Kaiser Permanente An Integrated Health Care Model for Marsh & McLennan Companies

2018 Benefits Overview October 19, 2017

Presented by:

Erica Elder

Executive Account Manager

2 October 19, 2017

Welcome! Our agenda for today……

Overview of 2018 MMC’s Benefits with Kaiser Permanente

Medical Plan Review

Pharmacy Coverage

Preventive Care

2018 Regional Plan Wide Changes

The Kaiser Permanente Model

Getting The Most Out of Your Health Care

Kaiser Permanente Regional Highlights

California, Northwest (Oregon & Washington), Colorado, Georgia,

Mid-Atlantic States (D.C., Maryland and Virginia)

Questions & Answers

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Plan Name $400 Deductible Plan $900 Deductible Plan $1,500 Deductible Plan $2,850 Deductible Plan

Deductible $400 individual / $800

family

$900 individual / $1,800 family $1,500 individual / $3,000

family

$2,850 individual / $5,700

family

OOP Max $2,200 individual / $4,400

family

$3,000 individual/

$6,000 family

$3,000 individual/

$6,000 family

$5,500 individual/

$11,000 family

Coinsurance 20% after deductible 20% after deductible 20% after deductible 30% after deductible

PCP/Specialist

*Preventive care

is covered at

100%*

$20 / $40 copay 20% coinsurance after deductible 20% coinsurance after

deductible

30% coinsurance after

deductible

Inpatient Hospital 20% coinsurance after

deductible

20% coinsurance after deductible 20% coinsurance after

deductible

30% coinsurance after

deductible

Emergency Room $150 copay; then 20%

coinsurance

20% coinsurance after deductible 20% coinsurance after

deductible

30% coinsurance after

deductible

Urgent Care $50 copay 20% coinsurance after deductible 20% coinsurance after

deductible

30% coinsurance after the

deductible

Pharmacy $10 generic

$30 brand,

$60 non-formulary brand

Mail order:

90 day supply

$20 generic

$60 brand

$120 non- formulary brand

Member pays 30% coinsurance

Generic – (min. $10/max. $20);

Mail Order- (min.$25/Max.$50)

Brand – (min. $25/ max. $50);

Mail Order (min.$62.50/max. $125)

Member pays 45% coinsurance

NFB (min. $40/max. $80)

Mail Order- (min.$100/Max.$200)

20% coinsurance after

deductible

30% coinsurance after

deductible

Overview: 2018 Plan Summary

Benefits may vary by region. Please refer to your plan documents for more detail.

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Prescription Drug Coverage

Prescription Drug Overview

You automatically receive Kaiser prescription drug coverage when you elect medical coverage under the $400/$900 Deductible Plans

and $1500/$2,850 Deductible Plans

Prescription drug coverage is provided and administered by Kaiser

Copay/Coinsurance levels include: Generic

Preferred Brand (when on Kaiser formulary) Non-Preferred Brand (not on Kaiser formulary; authorization

often needed) Specialty (authorization often needed)

For information on formulary visit KP.org/formulary

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Prescription Drug Coverage

• Your Kaiser Permanente ID card works for both medical and pharmacy coverage

• Pharmacies are often inside Kaiser Permanente medical facilities (visit

www.KP.org for pharmacy listings/locations in your area). Some Kaiser pharmacies are open 24/7

• Your physician writes prescriptions electronically, so most are filled

automatically and are ready for pick up during the same medical visit

• Refill most prescriptions on-line, by using our Kaiser mobile app, kp.org, or by calling the number on your prescription bottle

• Mail order is available on maintenance medications:

• Call our EZ Refill Line at 1-800-700-1479, 24 hours a day, 7 days a week • Mail order quantity may vary by location

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Preventive Care Coverage

Preventive exams are covered at 100% for every age group

Frequency is based on age, sex, current health and family history, and guidelines based on the US Task Force for Prevention

Types of Preventive Services covered:

Immunizations and wellness care Well woman care and exams Prenatal care Preventive labs such as Prostate Cancer screening, Colorectal

Cancer screening, Mammograms, etc.

Disclaimer – if a diagnosis is given, charges may be incurred as this event would no longer meet the preventive care criteria

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2018 Plan Changes By Region

• California: Contraceptives Annual Supply - This law requires health plans to cover a 12 month supply of self-administered hormonal contraceptives provided all at once upon a member’s request.

• Northwest: Wigs are now covered following chemo or radiation therapy

and are subject to the Durable Medical Equipment cost share.

• Colorado: Medical Foods – a new provision for severe protein allergic conditions was added to the list of medical conditions that the health plan must provide coverage for medical foods.

• Georgia: Home Phototherapy- Added to the base Durable Medical Benefit.

• Mid-Atlantic States: Contraceptives Annual Supply- This law requires

health plans to cover a 12 month supply of self-administered hormonal contraceptives provided all at once upon a member’s request.

The Kaiser Permanente Model Getting The Most Out of Your Health Care

How Health Care Works at Kaiser With an Integrated Health Care Model, care is coordinated,

connected, and all under one roof

Difference: Convenience and Ease of Accessing Care

Primary care, OBGYN, Pediatrician Specialty care (referral from your Kaiser PCP are needed for most care, except OB/GYN)

Laboratory services X-ray

Pharmacy Urgent Care*

Hospital*

* Not all centers have these options

Because “across the hall” is easier and faster than driving around town

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The right care, right place, at the right time

Easy to schedule or change routine appointments online, by phone, or mobile app

Save a trip and a doctor’s copay when you email your questions

24/7 access to medical advice

Emergency care coverage anywhere in the world

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Stay connected 24/7

My Health Manager on kp.org

– Email your questions to your doctor’s office

– View most lab results

– Refill prescriptions

– Schedule or change routine appointments

– Research or change doctors

– Print your children’s immunization forms

– Help manage the care of a family member or child*

– And more

*Requires separate authorization for children or family member over age 13

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Digital tools

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KP Mobile App – access to your health from anywhere in the world

– Email your doctor’s office with questions

– Schedule or change routine appointments

– Locate a medical center

– Find nearby KP facilities

– Stay fit with the free Every Body Walk! app—a fun, interactive tool to help you create and maintain a daily walking routine

Just download our free apps from the App StoreSM or Google Play*

*App Store is a service mark of Apple Inc. Google Play is a trademark of Google, Inc.

Maximize your health

Personalized online wellness programs on kp.org

Get a customized plan for making healthy, positive changes

Lose weight Stay active Reduce stress Sleep better Stop smoking, and much more

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Transition Of Care

At Kaiser Permanente, we know that transitioning to a new health care provider

can be stressful for both you and your family.

Whether online, by phone, or in person, we have dedicated clinical resources to take care of you. For additional information

regarding Transition of Care, please contact your regional member services department.

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Kaiser Permanente Regional Highlights

By the Region: California

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• According to NCQA, California is Among the highest rated health plans in California 2 years in a row.

• Scoring 216% better in clinical quality than the all plan average in Southern California.

• Scoring 21% better in cost efficiency than the all plan average in Northern California.

• Top performer in 38 HEDIS effectiveness-of-care measures.

• For 6 years in a row, Kaiser Permanente ranked highest in customer loyalty among health insurance based providers. 43 points higher.

By the Region: Northwest

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• Highest Member Satisfaction among commercial health plans in the Northwest region.

• NCQA top- rated plans in Oregon and Washington 2 years in a row.

• The Society of Thoracic Surgeons gave its highest rating to the Center for Heart and Vascular Care at Kaiser Permanente Sunnyside Medical Center, based on performance for adult heart bypass and valve replacement surgeries.

• Ranked number 1 in customer loyalty- 6 years in a row.

• Rated 5 out of 5 stars in Oregon and Washington by Centers for Medicare and Medicaid Services. Maximum rating is 5 stars.

By the Region: Colorado

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• For the 10th consecutive year, Kaiser Permanente was rated highest by members in Colorado.

• Colorado Biz Magazine readers name Kaiser Permanente Colorado Best Health Insurer 2 years in a row

• Kaiser Permanente is the 2nd

most cost efficient plan in the Colorado region. 9% higher than the average market plans.

• 14 Kaiser Permanente Colorado physicians listed in its 2016 Top Doctors issue.

• For the entire Colorado region, Kaiser Permanente’s Clinical Quality Score is the highest in the market. 247% better than the all plan average.

By the Region: Georgia

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• Leader in member satisfaction among the commercial plans in the South Atlantic Region- 7 years in a row.

• Leader in plan performance for the entire Georgia region. 56% better than the all plan average.

• Top rated commercial health plan in Georgia for the 12

th consecutive year.

NCQA rating for preventive and quality care.

• Received the Hypertension Control Champion Award for blood pressure control rates above 70%.

• Atlanta’s Top Doctors Magazine honors 17 Kaiser Permanente physicians in its 2016 “Top Doctors” issue.

By the Region: Mid-Atlantic States

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• Kaiser Permanente is the number 1 rated private health plan in Virginia, Maryland, and Washington DC from 2012-2017.

• Received the Green Power Leadership Award for reducing our impact on the environment.

• Top Doctor recognition for the Mid-Atlantic Permanente Medical Group Physicians.

• NCQA recognition for leading the way in quality of care.

• For 6 years in a row, Kaiser Permanente ranked highest in customer loyalty among health insurance based provider.

Perks of Being a Kaiser Permanente Member!

Medical Advice whenever you need it, by calling a registered nurse to discuss your health concerns

Great doctors - with the background and training to take care of you and your family

Convenience - where you can see your doctor, have lab tests done, and pick up prescriptions all under one roof

Time and Money Saver - answers to your health questions, by e-mailing your doctor’s office with routine questions

Connected Care - an electronic health record that shows your doctor a picture of your health at every visit

A Care Team Approach - a health care team that is electronically connected to each other, works together, sharing information and expertise to keep you healthy

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You Have Questions? We Have Answers.

Pre-enrollment support Call one of our representatives to get answers to your questions about

Kaiser Permanente in your area before you enroll.

1-877-580-6125 (toll free) Language interpretation services available

Hours California, Oregon, and Washington (Pacific Time Zone)

5 a.m. -- 8 p.m. Monday -- Friday 7 a.m. -- 3 p.m. Weekends

Colorado (Mountain Time Zone) 6 a.m. -- 9 p.m. Monday -- Friday

8 a.m. -- 2 p.m. Weekends

District of Columbia, Georgia, Maryland, and Virginia (Eastern Time Zone) 8 a.m. -- 5 p.m. Monday -- Friday

10 a.m. -- 6 p.m. Weekends 22

Thank You For Your Time and Consideration!

A Few Reminders:

MMC Annual Enrollment is 10/23/17 to 11/10/17

You must elect your benefits online by 11/10/2017 midnight

We encourage all benefits eligible employees to review their benefits during the annual enrollment period

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