2016 Open Enrollment 2016 Benefits Highlights Benefits Administration

2016 Open Enrollment

2016 – Benefits Highlights § Benefits Administration: First Choice Health (medical, dental & vision) § Pharmacy Benefits Administrator/Network: Med. Impact § FSA (Flexible Spending Account) Administration: Health. Equity § 24 Hour Nurse Line § Maternity Program § No changes to medical benefits § No new ID cards unless you make enrollment changes Health Care Reform & the ASD plan: § The ASD plan is considered Grandfathered, so certain Health Care Reform provisions aren’t applicable to our medical plan, such as copays being required for Preventive Services and contraceptives.

2016 MEDICAL BENEFITS

Medical Plan – Definitions Health benefits have a terminology all their own. As we discuss your benefits the following terms will be used frequently: Deductible: A deductible is a portion of money that you pay before the plan begins to pay benefits. Your plan only has a deductible if you choose to go out of the provider network Copay: A fee paid directly to a provider, facility or pharmacy at time of service. Copays due accrue toward your annual out of pocket maximum. Coinsurance: The portion of the bill you are responsible to pay. Out of Pocket Maximum: caps your member responsibility for in-network services. Prior Authorization: certain services require medical review in order to determine medical necessity. View the Prior Authorization listing at www. fchn. com or in your Open Enrollment Guide posted on the district website.

Medical Benefits – Plan Specifics FCHA Network Out of Network $0 $300 Individual $900 Family 80% 50% Office Visit 100% after $25 copay 50% after deductible Preventive Office Visit 100% after $25 copay 50% after deductible Deductible Coinsurance Emergency Room 80% after $100 copay (copay waived if admitted) Inpatient Hospital 80% 50% after $250 copay per confinement. Deductible applies.

What Happens When I? FCHA Network Out of Network Type of Service: You’ll Pay: Need to go to the doctor… $25 copay Deductible* & 50% of all additional charges Am hospitalized… 20% of the cost up to the Out of Pocket Maximum Deductible*, $250 per confinement copay & 50% of all additional charges Visit the ER… $100 copay then 20% of the cost up to the Out Of Pocket Maximum $100 copay then 20% of all additional charges Get my annual exam… $25 copay Deductible* & 50% of all additional charges Have outpatient surgery… 20% of the cost up to the Out of Pocket Maximum Deductible* & 50% of all additional charges *Annual Deductible $300 Individual/$900 Family

How is Alternative Care Covered? FCHA Network Type of Service: You’ll Pay: Out of Network You’ll Pay: Acupuncture Chiropractic – 20 visit Limit /Calendar Year $300 annual deductible* & Massage Therapy $25 copay 50% of all additional 12 visit Limit /Calendar charges Year Prescription must be submitted with the *The annual deductible indicated is the overall medical plan deductible. claim. Naturopathic Care

2016 PRESCRIPTION BENEFITS

Prescription Benefit Highlights § Local Med. Impact Participating Pharmacies: § Ashland Drug § Phoenix Pharmacy § Fred Meyer § Bi-Mart § Savon § Walgreens § Rite Aid § Wal-Mart § Safeway § Medicap Pharmacy § § 90 day fills (Pharmacy & Mail Order): 90 day supply of your prescriptions are available at participating Choice 90 pharmacies. You can also get a 90 day supply through the Med. Impact mail order program. Generic vs. Brand Name: Members pay the difference in cost between the brand generic medication(s) anytime there is a genetic available and a brand name medication is chosen when your prescribing physician allows for a generic substitution.

Prescription Benefit Copays 30 Day Supply 90 Day Supply (Choice 90 retail) (mail order) Generic $15 copay $45 copay $30 copay Preferred Brand $30 copay $90 copay $60 copay Non-Preferred $45 copay $135 copay $90 copay Brand How are specialty drugs (Copaxone, Embrel, etc. ) covered by the plan? Specialty drugs are covered by the plan when obtained through the Diplomat Specialty Pharmacy. Specialty Drugs may require prior-authorization and/or have quantity limits. Copays for Specialty Drugs align with the Generic/Preferred/Non-Preferred copay tiers. How are compound drugs covered by the plan? Compound drugs are covered by the plan at the applicable tier copay. Pre. Authorization is required for compound drug charges greater than $400. Please keep in mind: If the cost of your drug is less than the tier copay you will pay the lower amount.

2016 DENTAL & VISION

2015 Dental Benefits Annual Deductible $50 Individual $150 Family (Waived for Preventive Services) Annual Maximum $1, 500 Per Covered Individual Class A Expenses – 100% of allowed amount Preventive & Diagnostic Class B Expenses – 80% of allowed amount Basic Services (fillings, root scaling)* Class C Expenses - 50% of allowed amount Major Services (crowns, dentures)* a benefits pre-determination is recommended prior to beginning extensive *Obtaining dental services.

2015 Vision Benefits FCHA Network Out of Network Annual Routine Vision Exam 100% of allowed amount Vision Hardware* 100% up to $350 per calendar year Vision Hardware includes: Eyeglass lenses, frames, contact lenses and contact lens fitting. *For those with vision hardware coverage.

SPECIAL PROGRAMS

24/7 Nurse Line & Health Information Library Available around the clock to answer your health questions! n n n Have a sick child at 2 am? Unsure if you should go to the doctor or Emergency Room? Looking for an answer to a health question? Call the 24/7 Nurse Line to speak with a Registered Nurse who can answer your health questions at no cost to you. You can also access the Health Information Library, with information on over 1, 500 health topics available in English & Spanish.

Maternity Management For a healthy pregnancy and a healthy baby. Available at no cost to you – even if you aren’t a first time mom! § § One on one support from a Registered Nurse Regular telephone sessions with your nurse Sessions provide educational information and ways to minimize risks to you and your baby Your nurse can assist you with managing your diet, exercise and other ways to maintain a healthy pregnancy

ONLINE TOOLS

First Choice e-Tools Did you know? First Choice’s member website offers you the ability to access your plan and medical claim information online. Create an account to: n n n n Find a provider (local or national) View enrollment status Print a temporary ID card/Order a new card Sign up for e-EOBs Review medical plan documents Review claims information & EOBs Email customer service Download forms Please visit www. my. First. Choice. fchn. com

Landing Page

Eligibility & Benefits Navigate here to: ü Update your email address ü Verify your eligibility ü Check your plan deductible, out of pocket and other benefits ü Order/view your ID card

Claims Navigate here to: ü View claims ü Download copies of EOBs ü Move your claim history to an excel file via cut & paste ü Filter by date, family member and claim type

Find a Provider Navigate here to: ü Search for providers in the First Choice Health Network ü Search for providers in the First Health Network

Customer Service Navigate here to: ü Contact Customer Service ü View forms: ü Claim ü HIPAA

Health Resources Navigate here to: ü View online Health Tools ü Access Health Links

What YOU Need To Do – Wrapping Up Everyone: ü Complete the First Choice Health Enrollment Application – Not making any changes? No form required ü Complete the Health Equity Enrollment Application for the FSA program – Even if you aren’t enrolling, we need your declination to participate on file ü Complete Premium Withholding Form ü Turn all forms in to Human Resources by November 30, 2015 .

2016 FLEXIBLE SPENDING ACCOUNT

When you choose to participate in the ASD Flexible Spending Account Program you can set aside pre-tax dollars to: • Cover medical, dental or vision expenses not covered by your health plan. • Pay for non-medical dependent care expenses. 2016 Contribution Limits: $2, 550 Healthcare FSA $5, 000 Dependent Care FSA $300 Minimum Contribution

How an FSA Works 1. 2. 3. Sign Up § Review your medical expenses for the last year and estimate your expenses for 2016. § Determine the amount you would like to contribute to your FSA on a pre-tax basis Contribute § ASD will arrange to have the determined amount of your pre-tax earnings contributed to your FSA. Use Your Funds § When you incur a qualified expense, you can either pay with the Health. Equity Visa debit card or submit the expenses through the Health. Equity online tool for reimbursement. § Save your receipts! You’ll need them to submit reimbursements or to validate debit card expenses.

Plan Wisely When Setting Aside FSA Funds The FSA is a tax-preferred account and federal guidelines are very specific about what happens to funds that are not spent by the end of the plan year. Healthcare FSA: ¨ Annual rollover of up to $500 is allowed ¨ You are eligible to roll funds over to the next year even if you decide not to make additional contributions. Example: Lisa set aside $1, 400 in 2014 for Healthcare expenses. She spent $1, 100. Lisa decides that she won’t contribute additional funds to the FSA in 2015. Lisa has $300 that will roll over to the 2015 plan year. ¨ Healthcare FSA accounts with a balance of more than $500 will forfeit amounts over $500 Dependent Care FSA: ¨ No rollover is available. Unused contributions are forfeited.

Qualified FSA Expenses: § § § Acupuncture § Alcoholism § Ambulance § Amounts not covered § under another health plan Annual physical § examination Artificial limbs/teeth § Birth control § pills/prescription contraceptives § Body scans § Breast reconstruction § surgery following § mastectomy for cancer § Chiropractor § Contact lenses Crutches Dental treatments Eyeglasses/eye surgery Hearing aids Long-term care expenses Medicines (prescribed, not imported from other countries) Nursing home medical care Nursing services Optometrist Orthodontia Oxygen Stop-smoking programs Surgery, other than unnecessary cosmetic § § § surgery Telephone equipment and repair for hearingimpaired Therapy Transplants Weight-loss program (if prescribed by a physician for a specific disease) Wheelchairs Examples of Non. Wigs (if prescribed) Qualified Expenses: § Concierge services § Diaper service § Elective cosmetic surgery § Future medical care § Hair transplants § Non-prescribed drugs § Nutritional supplements § Health club memberships § Insurance Premiums

FSA Features n n Convenient access ¨ Debit card ¨ Online - http: //healthequity. com/ ¨ Health. Equity free mobile app ¨ 24/7 telephone assistance Use your Health. Equity account to ¨ Check your balance ¨ Review transactions ¨ Review claims ¨ Enroll in direct deposit reimbursement ¨ Submit new claims or documents ¨ Send payments and reimbursements Mobile App Features Available for i. OS and Android • • • On-the-go access for all account types Take a photo of documentation with phone and link to claims and payments Ability to directly pay provider via online tools or request reimbursement from your FSA account Manage debit card transactions View claims status