EXHIBIT_A_2018_2019_MED_RX_BH_PLAN_DESIGN_RECOMMENDATIONS_11_13_2017.DOCX
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Exhibit A Medical Plans Proposed changes to the Cigna HMO are as follows: Increase the Out-Patient Facility Copay. o From $125 after Deductible to $150 after Deductible Reduce the Out-Patient member cost share for Major Diagnostic Imaging (MRI, CT, PET scans, etc). o From $100 Copay per scan after Deductible to covered at 100% after Deductible Reduce the member cost share for Durable Medical Equipment. o From $75 Copay per item per month to covered at 100% Change the member cost share for Allergy Injections. o From $13/$28 for injection to $30 Copay Change Home Health Visit Limit. o From unlimited visits to 100 visit limit per plan year Expand coverage for Autism. o From ABA therapy with limits to ABA therapy with no age or visit limits Change coverage for PSA Tests. o From covered as preventive to covered as diagnostic (with employee cost share) Proposed changes to the Cigna HDHP with H.S.A. are as follows: Change Home Health Visit Limit. o From unlimited visits to 100 visit limit per plan year Expand coverage for Autism. o From ABA therapy with limits to ABA therapy with no age or visit limits Change coverage for PSA Tests. o From covered as preventive to covered as diagnostic (with employee cost share) Increase the annual Health Savings Account Contribution Limits. o From $3,400 to $3,450 for Individual Coverage o From $6,750 to $6,900 for Family Coverage Proposed changes to the UnitedHealthcare PPO are as follows: Reduce the Out-Patient member cost share for Major Diagnostic Imaging (MRI, CT, PET scans, etc). o From $100 Copay per scan, plus 10% Coinsurance after Deductible to 10% Coinsurance after Deductible Increase the member cost share for Allergy Injections. o From $18/$33 for injection to $40 Copay Change Home Health Visit Limit. o From unlimited visits to 100 visit limit per plan year Expand coverage for Autism. o From ABA therapy with limits to ABA therapy with no age or visit limits Change coverage for PSA Tests. o From covered as preventive to covered as diagnostic (with employee cost share) Increase the Emergency Room Copay. o From $200 Copay to $250 Copay Implement a Preferred Copay Structure for Primary Care Physicians. o Tier 1 PCPs - $35 Copay o Non-Tier 1 PCPs - $45 Copay Increase Out-of-Network Urgent Care Center member cost share. o From covered at 100% after $75 Copay to 50% Coinsurance after Deductible Increase the In-Network Coinsurance. o From 10% Coinsurance after Deductible to 15% Coinsurance after Deductible Proposed changes to the UnitedHealthcare HDHP with H.S.A. are as follows: Change Home Health Visit Limit. o From unlimited visits to 100 visit limit per plan year Expand coverage for Autism. o From ABA therapy with limits to ABA therapy with no age or visit limits Change coverage for PSA Tests. o From covered as preventive to covered as diagnostic (with employee cost share) Increase the annual Health Savings Account Contribution Limits. o From $3,400 to $3,450 for Individual Coverage o From $6,750 to $6,900 for Family Coverage Prescription Plans Proposed changes to the OptumRx Co-Insurance Prescription Plan are as follows: Add a new tier, ‘Lower Cost Generics’ to existing plan structure; Copay is $4.00. Increase the tier maximums on existing plan structure. Generic - No Change Preferred Brand – No Change Non-Preferred Brand o Retail 30-day: from $120 to $200 maximum o Retail 90-day: from $360 to $600 maximum o Mail Order 90-day: from $300 to $500 maximum Specialty Value – No Change Specialty Preferred – No Change Specialty Non-Preferred – No Change Cover certain Generic Statins at zero cost share (age limits, prior authorizations, and other restrictions may apply). Proposed change to the OptumRx HDHP Prescription Plan is as follows: Implement “Generics Preferred” program whereas if a higher tier brand-name drug is dispensed instead of its generic equivalent, the member pays the difference in cost plus the normal coinsurance.