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2013 Benefit Options PresentationPlan Year January 1 through December 31, 2013

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How to access the Guide:

• View the Guide on the OSEEGIB website at www.sib.ok.gov or www.healthchoiceok.com

• Complete the online request to get one by mail

• Contact your Insurance Coordinator• Contact OSEEGIB Member Services

The Employee BenefitOptions Guide

• 2013 Plan Changes• Health Plans• Dental Plans• Vision Plans• HealthChoice Life Insurance Plan• Eligibility

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Topics

For More Information

• 2013 Employee Benefit Options Guide• Frequently Asked Questions at

www.sib.ok.gov or www.healthchoiceok.com

• Plan websites and customer service representatives

• Your Insurance Coordinator • OSEEGIB Member Services

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Click the links below to access a particular section of this presentation.

• 2013 Plan Changes• HealthChoice Health Plans• Dental Plans• Vision Plans• HealthChoice Life Insurance Plan• Eligibility

Index

2013 PLAN CHANGES

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There are no eligibility changes for plan year 2013.

Eligibility Changes

Tobacco-free Attestation• To enroll in or remain enrolled in the

HealthChoice High or Basic Plan, you must attest that you and your covered dependents are tobacco-free

The Attestation is available:• On the OSEEGIB website• By calling HealthChoice Member

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HealthChoice Plan Changes

If you cannot complete the Attestation, you must either:• Enroll in the quit tobacco program AND

complete three coaching calls, or• Provide a letter from your doctor indicating

it is not medically advisable for you or your dependent to quit tobacco.

If you do not complete the Attestation or complete one of the reasonable alternatives as defined previously, you will be enrolled in the HealthChoice High Alternative or Basic Alternative Plan with a higher deductible and out-of-pocket limit. 9

HealthChoice Plan Changes

HealthChoice Dental

• Plan year maximum is increasing to $2,500

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Dental Plan Changes

Superior Vision

• $25 copay for standard progressive lenses in-Network; plan pays up to $49 out-of-Network

• 5% to 50% discount off surgical fees for laser vision correction

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Vision Plan ChangesNEW!

There are no changes to the HealthChoice Life Insurance Plan for Plan Year 2013

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HealthChoice Life Insurance Plan Changes

Continue End Presentation

HEALTHCHOICEHEALTH PLANS

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Available Plans

• HealthChoice High• HealthChoice High Alternative• HealthChoice Basic • HealthChoice Basic Alternative• HealthChoice S-Account• HealthChoice USAUsing a HealthChoice Network Provider will lower your out-of-pocket costs.

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Click here to view HealthChoice plan changes

When using a Network Provider:• $30 copay for primary care office visits• $50 copay for specialist office visits• Annual deductible $500 for an

individual or $1,500 for a family• Plan pays 80% and member pays 20%

of Allowed Charges up to the out-of-pocket limit of $2,800 for an individual or $8,400 for a family

High

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High AlternativeWhen using a Network Provider:• Benefits the same as High Plan except

deductible and out-of-pocket limit• Annual deductible $750 for an

individual or $2,250 for a family• Plan pays 80% and member pays 20%

of Allowed Charges up to the out-of-pocket limit of $3,050 for an individual or $9,150 for a family

When using a Network Provider:• Office visit copays do not apply• Plan pays first $500 then member pays

next $500 as deductible; $1,000 deductible for a family of two or more

• Plan then pays 50% until the out-of-pocket limit is met; $5,500 for an individual or $11,000 for a family

• Plan then pays 100% of Allowed Charges

Basic

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When using a Network Provider:• Office visit copays do not apply• Plan pays first $250 then member pays

next $750 as deductible; $1,500 deductible for a family of two or more

• Plan then pays 50% until the out-of-pocket limit is met; $5,750 for an individual or $11,500 for a family

• Plan then pays 100% of Allowed Charges

Basic Alternative

Plan designed for members with a Health Savings Account (HSA)When using a Network Provider:• Combined $1,500 deductible for an

individual and $3,000 for a family*• Entire deductible must be met before

benefits are paid (including prescriptions)• $50 copay for office visits• The calendar year out-of-pocket limit is

$3,000 for an individual or $6,000 for a family

*Individual deductible does not apply if two or more family members are covered.

S-Account

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• For members who live and work outside of Oklahoma and Arkansas for more than 90 consecutive days

• Benefits are the same as the HealthChoice High Plan

• Members have access to the USA Plan’s nationwide provider network

USA

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Network Pharmacy Benefits

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• Prescriptions can be filled at HealthChoice Network Pharmacies

• Benefits are the same for all plans; S-Account members must meet the Plan deductible before benefits are paid

• You are responsible for the cost difference when choosing a brand-name if a generic is available

Network Pharmacy Benefits

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When purchasing up to a 30-day supply:• Generic – cost of medication up to a

$10 copay• Preferred brand-name – maximum

copay of $30• Non-Preferred brand-name –

maximum copay of $60

Network Pharmacy Benefits

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When purchasing up to a 90-day supply• Generic – cost of medication up to a

$25 copay• Preferred brand-name – maximum

copay of $60• Non-Preferred brand-name –

maximum copay of $12090-day fill does not apply to medications with quantity or dosage limits

Network Pharmacy Benefits

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• Certain prescription tobacco cessation medications for a $0 copay

• A calendar year pharmacy out-of-pocket limit of $2,500 per person (does not apply to S-Account Plan)

• Specialty medications must be purchased through Accredo Health, the HealthChoice specialty care, delivery service pharmacy

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DENTAL PLANS

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• Assurant Freedom Preferred• Assurant Heritage Plus with SBA

(Prepaid)• Assurant Heritage Secure (Prepaid)• CIGNA Dental Care Plan (Prepaid)• Delta Dental PPO• Delta Dental Premier• Delta Dental PPO – Choice• HealthChoice

Dental Plans Available

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All the dental plans have the same core benefits which are divided into four different classes:

• Preventive Care includes cleanings, bitewing x-rays, and routine oral exams

• Basic Care includes fillings, extractions, root canals, endodontics, and periodontics

Dental Benefits

* HealthChoice and Assurant Freedom Preferred have a 12-month waiting period for orthodontic care unless you provide proof of prior group dental coverage.

• Major Care includes dentures, bridgework, crowns, and implants

• Orthodontic Care* is covered for members under age 19 and members age 19 or older with temporomandibular joint dysfunction (unless otherwise noted)

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Dental Benefits

• Preventive Care is covered at 100%• A $25 deductible applies to Basic and

Major Care. After the deductible:• Basic Care is covered at 85%• Major Care is covered at 60%• Orthodontic Care under age 19 covered

at 60%; lifetime maximum benefit $2,000 • All other services have a combined

$2,000 maximum annual benefit

Freedom Preferred Dental Plan

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• No deductible or annual maximum for general dentist

• You must select a Primary Care Dentist for each covered person

• Preventive Care is covered at 100%• Copay schedule applies to other services• Orthodontic Care for children and adults• The Special Benefit Amendment provides

an additional discount for network specialists

Heritage Plus with SBA Dental Plan

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• No deductible or annual maximum with general dentist

• You must select a Primary Care Dentist for each covered person

• Preventive Care is covered at 100%• Copay schedule applies to other

services• Orthodontic Care for children and

adults

Heritage Secure Dental Plan

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• No deductible or maximum annual benefit

• You must select a Primary Care Dentist for each covered person

• After a $5 copay, routine cleanings, x-rays, and evaluations are covered at 100%

• A copay schedule applies to other services, including specialist care

• Orthodontic Care for children and adults

Dental Care Plan

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• Preventive Care is covered at 100% • $25 annual deductible for Basic and

Major Care• Preventive Care is covered at 100%• Basic Care is covered at 85%• Major Care is covered at 60%• Orthodontic Care for children and adults

is covered at 60% with a $2,000 lifetime maximum benefit

• $2,500 maximum annual benefit for other services

Delta Dental PPO

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• A $50 combined deductible applies to Diagnostic, Preventive, Basic, and Major Care

• Preventive Care is covered at 100%• Basic Care is covered at 70%• Major Care is covered at 50%• Orthodontic Care for children and adults

is covered at 60% with a lifetime maximum of $2,000

• $3,000 maximum annual benefit

DeltaDental

Premier

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• You must select a Primary Care Dentist for each covered person

• No deductible for Preventive or Basic Care

• $100 deductible for Major Care• Copay schedule for all other services • Orthodontic Care for children and adults

has a maximum lifetime benefit of $1,800

• $2,000 maximum annual benefit for Preventive, Basic, and Major Care

Delta Dental PPO – Choice

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When using a Network Provider:• Preventive Care is covered at 100%• A $25 deductible applies to Basic and

Major Care• Basic Care is covered at 85%• Major Care is covered at 60%• Orthodontic Care is covered at 50% —

no lifetime maximum• A $2,500 calendar year maximum

applies to all other services

Dental

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VISION PLANS

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• Humana CompBenefits VisionCare Plan• Primary Vision Care Services (PVCS)• Superior Vision Plan• United Healthcare Vision• Vision Service Plan (VSP)

Vision Plans Available

• Each vision plan has its own provider network

• A copay schedule for services and materials

• The toll-free number and website address of each plan is listed in the Employee Benefit Options Guide

• Contact each vision plan for specific benefit questions

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Vision Plans Overview

When using an in-network provider:• $10 copay for an annual eye exam• $25 copay for lenses and frames; one

pair per year• Discounts are available for other vision

services and lens options• Contact lenses are available instead of

glasses; $130 allowance• Discount through TLC for laser surgery

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When using an in-network provider:• There is no copay or limit on the

number of eye exams• Lenses and frames are sold at wholesale

cost• There is no limit on the number of pairs

of glasses • Benefits available for contact lenses• Discount through TLC for laser surgery

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When using an in-network provider:• $10 copay for eye exams; one per year• $25 copay for lenses and frames; one pair

per year• Contact lenses – available instead of

glasses; $25 copay/standard fitting then plan pays 100% or $25 copay/specialty fitting then plan pays up to $50

• Discounts available for other vision services and lens options, including laser vision correction

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When using an in-network provider:• $10 copay for eye exams; one per year• $25 copay for lenses and frames; one pair

per year• Lens UV coating and tints are covered in

full• Contact lenses are available instead of

glasses• Discounts available for other vision

services and lens options including laser vision correction

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When using an in-network provider:• $10 copay for eye exams; one per year• $25 copay for lenses and frames; one

pair per year• No copay for contact lens exam with

network provider• Contact lenses are available instead of

glasses• Discounts are available for glasses and

other vision benefits, including laser vision correction

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LIFE INSURANCE PLAN

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Basic and Supplemental Life for You• First $20,000 of life coverage (Basic Life)• All additional coverage is known as

Supplemental Life• $500,000 of Supplemental Life coverage

is available with an approved Life Insurance Application

• Basic Life and the first $20,000 of Supplemental Life include Accidental Death and Dismemberment (AD&D) benefits 46

Employee Life

During initial enrollment:• You can enroll in Guaranteed Issue

(two times your annual salary rounded up to the next $20,000) without a Life Insurance Application

• You can apply for amounts above Guaranteed Issue; a Life Insurance Application is required

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Employee Life

During Option Period: • You can enroll in Basic Life• You can enroll in Supplemental Life• You can enroll in up to $500,000 of

Supplemental Life insurance coverage• An approved Life Insurance Application

is required

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Employee Life

• Keep your beneficiary designation up-to-date

• Beneficiaries can be changed at any time• Review your beneficiaries if you have a

change, such as a marriage, divorce, death of a family member, or birth of a child

• Beneficiary Designation Forms are available online, from your Insurance Coordinator, or by calling OSEEGIB Member Services

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Beneficiary Designation

All three options offer $1,000 of coverage for dependents under six months of age.

Premier OptionSpouse $20,000Child $10,000

Standard OptionSpouse $10,000Child $5,000

Low OptionSpouse $6,000Child $3,000

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You must be enrolled in Basic Life coverage to enroll your eligible dependents in Dependent Life.

Dependent Life

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ELIGIBILITY

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An education employee must be:• Currently employed, eligible for TRS,

and working at least four hours a day or 20 hours a week

A local government employee must be:• Currently employed, regularly

scheduled to work 1,000 hours or more per year, and cannot be listed as a temporary or seasonal employee

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Eligible Employees

Eligible dependents include:

• Your legal spouse (including common-law)

• Your daughter, son, stepdaughter, stepson, eligible foster child, adopted child or child legally placed with you for adoption up to age 26, whether married or unmarried

• Disabled dependents over age 26 with approved documentation

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Eligible Dependents

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• Other unmarried dependent children up to age 26, upon completion of an Application for Coverage for Other Dependent Children

• Guardianship papers or a tax return showing dependency can be provided in lieu of the application

Other Dependent Children

• If you insure one dependent, all eligible dependents must be insured

• You can exclude dependents who do not reside with you, are married, are not financially dependent on you for support, have other group insurance, or are eligible for Indian or military benefits

• A spouse can be excluded by signing the Spouse Exclusion Certification statement on the back of the form

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Dependent Eligibility

Certain qualifying events allow you to make a midyear change, examples include:

• Marriage• Divorce• Adoption• Death• Childbirth• Gain or loss of other group insurance

Notify your Insurance Coordinator within 30 days

of the event or wait until the next annual Option Period.

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Midyear Qualifying Events

Option Period Enrollment/Change Form:• Your Insurance Coordinator will

provide the deadlineInsurance Enrollment Form:• Return your form to your Insurance

Coordinator within 30 daysInsurance Change Form:• Return your form to your Insurance

Coordinator within 30 days of a qualifying event

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Deadlines for Forms

Tobacco-free Attestation:• Must be completed as part of the

Option Period enrollment process. • The Attestation can be completed

online or returned to your Insurance Coordinator.

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Deadlines for Forms

• OSEEGIB mails you a Confirmation Statement when you enroll or make changes to coverage

• If your Confirmation Statement is incorrect, contact your Insurance Coordinator immediately

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Confirmation Statements

If you do not make changes during the annual Option Period and are not automatically enrolled in a HealthChoice alternative plan, no Confirmation Statement will be sent; keep your enrollment form as verification of coverage

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Confirmation Statements

• HealthChoice High and Basic require a completed tobacco-free Attestation

• To enroll in dental or life coverage, you must have group health insurance

• If excluding your spouse, your spouse must sign the Spouse Exclusion Certification

• Return your signed and dated forms to your Insurance Coordinator by the set deadline

• Notify your Insurance Coordinator if you have a change of address 61

Reminders

• The 2013 Employee Benefit Options Guide

• Plan websites and toll-free numbers available in your Option Period packet

• The FAQ section of the OSEEGIB website• OSEEGIB Member Services at 1-405-

717-8780 or toll-free 1-800-752-9475 TDD users call 1-405-949-2281 or toll-free 1-866-447-0436

• Your Insurance Coordinator62

Questions

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