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1 GROUP MEDICARE PLANS GROUP MEDICARE PLANS AT A GLANCE FOR EMPLOYER GROUPS 2016 Toll-free ext TTY: 711 HealthAlliance.org

2 Coverage You Know and Trust If you ve worked with Health Alliance before, you know that member satisfaction is our top priority. We are constantly seeking to expand our network of providers and enhance our plan offerings. With our group Medicare plans, we have numerous stock options to choose from. We can also build custom plans for groups of 25 or more. Local, Personal Customer Service We provide local, personal customer service in the heart of Central Illinois. When members call, they ll speak with a friendly and knowledgeable Health Alliance Medicare representative in Champaign. Our local customer service representatives are available between 8 a.m. and 8 p.m., Monday through Friday. Large Provider Network When you choose Health Alliance Medicare for your retirees, you re giving them access to our ever-growing network of doctors, hospitals and other health care professionals who can provide top-notch care and services. Members can call us to request a provider directory or visit HealthAlliance.org. Formulary The Medicare Part D Formulary is a list of drugs covered by Health Alliance Medicare. Generally, we only cover drugs listed in the formulary. Visit HealthAlliance.org to view our formulary. Extras Health Alliance Medicare offers a host of extras at no extra cost to help members save money and get healthy. See the Extras section for more information.

3 About Our Group Medicare Plans Group Medicare Plans from Health Alliance Medicare can help you support your employees once they become Medicare primary eligible. This is the next step in benefit offerings. It will help you retain talent or show appreciation for those who gave you their best years. How it Works Employer Contribution toward Premium Employers can contribute anything from $0 to the full amount toward enrollee premiums. If retirees within the organization qualify for different levels of employer contribution, the employer can establish those levels. Billing Options Health Alliance Medicare can do a group bill or bill members individually. Dedicated Employer Group Client Consultant Employers have a single point of contact for any questions about group Medicare benefits. This representative can help with every aspect of your plan. Low-Income Subsidy Members may qualify for extra help from the federal government for paying their monthly premium and prescription drug copayments. If retirees qualify for assistance, the premium billed for those members will be reduced by the amount of assistance they receive. This can vary from member to member, and employers must pass the subsidy to the member s portion of the premium. State help may also be available. We Make it Easy Plans that Fit We work with you to find the plan that fits the needs of your organization. There are several stock plans to choose from, and we can custom-build a plan for groups of 25 or more. We also have plan options for employers with retirees who live outside Illinois. And all our plans help reduce FASB/GASB liabilities and expenditures. Less Paperwork We administer the plan, which means less paperwork for you. Member Materials We send plan materials, including an ID card and policy (called an Evidence of Coverage) to all new members and upon renewal. Members on a Medicare plan with pharmacy coverage receive a monthly Explanation of Benefits detailing monthly and year-to-date drug expenses. No Enrollment Lock-In Retirees can enroll in Health Alliance Medicare at any time during the year. They are not limited to the Annual Election Period imposed upon those on individual Medicare plans.. Eligibility Retirees, as well as employees with Medicare as primary, are eligible for group coverage. Underwriting isn t required. Members must continue to pay their Medicare Part B premium if not otherwise paid for under Medicare or by another third party. Medicare Supplement and Stand-Alone Prescription Drug Plans only Medicare Advantage HMO and PPO, Medicare Supplement and Stand-Alone Prescription Drug Plans Medicare Advantage PPO, Medicare Supplement and Stand-Alone Prescription Drug Plans Please note: If you have retirees who live outside Illinois, talk with your client consultant about coverage options.

4 Comprehensive Medicare Advantage Plans PPO The Numbers: 1. Five PPO Rx Plans (includes prescription coverage) 2. One PPO plan without Rx 3. $0 Tier 1 Preferred Generic Drugs at Walmart and Sam s Club (Rx plan members only) The Reasons: 1. Most benefit-rich plans 2. Pay less at the time of service 3. Ability to see out-of-network providers 4. No in-network deductible 5. Health and savings extras included 6. Can be sold to employers based in Illinois with at least 51% of eligible employees residing in Medicare Advantage-licensed counties Bonus Info: PPO Option 1, PPO Option 2 and PPO Option 3 all offer prescription drug benefits through the coverage gap. HMO The Numbers: 1. Two HMO Rx Plans (includes prescription coverage) 2. $0 Tier 1 Preferred Generic Drugs at Walmart and Sam s Club (Rx plan members only) The Reasons: 1. Most cost-effective 2. Members have one main doctor to manage their care 3. Access to Emergency and Urgent Care providers nationwide 4. No in-network deductible 5. Health and savings extras included 6. Can be sold to employers based in Illinois with at least 51% of eligible employees residing in Medicare Advantage-licensed counties Bonus Info: HMO Option 1 offers prescription drug benefits through the coverage gap. Help Members Bridge the Coverage Gap Retirees can t purchase prescription coverage through the coverage gap on their own. They can only get it through an employer plan. When you choose our PPO Option 1, PPO Option 2, HMO Option 1 or PDP Option 2, you ll give your retirees this key coverage. Drug Plans and Medicare Supplement Our most popular choice combines a PDP and a Medicare Supplement plan. Stand-Alone Prescription Drug Plans (PDP) Medicare Supplement plan The Numbers: 1. Two PDP options 2. $0 Tier 1 Preferred Generic Drugs at Walmart and Sam s Club (Rx plan members only) The Reasons: 1. Nation-wide prescription coverage 2. Can be paired with with a Medicare Supplement plan 3. Available to employers nationwide, and retirees may reside anywhere in the U.S. Bonus Info: PDP Option 2 offers prescription drug coverage through the coverage gap. + The Numbers: 1. Four coverage options The Reasons: 1. Ability to see any provider who accepts Medicare, without a referral 2. Most plans have no copayments 3. Can be paired with a stand-alone PDP 4. Employer group must have a domiciled location in Illinois, retirees may reside anywhere in the U.S. Bonus Info: Health Alliance Medicare Supplement members can get a discount at the pharmacy when they present their ID card.

5 Medicare Advantage PPO PPO Option 1 PPO Option 2 PPO Option 3 Monthly Premium $225 $288 $339 Medical Benefits In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network Plan Year Deductible $0 $200 $0 $200 $0 $200 Plan Year Out-of-Pocket Maximum $3,400 $5,100* $3,400 $5,100* $3,400 $5,100* total in- and out-of-network* Be Healthy Annual Physical and Preventive Services* $0 copayment $30 copayment $0 copayment $30 copayment $0 copayment $30 copayment Primary Care Office Visit $20 copayment $30 copayment $20 copayment $30 copayment $20 copayment $30 copayment Specialist Office Visit $30 copayment $40 copayment $30 copayment $40 copayment $30 copayment $40 copayment Laboratory Services and Diagnostic Tests $0 copayment $30 copayment $0 copayment $30 copayment $0 copayment $30 copayment Outpatient Surgery $150 copayment $200 copayment $150 copayment $200 copayment $150 copayment $200 copayment Inpatient Hospital Care Unlimited days each benefit period Skilled Nursing Facility (SNF) (in a Medicare-certified skilled nursing facility) Emergency Department Visits (Worldwide Coverage) Durable Medical Equipment and Prosthetic Devices $100 each day for days 1-8, $0 for each days 9 and beyond Days 1 20: $25 Days : $75 $200 each day for day(s) 1-8, $0 each day for days 9-60, $150 each day for day(s) Days 1 20: $25 Days : $125 $100 each day for days 1-8, $0 for each days 9 and beyond Days 1 20: $25 Days : $75 $200 each day for day(s) 1-8, $0 each day for days 9-60, $150 each day for day(s) Days 1 20: $25 Days : $125 $100 each day for days 1-8, $0 for each days 9 and beyond Days 1 20: $25 Days : $75 $200 each day for day(s) 1-8, $0 each day for days 9-60, $150 each day for day(s) Days 1 20: $25 Days : $125 $75 copayment $75 copayment $75 copayment $75 copayment $75 copayment $75 copayment 20% coinsurance 20% coinsurance 20% coinsurance 20% coinsurance 20% coinsurance 20% coinsurance Diabetic Test Strips and Blood Glucose Monitors $0 copayment 20% coinsurance $0 copayment 20% coinsurance $0 copayment 20% coinsurance Dental, Vision and Hearing (supplemental to Medicare) Prescription Drugs $0 Copayment; $100 limit for Supplemental Dental, Vision and Hearing Combined These plans do not have a pharmacy deductible. Tier 1-Preferred Generic at Walmart and Sam s Club $0 copayment Coverage for $0 copayment Coverage for $0 copayment Coverage for Tier 1 Preferred Generic Elsewhere $20 copayment other drugs $15 copayment other drugs $10 copayment other drugs is available is available is available Tier 2 Generic $40 copayment in special $30 copayment in special $20 copayment in special Tier 3 Preferred Brand $40 copayment circumstances. $30 copayment circumstances. $20 copayment circumstances. Tier 4 Non-Preferred Brand $100 copayment $100 copayment $100 copayment Tier 5 Specialty 25% coinsurance 25% coinsurance 25% coinsurance Prescription Drug Coverage continues through Medicare s Coverage Gap. Post-Coverage Gap After member s yearly out-of-pocket drug costs reach $4,850, member pays the greater of: $2.95 copay for Tier 1 and Tier 2 drugs and $7.40 copay for all other drugs, OR 5% coinsurance. *Immunizations, annual physical exam, mammograms, Pap smears, cancer screenings, and more. Age/frequency schedules apply.

6 Medicare Advantage PPO, continued PPO 10 Rx PPO 30 Rx PPO 30 Monthly Premium $144 $79 $45 Member Benefits In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network Plan Year Deductible $0 $0 $0 $0 $0 $0 Plan Year Out-of-Pocket Maximum $3,900 $5,500* $5,000 $10,000* $5,000 $10,000* total in- and out-of-network* Be Healthy Annual Physical and Preventive Services* $0 copayment $30 copayment $0 copayment $50 copayment $0 copayment $50 copayment Primary Care Office Visit $20 copayment $30 copayment $15 copayment $50 copayment $15 copayment $50 copayment Specialist Office Visit $30 copayment $40 copayment $45 copayment $50 copayment $45 copayment $50 copayment Laboratory Services and Diagnostic Tests $0 copayment $30 copayment $40 copayment $50 copayment $40 copayment $50 copayment Outpatient surgery $125 copayment $200 copayment $175 copayment $200 copayment $175 copayment $200 copayment Inpatient hospital care Days 1-10, $125 per day, Days 11 and beyond, $0 Days 1-8, $200, Days 9 and beyond, $0 Days 1-8, $200 per day, Days 9-60, $0, Days 61-90, $150 Days 1-8, $200 per day, Days 9-60, $0, Days 61-90, $150 Skilled Nursing Facility (SNF) (in a Medicare-certified skilled nursing facility) Emergency Department Visits (Worldwide Coverage) Durable Medical Equipment and Prosthetic Devices Days 1 20: $0 Days , $160 $75 copayment per visit Days 1 20: $75 Days , $200 $75 copayment per visit Days 1-8, $150 per day, Days 9-60, $0, Days 61-90, $100, Days 91+, $0 Days 1 20: $0 Days , $150 $75 copayment per visit Days 1 20: $200 Days , $400 $75 copayment per visit Days 1-8, $150 per day, Days 9-60, $0, Days 61-90, $100, Days 91+, $0 Days 1 20: $0 Days , $150 $75 copayment per visit Days 1 20: $200 Days , $400 $75 copayment per visit 20% coinsurance 20% coinsurance 20% coinsurance 20% coinsurance 20% coinsurance 20% coinsurance Diabetic Test Strips and Blood Glucose Monitors $0 copayment 20% coinsurance $0 copayment 20% coinsurance $0 copayment 20% coinsurance Dental, Vision and Hearing (supplemental to Medicare) $0 Copayment; $100 limit for Supplemental Dental, Vision and Hearing Combined Prescription Drugs (deductibles exclude Tier 1) $360 deductible $360 deductible Tier 1-Preferred Generic at Walmart and Sam s Club $0 copayment Coverage for other drugs Tier 1 Preferred Generic Elsewhere $14 copayment is available $15.50 copayment in special Tier 2 Generic $20 copayment $20 copayment circumstances. Tier 3 Preferred Brand $47 copayment $47 copayment Tier 4 Non-Preferred Brand $100 copayment $100 copayment Tier 5 Specialty Pharmacy 25% coinsurance 25% coinsurance Coverage Gap Post-Coverage Gap $0 copayment Coverage for other drugs is From $3,310 until member s annual drug costs reach $4,850 58% percent for generic drugs and 45% percent for brand-name drugs available in special circumstances. After member s yearly out-of-pocket drug costs reach $4,850, member pays the greater of: $2.95 copayment for Tier 1 and 2 drugs and $7.40 copayment for all other drugs, OR 5% coinsurance. This plan does not include prescription drug coverage. *Immunizations, annual physical exam, mammograms, Pap smears, cancer screenings, and more. Age/frequency schedules apply.

7 Medicare Advantage HMO HMO Option 1 HMO 20 Rx Monthly Premium $208 $119 Member Benefits In-Network Only In-Network Only Plan Year Deductible $0 $0 Plan Year Out-of-Pocket Maximum $3,400 $3,000 Be Healthy Annual Physical and Preventive Services* $0 copayment $0 copayment Primary Care Office Visit $20 copayment $20 copayment Specialist Office Visit $40 copayment $40 copayment Laboratory Services and Diagnostic Tests $0 copayment $0 copayment Outpatient Surgery $100 copayment $125 copayment Inpatient Hospital Care Unlimited days each benefit period Skilled Nursing Facility (SNF) (in a Medicare-certified skilled nursing facility) $100 each day for days 1-7, $0 each day for days 8 and beyond $100 each day for days 1-7, $0 each day for days 8-60, $50 each day for days 61-90, $0 for each day 91 and beyond $25 (1-20) / $125 (21-100) $25/Day (1-20) $125/Day (21-100) Emergency Department Visits (Worldwide Coverage) $75 copayment $75 copayment Durable Medical Equipment and 20% coinsurance 20% coinsurance Prosthetic Devices Diabetic Test Strips and Blood Glucose Monitors $0 copayment $0 copayment Dental, Vision and Hearing (supplemental $0 Copayment; $100 limit for Supplemental Dental, Vision and Hearing Combined to Medicare) Prescription Drugs (deductibles exclude Tier 1) $0 deductible $360 deductible Tier 1-Preferred Generic at Walmart and Sam s Club $0 copayment $0 copayment Tier 1 Preferred Generic Elsewhere $20 copayment $14.50 copayment Tier 2 Generic $40 copayment $20 copayment Tier 3 Preferred Brand $40 copayment $47 copayment Tier 4 Non-Preferred Brand $50 copayment $100 copayment Tier 5 Specialty Pharmacy $60 copayment 25% coinsurance Coverage Gap Post-Coverage Gap Prescription Drug Coverage continues through Medicare s Coverage Gap. From $3,310 until member s annual drug costs reach $4,850, member pays 58 percent of generic drugs and 45 percent for brand-name drugs. After member s yearly out-of-pocket drug costs reach $4,850, member pays the greater of: $2.95 copay for Tier 1 and Tier 2 drugs and $7.40 copay for all other drugs, OR 5% coinsurance. *Immunizations, annual physical exam, mammograms, Pap smears, cancer screenings, and more. Age/frequency schedules apply.

8 Stand-Alone Prescription Drug Plans Our most popular plans combine a PDP and a Medicare Supplement plan Prescription Drug Plan 1 Monthly Premium $62 Member Benefits Prescription Drugs from a retail pharmacy or through mail order until total drug costs (both the member s costs and the plan s costs) reach $3,310. Coverage Gap Post-Coverage Gap In-Network $0 deductible $0 for Tier 1 Preferred Generic at Walmart and Sam s Club $20 for Tier 1 Preferred Generic Elsewhere $47 for Tier 2 Generic $47 for Tier 3 Preferred Brand $100 for Tier 4 Non-Preferred Brand 25% for Tier 5 Specialty Pharmacy Out-of-Network Covered drugs are available in special circumstances, including illness and while traveling outside the plan s service area where there is no network pharmacy. Members may incur an additional cost. From $3,310 until member s annual drug costs reach $4,850. Member pays 58% for generic drugs and 45% for brand-name drugs. After member s yearly out-of-pocket drug costs reach $4,850, member pays the greater of: $2.95 copay for Tier 1 and Tier 2 drugs and $7.40 copay for all other drugs, OR 5% coinsurance. Prescription Drug Plan 2 $149 In-Network $150 deductible (excludes Tier 1) $0 for Tier 1 Preferred Generic at Walmart and Sam s Club $20 for Tier 1 Preferred Generic Elsewhere $47 for Tier 2 Generic $47 for Tier 3 Preferred Brand $100 for Tier 4 Non-Preferred Brand 25% for Tier 5 Specialty Pharmacy Out-of-Network Covered drugs are available in special circumstances, including illness and while traveling outside the plan s service area where there is no network pharmacy. Members may incur an additional cost. Coverage continues through the gap After member s yearly out-of-pocket drug costs reach $4,850, member pays the greater of: $2.95 copay for Tier 1 and Tier 2 drugs and $7.40 copay for all other drugs, OR 5% coinsurance.

9 Medicare Supplement (non-tobacco) Plan Design Plan A Plan F Plan G Plan N Services/Benefits Physician Services Part B deductible, then $0 Member Pays with Health Alliance Medicare Supplement Plans $0 Part B deductible, then $0 Hospitalization (first 60 days) Part A deductible $0 $0 $0 Laboratory Services and $0 $0 $0 $0 Diagnostic Tests Annual Out-of-Pocket Maximum N/A N/A N/A N/A $20 copayment after the Part B deductible is met; up to $50 copayment for emergency room 2016 Monthly Premium Age<65 $177 $295 $266 $210 Spouses who enroll in the same Medicare Supplement plan are eligible for a 7 percent discount in their Medicare Supplement premium.** Premiums listed are for Illinois residents who live outside of Cook, DuPage, Kane, Lake, McHenry or Will counties. Your client consultant can provide premium information for retirees in those Chicago-area counties. 65 $84 $139 $125 $99 66 $89 $148 $133 $ $96 $161 $145 $ $101 $169 $152 $ $111 $185 $166 $ $118 $197 $177 $ $125 $208 $187 $ $132 $220 $198 $ $139 $232 $209 $ $145 $242 $218 $ $157 $262 $236 $ $165 $275 $247 $ $171 $285 $257 $ $177 $295 $265 $ $182 $303 $273 $ $184 $307 $276 $ $190 $317 $285 $ $193 $322 $290 $ $196 $327 $294 $ $201 $336 $302 $ $219 $364 $328 $259 **Spousal relationship must be noted on enrollment application.

10 Medicare Supplement (tobacco) Plan Design Plan A Plan F Plan G Plan N Services/Benefits Physician Services Part B deductible, then $0 Member Pays with Health Alliance Medicare Supplement Plans $0 Part B deductible, then $0 Hospitalization (first 60 days) Part A deductible $0 $0 $0 Laboratory Services and $0 $0 $0 $0 Diagnostic Tests Annual Out-of-Pocket Maximum N/A N/A N/A N/A $20 copayment after the Part B deductible is met; up to $50 copayment for emergency room 2016 Monthly Premium Age<65 $191 $318 $286 $225 Premiums listed are for Illinois residents who live outside of Cook, DuPage, Kane, Lake, McHenry or Will counties. Your client consultant can provide premium information for retirees in those Chicago-area counties. 65 $90 $150 $135 $ $95 $159 $143 $ $104 $173 $155 $ $109 $181 $163 $ $119 $199 $179 $ $127 $211 $190 $ $134 $223 $201 $ $142 $236 $213 $ $150 $249 $225 $ $156 $261 $235 $ $169 $282 $254 $ $177 $296 $266 $ $184 $307 $276 $ $190 $317 $285 $ $196 $326 $293 $ $198 $330 $297 $ $205 $341 $307 $ $208 $346 $312 $ $211 $351 $316 $ $217 $361 $325 $ $235 $392 $353 $278

11 Extras Health Programs For HMO and PPO plan members only SilverSneakers Healthways SilverSneakers fitness program, helps you achieve your health and fitness goals with access to more than 11,000 fitness locations, where you can: Use all basic amenities plus take SilverSneakers classes. Have guidance and assistance from a Program Advisor SM. SilverSneakers is a registered trademark of Healthways, Inc Health Ways, Inc. Assist America When Health Alliance Medicare members are more than 100 miles from home, Assist America can help with: Guaranteed hospital admission. Prescription assistance, if they forget or lose a prescription medication. Transportation for a loved one to join the member if hospitalized for more than seven days. Return of mortal remains, in the unfortunate event that a member passes away while traveling. Health and Wellness As part of our disease management programs, we send members newsletters, brochures and reminders about important condition-specific topics like asthma, COPD, diabetes, blood pressure and cholesterol, as well as help to quit smoking. To help members in their health and fitness efforts, Health Alliance Medicare offers discounts on weightloss programs and fitness club memberships. Visit the Health and Wellness section of HealthAlliance.org for more information on disease management programs and fitness discounts. Be Healthy To encourage Health Alliance Medicare members to seek preventive care, we cover 100 percent of charges for an annual exam (in-network for PPO members) and medically appropriate screenings. Case Management Health Alliance Medicare members who are eligible have free access to case managers who help make coping with hospital stays and chronic illnesses easier. Case managers can help: Explain a diagnosis, test results and treatment options. Take the confusion out of hospital discharge notices and other documents. Assist with home health care, skilled nursing facility stays and durable medical equipment. Health Alliance Medicare is an HMO, PPO and PDP plan with a Medicare contract. Enrollment in Health Alliance Medicare depends on contract renewal. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change January 1 of each year. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Drug Programs For all members with drug coverage $0 Copay and More at Walmart and Sam s Club Members with Part D coverage can receive their Tier 1 drugs for $0 at Walmart and Sam s Club. Tier 1 drugs are some of our most commonly used drugs. Members also receive a 90 day supply of any other covered medication for only two copayments when purchased at these preferred pharmacies. Members can continue to receive drugs at other network pharmacies. Medication Therapy Management This program helps members who take multiple medications use them safely and effectively. Health Alliance s pharmacy network offers limited access to pharmacies with preferred cost sharing in Illinois. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-todate information about our network pharmacies, including pharmacies with preferred cost sharing, please call Member Services at , ext GROUP 8024, TTY MEDICARE 711 or consult the online PLANS pharmacy directory at HealthAlliance.org. GROUP MEDICARE PLANS Toll-free ext TTY/TDD 711 HealthAlliance.org

12 GROUP MEDICARE PLANS Toll-free ext TTY: 711 HealthAlliance.org mkt-grpmedicarebrch-v3-0116

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