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Public Employees’ Benefit

Board

Plan Design Options: Updated

February 15, 2011

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Plan Design Options

PEBB Statewide PPO – Updated Impacts
Description of Option for Savings
% of Benchmark -
Estimated Savings Premium Member Impact Current Benefit Government (1) Timing
$100 Emergency Room Copay ($2,700,000) -0.5% Low 15% Coinsurance $50 Copay Any
20% PCP, 35% Specialist Office Visit Coinsurance ($5,600,000) -1.0% Low 15% Coinsurance $20 PCP, $30 Sp. Any
4th Rx Tier for Specialty Drugs - $100 Copay ($600,000) -0.1% Low No 4th Tier No 4th Tier Any
Discontinue Rural Subsidy ($1,400,000) -0.3% Medium Rural Subsidy N/A Any
Discontinue Prescription Drug Exceptions ($1,500,000) -0.3% Medium Includes Exceptions N/A Any
$5/$15/Max of $50 or
Retail: $10 Generic, $30 Brand, Higher of 50% or 50% Retail
$60 Brand non-Formulary $12.50/$37.50/Max of $8/$20/$34 Retail
Mail Order: 2.5x Retail ($11,500,000) -2.1% Medium $125 or 50% Mail $14/$37/$61 Mail Any

$100 In-Network/$200 Out-of-Network Deductible ($6,300,000) -1.1% Low No Deductible $400 In/$500 Out Plan Year
$250 In-Network/$500 Out-of-Network Deductible ($15,000,000) -2.6% Medium No Deductible $400 In/$500 Out Plan Year
$500 In-Network/$1,000 Out-of-Network
Deductible ($27,600,000) -4.8% High No Deductible $400 In/$500 Out Plan Year
$100/$200 Deductible, 4 Office Visits not subject to
Deductible ($5,500,000) -1.0% Low No Deductible $400 In/$500 Out Plan Year
$250/$500 Deductible, 4 Office Visits not subject to
Deductible ($12,900,000) -2.3% Medium No Deductible $400 In/$500 Out Plan Year
$500/$1,000 Deductible, 4 Office Visits not subject
to Deductible ($23,600,000) -4.1% High No Deductible $400 In/$500 Out Plan Year
$1,250 Out-of-Pocket Max ($3,400,000) -0.6% Low $1,000 OOP Max $2000 OOP Max Plan Year
$1,500 Out-of-Pocket Max ($6,200,000) -1.1% Low $1,000 OOP Max $2000 OOP Max Plan Year
$2,000 Out-of-Pocket Max ($10,800,000) -1.9% Medium $1,000 OOP Max $2000 OOP Max Plan Year
$50 Deductible for Rx only ($1,600,000) -0.3% Low No Deductible No Rx Deductible Plan Year
Alternative Care Limit of 60 Visits ($600,000) -0.1% Low No Limit N/A Plan Year
Rate Retirees and Actives Separately ($10,400,000) -1.8% High Combined Rating N/A Plan Year
Bariatric Surgery Copay of $500 (2) ($250,000) <0.1% Low 15% Coinsurance N/A Any
Additional Cost Tier Copay of $500 - Value Based
Design(2) (3) ($6,300,000) -1.1% Low 15% Coinsurance N/A Any

(1) Government benchmark represents median plan designs from the 2009 Mercer National Survey of Employer-Sponsored Health Plans

(2) These line item calculations assume a change in utilization of services as well as the addition of a copay.

(3) This estimate started from a Providence 2010 estimate, and was slightly adjusted.
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Plan Design Options

Kaiser, Providence Choice & ODS- Updated Impacts
Kaiser Permanente HMO
Description of Option for Savings

Estimated % of Benchmark -
Savings Premium Member Impact Current Benefit Government * Timing
$1,000 Out-of-Pocket Max ($25,000) 0.0% Low $600 OOP Max $400 In/$500 Out Plan Year
$10 PCP, $10 Specialist, $5 X-Ray/Lab Copay ($1,800,000) -1.6% Low $5 PCP, $5 Sp, $0 Lab $10 PCP, $30 Sp. Any

$10 PCP, $10 Specialist, $5 X-Ray/Lab Copay, $5 PCP, $5 Sp, $0 Lab,

$1,000 Out-of-Pocket Max ($1,800,000) -1.6% Low $600 OOP Max $10 PCP, $30 Sp. Plan Year
Rate Retirees and Actives Separately ($2,100,000) -1.9% High Combined Rating N/A Plan Year

Providence Choice
Description of Option for Savings

Estimated % of Benchmark -
Savings Premium Member Impact Current Benefit Government * Timing
$10 PCP, $10 Specialist, $5 X-Ray/Lab Copay ($400,000) -0.5% Low $5 PCP, $5 Sp, $0 Lab $20 PCP, $30 Sp. Any
Rate Retirees and Actives Separately ($1,500,000) -1.9% High Combined Rating N/A Plan Year
Discontinue Prescription Drug Exceptions ($100,000) -0.2% Medium Includes Exceptions N/A Any

ODS
Description of Option for Savings

Estimated % of Benchmark -
Savings Premium Member Impact Current Benefit Government * Timing
50% Crown Benefit ($1,800,000) -4.4% Low 25% Coinsurance 50% Plan Year

* Government benchmark represents median plan designs from the 2009 Mercer National Survey of Employer-Sponsored Health Plans
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Plan Design Options

Other Considerations

Description of Option for Savings Estimated Savings

$35 Spousal Surcharge ($9,000,000)

Premium Contributions TBD