2015 RETIREE BENEFITS BULLETIN

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1 BENEFITS BULLETIN 2015 RETIREE BENEFITS BULLETIN This bulletin describes benefit changes and coverage provisions effective Jan. 1, This bulletin updates the complete summary of coverage described in the Summary Plan Descriptions and related Benefits Bulletins. After you ve reviewed the information, decide if you need to make a change in your health care or life insurance coverage. Submit the enrollment form only if you are making a change in the coverage shown on your personalized annual enrollment forms. Questions about coverage? For questions about coverage for specific conditions or particular prescription drugs, see the 2015 Retiree Annual Enrollment Guide for contact information Nationwide, Nationwide is on your side and the Nationwide N and Eagle are service marks of Nationwide Mutual Insurance Company. 1

2 IN THIS BENEFITS BULLETIN: Medicare-Eligible Retiree Coverage 3 Medical Coverage Options 3 Prescription Drug Coverage Options 3 Change in Contributions 3 Non-Medicare-Eligible Retiree Coverage 5 PPO Basic Option No Longer Available 5 Health Care Coverage and Options 5 Change in Contributions 6 Health Savings Account (HSA) Contribution Limit Changes 6 Supplemental Accident Claims Administrator 6 All Retirees 7 Life Insurance Contribution Increase 7 Household Members Benefits Changes 7 Health Care Reform 8 2

3 MEDICARE-ELIGIBLE RETIREE COVERAGE You must be enrolled in both Medicare Parts A and B and pay any required Part B premium to enroll in a Nationwide-offered health care option. Medical Coverage Options For 2015 the coverage options offered through UnitedHealthcare (UHC) continue: 1. UnitedHealthcare Group Medicare Advantage (PPO) Plan 2. UnitedHealthcare Senior Supplement Insurance Plan F (Plan F) 3. UnitedHealthcare Senior Supplement Insurance Plan K (Plan K) For 2015, the only change in medical coverage under the UnitedHealthcare Group Advantage (PPO) Plan, is that coverage under Skilled Nursing Facility has expanded the $0 per day copay to include the first 20 days. See the summary of the plan provisions for each of the available options in your 2015 Medicare Options Booklet. We will continue to offer retirees the opportunity to waive Nationwide-offered coverage to enroll in an Individual Medicare Advantage Plan and, if eligible for cost-sharing, to receive a $70 credit per month into a Health Reimbursement Account (HRA). For a complete summary of the plan provisions for each of the available options, please refer to your 2015 Medicare Options Booklet. Refer to your personalized enrollment form for the coverage options that apply to you. You will automatically remain in your current coverage option if no action is taken. You do not need to take any action if you are satisfied with the coverage option you are currently enrolled in. You will need to complete an enrollment form during annual enrollment only if you wish to change your election(s). Prescription Drug Coverage Options Nationwide continues to offer two prescription drug plans (PDPs) for Medicare-eligible individuals: 1. UnitedHealthcare MedicareRx for Groups Option 1 2. UnitedHealthcare MedicareRx for Groups Option 2 For 2015, the only change in prescription drug coverage is that coverage is updated to reflect the 2015 Medicare Part D coverage limits. For a complete summary of the plan provisions for each of the available options, please refer to your 2015 Medicare Options Booklet. Refer to your personalized enrollment form for the enrollment options that apply to you. You will automatically remain in your current coverage option if no action is taken. You will need to complete an enrollment form during annual enrollment if you wish to change your election(s). Change In Contributions The medical and prescription drug option costs will increase starting in January The changes reflect the claims experience of the Nationwide group options and the expected increase in the price of prescription drugs and medical services. 3

4 Medical Option Costs The total cost of the medical options will increase in Refer to your personalized annual enrollment form for the contribution that applies to you, based on your cost-sharing level. The chart below shows the total monthly cost - before any company cost-sharing - for a member in 2015, compared to The amount that you contribute depends on your individual cost-sharing and who you elect to cover. TOTAL MONTHLY COST 2014 PER MEMBER PER MONTH 2015 PER MEMBER PER MONTH UNITEDHEALTHCARE GROUP MEDICARE ADVANTAGE (PPO) PLAN UNITEDHEALTHCARE SENIOR SUPPLEMENT PLAN K UNITEDHEALTHCARE SENIOR SUPPLEMENT PLAN F $82.94 $87.09 $ $ $ $ Prescription Drug Plan (PDP) Costs If you elect one of the UHC PDPs, each Medicare-eligible individual enrolled in coverage will receive a bill (coupon booklet) directly from UHC. The cost for prescription drug coverage will increase in TOTAL MONTHLY COST * 2014 PER MEMBER PER MONTH 2015 PER MEMBER PER MONTH UNITEDHEALTHCARE MEDICARE Rx FOR GROUPS OPTION 1 UNITEDHEALTHCARE MEDICARE Rx FOR GROUPS OPTION 2 $79.90 ($44.90 if eligible for credit) $55.81 ($20.81 if eligible for credit) $89.49 ($54.49 if eligible for credit) $62.51 ($27.51) if eligible for credit) *If you are eligible for cost-sharing and enroll in a health care option, you continue to be eligible for the $35 monthly credit for prescription drug coverage. 4

5 NON-MEDICARE-ELIGIBLE RETIREE COVERAGE The health care coverage options available in 2015 have changed. In all locations, you have the choice of the PPO Premium option and two Health Savings Choice (HSC) options - HSC1 and HSC2. All available options are administered by UnitedHealthcare (UHC). The options you are eligible for will automatically be displayed during the annual enrollment process as part of your personalized enrollment forms. PPO Basic Option No Longer Available The PPO Basic option, administered by Anthem, is no longer offered in When making this decision, Nationwide reviewed the networks carefully and believe that very few members will need to select a new doctor in order to remain in-network. Check the UHC website at welcometouhc.com/nationwide or call them at to make sure your provider is in the UHC network. If your doctor isn t in the network, you may want to select a new doctor who is in the UHC network to avoid higher out-of-network costs. Claims incurred through the end of 2014 will be processed by Anthem. Claims incurred on or after Jan. 1, 2015 will be handled by UHC, if you do not waive medical coverage. If you or one of your covered dependents are currently enrolled in the PPO Basic option and do not make another election during annual enrollment, you or your covered dependent will automatically be enrolled in the PPO Premium option beginning Jan. 1, If you are enrolled in health care coverage for 2015, you ll receive a new UHC identification card in late December/early January be sure to inform your providers of this change and use your new identification card for any 2015 services. Health Care Options and Coverage There is no change to the PPO Premium or HSC1 coverage options. A second high deductible health care plan option, HSC2 is added as a new option for non-medicare-eligible retirees and dependents in 2015 and is administered by UHC. The HSC2 coverage is the same as HSC1 except it offers a higher annual deductible and out-of-pocket expense limit. As with HSC1, you are eligible to contribute to a Health Savings Account (HSA). The chart below shows a comparison of 2015 coverage between the two HSC options - all other HSC coverage provisions are the same for both options. In-Network Out-Of-Network HSC1 Single/Family Single/Family Annual Deductible $1,500/$3,000 $3,100/$6,200 Annual Out-of-Pocket Maximum $5,000/$10,000 $6,600/$13,200 HSC2 Annual Deductible $3,000/$6,000 $6,000/$12,000 Annual Out-of-Pocket Maximum $6,200/$12,400 $8,700/$17,400 HSC2 offers a lower contribution and may be best if you, for example, expect little or no health care expenses or, if you have an accumulated balance in your HSA to cover your health care expenses. In general, when comparing HSC1 and HSC2 coverage, HSC2 may provide a favorable financial benefit if you have in-network expenses less than $2,025 for single coverage and less than $4,050 for retiree & spouse coverage. Medical Necessity guidelines and Prior Authorization requirements and processes are revised for Services are subject to review based on evidence-based medicine to ensure coverage is both appropriate and cost-effective. Prior authorization will be required for many types of services including radiology and certain surgical services. Generally, in-network providers are responsible for obtaining prior approval. Network providers cannot bill you for services they fail to obtain prior approval when required. The member is responsible for obtaining prior approval if using an out-of-network provider For a complete summary of the plan provisions for each of the available options, please refer to your2015 Non-Medicare-Eligible Options Booklet. 5

6 Changes In Contributions Health care costs continue to increase. Consistent with national trends, based on an actuarial analysis of our health care plan(s) experience, an increase in funding is required in 2015 due to increased claims and expected medical inflation. The chart below shows the total monthly cost prior to any company cost-sharing: PPO PREMIUM RETIREE ONLY $700 $750 RETIREE & SPOUSE $1,400 $1,500 RETIREE & CHILD(REN) $1,400 $1,500 FULL FAMILY $2,100 $2,250 HSC1 RETIREE ONLY $535 $560 RETIREE & SPOUSE $1,070 $1,120 RETIREE & CHILD(REN) $1,070 $1,120 FULL FAMILY $1,605 $1,680 HSC2 RETIREE ONLY N/A $525 RETIREE & SPOUSE N/A $1,050 RETIREE & CHILD(REN) N/A $1,050 FULL FAMILY N/A $1,575 Your cost as a retiree varies depending on your eligibility for and amount of company cost-sharing. Refer to your annual enrollment form for the contribution that applies to you. Be sure to evaluate all of your options to ensure you are making the best financial decisions for you and your family. Health Savings Account (HSA) Contribution Limit Changes If you enroll in a HSC option, and you meet the IRS other criteria, you have the opportunity to set aside pre-tax money in the Nationwide-offered HSA. The money set aside can be used tax-free to meet your deductibles, co-pays and other out-of-pocket qualified medical, dental and vision expenses. Any balance you have at the end of the year rolls over, so you can use it to pay qualified health care expenses in future years. It s yours to keep, plus, the balance can grow over time and you can choose the investment options that best fit your financial needs. The tax-code maximum contribution for 2015 has increased. As a result, the maximum amount you can contribute is $3,350 for an individual and $6,650 for a family. If you are already age 55 or older you can make an additional catch-up contribution of $1,000. Supplemental Accident Claims Administrator You automatically receive company-paid Supplemental Accident coverage when you are enrolled in the HSC1 or HSC2 health care option. The Claims Administrator for Supplemental Accident has changed. Claims for benefits or appeals should be sent to: NATIONWIDE EMPLOYEE BENEFITS PO BOX 420 SPRINGFIELD, MA FAX:

7 ALL RETIREES Life Insurance Contribution Increase Based on claims experience, the contributions for retiree life insurance will increase in The chart below shows the new contribution rates. Age*: (Monthly Rate Per $1,000 of coverage) 2014 Coverage Amounts 2015 Coverage Amounts $10,000 and under Over $10,000 $10,000 and under Over $10, $.43 $.43 $.50 $ $.50 $.66 $.58 $ $.50 $1.27 $.58 $ $.50 $2.06 $.58 $2.37 *Based on age as of the end of the calendar year. For example, if you are age 72 in 2015 and have $10,000 of retiree life insurance coverage, your monthly contribution will increase from $4.30 to $5.00; if $20,000 of coverage, your contribution will increase from $25.60 to $ We expect that retiree life contribution rates will continue to increase in future years. You may elect to decrease the amount of your life insurance coverage at any time. Household Member Benefits Changes Changes to the eligibility for Household Member coverage are effective for Refer to the Household Member Benefits Bulletin included with your annual enrollment kit for a description of those changes. Only currently enrolled Household members may continue coverage, if they meet the new eligibility requirements. Here s what s changing in the coverage and contributions for 2015: All coverage changes to the health care options described under non-medicare-eligible retiree coverage of this bulletin will also apply to Household Member Coverage. For Medicare-eligible Household Members, changes to the health care options described under Medicareeligible retiree coverage of this bulletin will apply. In 2015, there will be changes to the contributions for non-medicare-eligible and Medicare-eligible Household Member health care coverage. The following rates apply if you are eligible for company cost-sharing: PLAN 2014 CONTRIBUTION ON MONTHLY BASIS 2015 CONTRIBUTION ON MONTHLY BASIS PPO PREMIUM $ $ HSC1 $82.33 $ HSC2 N/A $ UNITEDHEALTHCARE GROUP MEDICARE ADVANTAGE (PPO) PLAN UNITEDHEALTHCARE SENIOR SUPPLEMENT PLAN F UNITEDHEALTHCARE SENIOR SUPPLEMENT PLAN K UNITEDHEALTHCARE MEDICARE Rx FOR GROUPS OPTION 1 UNITEDHEALTHCARE MEDICARE Rx FOR GROUPS OPTION 2 $23.22 $30.48 $ $ $51.99 $61.80 $79.90 (BILLED BY UHC) $89.49 (BILLED BY UHC) $55.81 $62.51 (BILLED BY UHC) If you are not eligible for company cost-sharing, you pay the entire cost of coverage. Please note: Elections for Household Members do not default into the prior year s coverage. You must actively re-enroll Household Members during annual enrollment. If you currently have a Household Member 7

8 enrolled and did not receive the 2015 Household Member Enrollment Packet in your enrollment packet, you can call the ASC at Health Care Reform In 2010, the Patient Protection and Affordable Care Act, commonly referred to as health care reform, was first enacted with a number of key mandates. As previously communicated, beginning in 2014, all individuals must have minimum essential health care coverage or pay a penalty. Coverage through Medicare or employer-offered coverage that meets the minimum essential requirements will satisfy the individual coverage requirement. Enrollment in a Nationwide-offered health care option meets the requirement of health care coverage. Alternatively, individuals who are not eligible for Medicare may purchase coverage through federal or state health insurance exchanges, called the Health Insurance Marketplace (the Marketplace). You can visit healthcare.gov, the official government website for information and updates on health care reform and the Marketplace or call Health Advocate is also available to answer questions at Questions about Enrollment or these Changes? If you have questions about the changes explained in this bulletin, the coverages you will be automatically enrolled in for 2015, need help deciding which options are right for you or help filling out the annual enrollment forms during the annual enrollment period, call Health Advocate at Select option 3 and tell the customer service representative you re a Nationwide retiree (or related to a Nationwide retiree) with questions about annual enrollment. Enrollment advocates are available weekdays 8 a.m. to 9 p.m. ET. You can also call the ASC at or This bulletin describes benefit changes that take effect January 1, 2015 (except where otherwise indicated). It also updates the complete summary of coverage as described in the Summary Plan Descriptions and the health care Schedule of Benefits. For options and contribution amounts specific to you, refer to your personalized annual enrollment information. 8

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