Benefits Education Sessions09/30/19 to 10/16/19

2020 OPEN ENROLLMENT

Plan Changes & Eligibility Already Effective

New Hire Plan Eligibility (Effective on or after 1/1/2019)

Medical (Effective 7/1/2019) New medical Advantage plan options Utilization driven copayments PHCS providers in the service area no longer part of the network

(PHCS providers are still part of Elite network) *Non-hospital affiliated facilities for Hi-Tech imaging (MRIs, CTs,

PET)(Exception JHS)

Pharmacy (Effective 7/1/2019) AvMed Standard Formulary Generics first across all plans 90 Day Mail Order or Retail Maintenance Choice limited pharmacy

network for maintenance medications

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Informational/Regional Meetings

Education Sessions will be held from 9/30/19 to 10/16/19

The Open Enrollment will be held from 10/7/19 - 10/21/19

Eligibility documents for newly enrolled dependents are due to the Plan by 10/21/19.

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Plan design changes currently in effect apply to the following employees

Bargaining Units K, M (GSAF)

Non-Bargaining (L)

Bargaining Unit C (Fire)

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New Hires

The County offers all benefits eligible non-bargaining & bargaining employees in GSAF Professional, GSAF Supervisory & IAFF hired on or after 1/1/19, the following plans:

FIRST CHOICE ADVANTAGE HMO SELECT ADVANTAGE HMO

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Medical: Plan Options

All benefits eligible bargaining employees in AFSCME Aviation, AFSCME General, AFSCME Solid Waste, AFSCME Water & Sewer, Transport Workers, and PBA Rank & File/Supervisory hired prior to January 1, 2019 will remain Status Quo and have the following options:

Jackson First HMO Select HMO High Option HMO POS (out-of-network option)

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Medical: Plan Options

All benefits eligible bargaining employees in PBA Rank & File/Supervisory hired on or after January 1, 2019 have the following plan options:

Jackson First HMO Select HMO High Option HMO

* PBA Rank & File/Supervisory no longer offers POS to new hires.

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Medical Plan Summary

Medical: Review the copayments before making your plan election

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Medical: PHCS Providers In the Service Area

Private Health Care System (PHCS) is an additional network of providers offered in the High Option and POS plans.

The HMO Advantage and POS Advantage no longer includes PHCS providers in the AvMed service areas. POS Advantage members may access using out-of-network option and cost-sharing.

Dependents and students registered for the Away from Home program may continue to use PHCS outside of the service area in applicable plans. (excludes Jackson First HMO & First Choice Advantage)

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What is PHCS?

Medical: Hi-Tech Imaging at Non-Hospital Affiliated Facilities under Advantage plans

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Non-emergency Hi-Tech imaging procedures (outpatient MRIs, PET, CTs) have to be performed at non-hospital affiliated facilities, instead of hospital affiliated facilities (exception-you may use any JHS facility)

What is Hi-Tech Imaging? Hi-Tech diagnostic imaging tests are

radiology procedures to diagnose or treat a condition, for which providers must request a prior authorization to the Plan

This change does not include preventive radiology such as mammograms, or other diagnostic x-rays and ultrasounds

What is the goal?To promote the use of more cost effective non-hospital affiliated facilities

Hi-Tech Imaging and SmartShopper

Members can receive cash incentives for using lower cost-effective non-hospital affiliated facilities through AvMed’s SmartShopper program

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What is SmartShopper?A rewards and engagement PROGRAM used to redirect members to high-quality, lower-cost provider options and earn cash back.

1-866-285-7453 AvMed.org/SmartShopper

* Jackson First HMO/First Choice Advantage not applicable

Pharmacy: Standard FormularyWhat is the goal?Move to AvMed’s Standard Formulary, with newly approved drugs

that are more cost effective.

What is a drug formulary?A list of prescription drugs, both generic and brand name covered

by the Plan.

Standard Formulary & listed medications can be accessed at www.AvMed.org/mdc

Members taking a medication no longer available under the Standard Formulary will be allowed to continue use of that medication until no longer prescribed without interruption. Thereafter, all new prescriptions will use the Standard Formulary.

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Pharmacy: Generics First Across all PlansWhat is the Goal?

Increase generic drug utilization

This change applies to the POS Advantage option.

POS Advantage members currently using brand drugs will be allowed to continue use until no longer prescribed without interruption. This continues even if the member elects a new plan during open enrollment. All new prescriptions will use the standard formulary, and brand drugs will be subject to any cost differential between generic and brand, plus applicable copays as they are today in the HMO plans.

This is currently in place for all of the HMOs and it means that members pay the tier copayment plus brand additional charges when a generic is available, whether the member or a physician requests brand. 14

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Pharmacy: 90 Day Supply of Maintenance Prescriptions via Mail Order or Maintenance Choice Network

What is a maintenance medication? Prescription drugs that are taken regularly for long term

treatment of a condition, such as high blood pressure, asthma, and high cholesterol.

Refills are required via CVS Mail Order or at a Maintenance Choice limited retail pharmacy network

Maintenance Choice network includes CVS Mail Order, or CVS, Target, and Navarro pharmacies

Members pay only 2 copays instead of 3 copays for up to a 90 day supply, saving members 1 copay

*Does not impact short term medications such as antibiotics

What is the Goal? Increase member adherence of maintenance drugs Increase mail order/limited pharmacy network utilization Savings to employees with 2 copayments for 90 day refills

Pharmacy: Maintenance Choice Limited Retail Pharmacy Network

What Can I Order? 60-90 day of Maintenance class prescriptions.

Where can I have my order delivered? Delivered to your home with tamper-evident packaging Pick it up at a retail Maintenance Choice pharmacy

To transfer your prescriptions, registered Members can login to their AvMed Member portal account and select the Caremark link at www.AvMed.org/mdc. In addition, Members can register at Caremark.com, (if not already registered) and navigate to View/Refill All Prescriptions and select Refill Options to transfer their non-CVS prescriptions to a CVS retail of your choice.

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MDC Member Portal www.avmed.org/mdc

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Select Login or my account – to register or log into the member portal

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Online Access to the MDC Member Portal

Tools & Resources

View your 2020 Summary of Benefits (SBCs)

Formulary lists for all MDC AvMed plans

Provider Directories for all MDC AvMed plans

Wellness Works Program

You can register to view your account:

Claims information

Print/order ID cards

Take your personal health assessment

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Links

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AvMed Member Portal: www.avmed.org/mdc

AvMed Member Engagement (800) 682-8633

Miami-Dade County’s HR/Benefits Website: http://www.miamidade.gov/humanresources/benefits.asp

Open Enrollment Website 10/7/19 to 10/21/19: http://www.miamidade.gov/openenrollment

•QUESTIONS

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