ASEA UNION HEALTHCARE TRUST VS. UNIVERSITY OF ALASKA PLAN. T O O L S September 10, 2010

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1 HEALTHCARE PLAN COMPARISON: ASEA UNION HEALTHCARE TRUST VS. UNIVERSITY OF ALASKA PLAN T R E N D S A N A L Y S I S T O O L S September 10, 2010 S T A T I S T I C S P L A N N I N G T R E N D S A N A L Y S I S S T A T I S T I C S P L A N N I N G T O O L S

2 This review has been undertaken to provide a comparison between s health care plans and the ASEA Union s plans in place for the General Government Unit (GGU). Members of the GGU are employees of the State of Alaska and are represented by ASEA. Observations Holistically, the University of Alaska () medical plans provide richer benefits than the ASEA Union plans. Differences between the ASEA Union plans and s health plans: ASEA Union plans do not offer Pharmacy co-pays, so members pay a percent of the cost up to a fixed dollar limit ASEA Union plans have an Unlimited Lifetime Maximum benefit. s plan will have an Unlimited Lifetime Maximum beginning 7/1/2011 ASEA Union Plan C is a supplemental plan for employees with other coverage This plan pays as a secondary plan to coverage additional out of pocket amounts from a primary coverage plan Plan reimbursement is limited it to $10, per year Union Plan D is a catastrophic medical plan with no coverage for dental or vision Other than preventive care, no coverage provided for the first: 1. $5,000 of expenses for an individual 2. $10,000 of expenses for a family After the above-mentioned expenses have been met, the plan pays 100% of expenses for remainder of plan year 2

3 The ASEA Health Trust offers four health plan options: Plan A / Full Plan for Employees and Families offers medical, dental, vision, audio and prescription drug benefits. 2009/2010 Monthly Full-time Employee Contribution: $ Plan B / Full Plan for Employees Only is identical to Plan A, but covers the employee only. 2009/2010 Monthly Full-time Employee Contribution: $ Plan C / Supplemental Plan provides 20% medical, audio and prescription drug coverage, as well as the same dental and vision benefits as Plan A. This plan is designed to coordinate with other health plan coverage you and your family may have. 2009/2010 Monthly Full-time Employee Contribution: $ Plan D / Low Option Plan for Employees and Families offers medical, audio and prescription drug coverage after you satisfy a high deductible. Plan D does not include dental or vision benefits. 2009/2010 Monthly Full-time Employee Contribution: $

4 The University of Alaska Choice Plans offers three health plan options and an opt-out out option: Deluxe Plan / Full Plan for Employees and Families offers medical, dental, vision, audio and prescription drug benefits. 2010/2011 Monthly Part-time or Full-time Employee Single coverage: $ /2011 Monthly Part-time or Full-time Employee Family coverage: $ Standard Plan / Full Plan for Employees and Families offers medical, dental, vision, audio and prescription drug benefits. 2010/2011 Monthly Part-time or Full-time Employee Single coverage: $ /2011 Monthly Part-time time or Full-time Employee Family coverage: $ Economy Plan / Full Plan for Employees and Families offers medical, dental, vision, audio and prescription drug benefits. 2010/2011 Monthly Part-time time or Full-time Employee Single coverage: $ /2011 Monthly Part-time or Full-time Employee Family coverage: $91.17 The ability to opt-out of coverage if the employee has other health coverage. 4

5 Medical Plan Comparison Plan Type Economy Plan Standard Plan Deluxe Plan A & B Plan C Plan D Individual Deductible $500 $250 $100 $250 None $5,000 Family Deductible $1,500 $600 $300 $500 None $10,000 Coinsurance - In-Network 80% 80% 80% 80% 20% 100% Individual Out of Pocket (excludes ded) $3,000 $750 $400 $1,000 N/A None Family Out of Pocket (excludes ded) $6,000 $1,500 $800 $2,000 N/A None Lifetime Maximum Benefit $2,000,000 $2,000,000 $2,000,000 Unlimited $10, per yr Unlimited Preventive Care Benefit $750 per year $750 per year $750 per year $350 per year -- $350 per year Primary Care Physician Copayment 80% after Ded 80% after Ded 80% after Ded 80% after ded. 20% 100% after ded. Specialist Copayment 80% after Ded 80% after Ded 80% after Ded 80% after ded. 20% 100% after ded. Emergency Room Copayment 80% after Ded 80% after Ded 80% after Ded 80% after ded. 20% 100% after ded. Inpatient Copay None None None None None None Retail Rx Generic $5 $5 $5 20% to $50 20% 100% after ded. Preferred $25 $25 $25 20% to $50 20% 100% after ded. Non-Preferred $40 $40 $40 20% to $50 20% 100% after ded. Annual OOP Rx Maximum $1,000 $1,000 $1,000 $500 N/A N/A Monthly Employee Contributions Employee $32.92 $93.00 $ $100 $30 $35 Employee + Spouse $65.83 $ $ Employee + Child(ren) $59.25 $ $ EE + Family $92.17 $ $ $ Note: ASEA Union plans require preauthorization for inpatient confinements and specified procedures. 5

6 Pre-Authorization Penalties University of Alaska Pre-Authorization is not required and there are no penalties ASEA Union If you fail to preauthorize and the Plan determines the services are not Medically Necessary, then the plan pays nothing. If you fail to preauthorize and the Plan determines the services are Medically Necessary, the following penalties will apply: Hospital or treatment facilities (other than for mental health services) the first $400 of Allowable Expenses will not be paid. Skilled nursing facilities the first $200 of Allowable Expenses will not be paid. Outpatient procedures (other than for mental health services) the first $200 of Allowable Expenses will not be paid. 50% of Allowable Expenses. Outpatient mental health services the Plan s reimbursement will be limited to 50% of Allowable Expenses, and the Plan will limit the covered services to 30 visits per benefit year. Inpatient and outpatient chemical dependency services the first $400 of hospital or treatment facility Allowable Expenses will not be paid and the first $200 of outpatient Allowable Expenses will not be paid. Benefits will be limited to $11,350 benefit every 2 consecutive benefit years and $22,700 for the participant s lifetime. 6

7 ASEA Union Pre-Authorization List (Not required on current University of Alaska plans) ASEA Union plans require pre-authorization for the following: Confinement in a hospital, treatment t t facility, or skilled nursing facility Outpatient psychiatric and chemical dependency treatment in excess of 5 visits The following procedures: Bunionectomy - surgical removal of bunions Carpal tunnel release - surgery of wrist nerve Colonoscopy - scope exam of large intestine (when done with upper GI Endoscopy) Hospital admission for lower back pain Hysterectomy - surgical removal of the uterus Knee Arthroscopy -scope inserted through surgical opening in knee joint for diagnosis and/or treatment Laminectomy - surgical removal of thin vertebral plate MRI-knee - study of the knee using magnetic resonance imagingtechnology MRI-spine - study of the spine, including the neck, using magneticresonance imaging technology Pelvic Laparoscopy - scope exam of abdomen inserted through small surgical opening for diagnosis or treatment t t of pelvic problems Tympanotomy tube insertion - tubes surgically inserted in ears Upper GI Endoscopy - scope exam of esophagus, stomach, and small intestines (when done with Colonoscopy) Hyperbaric Oxygen Therapy Treatment - oxygen is administered while placed in a pressurized chamber Surgical Treatment of Obesity. University of Alaska Plans Pre-Authorization is not required and there are no penalties 7

8 Dental Plan Comparison Plan Type Economy Plan Standard Plan Deluxe Plan A & B Plan C Plan D Calendar Year Maximum $2,000 $2,000 $2,000 $2,000 $2,000 Not Covered Individual Deductible - Per Member $50 $25 $0 $25 $25 N/A Coinsurance Pe Preventive enti ecae Care 80% 100% 100% 100% 100% N/A Basic Care 80% subj to Ded 80% subj to Ded 80% 85% 85% N/A Major Care 50% subj to Ded 50% subj to Ded 50% 50% 50% N/A Orthodontia Orthodontic Care Not Covered Not Covered 50% Not Covered Not Covered N/A Individual Lifetime Maximum Not Covered Not Covered $1,500 Not Covered Not Covered N/A Monthly Employee Contributions Employee Included in Med Included in Med Included in Med Included in Med Included in Med N/A Employee + Spouse Included in Med Included in Med Included in Med Included in Med Included in Med N/A Employee + Child(ren) Included in Med Included in Med Included in Med Included in Med Included in Med N/A EE + Family Included in Med Included in Med Included in Med Included in Med Included in Med N/A 8

9 Vision Plan Comparison Plan Type Copays / Allowance All Plans Plan A & B Plan C Plan D Exams $10 Copay $110 Max Benefit $110 Max Benefit Not Covered Lenses / Frames Copay $25 None None N/A Lense Allowance Covered in Full $150 $150 Frame Allowance $120 $125 $125 N/A Frequency Allowance 24 Months 24 Months 24 Months N/A Contact Lenses Copay None None None N/A Contact Allowance $120 $170 $170 N/A Frequency Allowance 24 Months 12 Months 12 Months N/A Monthly Employee Contributions Employee Included in Med Included in Med Included in Med N/A Employee + Spouse Included in Med Included in Med Included in Med N/A Employee + Child(ren) Included in Med Included in Med Included in Med N/A EE + Family Included in Med Included in Med Included in Med N/A 9

10 Differences Between (Premera) and ASEA Union (Beechstreet) Network Providers ANCHORAGE FAIRBANKS JUNEAU Premera Beechstreet Premera Beechstreet Premera Beechstreet General Physician Pediatrician OBGYN Internist Dermatologist Orthopedic In-Network Providers Treatment t provider who is in-network can not charge amounts in excess of an allowable charge established by the health care administrator (Premera or Beechstreet) Providers cannot balance-bill members (charge employees above the allowable charge) By using network providers, employees receive a higher benefit level from the plan Out-of-Network Providers Treatment provider who is out of network may balance-bill members for amounts over the allowable charge If network providers are not used or are not available, employees receive a lower benefit level from the plan In each main campus location, University of Alaska s healthcare plan provides more in-network providers than the ASEA plan. 10

11 Comparison of In-Network Status of Hospitals in Alaska Beech Street Premera ASEA Univ. of Alaska Anchorage, AK Alaska Native Medical Center Yes Yes Alaska Regional Hospital Yes No Providence Alaska Medical Center Yes Yes Mat Su Valley Regional Medical Center Yes Yes St Elias Specialty Hospital No Yes Fairbanks, AK Fairbanks Memorial Hospital Yes Yes Juneau, AK Bartlett Regional Hospital No Yes 21 Hospitals in Alaska are in the -Premera network, compared to only 12 in the ASEA- Beechstreet network. Juneau Recovery Hospital No Yes Dillingham, AK Kanakanak Hospital No Yes Ketchikan, AK Ketchikan General Hospital No Yes Kotzebue, AK Maniilaq Health Center Yes Yes Sitka Mount Edgecumbe Hospital No Yes Sitka Community Hospital No Yes Sitka Medical Center No Yes Kodiak Providence Kodiak Island Medical Center Yes Yes Barrow Samuel Simmonds Memorial Hospital No No Bethel Yukon Kuskokwim Delta Regional Hospital No No Yukon Kuskokwim Health Center No No Nome Norton Sound Regional Hospital No Yes Other Providence Valdez Medical Center Yes Yes Providence Seward Medical Center Yes Yes Cordova Community Medical Center Yes Yes Wrangell Medical Center No Yes South Peninsula Hospital Yes Yes Central Peninsula Hospital Yes Yes 11

12 For additional Information ASEA 51#BPOverviewCost University of Alaska edu/benefits/health-plan/ 12