Medical plan 3 Extra support 10. Health Plan Information for ACA Eligibility

Medical plan 3 Extra support 10 Health Plan Information for ACA Eligibility

We all need a partner. Someone to count on for support. Someone who s always there for you. At HealthPartners, we re 23,000 people dedicated to caring for our plan members and patients the way we would our closest friends and family. This commitment has helped us deliver the best health outcomes 11 years running.* Our team is ready to help you navigate your care and coverage. We ll answer your questions and be there for you at every step. We re not just a health organization, we re HealthPartners. Let s make good happen together. HIGHEST MEMBER SATISFACTION We promise to give you an outstanding experience. Thanks to our members, HealthPartners has earned the highest overall member plan rating among Minnesota health plans for 10 straight years.** *The source for data contained in this publication is Quality Compass 2016 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass 2016 includes certain Consumer Assessment of Healthcare Providers and Systems (CAHPS) data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). **According to the 2007-2016 CAHPS surveys. 2

Welcome to School District 622 Health Insurance! Please review this handout carefully as it contains important information regarding the health plans and benefits administered by HealthPartners. You have two health plan options, see below. Summaries of the health plans can be found as inserts to this document. For more information, please refer to the Plans section of SmartBen or contact the Benefits Office. Affordable Care Act Eligibility: NationalONE 200-25 NationalONE HDHP $6200* *Note: There is not a health saving account associated with NationalONE HDHP $6200 plan through the District. The plan is considered a qualified high deductible health plan meaning it is eligible for an accompanying health saving account (HSA). The HSA would need to be established with a bank or another financial institution. All plans utilize the Open Access Provider Network. To search the provider network: On-line www.healthpartners.com At the top of the page under Insurance, go to I want to...find a Doctor in My Plan Network. Click on I get insurance through work Click on Open Access Network to reveal additional network options Under the Open Access Network option, click on Find Doctors & Clinics Enter search criteria For personal assistance, contact HealthPartners Member Services 1-800-883-2177; reference Group Number 23643 SmartBen is District 622 s on-line benefit system. Changes to your benefits due to benefits eligibility, a Life Event or Open Enrollment will all be done through SmartBen. SmartBen step-by-step instructions can be found at www.isd622.org/benefits Logging onto SmartBen Go to www.smartben.com and enter your Username (Social Security Number, no dashes) and Password (eight-digit date of birth, MMDDYYYY format). Example 123456789 for Social Security number 123-45-6789 Example: 06101964 for date of birth on June 10, 1964 For questions, please contact the Benefits Office at (651) 748-7425 or Visit www.isd622.org/benefits Human Resources 2520 East 12 th Avenue North St. Paul, MN 55109 651.748.7492 651.748.7448 (fax) www.isd622.org/benefits 3

HSA plan with the Open Access Network You re running low on gas, and there are two gas stations nearby. Do you stop at the closest one? The one with the best snacks? Or the one with the lowest price? If you re like me, the lowest price wins every time. I get a thrill from watching my savings account build up over time. That s what s so great about this plan. With a health savings account (HSA), you get to watch your bank account grow. How does it work? HSA plans usually have lower premiums. That means you pay less each month for your health plan. But don t forget the low premiums can come with a high deductible. So while you pay less in premiums (and who doesn t like that), you re also in charge of paying more out of your own pocket before your plan kicks in. The idea is that you ll use your saved money in your HSA to pay for care until you reach your deductible or for coinsurance after you reach it. So you should be stashing away some of that cash you re saving each month into your HSA. Then you ll feel confident in your safety net, in case you do have some care needs in the future. What s an HSA? Think of your HSA as a special savings account for qualified medical costs. You put tax-free money into your HSA either through payroll or direct deposits. You could even earn interest or invest it. And the money in your HSA is yours to keep, even if you switch jobs. What will your plan help pay for? Here are just a few things: Preventive care, at no cost to you Convenience and online care Specialty care, without referrals Prescriptions What can you use your HSA money for? Deductibles or coinsurance Prescription medicines Dental care and braces Vision care and LASIK surgery Medical equipment you use at home Where can you get care? You pick where you want to go. This plan has the most choices for doctors and clinics covered in-network. Check your doctor or find a new one at healthpartners.com/openaccess. Member Services Find how much you ll pay and what your plan will cover in your Summary of Benefits and Coverage (SBC). And remember, we re here to help. Call us at 952-883-5000 or 800-883-2177. 10669 (7/16) 2016 HealthPartners 4

Care today for a healthier tomorrow Growing up, my mom was a stickler about making our routine doctor and dentist appointments. Looking back, I m so glad she was. I m the same way today! Getting regular preventive care helps keep you healthy. In fact, people who get the preventive care that s recommended for them are more likely to stay healthy for years to come. What counts as preventive care? Alcohol, tobacco and weight screenings Blood pressure, diabetes and cholesterol tests Breast, cervical and colorectal cancer screenings Routine pre- and post-natal care Vaccines Well-child visits What s recommended for you? Your doctor can always tell you what you should be checked for. But you can also visit healthpartners.com/preventive to find out. Member Services Recommended preventive care is covered at no cost to you. If you have questions on what's covered or where you should go, call us at 952-883-5000 or 800-883-2177. We re here to help. 10979 (7/16) 2016 HealthPartners 5

Get Well@Work Wouldn t it be great if you didn t have to leave work to go to the doctor? Now you don t have to. We ve brought the clinic to you. What s a Well@Work clinic? It s a clinic at the District Education Center that treats many of the same things your regular doctor does. What can I be seen for at the clinic? You can get a diagnosis, treatment and prescription for many conditions. This includes: Sinus infections Cold and flu Allergies Preventive care Lab work and more! Who can be seen? All employees and dependents 18 months and older covered by the District s health plan. How much does it cost? All services and prescriptions from the clinic are at no cost to you and your dependents. Clinic location and hours District Education Center Monday, Wednesday and Friday from 6 a.m. to 2 p.m. Tuesday and Thursday from 10 a.m. to 6 p.m. Make an appointment. Call 952-967-6857. The HealthPartners family of health plans is underwritten and/or administered by HealthPartners, Inc., Group Health, Inc., HealthPartners Insurance Company or HealthPartners Administrators, Inc. Fully insured Wisconsin plans are underwritten by HealthPartners Insurance Company. 2016 HealthPartners. 6 8620 (1/16)

Get back in the game Who is PNBC? Physicians Neck and Back Clinics (PNBC) is a leader in the treatment of chronic (long term) spinal pain. Back pain often keeps you from doing the activities you love. Whether it is golf, hiking, running, biking or playing with your kids, let PNBC help you to resume activity. Get rid of pain without surgery Major spine surgery is often unnecessary and may worsen your condition or only provide temporary relief from long term back pain. PNBC s Board-certified medical doctors and trained rehabilitation professionals offer a better solution. PNBC offers an exercise based program that emphasizes muscle strengthening using specialized, computerized equipment that isolates important neck and back muscles. The goal of the program is to improve core strength, mobility, and endurance to restore function and remove pain from your back and neck. More than 80% of patients experience a significant reduction in symptoms after completing the PNBC rehabilitation program. PNBC locations PNBC has multiple locations. Call the PNBC most convenient for you to learn more or to schedule your appointment. Sartell Burnsville (320) 253-5385 952-851-6000 158 19th St 14300 Nicollet Court, Suite 335 Maple Grove (763) 585-0600 Roseville 11671 Fountains Dr (651) 631-4242 3050 Ctr Pointe Dr Coon Rapids (763) 585-0700 Woodbury 10160 Foley Blvd NW (651) 735-6100 1000 Radio Dr Edina (952) 851-8200 3601 Minnesota Dr Treatment usually consists of two sessions per week for 8-12 weeks. During treatment sessions a specially trained staff-member will work with you to perform customized, aggressive strengthening of the neck and spine. After your treatment sessions are completed, PNBC s staff will create a customized at-home maintenance program for you so you will be able to keep your spine strong. The HealthPartners family of health plans is underwritten and/or administered by HealthPartners, Inc., Group Health, Inc., HealthPartners Insurance Company or HealthPartners Administrators, Inc. Fully insured Wisconsin plans are underwritten by HealthPartners Insurance Company. 6783 (5/15) 2015 HealthPartners 7

virtuwell your 24/7 online clinic Who has time to be sick? Between work, errands and activities, I know it s hard to fit in a trip to the doctor. But you don t have to. I ve got an easy way for you to get back to normal ASAP. Head over to virtuwell.com. Our team of certified nurse practitioners can give you a diagnosis, treatment plan and even a prescription. All in about 30 minutes. My favorite story is the time I helped someone whose daughter got pink eye on a family trip. She used virtuwell and answered the questions right on her phone. In 20 minutes, we sent a treatment plan to her inbox and a prescription to the pharmacy by their hotel. I followed up a few days later to make sure she was feeling better. Vacation saved! How does it work? We re real people, giving you real treatment, really fast. 1 It s convenient. We ll start with a simple question: What do you think 2 It s safe. We only treat conditions that we can do safely online, 3 It s affordable.you re only charged if we can treat you. you have? You ll answer online like sinus and bladder infections, In the end, you ll never pay more anytime, anywhere. pink eye and acne. Go to than $45. Member Services can Then, one of our nurses will create your treatment plan. You ll get a text or email when it s ready. virtuwell.com/conditions to see what we can treat there are more than 60. tell you if your plan will pay for some or all of your visit. Call them at 952-883-5000 or 800-883-2177. Certified Nurse Practitioner The next time you get sick, my team is ready and waiting to get you better. Try virtuwell.com. virtuwell is available for residents of AZ, CA, CO, CT, IA, MI, MN, NY, ND, PA, VA and WI. 11458 (8/16) 2016 HealthPartners 8

Qualifies as a WEllnes Program! It s time to get healthy and feel great. Health and Well-Being: It s as simple as 1-2-3! 1. Take the Health Assessment starting July 1, 2017. Well@Work Screening Qualifies as a Wellness Program! Become informed on your overall health and possible risk areas with a Biometric Screening completed at the Well@Work Clinic. To make your free appointment call 952-967-6857. The first step to participating is to take the Health Assessment. This 15 to 20 minute, online assessment generates your personal report to give you tips for healthier living. You ll discover your strengths and what you can do to improve your health. 2. Complete a wellness program by March 31, 2018 Your health assessment results will help guide you toward an ISD 622 or HealthPartners wellness program that s right for you. These programs give you the tools you need to be healthy and stay healthy. Choose from a wide variety of phone-based, online programs or team based challenges. 3. Get rewarded More information on ISD 622 s wellness programs can be found on the District s wellness website. Just go to www.isd622.org/wellness. There is no greater reward than living a happier, healthier life. But just in case you need a little more incentive, you ll also qualify for a Preferred Benefit effective July 1, 2018. If you have questions, please call 952-883-7800, 800-311-1052 or TTY 952-883-7498. Log on to healthpartners.com/isd-622 to take your health assessment and enroll in a wellness program now. The HealthPartners family of health plans are underwritten and/or administered by HealthPartners, Inc., Group Health, Inc., HealthPartners Insurance Company or HealthPartners Administrators, Inc. Fully insured Wisconsin plans are underwritten by HealthPartners Insurance Company. 470564 01/ 2012 HealthPartners 9

Helping you live your best life Let s get real you re busy and it s hard to find time to do all the healthy stuff you should. We can help. We ve got some pretty cool things to help you get healthy, no matter what your goal is. And it's all free as a HealthPartners member. If you re not sure where to start, we can help with that too. Give our team a call. We re happy to help you figure it out. Health Coach Making changes can be hard. Why not get a little support? WHAT DO YOU WANT TO DO? YOU CAN: HERE S HOW: Quit smoking? Talk with a health coach 800-311-1052 Eat better? Learn how with a virtual coach healthpartners.com/letstalk Find tasty recipes yumpower.com Get better-for-you eating tips on Text YUM to 77199 your phone Feel less stressed? Learn to manage stress through healthpartners.com/btb confidential online support Discover what you can do to feel less healthpartners.com/letstalk stressed with a virtual coach Get more sleep? Learn how with a virtual coach healthpartners.com/letstalk Save money? Get discounts on exercise equipment, healthpartners.com/discounts spa services, eyeglasses and more Meet other people like you? Sign up for a class or group session healthpartners.com/classes for things like asthma, car seat clinics, weight loss and more Find healthy tips for your family? Get tips for your family s health on Text FAMILY to 77199 your phone Get tips while pregnant or after having a baby Text BABY (or BEBE for Spanish) to 511411 Get your health questions answered? Talk with a nurse 24/7 Search health topics or use a symptom checker 800-551-0859 healthpartners.com/healthlibrary Make sure you re getting the right care? Talk with a nurse to figure out what the best care for you is Want even more? Find it at healthpartners.com/healthyliving. Call Member Services at the number on the back of your member ID card and ask for the Nurse Navigator SM program 10498 (7/16) 2016 HealthPartners 10

Save $$$ at the gym Helping people get healthy is my thing. That s why I m so excited to tell you how you can start saving money on your gym membership. Did you know you can save up to $20 on your monthly gym membership when you work out 12 days or more each month? That s just three days a week. You ve got this. Ready to start saving? Here s how you do it: 1 2 Go to healthpartners.com/frequentfitness or call Member Services at 952-883-5000 or 800-883-2177 to find participating gyms, including: Anytime Fitness* Life Time Fitness Curves Snap Fitness LA Fitness* And more! Sign up. Show your member ID card at the front desk and they ll get you enrolled. 3 Work out at least 12 times each month. 4 Get paid. Your gym membership account will be reimbursed six to eight weeks after your monthly workouts. Cheers to better health in 2017! Health Coach *Not all locations apply. Frequent Fitness is limited to members, age 18 years or older, of HealthPartners senior or individual medical plans and members of participating employer groups. Some restrictions apply. Termination of club membership may result in forfeiture of any unpaid incentive. See participating club locations for program details. Workout requirements and program eligibility may vary by employer. Please check with your employer or call Member Services to verify eligibility and visits requirements. 10677 (7/16) 2016 HealthPartners The HealthPartners family of health plans is underwritten and/or administered by HealthPartners, Inc., Group Health, Inc., HealthPartners Insurance Company or HealthPartners Administrators, Inc. Fully insured Wisconsin plans are underwritten by HealthPartners Insurance Company. 11

Here for you, 24/7 One thing I love about my job is how my team helps people 24/7. Like this: a man called because his chest felt heavy, his skin felt clammy, and he wasn t sure what to do. Scary, right? The CareLine SM service nurse told him to hang up and call 911 immediately he was having a heart attack. He was rushed to the hospital for emergency surgery. Afterward, he called us to say thank you. He didn t realize how serious the situation was until he called and was so grateful that we were there to give him advice. Registered Nurse Call us at one of the numbers below if you have questions about your health or what your plan covers. We re here to help. IF YOU HAVE QUESTIONS ABOUT: Your coverage, claims or account balances Finding a doctor, dentist or specialist in your network Finding care when you're away from home Health plan services, programs and discounts Whether you should see a doctor Home remedies A medicine you re taking Understanding your health care and benefits How to choose a treatment Your pregnancy The contractions you re having Your new baby Finding a mental or chemical health care professional in your network Your behavioral health benefits CONTACT: Member Services Monday Friday, 7 a.m. 7 p.m., CT Call the number on the back of your member ID card, 952-883-5000 or 800-883-2177. Español: 866-398-9119 Interpreters are available if you need one. healthpartners.com CareLine SM service nurse line 24/7, 365 days a year 612-339-3663 or 800-551-0859 Nurse Navigator SM program Monday Friday, 8 a.m. 5 p.m., CT Call the Member Services number on the back of your member ID card. BabyLine phone service 24/7, 365 days a year 800-845-9297 Behavioral Health Navigators Monday Friday, 8 a.m. 5 p.m., CT 888-638-8787 10494 (7/16) 2016 HealthPartners 12

Get help with your medicine I like to think that managing your medicines is like creating a great meal. It happens one step at a time and with the help of a recipe. Just like there are many recipes, there are lots of ways to stay on track with your medicine. You just need to find the recipe that works best for you. You don t have to be a pharmacist to know when a medicine isn t working right. For example, I had a patient who was taking high cholesterol meds for years. He also started taking a new blood pressure medicine. He followed the directions for both of them, but he started having terrible pain. So he stopped taking his blood pressure medicine. Uh oh. That's where I came in. Turns out, it was just a bad interaction. We got him on a different blood pressure medicine that worked better, and he was feeling better in no time. My team and our tools are here to help you find the right medicines to achieve your best health. Talk with a pharmacist In a one-on-one visit, you ll review your medicines to make sure they re effective and right for you. Plus, it s free. Even if you feel fine, you might have questions about your medicines, like: Am I taking the right medicines for the best results? Are my medicines working together correctly? How can I stop side effects and interactions between my medicines and with the things I eat and drink? Is there a way my medicines can better fit my lifestyle? Can I save money on my medicines? Learn more about your medicine Visit healthpartners.com/pharmacy. The health library has information on how to take your medicine, what it should look like, what to do if you miss a dose and more. And our Drug Interaction Checker will let you know what food or drinks to avoid. You can also learn about other options if your medicines don t work well together. Pharmacist Your health plan can do more than just help pay for visits to your doctor. Call Member Services at 952-883-5000 or 800-883-2177 for help with your prescription benefits. 10502 (7/16) 2016 HealthPartners 13

Medicine delivered to your door Most of my patients tell me they re busy, and it s hard to get to the pharmacy every month to get their medicines refilled. You might feel that way too. But did you know? There s another way to get your medicines filled every month: mail order pharmacy. What s so great about mail order pharmacy? Your medicine gets shipped right to your door, within five days. You ll never pay for shipping. It s free. You only pay for your medicine. There s no need to worry about privacy. All orders are sent in a plain package. Safety is important to us too. You ll get the best quality medicine. Want to take it a step further? Do you and your family have more than one medicine? Get everyone on the same schedule. Have all your medicines refilled and delivered on the same day with HealthPartners Sync My Meds. Plus, you can pay for everything at once. A pharmacist on my team will work with you to pick the day that works best. Plus, if you re on a copay plan, you get three months of your medicine for the price of two months. Isn t that great? Pharmacist Have questions about your mail order pharmacy benefits? Give us a call at 800-591-0011. We ll be happy to help. Wondering how much your medicine will cost? Use the drug cost calculator at healthpartners.com/pharmacy. 10503 (7/16) 2016 HealthPartners 14

Manage your health on the go Life doesn t always operate on business hours. Sometimes you have a question at 9 p.m. on a Friday or 6 a.m. before you need to leave for work. That s where your myhealthpartners account and the myhp mobile app come in. Want to check on a claim? Need to find an urgent care near your house, NOW? These are just a couple of the things we help members with every day. We love directing members to their online account and mobile app, especially since it means they can get help when we re not in the office. There s so much more you can do. Signing up is easy! Learn more at healthpartners.com/signupnow. Member Services Top 5 ways to use your online account and mobile app: 1 2 3 4 5 See recent claims and how much you owe for your health care. Search for doctors in your network or near your current location. Get cost estimates for treatments and procedures, specific to your plan. Check your balances, including how much you owe before your plan starts paying (deductible) and the most you ll have to pay (out-of-pocket maximum). View your HealthPartners member ID card and fax it to your doctor s office. 10495 (7/16) 2016 HealthPartners 15

Know where to go "I need care, but who should I see?" What a tough question, right? I spend a lot of my day answering this. I tell people it s tempting to rush to the emergency room when you need care now, but online care might be faster and cost less. Registered Nurse Use my notes below to help you decide where to go when it s between ouch and OMG. If you re still not sure, a CareLine SM service nurse can help. WHEN YOU NEED GO TO AVERAGE COST AVERAGE TIME SPENT Health advice from a nurse for: CareLine SM service Where to go for care Call 24/7 at 612-339-3663 or Free At-home remedies 800-551-0859 Treatment and prescriptions for minor medical issues, like: Bladder infection virtuwell (a 24/7 online clinic) or $ Pink eye Upper respiratory infections Convenience clinics (found in retail and grocery stores) A regular checkup or special care during the day for things like: Diabetes management Primary care clinics $$ Vaccines Care for urgent problems when your doctor s office is closed, like: Cuts that need stitches Urgent care clinics $$$ Headaches Help in an emergency, such as: Chest pain or shortness of breath Head injury Emergency room $$$$ Virtuwell is available for residents of AZ, CA, CO, CT, IA, MI, MN, NY, ND, PA, VA and WI. 10453 (7/16) 2016 HealthPartners 16

Employee Assistance Program (EAP) Support for your life Whether you or your family need help with your personal life or are having issues at work, HealthPartners Employee Assistance Program (EAP) is here for you. Call 24/7 for help from a counselor finding child care, dealing with a loss, finding community resources and more. Help by phone EAP counselors are ready to give you the type of support you need. Just call and they ll listen to your concerns, give you guidance and help you find solutions that are right for you. Here are just a few things they can help you with: Marital/partner issues Balancing work and family Financial concerns Mental and emotional health Parenting Job stress Legal issues Substance abuse Personal relationships Child and elder care Grief and loss Divorce Finding community resources Help online Get help 24/7 with our wide range of online resources. You ll find: Thousands of articles and tip sheets Self-assessment tools Child and elder care resource searches Legal information and forms More than 60 financial calculators Monthly online seminars Savings Center Relocation Center Skill Builders for your personal and professional needs And more! Can t find what you re looking for? Text or instant message an EAP counselor or work-life consultant anytime, day or night. Help at your fingertips Get help on-the-go with the iconnectyou mobile app for your iphone or Android. Use it for video visits with a counselor or to get help finding child and elder care. Visit the app store to download it today. Your privacy is important Everything you do with HealthPartners EAP is confidential. No information is shared with your employer or health plan and will only be released with your permission or when required by law. HealthPartners EAP is here for you anytime, day or night. Call 800-701-0030 or TTY 866-228-2809, text US HPEAP and your question to 919-324-5523 or log on to hpeap.com. Website password: isd622 iconnectyou passcode: 47858 The HealthPartners family of health plans is underwritten and/or administered by HealthPartners, Inc., Group Health, Inc., HealthPartners Insurance Company or HealthPartners Administrators, Inc. Fully insured Wisconsin plans are underwritten by HealthPartners Insurance Company. 9104 (3/16) 2016 HealthPartners 17 12

Provider reimbursement information for medical plans Our goal in reimbursing providers is to provide affordable care for our members while encouraging quality care through best care practices and rewarding providers for meeting the needs of our members. Several different types of reimbursement arrangements are used with providers. All are designed to achieve that goal. Some providers are paid on a fee-for-service basis, which means that the health plan pays the provider a certain set amount that corresponds to each type of service furnished by the provider. Some providers are paid on a discount basis, which means that when a provider sends us a bill, we have negotiated a reduced rate on behalf of our members. We pay a predetermined percentage of the total bill for services. Sometimes we have case rate arrangements with providers, which means that for a selected set of services the provider receives a set fee, or a case rate, for services needed up to an agreed upon maximum amount of services for a designated period of time. Alternatively, we may pay a case rate to a provider for all of the selected set of services needed during an agreed upon period of time. Sometimes we have withhold arrangements with providers, which means that a portion of the provider s payment is set aside until the end of the year. The year-end reconciliation can happen in one or more of the following ways:»» Withholds are sometimes used to pay specialty, referral or hospital providers who furnish services to members. The provider usually receives all or a portion of the withhold based on performance of agreed upon criteria, which may include patient satisfaction levels, quality of care and/or care management measures»» Some providers usually hospitals are paid on the basis of the diagnosis that they are treating; in other words, they are paid a set fee to treat certain kinds of conditions. Sometimes we pay hospitals and other institutional providers a set fee, or per diem, according to the number of days the patient spent in the facility»» Some providers usually hospitals are paid according to Ambulatory Payment Classifications (APCs) for outpatient services. This means that we have negotiated a payment level based on the resources and intensity of the services provided. In other words, hospitals are paid a set fee for certain kinds of services and that set fee is based on the resources utilized to provide that service.»» Occasionally our reimbursement arrangements with providers include some combination of the methods described above. For example, we may pay a case rate to a provider for a selected set of services needed during an agreed upon period of time, or for services needed up to an agreed upon maximum amount of services, and pay that same provider on a fee-for-service basis for services that are not provided within the time period or that exceed the maximum amount of services. In addition, although we may pay a provider such as a medical clinic using one type of reimbursement method, that clinic may pay its employed providers using another reimbursement method. Check with your individual provider if you wish to know the basis on which he or she is paid. 11010 2016 HealthPartners The HealthPartners family of health plans is underwritten and/or administered by HealthPartners, Inc., Group Health, Inc., HealthPartners Insurance Company or HealthPartners Administrators, Inc. Fully insured Wisconsin plans are underwritten by HealthPartners Insurance Company. 18

Summary of utilization management programs HealthPartners utilization management programs help ensure effective, accessible and high quality health care. These programs are based on the most up-to-date medical evidence to evaluate appropriate levels of care and establish guidelines for medical practices. Our programs include activities to reduce the underuse, overuse and misuse of health services. These programs include: Inpatient concurrent review and care coordination to support timely care and ensure a safe and timely transition from the hospital Best practice care guidelines for certain kinds of care Outpatient case management to provide care coordination The CareCheck program We require prior approval for a small number of services and procedures. For a complete list, go to healthpartners.com or call Member Services. You must call CareCheck at 952-883-5800 or 800-942-4872 to receive maximum benefits when using out-of-network providers for inpatient hospital stays; same-day surgery; new or experimental or reconstructive outpatient technologies or procedures; durable medical equipment or prosthetics costing more than $3,000; home health services after your visits exceed 30; and skilled nursing facility stays. Benefits will be reduced by 20 percent if CareCheck is not notified. Our approach to protecting personal information HealthPartners complies with all applicable laws regarding privacy of health and other information about our members and former members. When needed, we get consent or authorization from our members (or an authorized member representative when the member is unable to give consent or authorization) for release of personal information. We give members access to their own information consistent with applicable law and standards. Our policies and practices support compliant, appropriate and effective use of information, internally and externally, and enable us to serve and improve the health of our members, our patients and the community, while being sensitive to privacy. For a copy of our Notice of Privacy Practices, visit healthpartners.com or call Member Services at 952-883-5000 or 800-883-2177. Appropriate use and coverage of prescription medications We provide our members with coverage for high quality, safe and cost-effective medications. To help us do this, we use: A formulary (drug list). These prescription medicines are continually reviewed and approved for coverage based on quality, safety, effectiveness and value. A free, confidential one-on-one appointment (in-person or telephonic) with an experienced clinical pharmacist. Our Medication Therapy Management (MTM) program helps members who use many different medications get the results they need from their medicines. A pain management program. Our opioid management program supports members in managing their pain. A pharmacy transition of care program. Our patient alert program provides seamless transition to our formulary. We allow coverage for a first time fill of a qualifying non-preferred medicine within the first three months of a member s time with HealthPartners. The formulary is available at healthpartners.com, along with information on how medications are reviewed, the criteria used to determine which medications are added to the list and more. You may also get this information from Member Services. THIS PLAN MAY NOT COVER ALL YOUR HEALTH CARE EXPENSES. READ YOUR PLAN MATERIALS AND SUMMARY OF BENEFITS AND COVERAGE (SBC) CAREFULLY TO DETERMINE WHICH EXPENSES ARE COVERED. For details about benefits and services, call Member Services at 952-883-5000 or 800-883-2177. 11008 2016 HealthPartners The HealthPartners family of health plans is underwritten and/or administered by HealthPartners, Inc., Group Health, Inc., HealthPartners Insurance Company or HealthPartners Administrators, Inc. Fully insured Wisconsin plans are underwritten by HealthPartners Insurance Company. 19