H E A L T H C A R E P L A N C O M P A R I S O NH E A L T H C A R E P L A N C O M P A R I S O N :A S E A U N I O N H E A L T H C A R E T R U S TV S .U N I V E R S I T Y O F A L A S K A P L A NT R E N D S A N A L Y S I S

S T A T I S T I C S P L A N N I N G

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T R E N D S A N A L Y S I S S T A T I S T I C S P L A N N I N G T O O L S

This review has been undertaken to provide a comparison between UA’s health care plans and the ASEA Union’s plans in place for the General Government Unit (GGU) Members of the GGU are

Holistically the University of Alaska (UA) medical plans provide richer benefits

Observations

General Government Unit (GGU). Members of the GGU are employees of the State of Alaska and are represented by ASEA.

Holistically, the University of Alaska (UA) medical plans provide richer benefits than the ASEA Union plans.

Differences between the ASEA Union plans and UA’s health plans:– ASEA Union plans do not offer Pharmacy co-pays, so members pay a percent of the

cost up to a fixed dollar limit– ASEA Union plans have an Unlimited Lifetime Maximum benefit. UA’s plan will have

an Unlimited Lifetime Maximum beginning 7/1/2011an Unlimited Lifetime Maximum beginning 7/1/2011– ASEA Union Plan C is a supplemental plan for employees with other coverage

This plan pays as a secondary plan to coverage additional out of pocket amounts from a primary coverage plan

Pl i b t i li it d t $10 000 Plan reimbursement is limited to $10,000 per year

– Union Plan D is a catastrophic medical plan with no coverage for dental or vision Other than preventive care, no coverage provided for the first:

1. $5,000 of expenses for an individual2. $10,000 of expenses for a family

After the above-mentioned expenses have been met, the plan pays 100% of expenses for remainder of plan year

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The ASEA Health Trust offers four health plan options:options:

Plan A / Full Plan for Employees and Families offers medical, dental, vision, audio and prescription drug benefits.

– 2009/2010 Monthly Full-time Employee Contribution: $220.00

Plan B / Full Plan for Employees Only is identical to Plan A, but covers the employee only.

– 2009/2010 Monthly Full-time Employee Contribution: $100.00

Plan C / Supplemental Plan provides 20% medical, audio and prescription drug coverage, as well as the same dental and vision benefits as Plan A. This plan is designed to coordinate with other health plan coverage you and your family may have.

– 2009/2010 Monthly Full-time Employee Contribution: $30 00– 2009/2010 Monthly Full time Employee Contribution: $30.00

Plan D / Low Option Plan for Employees and Families offers medical, audio and prescription drug coverage after you satisfy a high deductible. Plan D does not include dental or vision benefits.does not include dental or vision benefits.

– 2009/2010 Monthly Full-time Employee Contribution: $35.00

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The University of Alaska UA Choice Plans offers three health plan options and an opt out option:three health plan options and an opt-out option:

Deluxe Plan / Full Plan for Employees and Families offers medical, dental, vision, audio and prescription drug benefits.

– 2010/2011 Monthly Part-time or Full-time Employee Single coverage: $212.250– 2010/2011 Monthly Part-time or Full-time Employee Family coverage: $594.25

Standard Plan / Full Plan for Employees and Families offers medical, dental, vision, audio and prescription drug benefits.

– 2010/2011 Monthly Part-time or Full-time Employee Single coverage: $93.002010/2011 Monthly Part time or Full time Employee Family coverage: $260 42– 2010/2011 Monthly Part-time or Full-time Employee Family coverage: $260.42

Economy Plan / Full Plan for Employees and Families offers medical, dental, vision, audio and prescription drug benefits.

2010/2011 Monthly Part time or Full time Employee Single coverage: $32 92– 2010/2011 Monthly Part-time or Full-time Employee Single coverage: $32.92– 2010/2011 Monthly Part-time or Full-time Employee Family coverage: $91.17

The ability to opt-out of coverage if the employee has other health coverage.

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Medical Plan Comparisonp

Plan Type UAEconomy Plan

UAStandard Plan

UADeluxe Plan A & B Plan C Plan D

Individual Deductible $500 $250 $100 $250 None $5,000 $ $ $ $ $ ,

Family Deductible $1,500 $600 $300 $500 None $10,000

Coinsurance - In-Network 80% 80% 80% 80% 20% 100%

Individual Out of Pocket (excludes ded) $3,000 $750 $400 $1,000 N/A None

Family Out of Pocket (excludes ded) $6,000 $1,500 $800 $2,000 N/A None

Lifetime Maximum Benefit $2 000 000 $2 000 000 $2 000 000 Unlimited $10 000 per yr UnlimitedLifetime Maximum Benefit $2,000,000 $2,000,000 $2,000,000 Unlimited $10,000 per yr Unlimited

Preventive Care Benefit $750 per year $750 per year $750 per year $350 per year -- $350 per year

Primary Care Physician Copayment 80% after Ded 80% after Ded 80% after Ded 80% after ded. 20% 100% after ded.

Specialist Copayment 80% after Ded 80% after Ded 80% after Ded 80% after ded. 20% 100% after ded.

Emergency Room Copayment 80% after Ded 80% after Ded 80% after Ded 80% after ded. 20% 100% after ded.

Inpatient Copay None None None None None NoneRetail RxGeneric $5 $5 $5 20% to $50 20% 100% after ded.

Preferred $25 $25 $25 20% to $50 20% 100% after ded.

Non-Preferred $40 $40 $40 20% to $50 20% 100% after ded.

Annual OOP Rx Maximum $1,000 $1,000 $1,000 $500 N/A N/AMonthly Employee ContributionsEmployee $32.92 $93.00 $212.25 $100 $30 $35

Employee + Spouse $65.83 $186.00 $424.50 -- -- --

Employee + Child(ren) $59.25 $167.42 $382.00 -- -- --

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p y ( ) $ $ $

EE + Family $92.17 $260.42 $594.25 $220 -- --Note: ASEA Union plans require preauthorization for inpatient confinements and specified procedures.

Pre-Authorization Penalties

University of Alaska Pre-Authorization is not required and there are no penalties

ASEA Union If you fail to preauthorize and the Plan determines the services are not Medically Necessary, then the

plan pays nothing.

If you fail to preauthorize and the Plan determines the services are Medically Necessary, the following penalties will apply:

Hospital or treatment facilities (other than for mental health services) – the first $400 of Allowable Expenses will not be paid.

Skilled nursing facilities the first $200 of Allowable Expenses will not be paid Skilled nursing facilities – the first $200 of Allowable Expenses will not be paid.

Outpatient procedures (other than for mental health services) – the first $200 of Allowable Expenses will not be paid.

50% of Allowable Expenses.50% of Allowable Expenses.

Outpatient mental health services – the Plan’s reimbursement will be limited to 50% of Allowable Expenses, and the Plan will limit the covered services to 30 visits per benefit year.

Inpatient and outpatient chemical dependency services – the first $400 of hospital or treatment

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facility Allowable Expenses will not be paid and the first $200 of outpatient Allowable Expenses will not be paid. Benefits will be limited to $11,350 benefit every 2 consecutive benefit years and $22,700 for the participant’s lifetime.

ASEA Union Pre-Authorization List(Not required on current University of Alaska plans)(Not required on current University of Alaska plans)

ASEA Union plans require pre-authorization for the following:

C fi t i h it l t t t f ilit kill d i f ilit Confinement in a hospital, treatment facility, or skilled nursing facility

Outpatient psychiatric and chemical dependency treatment in excess of 5 visits

The following procedures: Bunionectomy - surgical removal of bunions Bunionectomy surgical removal of bunions Carpal tunnel release - surgery of wrist nerve Colonoscopy - scope exam of large intestine (when done with upper GI Endoscopy) Hospital admission for lower back pain Hysterectomy - surgical removal of the uterus Knee Arthroscopy - scope inserted through surgical opening in knee joint for diagnosis and/or py p g g p g j g

treatment Laminectomy - surgical removal of thin vertebral plate MRI-knee - study of the knee using magnetic resonance imagingtechnology MRI-spine - study of the spine, including the neck, using magneticresonance imaging technology Pelvic Laparoscopy - scope exam of abdomen inserted through small surgical opening for diagnosis or

t t t f l i bltreatment of pelvic problems Tympanotomy tube insertion - tubes surgically inserted in ears Upper GI Endoscopy - scope exam of esophagus, stomach, and small intestines (when done with

Colonoscopy) Hyperbaric Oxygen Therapy Treatment - oxygen is administered while placed in a pressurized chamber Surgical Treatment of Obesity

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Surgical Treatment of Obesity.

University of Alaska Plans Pre-Authorization is not required and there are no penalties

Dental Plan Comparisonp

Plan Type UAEconomy Plan

UAStandard Plan

UADeluxe Plan A & B Plan C Plan D

Calendar Year Maximum $2,000 $2,000 $2,000 $2,000 $2,000 Not Covered

Individual Deductible - Per Member $50 $25 $0 $25 $25 N/A

Coinsurance

P e enti e Ca e 80% 100% 100% 100% 100% N/APreventive Care 80% 100% 100% 100% 100% N/A

Basic Care 80% subj to Ded 80% subj to Ded 80% 85% 85% N/A

Major Care 50% subj to Ded 50% subj to Ded 50% 50% 50% N/A

OrthodontiaOrthodontia

Orthodontic Care Not Covered Not Covered 50% Not Covered Not Covered N/A

Individual Lifetime Maximum Not Covered Not Covered $1,500 Not Covered Not Covered N/A

Monthly Employee Contributions

Employee Included in Med Included in Med Included in Med Included in Med Included in Med N/A

Employee + Spouse Included in Med Included in Med Included in Med Included in Med Included in Med N/A

Employee + Child(ren) Included in Med Included in Med Included in Med Included in Med Included in Med N/A

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Employee + Child(ren) Included in Med Included in Med Included in Med Included in Med Included in Med N/A

EE + Family Included in Med Included in Med Included in Med Included in Med Included in Med N/A

Vision Plan Comparisonp

Plan Type UAAll Plans Plan A & B Plan C Plan D

Copays / Allowance

Exams $10 Copay $110 Max Benefit $110 Max Benefit Not Covered

Lenses / Frames

Copay $25 None None N/A

Lense Allowance Covered in Full $150 $150

Frame Allowance $120 $125 $125 N/A

Frequency Allowance 24 Months 24 Months 24 Months N/A

Contact LensesContact Lenses

Copay None None None N/A

Contact Allowance $120 $170 $170 N/A

Frequency Allowance 24 Months 12 Months 12 Months N/A

Monthly Employee Contributions

Employee Included in Med Included in Med Included in Med N/A

Employee + Spouse Included in Med Included in Med Included in Med N/A

Employee + Child(ren) Included in Med Included in Med Included in Med N/A

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EE + Family Included in Med Included in Med Included in Med N/A

Differences Between UA (Premera) and ASEA Union (Beechstreet) Network ProvidersUnion (Beechstreet) Network Providers

ANCHORAGE FAIRBANKS JUNEAU

Premera Beechstreet Premera Beechstreet Premera Beechstreet

General Physician 209 162 65 47 72 11

Pediatrician 209 32 37 10 49 3

OBGYN 140 19 28 3 42 0

Internist 51 32 19 8 11 4

Dermatologist 0 1 2 0 1 0

Orthopedic 4 8 18 1 7 1

In-Network Providers T t t id h i “i t k” t h t i f ll bl h Treatment provider who is “in-network” can not charge amounts in excess of an allowable charge

established by the health care administrator (Premera or Beechstreet) Providers cannot “balance-bill” members (charge employees above the allowable charge) By using network providers, employees receive a higher benefit level from the plan

Out-of-Network Providers Treatment provider who is “out of network” may balance-bill members for amounts over the allowable

charge If network providers are not used or are not available, employees receive a lower benefit level

from the plan

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In each main campus location, University of Alaska’s healthcare plan provides more in-network providers than the ASEA plan.

Comparison of In-Network Status of Hospitals in AlaskaAlaska

Beech Street PremeraASEA Univ. of Alaska

Anchorage, AKAlaska Native Medical Center Yes YesAlaska Regional Hospital Yes NoAlaska Regional Hospital Yes NoProvidence Alaska Medical Center Yes YesMat Su Valley Regional Medical Center Yes YesSt Elias Specialty Hospital No Yes

Fairbanks, AKFairbanks Memorial Hospital Yes Yes

Juneau, AKBartlett Regional Hospital No Yes 21 Hospitals in Alaska are in theJuneau Recovery Hospital No Yes

Dillingham, AKKanakanak Hospital No Yes

Ketchikan, AKKetchikan General Hospital No Yes

Kotzebue, AKManiilaq Health Center Yes Yes

Si k

21 Hospitals in Alaska are in the UA-Premera network, compared to only 12 in the ASEA-Beechstreet network.

SitkaMount Edgecumbe Hospital No YesSitka Community Hospital No YesSitka Medical Center No Yes

KodiakProvidence Kodiak Island Medical Center Yes Yes

BarrowSamuel Simmonds Memorial Hospital No NoSamuel Simmonds Memorial Hospital No No

Bethel

Yukon Kuskokwim Delta Regional Hospital No No

Yukon Kuskokwim Health Center No NoNomeNorton Sound Regional Hospital No Yes

Other

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Providence Valdez Medical Center Yes YesProvidence Seward Medical Center Yes YesCordova Community Medical Center Yes YesWrangell Medical Center No YesSouth Peninsula Hospital Yes YesCentral Peninsula Hospital Yes Yes

For additional Information

ASEA– www.aseahealth.org/index.php?option=com_content&view=article&id=77&Itemid=

51#BPOverviewCost– www.aseahealth.org/index.php?option=com_content&view=article&id=63&Itemid=

128128

University of Alaska– www alaska edu/benefits/health-plan/www.alaska.edu/benefits/health plan/

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