BOROUGH OF ROSELLE NEW MEDICAL PRESCRIPTION PLAN EFFECTIVE

Brown & Brown Insurance Broker for the Borough’s medical benefits Insurance advocate for employees and retirees Brown & Brown Insurance is the insurance broker for the Borough’s health benefits, including the medical, prescription and dental insurance benefits. If you’ve contacted Horizon / Optum regarding your benefits or a question about a claim but are unable to resolve it, we can assist you. Our dedicated member liaisons have the ability and the resources to resolve your issue and answer your questions quickly and efficiently. If anyone has a specific plan coverage question or existing claim problem that cannot be resolved after contacting the insurance carrier, please contact our office for assistance by calling 973 -549 -1916. You can also contact us by sending an email to sklarfeld@bbmetro. com and a representative will get back to you. Available to answer any questions regarding SHBP plan offerings as well as any other benefit / enrollment questions

Overview Ø SHBP will be replacing your current medical and prescription effective November 1, 2020 Ø Why are we leaving your current health plan? Ø The SHBP represents a significant savings compared to the current rates for both The Borough and employees who make contributions toward their benefits. Ø The SHBP does offer a separate dental plan that you can enroll in and pay for, however there is no change to your current dental plan with Borough and you will continue to be enrolled in the dental plan. You must sign the waiver form from the SHBP in case you decide in the future to enroll with the SHBP dental plan. If you do not fill out the waiver form you will lose the ability to enroll at a later date.

NEW MEDICAL/PHARMACY PLAN Ø Pharmacy Benefits Administrator under the SHBP Ø Optum. Rx will be your new Pharmacy Administrator Ø Any refills you have at your RETAIL pharmacy will still be on file. Ø You may need to have your provider update any existing pre-authorizations Ø Mail Order Prescription Vendor is changing to Optum. Rx Home Delivery Pharmacy. If possible, refill your mail order prescriptions prior to November 1, 2020 to avoid disruption. Any mail order prescription you need to fill after this date will require a new script to be completed by your provider and must be submitted to your new Mail Order Vendor. Forms can be found online. Ø ID CARDS Ø You will receive 2 separate ID Cards, one for Medical and one for Prescription Ø If you do not receive your ID cards, you can print one online or view via your MOBILE APP on or after November 1. Ø Don’t forget to give your new Medical and RX ID cards to your Doctor and Pharmacy beginning 11/1/20!

ENROLLMENT FORM SUBMISSION Please submit your fully completed, signed enrollment form(s) and any required dependent documentation to the Division of Pension and Benefits. Their address is included with the enrollment form (PO Box 299, Trenton, NJ 08625) by October 5 th If sending via email, please note that electronic signatures are acceptable for the time being due to the COVID-19 health crisis. If you do not submit a form, you will not have coverage beginning November 1 st. You will receive ID cards for medical and prescription separately.

ENROLLMENT FORMS All retirees eligible for benefits must complete the enrollment form, unless you are waiving. If you are enrolling in medical/prescription coverage, please complete Sections 1, 2, 4, 5, 6 and 8. If you are enrolling dependents regardless of their Medicare status also, complete section 7. (DO NOT place your dependents on a separate form. ) Section 2 - Check the box for “New Retiree” or “Survivor Enrollment” (and enter Decedent’s SSN) Section 7 - Covering more than 2 children? Check the box for “Additional Sheets attached” The second form must be fully completed or it will not be processed.

ENROLLMENT FORMS

ENROLLMENT FORMS Retirees are eligible for self-paid SHBP Retiree Dental. If you would like to enroll, please complete the Retiree Dental Plan Application, unless you are waiving. If you are enrolling in SHBP Retiree Dental, please complete Sections 1, 3, 4, 5, 6, 7 and 9. If you are enrolling dependents also, complete section 8. Section 4 – Check the box for “New Retiree” or Survivor” Section 6 - Covering more than 2 children? Check the box for “Additional Sheets attached” The second form must be fully completed or it will not be processed. NOTE: You must continue in your selected SHBP Retiree dental plan for a minimum of 12 months before changing plans or disenrolling.

ENROLLMENT FORMS Are you going to waive coverage? Here is what you need: Cancel/Decline/Waive Form Complete either section 3, 4 or 5. And of course complete section 1 and don’t forget to sign the form. Section 3 - you will NOT be able to enroll in SHBP Retiree coverage in the future. Section 4 – allows you to enroll in SHBP Retiree coverage in the future should you lose other group-based employer coverage (should you lose that coverage). Section 5 – allows Medicare-eligibles to waive SHBP prescription if they are enrolled in a different Medicare Part D plan.

DEPENDENT DOCUMENTATION REQUIREMENTS PLEASE REFER TO the page entitled “Required Documentation for Dependents” If you are covering a SPOUSE and/or CHILD, dependent documentation is required. If you are not covering a dependent, then no dependent documentation is required. If a form is submitted without the required dependent documentation, it may be rejected and cause a delay in the issuance of your enrollment/ID card.

DOCUMENTATION REQUIREMENTS If you or a dependent are Medicare eligible, you MUST include a photocopy of their Medicare card with your Enrollment Form! If you do not include it, your enrollment will NOT be processed.

CHILD DEPENDENT ELIGIBILITY presented by Meghan Presutti, Horizon BCBSNJ Children can be covered under your SHBP Retiree plans until the end of the calendar year that the child turns 26. At the end of the calendar year, the child has the following coverage options under SHBP: COBRA Chapter 375 (Dependents under 31) Coverage Continuation for Over Age Children with Disabilities

Life Events and Annual Enrollment Life Event If you have a life event (e. g. , birth, adoption, marry, lose other group-based employer coverage), you have 60 days to complete and submit your Enrollment Forms and documentation to the NJ Division of Pensions and Benefits. Coverage will then be retroactive to the date of the event. Annual Enrollment Ø You will have the opportunity every rolling 12 months. If plan changes are made, you will also have the opportunity to make enrollment changes for January 1 st. Ø However, for this change to SHBP that takes effect November 1, 2020, you can make the following Enrollment changes: § Add or delete dependents § Change plans § Waive Coverage (if enrolled in other group-based employer coverage) § Enroll in coverage (if previously waived due to other group-based coverage)

MEDICAL PLANS AVAILABLE

FINDING AN IN-NETWORK PROVIDER Pay less out of your pocket! To find an NJ DIRECT network provider, go to: • • Horizon. Blue. com/SHBP Click on “Find A Doctor” Enter the information for your search. All NJ DIRECT plans: If you are searching for a provider outside of NJ, scroll down further to “Find a doctor outside of NJ” and when prompted, be sure to enter your plan as “NJX”

…more info All of the SHBP medical plans include: Secure Member Online Services Horizon. Blue app (for your smartphone) This includes a Telemedicine app! Blue 365 discount program Livongo diabetes management program Horizon Health Guide member services

…more info All of the SHBP medical plans include Horizon Health Guide (exclusive to SHBP/SEHBP)! Once you are enrolled in the plan, your Horizon Health Guide can help you: Understand your benefits Make doctor appointments Claims and Billing questions Everyday health concerns Transferring medical records Managing Acute and Chronic Conditions And much more!

…more info Please visit us on our website at: www. Horizon. Blue. com/SHBP or call 800 -414 -7427, or Download the Mobile App Ø After you are enrolled, register on the member portal at horizonblue. com Ø Download the free Horizon Blue App by texting Get. App to 422 -272 or visit the Apple® App Store® or Google Play. 2 Ø Install the app on your device Ø Sign in by using the username and password you chose for Horizonblue. com

Learning about Aetna Medicare Advantage [

Knowledge and experience — centered around you Attention Engagement Holistic view Family Health Support 190 k+ 10+ years offering Medicare Advantage plans to State of New Jersey members 20+ years of Group Medicare Advantage experience {Source}*Aetna Group MA members as of January 1, 2020. 21 Proprietary © 2020 Aetna Inc. Aetna Group Retiree members retired from the State of New jersey*

How the Medicare Advantage plan works • One step for you • One medical ID card • One monthly Explanation of Benefits for medical services Medicare Advantage plans must cover all Medicare-approved services Medicare Part A One plan: Simplicity with care advocacy and wellness More benefits than Medicare Parts A and B 22 Proprietary © 2020 Aetna Inc. Easy to use – claims flow through one source Medicare Part B

Medicare Advantage is an all-in-one plan • Easy to use • One ID card for all medical needs • More benefits than Original Medicare Part A and Part B • Health Advocacy and wellness support 23 Proprietary © 2020 Aetna Inc. Your single ID card

How we make it simple to see your doctors 24 Proprietary © 2020 Aetna

We’ve got you covered with freedom of access Aetna Medicare Advantage Preferred Provider Organization (PPO) with Extended Service Area (ESA) • Access to providers nationwide • See any doctor or hospital who is eligible to receive Medicare payment and accepts your plan • Pay the same cost share for any doctor or hospital according the cost listed on your plan benefit summary. • No referrals needed • Covers you nationally when travelling • Over 800, 000 network doctors and specialists and 3, 500 network hospitals 25 Proprietary © 2020 Aetna Inc.

Your medical PPO ESA benefit plan options Aetna Medicare Advantage PPO ESA $10 Referral requirement None $0 $0 $400 $1, 000 Preventive care $0 $0 Primary care office visit $10 $15 Specialty care office visit $10 $15 $0 per stay $0 $0 Emergency Coverage Deductible Out-of-pocket maximum Inpatient hospital Outpatient surgery Foreign Travel 26 Proprietary Aetna Medicare Advantage PPO ESA $15 © 2020 Aetna Inc.

Extras you get with Aetna Medicare Advantage 27 Proprietary © 2020 Aetna Inc.

You can get help anywhere on your health journey with your Aetna Medicare Advantage plan Prevention Eye and hearing exams Annual physicals Fall Prevention Program Women’s annual health reminder Cancer screening reminder 28 Proprietary © 2020 Aetna Inc. Wellness Support Telehealth Resources For Living® Healthy Home Visits Chronic health condition support Healthy Lifestyle Coaching Behavioral Health Support 24/7 Nurse Line Readmission Avoidance Program Hearing and vision reimbursements Aetna Compassionate Care. SM

Voluntary visits with a health care professional • Home Safety Assessment - Talks about safety in your home What is a Healthy Home Visit? • Medication review • Care advocacy resources and support programs – Offered if helpful for you • Activity and independence assessment • Holistic health screening • Shares results with your doctor Proprietary

Note to design: Landing page has option to play these 2 videos: “What to expect if you’re turning 65 this year” or “What to expect if you’re a 2021 Horizon transition participant” How to learn more about Medicare: SONJ. Aetna. Medicare. com Proprietary

Explore our website – SONJ. Aetna. Medicare. com Call our dedicated customer service team 1 -866 -234 -3129 (TTY: 711) 31 Proprietary

SONJ. Aetna. Medicare. com website Proprietary

Questions? Aetna Member Services 1 -866 -234 -3129 (TTY: 711) Monday through Friday, 8 AM to 9 PM ET. SONJ. Aetna. Medicare. com Proprietary

Aetna Medicare is a HMO, PPO plan with a Medicare contract. Enrollment in our plans depends on contract renewal. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area. For accommodation of persons with special needs at meetings, call 1 -800 -307 -4830 (TTY: 711). Out-of-network/non-contracted providers are under no obligation to treat Aetna members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. The <formulary, provider and/or pharmacy network> may change at any time. You will receive notice when necessary. “Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. Y 0001_GRP_6013_3131_2021_M 72. 25. 382. 1 Proprietary

Thank you Proprietary

SHBP Prescription Plan Optum. Rx manages the SHBP prescription plans. The following information will help guide you before and after your transition into the State Health Benefits Prescription plan Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

Important Information The following boxes contain important information to help guide your transition into the State Health Benefits Plan (SHBP) Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

Research your benefit The information contained in this slide will help you prepare for your upcoming benefit transition. The website listed is where you can research and find out about coverage under your new plan before your plan’s effective date. You can search for in-network pharmacies, check for drug coverage and pricing, and determine if a medication has any special requirements, such as priorauthorization (pre-approval), step therapy, or specialty pharmacy. Research and planning will help aid your transition to SHBP benefits Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

Website When performing your research pretransition, you will select from one of the two highlighted retiree links, depending on your Medicare status. Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

Research You will be able to find: In-network pharmacies Approved compounding pharmacies Drug coverage and requirements Drug pricing Additional information Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

SHBP PRESCRIPTION PLAN – Non Medicare Retirees Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

What is “Member pays the difference” ? • When a member chooses the brand name drug over its own generic equivalents, the member pays the applicable copay plus the cost difference between the brand drug and the generic drug. • The “member pays the difference” charge does not count towards the member’s out of pocket maximums. • Members who require a brand name medication over its own generic for a documented medical reason can request a determination of medical necessity. If it is determined that the brand is medically necessary, the member pays the difference charge would be removed and the applicable copay would remain. • For brand name medications without a generic, member pays difference does not apply. Standard formulary rules and coverage would apply Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

SHBP PRESCRIPTION PLAN – Medicare Eligible Member pays the difference does not apply to Medicare Members. You will pay the appropriate copay for the medication you choose. There is no “member pays the difference” on Medicare” Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

SHBP Prescription Drug List and Drug Pricing Search Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

SHBP PRESCRIPTION PLAN – Medicare Eligible Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

Important Information MEDICARE Members The following boxes contain important information to help guide your transition into the State Health Benefits Plan (SHBP) Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

SHBP PRESCRIPTION PLAN – Medicare Eligible Member pays the difference does not apply to Medicare Members. You will pay the appropriate copay for the medication you choose. There is no “member pays the difference” on Medicare” Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

SHBP Prescription Drug List and Drug Pricing Search Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

SHBP Maintenance Prescriptions from Optum. Rx Home Delivery You can use the drug pricing tools to compare your out of pocket costs at various pharmacies, both retail and Home delivery. Your maintenance medications may cost less, sometimes significantly less for a 90 day supply of your maintenance medications when filled thru Optum. Rx Home Delivery Use the pricing tools to lower your out of pocket costs. Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

Receiving your Prescription Id card You will receive ID cards from both Horizon Blue Cross for medical and Optum. Rx for prescription They will come in separate envelopes and most likely on separate days Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

What do I need to do for my benefit effective date ? For Members who use a local retail pharmacy: Before you fill your first prescription show the pharmacy your new prescription card and let them know this will be your new benefit starting on your plans effective date. Also let them know who else is covered by your new plan so they can update everyone's prescription benefits. Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

After your effective date, whether you have a new prescription or need to transfer an existing one, it’s easy to get started with Optum. Rx. Here’s how: e. Prescribe Ask your doctor to send an electronic prescription to Optum. Rx. Discover the convenience of home delivery from Optum. Rx. Online Visit optumrx. com and select Get Started or use the Optum. Rx app. From there, you can fill new prescriptions, transfer others to home delivery and more. Phone Call 1 -844 -368 -8740 to speak to a customer service advocate. Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

Register online once your plan is effective www. optumrx. com • Website features and tools • Set up your online account at optumrx. com and: • • Compare medication prices at different pharmacies. • • Locate a network pharmacy. • • Manage medication for covered dependents and spouses. • • View real-time benefits and claims history. • If you use home delivery, you can: • • Transfer retail prescriptions to home delivery. • • Track orders. • • Refill home delivery prescriptions. • You can save time, money and improve your health • • Save time — Skip the pharmacy line. Order medications you take regularly online and make fewer trips to the pharmacy. • • Save money — Get 3 -month supplies and you could pay less. Orders are sent using free standard shipping. Optum. Rx app Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

Summary – Non Medicare • Prior to your effective date, research your new benefits • Check drug coverage • Register for online access • Setup up your home delivery prescriptions and account • Find a network pharmacy Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

Summary - Medicare • Prior to your effective date, research your new benefits • Check drug coverage • Register for online access • Setup up your home delivery prescriptions and account • Find a network pharmacy Presented by William Bukwich-Optum. Rx Copyright 2020 Optum. Rx Any use, copying, change, or distribution without written permission from Optum. Rx is prohibited.

SHBP Retiree DENTAL PLANS presented by Meghan Presutti, Horizon BCBSNJ Horizon Dental Choice Plan available

Retiree Dental Expense Plan (RDEP/PPO) In and Out of network coverage Proprietary

Retiree Dental Plan Organization (RDPODMO) In Network Plan Only – Need Referrals for Specialist Choose a Primary Care Dentist Proprietary Benefit Tier 1 Tier 2 Tier 3 Deductible None Coverage Diagnostic & Preventive benefits only Diagnostic, Preventive, and Preventive, Restorative only Restorative and Major services Annual Maximum None

Aetna Website - Aetna. State. NJ. com Proprietary

Find a DoctorDentist Welcome to the online provider directory designed specifically for you, the State of New Jersey employees, retirees and members. This site provides easy access to lists of Aetna participating medical and dental providers for the plans offered by SHBP and SEHBP. Select Plan Proprietary

Find a Dentist Write the primary Care ID on the enrollment form for the DPODMO in network plan Proprietary

Aetna Discount Programs • Vision – Frames, contact lenses, sunglasses, and LASIK eye surgery • Fitness – Gym memberships, home fitness products, and fitness plans, visit Globalfit. com/fitness or call 1 -800 -298 -7800 • Hearing – Hearing aids, batteries, repairs and other hearing aid services For more information call 1 -877 -STATENJ (1 -877 -782 -8365) or visit our website Aetna. State. NJ. com Proprietary

REMINDERS Please submit your fully completed forms and documentation directly to the Division of Pension and Benefits at the address below by October 5 th to ensure you receive ID cards and have eligibility in our plans by November 1 st. Resources: Horizon Blue Cross Blue Shield 800 -414 -7427 Horizon. Blue. com/SHBP Aetna Medicare Advantage 866 -234 -3129 SONJ. Aetna. Medicare. com Optum. Rx (Rx) non-Medicare 844 -368 -8740 Optum. Rx. com/Stateof. New. Jersey Optum. Rx (Rx) Medicare 844 -368 -8765 Optum. Rx. com/Stateof. New. Jersey Aetna Dental Plans 877 -782 -8365 Aetna. State. NJ. com Horizon Dental Choice 800 -433 -6825 NJ Division of Pensions and Benefits Horizon. Blue. com/SHBP PO Box 299, Trenton, NJ 08625 www. nj. gov/treasury/pensions/hb-info-retired. shtml