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Making Decisions 2017....Be In The Know

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2017

2017 PPO In Network (No Changes from 2016) Copay – Rx Drugs (generic/preferred/non-preferred) $15/$30/$60 Copay -PCP -Tier 1 Specialist/Specialist and Urgent Care $25/$35

Additional charge for Non EAN Pharmacy $10 Copay – Medical and Rx Counts towards Max OOP

Deductible $500/$1000 Coinsurance 80%/20% Out-of-Pocket (OOP) Max $3,000/$6,000 Hospital/Surgery 80%/20%

Emergency Room Cost $300 + coinsurance waived if admitted

Flexible Savings Account (FSA) Employee Max: $2,550 FSA – rollover up to $500 Preventive Care Paid At 100%

Other ways to save Many retailers offer:

• $4 generic programs (30-day supply) • $10 generic programs (90-day supply)

Your prescription drug benefits are administered by Express Scripts. Express Scripts ensures that you have access to high-quality, cost-effective medications through a network of retail pharmacies and by offering convenient home delivery of your maintenance medications from the Express Scripts Pharmacy.

Access Options PPO Plan HSA Retail Pharmacy (in-network) – up to a 30-day supply. Refills allowed as prescribed.

$15 Generic $30 Preferred Brand $60 Non-Preferred Brand

Regardless if retail or home delivery pharmacy, you pay 100% of Express Scripts cost until you meet deductible. After deductible, you pay 10% of Express Scripts cost until maximum OOP is met. After OOP, plan pays 100%.

Home Delivery Pharmacy- up to a 90-day supply. Refills allowed as prescribed.

$30 Generic $60 Preferred Brand $120 Non-Preferred Brand

Out-of-pocket maximum (OOP)

Copays Count toward OOP. Plan-covered expenses (Express Scripts cost) counts toward OOP.

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Express Scripts includes 32,000+ Pharmacies in Dallas and surrounding areas, including many major chains such as:

*If you purchase prescriptions from a Non-EAN, an additional $10 will be included with your copay. For a full list please visit: www.pebcinfo.com (password: 123dallas)

Non-EAN* are major chains such as:

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Preventive Care

Regardless of the plan you choose, both plans offer preventive care services at no cost to you.

Free preventive care services include the following: • Immunizations, well-woman check, well-child check • Mammogram, blood pressure tests, cholesterol tests • Annual physical exams and more

Your plan also covers other routine services, but those services may require you to pay out of your pocket. For more information, visit uhcpreventivecare.com

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2017

2017 High Deductible Health Plan w/HSA Copays do not apply for Rx Drugs/PCP/Specialist and Urgent Care

Pay full discounted cost, part of deductible and coinsurance

Deductible Single/Family $1,500/$3,000 Coinsurance 80%/20% Out-of-Pocket (OOP) Max $3,000/$6,000

Hospital/Surgery 80% / 20% Preventive Care Paid At 100% Emergency Room Cost Pay full discounted cost, part of

deductible and coinsurance

Plan Year 2017

2017 High Deductible Health Plan with HSA Limited Purpose Flexible Savings Account (LP-FSA) Max is $2,550

LP-FSA Dallas County’s Contribution is $240 LP-FSA can rollover Up to $500

HSA Max is: $3,400/$6,750 HSA Seed Money from Dallas County is $750/$750 Employee Max HSA contribution with Dallas County Seed is $2,650/$6,000

HSA Catch Up Age and amount 55+ extra $1,000 HSA Catch Up Max $4,400/$7,750 EE Max HSA contribution w/ ER Seed–Catch Up $3,650/$7,000

HSA funds are yours to keep even if you leave Keep it year after year

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Single ---- HDHP with HSA Allowable Neg. Rate You Owe Deductible Coinsurance

Running Max OOP

Annual Physical – Preventive $450.00 $0.00 $0.00 $0.00 $0.00 Doctor's Office Visit – Flu $120.00 $55.00 $55.00 $0.00 $55.00 Rx 1 generic med for Flu, normally $50.00 $10.00 $10.00 $0.00 $65.00 Doctor's Office Visit -- Knee problem $185.00 $75.00 $75.00 $0.00 $140.00

Specialist Visit - 2 times for Knee Problem $400.00 $275.00 $275.00 $0.00 $415.00 Ortho MRI Knee scan, special facility $1,200.00 $650.00 $650.00 $0.00 $1,065.00 Outpatient Hospital/Knee Repair $12,980.00 $7,500.00 $435.00 $1413.00 $2,913.00 Rx 1 formulary brand knee pain $140.00 $45.00 $0.00 $9.00 $2,922.00

Physical Therapy, 8 times @ $200 $1,600.00 $1360.00 $0.00 $78.00 $3,000.00 Specialist Visit-2 times, surgery follow-up $400.00 $269.00 $0.00 $0.00 $0.00 Total $17,525.00 $10,239.00 $1,500.00 $1,500.00 $3,000.00

Single ---- PPO Allowable TTL Co Pay Ded. TTL Co-ins

TTL Max OOP TTL Total $17,525.00 $264.00 $500.00 $2,780.00 $3,000.00

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Employee Only -- HDP + Allowable Copay Deductible Coinsurance Running

Max OOP Total $17,525.00 $0.00 $1,500.00 $1,500.00 $3,000.00

Dallas County Seed Money for Employee Only ($750.00) Out of Pocket minus Dallas County Seed $2,250.00

*based on 20% tax rate

Premium Difference PPO vs High Deductible Health Plan for Employee Only ($618.00) Out of Pocket minus Premium Difference PPO vs High Deductible Health Plan $1,632.00

Dallas County Limited Purpose FSA (LPFSA) contribution ($240.00) Out of Pocket minus DC LPFSA Savings $1,392.00

Pre-Tax Savings Resulting from HSA Contribution of Premium savings of $618* ($123.00) Out of Pocket minus Pre-Tax Savings $1,269.00

IF YOU CAN COMMIT TO THE MAXIMUM HSA CONTRIBUTION OF $3,400

Pre-Tax Savings Resulting from MAXIMUM HSA Contribution* ($748.00)

Out of Pocket minus Pre-Tax Savings Max Contributions $521.00

HOW THE HIGH DEDUCTIBLE PLAN WITH HSA WORKS

Employee + Family Allowable TTL Co Pay Deductible Coinsurance Running Max OOP

Total $17,525.00 $0.00 $3,000.00 $3,000.00 $6,000.00 Dallas County Seed Money for Employee + Dependents: ($750)

Out of Pocket minus Dallas County Seed: $5,250.00

*based on 20% tax rate

Premium Difference PPO vs High Deductible Health Plan Employee + Family ($2,307.00) Out of Pocket minus Premium Difference PPO vs High Deductible Health Plan $2,943.00

Dallas County Limited Purpose FSA (LPFSA) contribution ($240.00) Out of Pocket minus DC LPFSA Savings: $2,703.00

Pre-Tax Savings Resulting from HSA Contribution of Premium savings of $2,307 ($461.00) Out of Pocket minus Pre-Tax Savings*: $2,242.00

IF YOU CAN COMMIT TO THE MAXIMUM HSA CONTRIBUTION OF $6,750 Pre-Tax Savings Resulting from MAXIMUM HSA Contribution * ($1,350.00)

Out of Pocket minus Pre-Tax Savings Max Contributions: $892.00

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Group Single - Employee Only Premium Difference PPO vs High Deductible Health Plan $618.00

Single - Employee + Spouse

Premium Difference PPO vs High Deductible Health Plan $1,801.00

Single - Employee + Child(ren) Premium Difference PPO vs High Deductible Health Plan $1,124.00

Employee + Family Premium Difference PPO vs High Deductible Health Plan $2,307.00

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MONTHLY RATES -- CALENDAR YEAR 2017 BI-WEEKLY RATES PPO

EE share % of Ttl CO share % of Ttl Total EE Rate 2016 EE Rate 2017

EE only $81.81 10% $736.26 90% $818.07 $34.32 $37.76

EE+spouse $613.55 38.0% $1,022.59 63% $1,636.14 $257.43 $283.18

EE+children $321.09 23% $1,028.73 77% $1,349.82 $134.73 $148.20

EE+family $852.84 39% $1,315.05 61% $2,167.89 $357.84 $393.62

High Deductible Health Plan Plan with HSA EE share % of Ttl CO share % of Ttl Total EE Rate 2016 EE Rate 2017

EE only $30.32 5% $836.01 95% $866.33 $12.72 $13.99

EE+spouse $463.48 27% $1,269.17 73% $1,732.65 $194.47 $213.92

EE+children $227.41 15% $1,202.03 85% $1,429.44 $95.42 $104.96

EE+family $660.57 29% $1,635.19 71% $2,295.76 $277.16 $304.88

100% Employee or Retiree Paid ASSURANT DENTAL Assurant Assurant Assurant Per Pay

2016 2016 2017 Period 2017 EE Only or Retiree $12.88 $12.88 $12.88 $5.94 EE + Sp or Retiree $21.94 $21.94 $21.94 $10.13 EE + Ch or Retiree $28.95 $28.95 $28.95 $13.36 EE + Fa or Retiree $36.99 $36.99 $36.99 $17.07

100% Employee or Retiree Paid PEBC DENTAL PEBC Per Pay PEBC Per Pay

2016 Period 2016 2017 Period 2017 EE Only or Retiree $31.19 $14.40 $31.19 $14.40 EE + Sp or Retiree $57.68 $26.62 $57.68 $26.62 EE + Ch or Retiree $71.72 $33.10 $71.72 $33.10 EE + Fa or Retiree $99.79 $46.06 $99.79 $46.06

VSP-HEALTHSMART VISION PLAN RATES 2017 – 100% Employee or Retiree Paid

VSP 2016 VSP 2016 VSP 2017 VSP 2017

EE/Ret Per Pay Period EE/Ret. Per Pay Period

Retiree or EE Only $6.15 $2.84 $6.46 $2.98 Retiree or EE + Sp $11.51 $5.31 $12.09 $5.58 Retiree or EE + Ch $12.26 $5.66 $12.87 $5.94 Retiree or EE + Fa $19.10 $8.82 $20.06 $9.26

Click YES to continue using your card or to have a card mailed to your home address on file.

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“Lasting change depends on each employee taking an increased role in managing their health outcomes and changing unhealthy behavior. “

• Participation: For all employees Opt-outs, part-time, and active • Activities: Update/confirm demographics, and participate in at least one

telephone or online health improvement module. • Baseline Activities: Complete Health Assessment via myUHC.com (must

be enrolled in a PEBC medical plan) • Core Activities: Annual preventive office visit that includes a Biometric

Screening, Wellness Coaching, Enroll and participate in Disease Management (if qualified), Enroll and participate in Healthy Pregnancy Program(if qualified)

• Member Options: Annual preventive office visit, screenings, • Participate in approved health/lie improvement learning modules, • Participate in fitness, activity/sponsored competition; employer • track.

Wellness Rewards • 300 points= $300 maximum annual reward (all or nothing) • Paid once each year • Option to take CASH (minus taxes) unless the employee selects FLEX or health savings accounts (after PEBC notifies reward has been earned) • No awards can be earned in November or December • NEW!!! Earn points and rewards for you and your covered spouse

Dallas County has paid out over $150,000 so far this year. October 31st is the deadline to complete for 2016 payout.

Are you eligible for HSA contributions?

If you do not qualify for HSA contributions

Reminder for those enrolled in Medicare: If you are enrolled in Medicare, you can no longer contribute to an HSA. Funds saved while an active employee can be used after retirement to reimburse the retiree for Medicare Part B premium AND can also be used to pay Medicare Advantage premium. HSA funds cannot be used to pay for a Senior Supplement or Medi-gap plan.

IMPORTANT!! HSA SHOULD ONLY BE USED FOR QUALIFIED MEDICAL EXPENSES, OTHERWISE A 20% PENALTY TAX AND TAXES ON FUNDS USED WILL OCCUR. The 20% tax penalty does not apply to account holders age 65 and older, those who become disabled or enroll in Medicare.

Please refer to www.pebcinfo.com for additional information on HSA eligibility or contact HR Benefits at 214-653-6161.

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Spouse optional term life (SLF)

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