Healthcare Plan 2011

Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA

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Saint Michael’s CollegePlan year: 1/1/2011-12/31/2011



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We are easy to work with.


Statement of Principles

Saint Michael’s College is committed to providing competitive and comprehensive healthcare benefits to its faculty and staff

The healthcare design should promote healthy choices and encourage informed use of plan features

The College will continually investigate new and contemporary plan designs and market changes

The College and employees will share in the cost of the plan


What will we cover today?

Review the new Choice Fund HRA plan effective 1/1/2011 What portion of expenses do you pay under the new Health Plan? How does the Health Reimbursement Account (HRA) work with the new

Health Plan? The Healthy Award Account; Additional ways you can earn $ to help with

your medical expenses Resources available to help you with your questions and your health Pre-enrollment After the effective date (1/1/2011)

What will it cost you to enroll in the new Choice Fund HRA plan? Next steps and future communication topics Most importantly! Answer your questions


Highlights of the new plan

100% coverage for Preventive Care 100 % coverage for routine eye exam when you use a CIGNA participating

provider Employer funded Health Reimbursement Account to help you with some of

your out of pocket medical costs Opportunities to earn additional dollars by voluntarily participating in Healthy

activities Unused funds may rollover for use in later years Access to Customer Service 24/7/365 Access to CIGNA’s National Provider Network Out of Network coverage Transition/Continuation of care Primary Care Physician recommended but not required Extensive resources to help you improve your physical and financial health

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New Terms to Familiarize Yourself With

Calendar Year Medical Plan Deductible: Amount you pay before the plan reimburses you for your medical expenses you incur

Medical Plan Coinsurance: % of expenses paid by the plan after you satisfy the deductible

Calendar Year Medical Plan Out of Pocket Maximum (OOP): A Cap on the $ amount you pay in deductibles + coinsurance. Once you meet the OOP maximum, the plan reimburses you for 100% of eligible expenses.

Health Reimbursement Account (HRA): $ made available to you by Saint Michael’s to help you offset your medical out of pocket (deductible/coinsurance) expenses

Healthy Awards Account (HAA): Additional $ you can earn to help you offset your medical out of pocket expenses.

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After you pay your deductible you pay the following coinsurance for services until you meet your Out of Pocket Maximum (OOP):

Service In-Network Coinsurance

PCP Office Visit you pay 20%, plan pays 80%

Specialist Office Visit you pay 20%, plan pays 80%

Inpatient Hospital Care you pay 20%, plan pays 80%

Outpatient Hospital Care you pay 20%, plan pays 80%

Emergency Room Visit you pay 20%, plan pays 80%

Lab and X-Ray you pay 20%, plan pays 80%

The Deductible does not apply to Certain Services! Preventive Care covered at 100% (including preventive lab work) Prescription Drug coverage (more on that later) Annual Eye Exam (more on that later)

Coverage begins after you meet your deductible for most services


Components of your Out of Pocket Maximum (OOP)

* Note: under 2-person and family coverage each individual has their own deductible, coinsurance and OOP maximum. Amounts above shown to illustrate your financial responsibility if multiple family members meet their per person maximum. Under family coverage this could mean that a family of five could meet their $1500 maximum deductible without any one person meeting the $500 per person deductible (5 x $300 = $1500 = family maximum deductible met.)

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Deductible Your 20% Coinsurance

Your OOP Maximum

Per Person: $500 $1000 $1500

Maximum for 2 person coverage:

$1000 $2000 $3000

Maximum for family (3+ coverage):

$1500 $3000 $4500

+ =


How your HRA and HAA help you with your deductible or OOP Maximum

Maximum Family Deductible

SMC Provided HRA

$ You can earn in your HAA

Your Share of Deductible

Employee only:

$500 $250 $275 $0 - You have $25 to help with coinsurance

Employee + 1: $1000 $500 $400 $100

Family (3+): $1500 $650 $525 $325

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After a person meets their deductible the member pays 20%, plan 80% until you meet your maximum out of pocket.

Maximum Family Out of Pocket

SMC Provided HRA

$ You earn in your HAA

Your Share of Out of Pocket Max*

Employee only: $1500 $250 $275 $975

Employee + 1: $3000 $500 $400 $2100

Family (3+): $4500 $650 $525 $3325

* This really assumes a worst case scenario. Remember each family member has their own deductible, coinsurance, OOP Max! However any family members deductible coinsurance expenses can be reimbursed from the families HRA or HAA – we will show an example later.

- -

- -

=

=


Prescription Benefits

Medical Plan Deductible does not apply to Pharmacy costs

Retail Pharmacy Generic …20% up to a maximum of $10 Preferred …25% up to a maximum of $30 Non-preferred …30% up to a maximum of $50

CIGNA Home Delivery Prescriptions Generic …20% up to a maximum of $25 Preferred …25% up to a maximum of $75 Non-preferred …30% up to a maximum of $125

Prescription out of pocket maximums are: $1,500 per person (new financial protection feature)

*You cannot use your Health Reimbursement Funds for Prescription drug costs


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Vision Plan Highlights

Benefit In Network Out of Network

Examination Copay $0 n/a

ExamCovered in

full$75 allowance


For In-Network coverage you need to use a CIGNA Vision Participating Provider. Find Providers at

Mycigna.com


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Healthy Awards



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Earn Additional dollars with Healthy Awards

Voluntarily Participate in activities to improve health

Earn $ in a Healthy Awards Account

Use $ to help pay for eligible claim expenses

What’s eligible?Expenses related to: • Medical Deductible and

Coinsurance you pay

Unused money “rolls over” to next year – you don’t lose it.


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Healthy Awards: Eligible Activities and Awards

ACTIVITY AWARD

Complete Health Assessment (Employee) $125

Complete Biometric Screenings (Employee) $150

Complete Health Assessment (Spouse) $125

Complete routine care visit (Children) $125

This enables the following potential for the year• Employee $275• Employee & Spouse $400• Employee & Child $400• Employee & Children or Employee & Spouse & Child(ren) $525

Unused money “rolls over” to next year – you don’t lose it.

* More information will be provided about the Healthy Incentives during November and December!

Funds will be made available in your account once activities have been completed.

Within 10 business days for:Health Assessment

Within 5 business days for:Employer activities reported via myCIGNA.com

Within 2-3 weeks for:Employer activities reported via paper form


Health Reimbursement Account vs. Healthy Awards AccountWhat is the difference??

Health Reimbursement Account Automatically funded each year

by Saint Michael’s Only a portion of unused funds

roll over year to year $125 for Employee $300 for Employee + 1 $550 for Family

These dollars are utilized toward services covered on the medical plan that are subject to the deductible or coinsurance.

Healthy Awards Account You earn dollars by participating in

health and wellness programs All of your unused funds roll over

year after year These dollars are utilized toward

services covered on the medical plan that are subject to the deductible or coinsurance.

Both are components of a Health Reimbursement Arrangement


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I’ve heard that I don’t have to pay at the time of service. How are my medical claims paid?

Medical Claim Payment Process

CIGNA updates quarterly Health Statement; sends email alert or mails to your home, based on preference setting

CIGNA provides an Explanation of Benefits (your receipt) showing:• Doctor fee, CIGNA discount, amount billed,

amount deducted from HRA-HAA, amount paid to doctor, remaining HRA-HAA balance.

CIGNA subtracts payment owed from your HRA -HAA balance and pays doctor.$200 deducted from HRA-HAA and sent to doctor and Updates claim and account information on myCIGNA.com.

Doctor bills CIGNA $200. CIGNA determines your payment responsibility:

You owe $200

Show CIGNA Choice Fund ID card. Pay nothing at visit. Doctor discounted CIGNA fee: $200

Sick visit to an in-network doctor/hospital/facility.Doctor standard fee: $250


Preventive visits are covered at 100%


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My life is busy. How does CIGNA help me understand and track my health care expenses?

Explanation of Benefits• Available by mail or online at myCIGNA.com• Based on your preference, either mailed to your

home or you're alerted by email after each claim is processed and posted to myCIGNA.com

• Clearly shows how and when claims were paid, and how the plan and account(s) paid toward claims

Quarterly Health Statement• Available by mail or online at myCIGNA.com• Based on your preference, either mailed to your

home or you're alerted by email after each statement is posted to myCIGNA.com

• Shows year-to-date deductibles, all claim activity and out-of-pocket expenses for that quarter



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End of Year 1

100

% P

reven

tive C

are

(in

-netw

ork

)

HRA$280

Carlos’ Share$220

($250 - $30)

HealthPlan80%

100% after $1,500(in-network)

100

% P

reven

tive C

are

(in

-netw

ork

)

Ded

ucti

ble

Ou

t-of-

Pocket

Max

HRA$250

Carlos’ Share$250

HealthPlan80%


Year 1 Year 2

CarlosSingle, 35 yrs. oldWorks hard, plays hardHealthy; occasional sport injury

$300 preventive care examCovered 100% by Plan; No cost to Carlos

+$ 70 urgent care doctor visit$150 sports medicine visit$220 total medical expenses

How Expenses Are Paid $220 paid from HRA($300 Preventive Covered by Plan) $520 paid by Plan $0 paid by Carlos

$300 preventive examCovered 100% by Plan;No cost to Carlos

+$200 specialist visits (2)$ 25 prescription coinsurance expense (not eligible for HRA reimbursement)

$225 total expenses

How Expenses Are Paid$200 HRA($300 covered by Plan) $500 paid by Plan $25 paid by Carlos

End of Year 2

$80 HRA Balance;Rolls over to

next year’s HRA

$30 HRA Balance;Rolls over to

next year’s HRA

Remember, Carlos could also earn extra dollars through the Healthy Awards Account


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The CoopersActive family of 6Spouse has diabetes

100

% P

reven

tive C

are

(in

-netw

ork

)

Ded

ucti

ble

Ou

t-of-

Pocket

Max

HRA$650

Cooper’s Share$850

HealthPlan80%


Year 1

$1,500 annual exams (5)Covered 100% by Plan; No cost to the Coopers

+$1,600 Endocrinologist visits (10)$1,500 Doctor visits (12)$3,100 total medical expenses

$1200 in Drug costs (her coinsurance averages 20%)

$5,800 Total

How Expenses Are Paid

$ 500 for Mrs. Cooper’s deductible$ 520 Coopers’ coinsurance- $650 (Available HRA not counting HAA)$370- Net cost to the Coopers*$ 240 Cooper’s portion of drug cost$ $610 Cooper’s total responsibility*

The total Medical Expense was $5800The Coopers paid $610 or about 10%The Plan paid $5,090 or about 90%

*If the Coopers earned Healthy award $ they could offset an additional $370 of their Cost



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The DavidsonsLate 50s, Empty nestersHusband in severe auto accident

100

% P

reven

tive C

are

(in

-netw

ork

)

Ded

ucti

ble

Ou

t-of-

Pocket

Max

HRA$500

Davidson’s Share$500

HealthPlan80%


Year 1

$600 annual exams (2)Covered 100% by Plan; No cost to the Davidsons

+$25,000 Hospitalization $ 2,500 Radiology$ 2,500 Specialist visits (10)$ 2,500 Rehabilitation (10)Total = $32,500 medical expenses

$1,500 in drug costs (their coinsurance averages 20%)

Total with Preventive = $34,600

How Expenses Are Paid

$500 for Mr. Davidsons’ deductible$1,000 Mr. Davidsons’ Coinsurance (he has met his OOP Maximum)-$500 (available HRA not counting HAA)$1,000 (Net Cost to Davidsons*$ 300 Davidson’s portion of drug cost$1,300 Davidson’s Total Responsibility


The total Medical Expense was $34,600The Davidson’s paid $1,300 or about 4%The Plan paid $33,300 or about 96%

*If the Davidson’s earned Healthy award $ they could offset an additional $400 of their Cost


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Helping you be well and live well.


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Help when you need it!

Help with coordinating care if you’re admitted to the hospital

Compare prescription drug costs – preferred brand vs. generic, retail vs. at-home delivery online drug-interaction checker helps you keep track of prescription medications and avoid interactions

Easy-to-use, confidential health assessment gives you an overall health “score” and a personalized report

Online coaching programs to help you maintain a healthy lifestyle

Save money on health and wellness products and services like fitness clubs, eyewear, massage therapy and more

A personal health advocate to help you prepare for office visits, improve your lifestyle and reduce your health risks, explore and choose treatment options, and answer health and coverage questions

Healthy pregnancy education programs with March of Dimes helps every baby get a healthy start.

Well Aware disease management program to help you with chronic conditions



11 conditions addressed in 5 Well Aware programs

COPDEmphysemaChronic Bronchitis

DiabetesType 1 DiabetesType 2 Diabetes

Heart Disease

Heart FailureCardiomyopathyCoronary Artery DiseaseAcute Myocardial InfarctionAngina

Asthma

Low Back Pain

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Participation in these programs is voluntary

Claims

Medical ,Pharmacy

Health Assessment

Referral from other programs

• Case Management

• Lifestyle Improvement

• Health Advisor

Self-Referral

Health Care Professional

Identify

Activate Support


Communications

Ongoing nurse outreach by phone

24/7 access to registered nurses

Routine preventive care reminders

Education Materials including:

• Program Workbook

• Quarterly Newsletters

Online tools and resources

• Goal Tracker

• Program Alerts

• Symptom Checker

mywellaware.com

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• Quality rankings let you compare doctors and hospitals

• Online resources let you check for dangerous drug interactions

• Alerts sent to you and your doctor if we see or anticipate possible gaps or errors in care

• Support from our care coordinators if you are hospitalized with a serious illness Features

• Quickly compare cost and quality using 1-3 star rating system

• Ratings for 29 conditions • Ratings based on Healthshare

plus CIGNA data

1 – 3 star rating system

3 Stars = Center of Excellence

Find CIGNA Centers of Excellence


What is CIGNA doing to make sure I’m getting quality care?


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How can I reach CIGNA when I need help?

• Call us anytime day or night – live, 24/7 customer service

• Find information when you need it at myCIGNA.com

• We speak many languages

For J.D. Power and Associates Certified Call Center ProgramSM information, visit www.jdpower.com.


http://www.jdpower.com/


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My life is busy. How can CIGNA save me time?

• 24/7 online and phone assistance to find doctors, specialists, hospitals, labs and pharmacies close to home or when you are traveling

• Talk to a trained nurse with questions when you can’t reach your doctor – day or night

• Self-service through myCIGNA.com lets you: Print forms or print/order ID cards Check your coverage Track claims, payments and deductibles View, print and download your explanation of benefits and health statements Access articles and health education resources, and sign up for online

coaching programs Keep track of your health history and records with a secure online database

• Award-winning decision support tools Learn about common health problems and options for treatment Find doctors, hospitals, specialist and labs Compare treatment and procedure costs

• Switch a prescription to CIGNA Home Delivery Pharmacy with one easy phone call and have your medications delivered to your door at no extra cost



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• Voted 2009 Best Employee Assistance Program as ranked by readers of Business Insurance

• Winner of “Innovation in Multicultural Health Care” Award from independent National Committee for Quality Assurance (NCQA)

• Top industry rankings for Effectiveness of Care by NCQA

• Our customer call centers are certified by J.D. Power and Associates* for providing “an outstanding customer service experience”

• Doctors and hospitals ranked us #1 and #2 respectively on our payment, accuracy and efficiency in the annual survey by AthenaHealth

• CIGNA’s Explanation of Benefits is one of only three to earn “Excellent” designation for clarity, content and design from Dalbar

• Earned #1 ranking for Best Innovation in customer intimacy across all industries for cost and quality tools on myCIGNA.com from Information Week 500

• Gold medal for “exemplary customer strategy and excellence in customer experience.”

Everyone says they are the best. Why should I trust CIGNA?

*For J.D. Power and Associates Certified Call Center ProgramSM information, visit www.jdpower.com.


http://www.jdpower.com/


Important Dates

• Enrollment packets to home addresses week of October 18, 2010.

• Forms due to Human Resources by November 17, 2010.

Questions about the new plan?

• Call the toll-free hotline 24/7/365 – 1.800.401.4041


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"CIGNA", “CIGNA HealthCare”, "myCIGNA.com" and the "Tree of Life" logo are registered service marks of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries and not by CIGNA Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), CIGNA Health and Life Insurance Company (CHLIC), Tel-Drug, Inc. and its affiliates, CIGNA Behavioral Health, Inc., Intracorp, and HMO or service company subsidiaries of CIGNA Health Corporation and CIGNA Dental Health, Inc. In Arizona, HMO plans are offered by CIGNA HealthCare of Arizona, Inc. In California, HMO plans are offered by CIGNA HealthCare of California, Inc. In Connecticut, HMO plans are offered by CIGNA HealthCare of Connecticut, Inc. In North Carolina, HMO plans are offered by CIGNA HealthCare of North Carolina, Inc. All other medical plans in these states are insured or administered by CGLIC or CHLIC. All models are used for illustrative purposes only.

838558 08/10 © 2010 CIGNA Some content provided under license.