2021 ENROLLMENT GUIDE State Employee Health Plan SEHP

2021 ENROLLMENT GUIDE State Employee Health Plan (SEHP) State of Kansas Retiree and Direct Bill Members

AGENDA • General Overview • What’s New • Open Enrollment • Non-Medicare Plan Coverage Details • Questions to Ask Yourself • Open Enrollment Portal Instructions • Direct Bill Call Center • Resources 2

General Overview https: //healthbenefitsprogram. ks. gov Meet Scopes, your SEHP guide, for helpful tips and information throughout this presentation! 3

General Overview We’ll provide you with: • • • Benefit Options Information Tools Resources Contact Information 4

What’s New Changes in 2021 • Plan A Deductible is changing for Employee/Children and Employee/Family coverage tiers from three Deductibles to two. The Plan Year 2021 Deductible amounts are $1, 000/single and $2, 000/family. The maximum deductible for memberships covering 2 or more people is now $2, 000. • The University of Kansas Health System (TUKHS) is now a participating vendor with the preferred lab benefit. 5

What’s New Medicare Changes in 2021 • New Medicare Part D Vendor - Silver. Script Members enrolled in one of the Kansas Senior Medicare Supplemental plans – C, C Select, G, G Select and N can enroll in one of the Silver. Script plans: Premier or Economy. • NEW in Plan Year 2021, members enrolled in one of the Aetna Medicare Advantage Plans will have three options for Part D prescription drug coverage. • Aetna Standard Part D • Aetna High Rx • Aetna Low Rx 6

Silver. Script Part D Coverage Silver. Script, is offering two Part D options. • Premier Part D will pay through the coverage gap, same as the current Premier Part D just with a lower premium. • Economy Part D is a more affordable Part D that is comparable to the Part D plans out on the Private Market. 7

Silver. Script Part D Coverage Continued • Members currently enrolled in Envision. Rx. Plus Premier Part D, who do NOT make any elections during the Open Enrollment period, will automatically be enrolled in Silver. Script Premier Part D coverage for 2021. • Members currently enrolled in Envision. Rx. Plus Value or Classic Part D plans will need to make elections for 2021. 8

Aetna Part D Coverage For Plan Year 2021, Aetna Medicare Advantage members will have three options for Part D prescription drug coverage. • Aetna Standard • Aetna High Rx does not have a deductible and will pay through the coverage gap, same as the Silver. Script Premier Part D. • Aetna Low Rx is a more affordable Part D that is comparable to the Part D plans out on the Private Market. 9

Open Enrollment October 16 th - November 15 th , 2020 • Any changes made during Open Enrollment will be effective January 1, 2021 and are in place for the 2021 plan year. • Open Enrollment is your chance to make any changes to your current coverage • Add dependents • Change medical coverage/carrier • Waive medical & keep dental and/or vision coverage 10

Cancelling Coverage • The changes listed below can only be made during Open Enrollment: • Medical & keep dental and/or vision • Dental & keep medical and/or vision • Vision & keep medical and/or dental • A member is able to cancel all coverage during the year by giving written notice, then coverage will be canceled the last day of the month in which the state is notified. Coverage for spouse and/or dependents will be cancelled as well. 11

Open Enrollment October 16 - November 15, 2020 • Any change made outside of the Open Enrollment period requires a qualifying event. • Remember: If you or a dependent are enrolled in Medicare, you must have a “Split Enrollment. ” • If you want to cancel all of your health insurance, you will need to contact our office at 1 -866 -541 -7100. This cannot be done in the Member portal. 12

Center for Medicare & Medicaid Services (CMS) Decision Just a reminder that Center for Medicare and Medicaid Services (CMS) made this decision in 2019 • Effective January 1, 2020, the Supplemental Plan C & C Select will no longer be available to people new to Medicare. BUT if you are already Medicare eligible, then the Supplemental Plans C & C Select will always be an option for you to select. 13

State Employees Health Care Commission (HCC) Decisions • The HCC voted to reduce the premiums for some tiers of the non-Medicare plans • The HCC awarded the Part D prescription drug contract to Silver. Script. • Silver. Script will offer two Part D Plans – Premier and Economy. 14

Continuing My Current Coverage for Plan Year 2021 Do I need to do anything during Open Enrollment to continue my current coverage for Plan Year 2021? Members enrolled in the plans listed below do not need to do anything to continue their current coverage for Plan Year 2021: • Aetna and BCBS Non-Medicare plans A, C, J, N or Q • Aetna Medicare Advantage Freedom, Liberty or Elite PPO ESA with Aetna Standard Part D • Kansas Senior Plans C, C Select, G, G Select or N without Part D • Kansas Senior Plans C, C Select, G, G Select or N with Envision. Rx. Plus Premier Part D coverage. Those currently enrolled in Envision. Rx. Plus Premier Part D coverage will be rolled over into Silver. Script Premier if they do not make elections. 15

Non-Medicare Medical Coverage Options • Pick a plan design (A, C, J, N or Q) Which plan design is right for you? Consider Premiums, Deductibles, Co -insurance listed in your 2021 Retiree and Direct Bill Enrollment Guide. You can review the provider networks on our website here: https: //healthbenefitsprogram. ks. gov/ sehp/state-employee-health-plan 16

Medical Coverage Telehealth Services 17

Medical Coverage Available Medical Plans • • • Plan A Plan J Plan Q Plan C Plan N Consider Deductible Co-insurance Out-of-Pocket 18

Plan A Office Visits & Prescriptions Office Visits (network providers) Primary Care Visits $40 Co-pay Specialist Visits $60 Co-pay Urgent Care Services $50 Co-pay Diagnostic Lab Services Covered At 100% (When Using Quest, Stormont Vail, or The University of Kansas Health System Labs) Prescriptions Generic 20% Preferred Name Brand 40% Non-preferred 65% Special Case Medications $100 Co-pay For A 30 -day Supply 19

Plan A Network Non-network Deductible $1, 000 Single/$2, 000 Family $1, 200 Single/$2, 400 Family Co-insurance (Paid by Member) 20% 50% Out of Pocket Maximum (OOP) $6, 250 Single/$12, 500 Family Pharmacy Co-insurance 20% for generic, 40% for preferred brand name drugs, and 65% for non preferred and specialty drugs. 20

Plan J Network Non-network Deductible $500 Single/$1, 000 Family $1, 000 Single/ $2, 000 Family Co-insurance (Paid by Member) 25% 50% Out of Pocket Maximum (OOP) $7, 350 Single/$14, 700 Family $10, 000 Single/$20, 000 Family Pharmacy Co-insurance 20% for generic, 40% for preferred brand name drugs, and 65% for non preferred and specialty drugs. 21

Plan Q Network Non-network Deductible $500 Single/$1, 000 Family $700 Single/ $1, 400 Family Co-insurance (Paid by Member) 50% 60% Out of Pocket Maximum (OOP) $6, 650 Single/$13, 300 Family Pharmacy Co-insurance 20% for generic, 40% for preferred brand name drugs, and 65% for non preferred and specialty drugs. 22

High Deductible Health Plans Plan C and Plan N are high deductible health plans (HDHPs). HDHPs have unique rules outlining how the coverage works, such as: • Higher annual deductibles • All services are subject to the annual deductible (except preventive care) • The plan pays 100% after the deductible and Coinsurance (OOP) are met 23

Plan C Network Non-network Deductible $2, 750 Single/$5, 500 Family Co-insurance (Paid by Member) 10% 50% Out of Pocket Maximum (OOP) $5, 500 Single/$11, 000 Family Pharmacy Co-insurance 20% for generic, 40% for preferred brand name drugs, and 65% for non preferred and specialty drugs. 24

Plan N Network Non-network Deductible $2, 750 Single/$5, 500 Family Co-insurance (Paid by Member) 35% 50% Out of Pocket Maximum (OOP) $6, 650 Single/$13, 300 Family Pharmacy Co-insurance 20% for generic, 40% for preferred brand name drugs, and 65% for non preferred and specialty drugs. 25

Non-Medicare Medical Coverage 2021 Rates 26

Medical Coverage Provider Networks • Broad Provider Networks • Provider Directories available on the SEHP website. • Network Providers save you money! 27

Medical Coverage Preventive Care 28

Prescription Benefit Coverage Included with all medical plans 29

Preferred Lab Benefit Included with all medical plans 30

Dental Coverage

Dental Coverage Dental Benefits Summary January 1 – December 31, 2021

Vision Coverage Basic Plan Office Visit Co-pay $50 Materials Co-pay $25 Frame Allowance $100 Lenses: single vision, standard bifocal, trifocal or lenticular 100% Enhanced Plan - Covers everything in the Basic Plan PLUS… Frame Allowance $150 High Index Allowance Up to $116 Polycarbonate lenses Covered in Full Contact lenses Allowance $150 Progressive lenses Allowance Contact Fitting Fee Co-pay $35 Scratch & UV coating Up to $165 Covered in full

Vision Coverage Important Note: If you are enrolled in any medical plan through the SEHP, your first vision exam for each year is included in the medical plan at 100% coverage.

Medicare Medical Coverage Options The State Employee Health Plan Medicare Options are: • Aetna Medicare Freedom PPO ESA (with Aetna Standard, High Rx or Low Rx Part D) • Aetna Medicare Liberty PPO ESA (with Aetna Standard, High Rx or Low Rx Part D) • Aetna Medicare Elite PPO ESA (with Aetna Standard, High Rx or Low Rx Part D) • • • Kansas Senior Plan C (with or without Silver. Script Part D - Premier or Economy) Kansas Senior Plan C Select (with or without Silver. Script Part D - Premier or Economy) Kansas Senior Plan G Select (with or without Silver. Script Part D - Premier or Economy) Kansas Senior Plan N (with or without Silver. Script Part D - Premier or Economy) 35

Aetna Medicare Advantage Plans Aetna Medicare Advantage PPO ESA (Extended Service Area) Plans • Freedom • Liberty • Elite Members must be enrolled in Medicare Part A and Part B and submit a copy of your Medicare card in the Member portal. With these plans, members cannot enroll in a Part D prescription plan out on the Private Market. 36

Aetna Medicare Advantage Plans NEW in 2021— Members enrolled or electing to enroll in Aetna Medicare Freedom, Aetna Medicare Liberty or Aetna Medicare Elite will have two additional Part D prescription drug options. Listed below are three Part D options for the Aetna Advantage Plans: • Aetna Standard Part D • Aetna High Rx Part D • Aetna Low Rx Part D Members will need to make an election if they wish to change their current Part D prescription drug coverage. 37

Aetna Medicare Advantage Plans Additional benefits offered with these plans: • • • Additional benefits than those offered by Medicare No referrals needed Access to providers nationwide Receive money each year toward hearing aids Resources for Living Silver. Sneakers 38

Aetna Medicare Advantage Plans • Takes the place of Medicare Part A and Part B • You are still responsible for Part B premium • Still have deductibles and co-payments • Enrollment in private Part D prescription plan = loss of ALL State of Kansas Health benefits 39

Aetna Medicare Advantage Plans Freedom Liberty Elite $0 $0 $150 $1, 000 $500 $150 $0 $0 $0 Primary care provider office visit $10 co-pay $15 co-pay $0 Specialist office visit $25 co-pay $15 co-pay $0 $150 co-pay per day, up to 5 days $0 $0 Outpatient surgery $150 co-pay $0 $0 Emergency room $80 co-pay $50 co-pay $0 Deductible Out-of-pocket maximum Preventive care Inpatient hospital Hearing Aids Fitness Benefit $500 every 12 months Silver. Sneakers 40

Aetna Medicare Advantage Plans • Coverage Gap or the “Donut Hole” – Begins when you and your plan have paid $4, 130 toward your medications. – Once you reach the coverage gap, you are responsible for the cost of the brand name and some generic medications. • Catastrophic Coverage – Begins when your Out-of-Pocket cost reaches $6, 550 41

Aetna High Rx Part D Prescription Drug Part D Plan Benefits – High Rx Prescription Network Retail 30 Day Supply Network Retail 60 Day Supply Network Retail/Mail Order 90 -Day Supply Tier 1 – Preferred Generic Drugs Preferred: 20% Max $30 Standard: 25% Max $30 Preferred: 20% Max $45 Standard: 25% Max $45 Tier 2 - Generic Drugs Preferred: 20% Max $30 Standard: 25% Max $30 Preferred: 20% Max $45 Standard: 25% Max $45 Preferred & Standard: 25% Max $100 Preferred & Standard: 25% Max $150 50% Co-insurance up to a $150 maximum 50% Co-insurance up to a $225 maximum 25% Co-insurance No maximum N/A Generics: the greater of 5% Co-insurance or $3. 70 Brands: the greater of 5% Co-insurance or $9. 20 Tier 3 – Preferred Brand Name drugs Tier 4 – Non Preferred Generic and Brand Name drugs Tier 5 – Specialty 30 day supply ONLY If out-of-pocket expenses exceed $6, 550 42

Aetna Low Rx Part D Prescription Drug – NEW in 2021 Part D Plan Benefits – Low Rx Prescription Network Retail 30 Day Supply Network Retail 60 Day Supply Network Retail/Mail Order 90 Day Supply Deductible - $350 deductible for initial out of pocket prior to tier coverage. All Co-payments would be cost of drug or Co-payment listed below. Whichever is less. Network / Preferred Pharmacy Tier 1 – Preferred Generic Drugs $0 / $15 $0 / $30 Tier 2 –Generic Drugs $10 / $20 / $40 Tier 3 – Preferred Brand Name drugs $47 Co-payment $94 Co-payment Tier 4 – Non Preferred Generic and Brand Name drugs 50% 50% 25% Co-insurance No Maximum N/A Tier 5 – Specialty 30 day supply ONLY 43

Blue Cross and Blue Shield of Kansas Medicare Supplemental Plans Blue Cross and Blue Shield of Kansas offers the following Medicare Supplemental Plans to the State Employee Health Plan members enrolled in Medicare Part A and Part B: • Kansas Senior Plan C Select • Kansas Senior Plan G Select • Kansas Senior Plan N – With or without the new Silver. Script Part D prescription drug plans —Premier or Economy • A copy of your Medicare card is required • Senior Plan C and C Select are not available options to those members who became Medicare eligible after 12 -31 -2019 44

Blue Cross and Blue Shield of Kansas Medicare Supplemental Select Plans To be eligible to enroll in one of these new plans you must live in one of the Select counties listed below. Atchison, Brown, Butler, Chase, Chautauqua, Clay, Cowley, Doniphan, Douglas, Elk, Greenwood, Harper, Harvey, Jackson, Jefferson, Kingman, Leavenworth, Marion, Marshall, Osage, Pottawatomie, Pratt, Reno, Riley, Sedgwick, Shawnee, Sumner, Wabaunsee or Washington. With these Select plans, you need to use a network hospital for any planned inpatient services. 45

Blue Cross Blue Shield of Kansas Medicare Supplemental Plans The Part D prescription drug options for the Medicare Supplemental Kansas Senior Plans C, C Select, G, G Select & N plans are listed below: • Enroll in one of the plans offered by Silver. Script § Silver. Script Premier Part D § Silver. Script Economy Part D NEW • Waive Part D through the state and enroll in a Part D out on the Private Market 46

Blue Cross Blue Shield of Kansas Medicare Supplemental Plans • Members currently enrolled in one of the Kansas Senior Plans C, C Select, G, G Select & N plans with Envision Premier Part D prescription drug coverage, do not need to make elections during open enrollment. Those enrolled in Premier coverage will be rolled into the new Silver. Script Premier plan. • Members currently enrolled in either Envision Value Part D or Envision Classic Part D are required to make elections during open enrollment to select a Silver. Script Part D plan for 2021. • If you need assistance in making your elections, please call the Direct Bill Call Center at 1 -866 -541 -7100 and someone will assist you. 47

Blue Cross Blue Shield of Kansas Senior Plan C Kansas Sr. Plan C Pays Part A Part B Inpatient Hospital Care: All deductible and co-insurance for Medicare covered services You Pay $0 Skilled Nursing: All co-insurance for Medicare covered services $0 Deductible $0 Outpatient Services $0 Durable Medical Equipment $0 48

Blue Cross Blue Shield of Kansas Senior Plan C Select Kansas Sr. Plan C Select Pays Part A Part B Inpatient Hospital Care: To receive full Select benefits, you must obtain your planned Hospitalization services from one of the network hospitals You Pay $0 Skilled Nursing: All co-insurance for Medicare covered services $0 Deductible $0 Outpatient Services $0 Durable Medical Equipment $0 49

Blue Cross Blue Shield of Kansas Senior Plan G Kansas Sr. Plan G Pays Part A Part B You Pay Inpatient Hospital Care: All deductible and co-insurance for Medicare covered services $0 Skilled Nursing: All co-insurance for Medicare covered services $0 Deductible $198 Outpatient Services $0 Durable Medical Equipment $0 50

Blue Cross Blue Shield of Kansas Senior Plan G Select Part A Part B Kansas Sr. Plan G Select Pays You Pay Inpatient Hospital Care: To receive full Select benefits, you must obtain your planned Hospitalization services from one of the network hospitals $0 Skilled Nursing: All co-insurance for Medicare covered services $0 Deductible Outpatient Services Durable Medical Equipment $198 $0 $0 51

Blue Cross Blue Shield of Kansas Senior Plan N Kansas Sr. Plan N Pays Part A Part B You Pay Inpatient Hospital Care: All deductible and co-insurance for Medicare covered services $0 Skilled Nursing: All co-insurance for Medicare covered services $0 Deductible Balance, other co-pays Durable Medical Equipment $198 Up to $20 office visit Up to $50 ER visit $0 52

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Silver. Script Part D Prescription Drug Silver. Script will be offering two Part D plans. Members enrolled in one the Kansas Senior Supplemental plans have the option to elect one of the Silver. Script Part D plans • Silver. Script Premier Part D • Silver. Script Economy Part D NEW If a member elects to enroll in one of these plans, they will be billed by Silver. Script for the premium. Members will receive information in the mail from Silver. Script regarding billing and payment. 54

Silver. Script Part D Prescription Drug • Plans have same pharmacy network and formularies (Preferred Drug List). • Be sure to review the formulary and verify which plan will be best for you based on the medications you take regularly. • Remember to take advantage of co-pay savings by getting 90 -day supplies when possible! To take advantage of getting the 90 supply, you need to be sure that your doctor has written your prescription to be filled for a 90 supply. • Premier plan pays through the coverage gap. • Specialty medications can only be filled for 30 days. 55

Creditable Prescription Drug Coverage To avoid the late Enrollment Penalty through Medicare, you must have creditable drug coverage. This means that the coverage that is as good or better than Medicare prescription drug coverage. All State of Kansas drug coverage is considered creditable coverage. If you are eligible for VA or Tricare, they are considered creditable coverage. 56

Silver. Script Premier Part D Prescription Drug Part D Plan Benefits – PREMIER Option— 1 -800 -411 -3986 Prescription Network Retail 30 Day Supply Network Retail 60 Day Supply Network Retail/Mail Order 90 -Day Supply Tier 1 – Preferred Generic Drugs Preferred: 20% Max $30 Standard: 25% Max $30 Preferred: 20% Max $45 Standard: 25% Max $45 Tier 2 - Generic Drugs Preferred: 20% Max $30 Standard: 25% Max $30 Preferred: 20% Max $45 Standard: 25% Max $45 Preferred & Standard: 25% Max $100 Preferred & Standard: 25% Max $150 50% Co-insurance up to a $150 maximum 50% Co-insurance up to a $225 maximum 25% Co-insurance No maximum N/A Generics: the greater of 5% Co-insurance or $3. 70 Brands: the greater of 5% Co-insurance or $9. 20 Tier 3 – Preferred Brand Name drugs Tier 4 – Non Preferred Generic and Brand Name drugs Tier 5 – Specialty 30 day supply ONLY If out-of-pocket expenses exceed $6, 550 57

Silver. Script Economy Part D Prescription Drug – NEW in 2021 Part D Plan Benefits – Economy Option— 1 -800 -411 -3986 Prescription Network Retail 30 Day Supply Network Retail 60 Day Supply Network Retail/Mail Order 90 Day Supply Deductible - $350 deductible for initial out of pocket prior to tier coverage. All Co-payments would be cost of drug or Co-payment listed below. Whichever is less. Network / Preferred Pharmacy Tier 1 – Preferred Generic Drugs $0 / $15 $0 / $30 Tier 2 –Generic Drugs $10 / $20 / $40 Tier 3 – Preferred Brand Name drugs $47 Co-payment $94 Co-payment Tier 4 – Non Preferred Generic and Brand Name drugs 50% 50% 25% Co-insurance No Maximum N/A Tier 5 – Specialty 30 day supply ONLY 58

Identification Cards Aetna Active plans, BCBS – Active and Senior plans, Caremark & Silver. Script are sending new ID cards to all members. Aetna Medicare PPO ESA plans, Delta, Surency and Quest are sending new ID cards to new enrollees and existing members that make changes only. 59

Questions to Ask Yourself Which health plan is best for me? • How often do I visit the doctor? • How many medications do I take? • Compare premiums, deductibles and co-insurance. Which health plan carrier is the best for me? • Ask my doctor’s office which insurance plans they accept. What is the total cost to me? • Add all premiums for the plans you elected. 60

Member Enrollment Portal The Member Enrollment Portal is here https: //sehp. member. hrissuite. com/ • Enroll online with any computer that has internet access • You will log in using – Your Kansas Employee ID – Your Social Security Number – Your Date of Birth – Email Address 61

Member Enrollment Portal Making Your Elections in the Member Portal - https: //sehp. member. hrissuite. com/ 1. Remember to review the contact information currently shown on your account in the system and make any necessary changes. All SEHP communications will be sent to the contact information listed in MAP. • Mailing address, phone number and email address. 2. If you are adding dependents during Open Enrollment, you will need to upload electronic copies of birth certificates & marriage licenses in MAP. Documents can be scanned to a pdf and uploaded or a photo of the document can be uploaded. 3. Click on the Enrollment & Events tab and then click the blue Launch Enrollment button. • Follow the instructions on the screen and make election changes. 4. Click the Save and Submit button to submit your elections. • Print off the summary of changes for your records. • An email confirmation statement will be sent to you at the email address listed in the MAP system. 62

Direct Bill Call Center The Direct Bill Call Center is open from October 5, 2020 through December 11, 2020 from 8: 30 am to 4: 30 pm Monday through Friday. It will be closed Wednesday, November 11 (Veteran's Day), Thursday, November 26 and Friday, November 27 (Thanksgiving) Call Center Phone Numbers • 1 -866 -541 -7100 (Toll Free) • 1 -785 -296 -1715 (Topeka Area) 63

Resources Online Here are some resources to help you make informed decisions on your 2021 elections during open enrollment. • Direct Bill Newsletter - includes important reminders and announcements. https: //healthbenefitsprogram. ks. gov/sehp/py 2021/open-enrollment • 2021 Direct Bill Open Enrollment Guide on our website here https: //healthbenefitsprogram. ks. gov/sehp/py 2021/open-enrollment • Medicare and You handbook for all Medicare participants https: //www. medicare. gov/medicare-and-you • Medicare Website www. medicare. gov 64

Resources Contact Information Direct Bill Call Center Contact Information • 1 -866 -541 -7100 (Toll Free) • 1 -785 -296 -1715 (Topeka area) • Email us at SEHPMembership@ks. gov Senior Health Insurance Counseling (SHICK) • 1 -800 -860 -5260 • Kansas Dept for Aging & Disability Services • County Extension Office Medicare • 1 -800 -633 -4227 Social Security Administration • 1 -800 -772 -1213 • 1 -800 -325 -0778 (TTY) 65

State Employee Health Plan New Website https: //healthbenefitsprogram. ks. gov/sehp/state-employee-health-plan 66