Kaiser Permanente. An Integrated Health Care Model for Marsh & McLennan Companies Benefits Overview October 19, 2017

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1 Presented by: Erica Elder Executive Account Manager Kaiser Permanente An Integrated Health Care Model for Marsh & McLennan Companies 2018 Benefits Overview October 19, 2017

2 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 2 October 19, 2017

3 Overview: 2018 Plan Summary 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%* Inpatient Hospital $20 / $40 copay 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible Emergency Room $150 copay; then 20% coinsurance 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible Urgent Care $50 copay 20% coinsurance after deductible 20% coinsurance after deductible 30% coinsurance after deductible 30% coinsurance after deductible 30% 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 3 Benefits may vary by region. Please refer to your plan documents for more detail.

4 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 4

5 5 Prescription Drug Coverage Your Kaiser Permanente ID card works for both medical and pharmacy coverage Pharmacies are often inside Kaiser Permanente medical facilities (visit 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 , 24 hours a day, 7 days a week Mail order quantity may vary by location

6 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 6

7 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.

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

9 How Health Care Works at Kaiser With an Integrated Health Care Model, care is coordinated, connected, and all under one roof Because across the hall is easier and faster than driving around town 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 9

10 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 your questions 24/7 access to medical advice Emergency care coverage anywhere in the world 10

11 Stay connected 24/7 My Health Manager on kp.org 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 11

12 Digital tools KP Mobile App access to your health from anywhere in the world 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 Store SM or Google Play* *App Store is a service mark of Apple Inc. Google Play is a trademark of Google, Inc. 12

13 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 13

14 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. 14

15 Kaiser Permanente Regional Highlights

16 By the Region: California 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 effectivenessof-care measures. For 6 years in a row, Kaiser Permanente ranked highest in customer loyalty among health insurance based providers. 43 points higher. 16

17 By the Region: Northwest 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. 17

18 By the Region: Colorado For the 10 th 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 2 nd 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. 18

19 By the Region: Georgia 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. 19

20 By the Region: Mid-Atlantic States Kaiser Permanente is the number 1 rated private health plan in Virginia, Maryland, and Washington DC from 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. 20

21 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 21

22 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 (toll free) Language interpretation services available Hours California, Oregon, and Washington (Pacific Time Zone) 5 a.m p.m. Monday -- Friday 7 a.m p.m. Weekends Colorado (Mountain Time Zone) 6 a.m p.m. Monday -- Friday 8 a.m p.m. Weekends 22 District of Columbia, Georgia, Maryland, and Virginia (Eastern Time Zone) 8 a.m p.m. Monday -- Friday 10 a.m p.m. Weekends

23 A Few Reminders: Thank You For Your Time and Consideration! 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 23