1 2013 benefit options presentation plan year january 1 through december 31, 2013

1 2013 Benefit Options Presentation Plan Year January 1 through December 31, 2013

2 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 Benefit Options Guide

2013 Plan Changes Health Plans Dental Plans Vision Plans HealthChoice Life Insurance Plan Eligibility 3 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 4

5 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 6

7 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 Services 8 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 10 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 11 Vision Plan Changes NEW!

There are no changes to the HealthChoice Life Insurance Plan for Plan Year 2013 12 Return to Index HealthChoice Life Insurance Plan Changes HealthChoice Life Insurance Plan Changes Continue End Presentation

HEALTHCHOICE HEALTH PLANS 13

Available Plans HealthChoice High HealthChoice High Alternative HealthChoice Basic HealthChoice Basic Alternative HealthChoice S-Account HealthChoice USA Using a HealthChoice Network Provider will lower your out-of-pocket costs. 14 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 15

16 High Alternative When 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 17

18 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 19

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 Plans nationwide provider network USA 20

Network Pharmacy Benefits 21 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 22 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 23 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 $120 90-day fill does not apply to medications with quantity or dosage limits

Network Pharmacy Benefits 24 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 Return to Index Continue End Presentation

DENTAL PLANS 25

26 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

27 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) 28 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 29

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 30

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 31

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 32

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 33

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 Delta Dental Premier 34

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 35

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 36 Return to Index Continue End Presentation

VISION PLANS 37

38 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 39 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 40

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 41

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 42

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 43

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 44 Return to Index Continue End Presentation

LIFE INSURANCE PLAN 45

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 47 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 48 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 49 Beneficiary Designation

All three options offer $1,000 of coverage for dependents under six months of age. Premier Option Spouse$20,000 Child$10,000 Premier Option Spouse$20,000 Child$10,000 Standard Option Spouse$10,000 Child $5,000 Standard Option Spouse$10,000 Child $5,000 Low Option Spouse$6,000 Child$3,000 Low Option Spouse$6,000 Child$3,000 50 You must be enrolled in Basic Life coverage to enroll your eligible dependents in Dependent Life. Dependent Life Return to Index Continue End Presentation

ELIGIBILITY 51

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 52 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 53 Eligible Dependents

54 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 55 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. 56 Midyear Qualifying Events

Option Period Enrollment/Change Form: Your Insurance Coordinator will provide the deadline Insurance Enrollment Form: Return your form to your Insurance Coordinator within 30 days Insurance Change Form: Return your form to your Insurance Coordinator within 30 days of a qualifying event 57 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. 58 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 59 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 60 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 Coordinator 62 Questions Return to Index

1 2013 benefit options presentation plan year january 1 through december 31, 2013

Documents

high plan

dental plan changes

network plan

basic plan

family plan

plan websites

eligibility changes

basic alternative plan