% coinsurance after ded PRESCRIPTION DRUG Retail Generic $5 $2 Brand Formulary $20 $2 Brand Non-formulary $40 $2

24

HAP Plan Designs - Retirees

Medical 1001 1001 Retirees Retirees HAP HMO HAP PPO In-Network In-Network Out-of-Network Deductible Single $250 $250 $500 Family $500 $500 $1,000 Coinsurance Inpatient 90% 80% 60% Outpatient 90% 80% 60% Coinsurance Max Single $750 $750 $1,500 Family $1,500 $1,500 $3,000 Out-of-Pocket Max Single $6,350 $6,350 $12,700 Family $12,700 $12,700 $25,400 Visits (Ded does not apply) PCP Office $15 copay $20 copay 60% coinsurance after ded Specialist Office $15 copay $20 copay 60% coinsurance after ded Urgent Care $30 copay $30 copay $30 copay ER $100 copay $150 copay $150 copay PRESCRIPTION DRUG Retail Generic $5 $5 Brand Formulary $20 $20 Brand Non-formulary $40 $40

25

HAP Plan Designs - Retirees

Medical 1101, 1501 1201, 1301, 1401 1206 1606 Retirees Retirees Retirees Retirees HAP HMO HAP HMO HAP Medicare HAP Medicare In-Network In-Network MAPD MAPD Deductible Single $0 $0 $0 $0 Family $0 $0 $0 $0 Coinsurance Inpatient 100% 100% 100% 100% Outpatient 100% 100% 100% 100% Coinsurance Max Single N/A N/A N/A N/A Family N/A N/A N/A N/A Out-of-Pocket Max Single $6,350 $6,350 $3,400 $3,400 Family $12,700 $12,700 N/A N/A Visits PCP Office 100% coinsurance 100% coinsurance 100% coinsurance 100% coinsurance Specialist Office 100% coinsurance 100% coinsurance 100% coinsurance 100% coinsurance Urgent Care $15 copay $15 copay $15 copay $15 copay ER $15 copay $15 copay $15 copay $15 copay PRESCRIPTION DRUG Retail Generic $5 $3 $0 $0 Brand Formulary $15 $3 $0 $0 Brand Non-formulary $25 $3 $0 $0

Factors that Impact Cost of Retiree Medical Plans

26

• The following factors most impact the costs associated with pre and Post 65

retiree medical costs

• Eligi

gibil ilit ity – generally some minimum combination of age and service must be met to even be eligible for retiree medical

• The higher the number, e.g. age 50 with 20 years of service for a factor
• f 70, vs. age 60 with 25 years of services for a factor of 85, would

determine the eligible population

• Higher the factor, the lower the cost – all other factors remaining equal
• Employer S

Subsi sidy dy or Retiree C Con

• ntribu

ibution ions– depending upon perspective this is either the portion of the premium that is paid for by the employer (subsidy), or the amount of a contribution paid by the retiree (retiree contribution)

• This can be different for the retired employee vs. any dependents, or

surviving spouse

• Subsidies of less than 100% directly reduce employer costs

Factors that Impact Cost of Retiree Medical Plans

27

• Type

pe of ben benefit t pl plan

• Plan type for both pre and post 65 retiree impacts costs –

but does so differently

• For Pre-65 plan types include –
• Traditional indemnity/comp major medical (no

network based discounted allowed charges/reimbursement)

• PPOs – reimbursement is based on negotiated

discounts and has different benefit payment levels for in and out-of-network providers

• HMOs – reimbursement is based on negotiated

discounts and only applies to in-network care (HMOs do not cover out-of-network care, unless emergency

• r specifically approved

Factors that Impact Cost of Retiree Medical Plans

28

• Type

pe of ben benefit t pl plan

• For Post-65 retirees, the plans available are identical to

those noted above, and nd i inc ncludes one additional plan type

• a MAPD
• The MAPD approach provides the opportunity for

lower costs because of:

• Government subsidies paid directly to the

Medicare approved carrier/administrator, and

• The risk pool used to set rates in not just that of

Genesee County, but includes an aggregation of all enrollees in that carrier’s MAPD plans

Factors that Impact Cost of Retiree Medical Plans

29

• Type o

pe of pl plan an finan ancing

• Plans are either insured – defined by the promise of benefits

provided by the insurance company directly to the plan participant,

• r
• Self-insured – defined by the promise of benefits provided by the

plan sponsor (employer) directly to the plan participant

• May or may not involve other levels of risk protection
• Generally speaking – adopting self-insured plans offers more cost

effectiveness due to:

• Elimination/reduction of state and federal taxes
• Carrier is transferring risk so the typical risk charges are less or

entirely eliminated

• Plan sponsor maintains its own terminal reserves (payment for

claims after termination but with dates of service prior to termination)

• Carried as a liability, but not a cash funding and eliminates

a profit margin source for the carrier

Factors that Impact Cost of Retiree Medical Plans

30

• Ou

Our recommended s strategies a are t to f

• first f

foc

• cus on
• n t

the type of

• f pl

plan an s since t that at has as the g greate test t opportu tunity ty t to impact t costs ts (short o t of eliminati ting p plans a alto togeth ther)

• Type of
• f be

benefit pl plan an

• For Post 65 retirees typical plans are
• Traditional indemnity/comp major medical
• PPO
• HMO
• Medicare Advantage Part D – program that delivers 100% of Medicare

Part A & B (facility and professional), plus supplemental benefits, and includes retail prescription drugs

• With the exception of the MAPD plans, the type of Post 65 Medicare plan has a

nominal impact on cost

• This is due to most services are delivered by providers than accept

Medicare as the basis of the reimbursement

• MAPD providers also accept Medicare reimbursement levels, but the

MAPD structure encompasses all coverage from a single vendor paid by a combination of:

• Premiums paid by Genesee to the carriers, and
• Subsidies paid by the federal government to the carrier

Factors that Impact Cost of Retiree Medical Plans - Additional Solutions

31

• Additional strategies include
• Modifying the eligibility for pre and post 65 retiree medical
• This could include extending the minimum age and service

for eligibility, or perhaps going as far as terminating future retiree medical altogether

• Not a common strategy for pre-65s
• Introducing higher retiree contributions
• Introducing an Employer Paid Health Reimbursement

Account (HRA)

• Plan is simply a defined cash stipend
• Stipend can be different for pre and post 65s
• This method, when used, is most useful for post 65s
• This is because, cost effective individual alternatives

are readily available and very competitively priced

32

BCBSM & HAP Plans - Actives

• This simply provides

the benefit summary for the Active employees

• While our report is

focused on retirees, it is important to have a reference point to the active plan

• We may find that a

strategy for cost reduction, where allowed, could be to replicate the active plan

Medical 019 1000, 1002 1000, 1002 Actives Actives Actives BCBSM HAP HMO HAP PPO In-Network Out-of-Network In-Network In-Network Out-of-Network Deductible Single $250 $500 $250 $250 $500 Family $500 $1,000 $500 $500 $1,000 Coinsurance Inpatient 80% 60% 80% 80% 60% Outpatient 80% 60% 80% 80% 60% Coinsurance Max Single $750 $1,500 N/A N/A N/A Family $1,500 $3,000 N/A N/A N/A Out-of-Pocket Max Single $6,350 $12,700 $1,000 $1,000 $2,000 Family $12,700 $25,400 $2,000 $2,000 $4,000 Visits PCP Office $20 copay Not covered $15 copay $20 copay 60% coinsurance after ded Specialist Office $20 copay Not covered $15 copay $20 copay 60% coinsurance after ded Urgent Care $20 copay Not covered $30 copay $30 copay $30 copay ER $150 copay $150 copay $100 copay $150 copay $150 copay PRESCRIPTION DRUG Retail Generic $5 $5 $5 Brand Formulary $20 $20 $20 Brand Non-formulary $40 $40 $40

33

BCBSM Plans – Retirees

Medical 002 003 004 Retirees Retirees Retirees BCBSM BCBSM BCBSM Comp/Major Medical Comp/Major Medical Comp/Major Medical Deductible Single $100 $50 $50 Family $200 $100 $100 Coinsurance Inpatient 90% 90% 90% Outpatient 90% 90% 90% Coinsurance Max Single N/A N/A N/A Family N/A N/A N/A Out-of-Pocket Max Single $1,100 $1,050 $1,050 Family $1,200 $1,100 $1,100 Visits PCP Office 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded Specialist Office 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded Urgent Care 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded ER 100% 100% 100% PRESCRIPTION DRUG Retail Generic $5 $2 $2 Brand Formulary $5 $2 $2 Brand Non-formulary $5 $2 $2

34

BCBSM Plans – Retirees

Medical 005 006 007 Retirees Retirees Retirees BCBSM BCBSM BCBSM BCBSM BCBSM Comp/Major Medical In-Network Out-of- Network In-Network Out-of- Network Deductible Single $100 $0 $1,000 $0 $1,000 Family $200 $0 $2,000 $0 $2,000 Coinsurance Inpatient 90% 100% 60% 100% 60% Outpatient 90% 100% 60% 100% 60% Coinsurance Max Single N/A N/A N/A N/A N/A Family N/A N/A N/A N/A N/A Out-of-Pocket Max Single $1,100 $600 $4,000 $600 $4,000 Family $1,200 $1,200 $8,000 $1,200 $8,000 Visits PCP Office 90% coinsurance after ded $15 copay Not covered $15 copay Not covered Specialist Office 90% coinsurance after ded $15 copay Not covered $15 copay Not covered Urgent Care 90% coinsurance after ded $15 copay Not covered $15 copay Not covered ER 100% $75 copay $75 copay $75 copay $75 copay PRESCRIPTION DRUG Retail Generic $5 $5 $5 Brand Formulary $5 $5 $15 Brand Non-formulary $10 $25 $25

35

BCBSM Plans - Retirees

Medical 008 009 010 Retirees Retirees Retirees BCBSM BCBSM BCBSM Comp/Major Medical Comp/Major Medical Comp/Major Medical Deductible Single $100 $100 $100 Family $200 $200 $200 Coinsurance Inpatient 90% 90% 90% Outpatient 90% 90% 90% Coinsurance Max Single N/A N/A N/A Family N/A N/A N/A Out-of-Pocket Max Single $1,100 $1,100 $1,100 Family $1,200 $1,200 $1,200 Visits PCP Office 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded Specialist Office 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded Urgent Care 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded ER 100% 100% 100% PRESCRIPTION DRUG Retail Generic $5 $5 $5 Brand Formulary $15 $5 $5 Brand Non-formulary $25 $5 $5

36

BCBSM Plans - Retirees

Medical 011 012 013 Retirees Retirees Retirees BCBSM BCBSM BCBSM Comp/Major Medical Comp/Major Medical Comp/Major Medical Deductible Single $100 $100 $100 Family $200 $200 $200 Coinsurance Inpatient 90% 90% 90% Outpatient 90% 90% 90% Coinsurance Max Single N/A N/A N/A Family N/A N/A N/A Out-of-Pocket Max Single $1,100 $1,100 $1,100 Family $1,200 $1,200 $1,200 Visits PCP Office 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded Specialist Office 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded Urgent Care 90% coinsurance after ded 90% coinsurance after ded 90% coinsurance after ded ER 100% 100% 100% PRESCRIPTION DRUG Retail Generic $5 $5 $5 Brand Formulary $5 $5 $5 Brand Non-formulary $5 $5 $10

37

BCBSM Plans - Retirees

Medical 015 016 Retirees Retirees BCBSM BCBSM BCBSM BCBSM In-Network Out-of-Network In-Network Out-of-Network Deductible Single $100 $100 $100 $100 Family $200 $200 $200 $200 Coinsurance Inpatient 90% 90% + 15% approved amount 90% 90% + 15% approved amount Outpatient 90% 90% + 15% approved amount 90% 90% + 15% approved amount Coinsurance Max Single N/A N/A N/A N/A Family N/A N/A N/A N/A Out-of-Pocket Max Single $1,100 $1,100 $1,100 $1,100 Family $1,200 $1,200 $1,200 $1,200 Visits (Ded does not apply) (Ded does not apply) PCP Office 100% 90% after ded + 15% approved amount 100% 90% after ded + 15% approved amount Specialist Office 100% 90% after ded + 15% approved amount 100% 90% after ded + 15% approved amount Urgent Care 100% Not Covered 100% Not Covered ER 100% 100% 100% 100% PRESCRIPTION DRUG Retail Generic $5 $5 Brand Formulary $5 $5 Brand Non-formulary $5 $5

38

BCBSM Plans - Retirees

Medical 017 018 Retirees Retirees BCBSM BCBSM BCBSM BCBSM In-Network Out-of-Network In-Network Out-of-Network Deductible Single $100 $100 $100 $100 Family $200 $200 $200 $200 Coinsurance Inpatient 90% 90% + 15% approved amount 90% 90% + 15% approved amount Outpatient 90% 90% + 15% approved amount 90% 90% + 15% approved amount Coinsurance Max Single N/A N/A N/A N/A Family N/A N/A N/A N/A Out-of-Pocket Max Single $1,100 $1,100 $1,100 $1,100 Family $1,200 $1,200 $1,200 $1,200 Visits (Ded does not apply) (Ded does not apply) PCP Office 100% 90% after ded + 15% approved amount 100% 90% after ded + 15% approved amount Specialist Office 100% 90% after ded + 15% approved amount 100% 90% after ded + 15% approved amount Urgent Care 100% Not Covered 100% Not Covered ER 100% 100% 100% 100% PRESCRIPTION DRUG Retail Generic $5 $5 Brand Formulary $5 $5 Brand Non-formulary $5 $10

39

BCBSM Plans - Retirees

Medical 021 022 Retirees Retirees BCBSM BCBSM BCBSM In-Network Out-of-Network In-Network Deductible Single $250 $500 $50 Family $500 $1,000 $100 Coinsurance Inpatient 80% 60% 90% Outpatient 80% 60% 90% Coinsurance Max Single $750 $1,500 N/A Family $1,500 $3,000 N/A Out-of-Pocket Max Single $6,350 $12,700 $1,050 Family $12,700 $25,400 $1,100 Visits PCP Office $20 copay Not covered 90% coinsurance after ded Specialist Office $20 copay Not covered 90% coinsurance after ded Urgent Care $20 copay Not covered 90% coinsurance after ded ER $150 copay $150 copay 90% coinsurance after ded PRESCRIPTION DRUG Retail Generic $5 $2 Brand Formulary $20 $2 Brand Non-formulary $40 $2

40

HAP Plan Designs - Retirees

Medical 1001 1001 Retirees Retirees HAP HMO HAP PPO In-Network In-Network Out-of-Network Deductible Single $250 $250 $500 Family $500 $500 $1,000 Coinsurance Inpatient 90% 80% 60% Outpatient 90% 80% 60% Coinsurance Max Single $750 $750 $1,500 Family $1,500 $1,500 $3,000 Out-of-Pocket Max Single $6,350 $6,350 $12,700 Family $12,700 $12,700 $25,400 Visits (Ded does not apply) PCP Office $15 copay $20 copay 60% coinsurance after ded Specialist Office $15 copay $20 copay 60% coinsurance after ded Urgent Care $30 copay $30 copay $30 copay ER $100 copay $150 copay $150 copay PRESCRIPTION DRUG Retail Generic $5 $5 Brand Formulary $20 $20 Brand Non-formulary $40 $40

41

HAP Plan Designs - Retirees

Medical 1101, 1501 1201, 1301, 1401 1206 1606 Retirees Retirees Retirees Retirees HAP HMO HAP HMO HAP Medicare HAP Medicare In-Network In-Network MAPD MAPD Deductible Single $0 $0 $0 $0 Family $0 $0 $0 $0 Coinsurance Inpatient 100% 100% 100% 100% Outpatient 100% 100% 100% 100% Coinsurance Max Single N/A N/A N/A N/A Family N/A N/A N/A N/A Out-of-Pocket Max Single $6,350 $6,350 $3,400 $3,400 Family $12,700 $12,700 N/A N/A Visits PCP Office 100% coinsurance 100% coinsurance 100% coinsurance 100% coinsurance Specialist Office 100% coinsurance 100% coinsurance 100% coinsurance 100% coinsurance Urgent Care $15 copay $15 copay $15 copay $15 copay ER $15 copay $15 copay $15 copay $15 copay PRESCRIPTION DRUG Retail Generic $5 $3 $0 $0 Brand Formulary $15 $3 $0 $0 Brand Non-formulary $25 $3 $0 $0