ORDER NO. 31081 PROPOSALS FOR KERB COUNTY EMPLOYEE BENEFITS FOR 2009 Came to be heard this the 5th day of November, 2008, with a motion made by Commissioner Williams, seconded by Commissioner Baldwin, the Court unanimously approved by a vote of 4-0-0 to: Approve the Kerr County Medical Benefit Plan for 2009 as recommended by Mr. Looney as follows: 1. Increase the individual stop loss level from $50,000 per annum to $60,000 per annum, as shown by Option C with Monumental Life 2. Increase the contribution by the retired employee from $13 5 a month to $180 per month 3. Leave the active employees' contributions at their current level 4. Set the HRA levels at $600 per employee, $600 per employee plus spouse and $600 per employee plus spouse plus children, for a total of $1,800 per family (for an employee with spouse and child coverage), and $600 for retirees, with no HRA levels for retirees' spouses or children 5. Maintain the employee life and accident coverage with Mutual of Omaha 6. Recommend to active employees to attend an educational seminar to inform them of the options of switching to Medicare as their primary insurance (~~ CC}~SSIONERS' ..COURT AGENDA RE4UEST MADE BY: E. Hyde MEETING DATE: 11-5-08 OFFICE: H.R. TIME PREFERRED: 1:00 PM ~~ ~ ~/ ~~ SUBJECT: Consider, discuss, and take appropriate action regarding Proposals received for Kerr County Employee Benefits for 2009. EXECUTIVE SESSION REQUESTED: (PLEASE STATE REASON) NO Personnel Matters 551.074 a) This chapter does not require a governmental body to conduct an open meeting: 1 } to deliberate the appointment, employment, evaluation, reassignment, duties, discipline, or dismissal of a public official or employee; or 2) to hear a complaint or charge against an officer or employee. b) Subsection a) does not apply if the officer or employee who is the subject of the deliberation or hearing requests a public hearing. NAME OF PERSON ADDRESSING THE COURT: Gary Looney, E. Hyde ESTIMATED LENGTH OF PRESENTATION: 10 minutes IF PERSONNEL MATTER -NAME OF EMPLOYEE: Eva Hyde Time for submitting this request for Court to assure that the matter is posted in accordance with Title 5, Chapter 551 and 552, Government Code, is as follows: Meeting scheduled for Mondays: THIS REQUEST RECEIVED BY: THIS REQUEST RECEIVED ON: 5:00 P.M. previous Tuesday. All Agenda Requests will be screened by the County Judge's Office to determine if adequate information has been prepared for the Court's formal consideration and action at time of Court Meetings. Your cooperation will be appreciated and contribute towards your request being addressed at the earliest opportunity. See Agenda Request Rules Adopted by Commissioners' Court. Self-Funded N e Plan Stop-Loss Proposal Comparison jtlwryuro Caller - TA)rd Adslinbtrator FARA FMA FARA BMwnam GreMr aumen $emp Pee •: E 7,ODD -Waived N/A N!A Reaewd Pee N/A N!A N/A Ruc-IOlRtm-Out: A®mioituntion Fce E9842 Waned N/A NiA Ertimeted rua out CWm IiebilOry SpceiPk Liitrime Maximum Agyregam Pka YeJr Amuel Maximum S 263 816 S 950,000 S 1,000.000 S 950000 S 1,000,000 S 950,000 S 1,000,000 Nure: 17rere tnn4 arc trot indudcd in mrda bebw. STOP•LOSS BA&t8 Numbs otEmpkayeex: 246 246 246 Numbs' of Spoae Ody 31 31 31 Number of ChiW(rm) ody 31 31 31 Number ofFamBy Unks 26 26 26 Number of Depeodea[ Units: 88 88 BB Specific DMrrc[ible; E 60.000 E 50.000 S ,000 SpaiPk Cootrect: 15/12 15/12 15/12 Specific Canact locludes Metl & Rs Med & Rx Med & Rx Aggmgate Conaact: I s/12 15/12 15/12 Maximum Aggregate Rm to S 260,367 COnrtacrtucludes Med & Rx Med & Rx Med & Rx MONTHLY FIXED COSTS 8pedh Ptemluan Employx: S 67.69 S 77.70 S 68.92 Employee and Spouse S I J0.29 E 154,45 E 138.16 Emplnyeeam Cn9dcra) s I1a.01 a 136.18 s 120.90 Dependent Unit: Family: S 146.58 E 173.80 S ISS.44 tr Preealum Compake: S 7.13 S 7.29 S 8.46 Natbl Yes - 860.00 AAmIWMIim(aB do ruolt awnW1 Claims Cou Per Bmploya : S 11.50 S 13.50 S 13.50 CLims Cos[ Per Depmdenr Ut8lurion Reviewpu EE s 2.0o s 2.0o s 2.00 PPO Network Per EE: S 4.50 S 4.50 S 4.50 Rx Program Fees(Deacribe) COBRA pa EE S 1.00 f 1.00 S 1.00 FI~AA Per EE locl lucl NCI Fiduc' LiaD'di Ea Beall EmployedMtb Unb/Mth: Coretmia Plan PSA Accouor Per Participant S 3,00 S 3.00 S 3.00 Child Csre Per Pane)paot Debu Card expense Inc! locl Inc! Strt up expense Olhm Cafeteria Plm Fees: IIRA Start up expense f 1,500.00 Per Accoum Fee E 4.00 E 4.00 S 4.00 Debk card expense loci Ircl Ircl OWc HRA Plan tees: WeSmye Cat Per ER/hhith Wellness PW Cat Per EEIMth Wellness Plan Cat 77 Dbgae Ma Deaml Dmml Admenn Fa per EE1Mtb Dmml Admen Fee per Dep/Mrh Deaml Netwaak Access Fce 9 Nets Povtive PaY/EE/Mm Paitive Pa Sd Fee Oa time se[ tee Broker Fa: Fee S 3.00 S 3.00 S 3.00 AGGREGATE FACTORS Employee Only: ~ S 410.05 E 441.32 S 462.90 Dependent Unit: S 392.90 Employes sad Spouse - S 804.72 S 880.08 S 908.41 Employce and Clllirl(rCO) E 704.13 S 757.65 f 794.91 Family: E 905.3) S 974.35 S 1,021.99 Com ke: /m4imat Poisb MmtWy: E 135,100 S 145403 S 152,513 Amual: S 1,621.204 E 1,744,834 S 1,830,154 TOTAL ANNUAL COSTS Specfu: Stop Loan Premium 264,953 309,298 275,54D Aggregarc Premium 21,048 2!.520 25.033 Adminunatia - 51,660 51,660 51,660 Adminiarntroo as % of Maximum Amual Coat UR. FPO. Rx, Brdcer, and all otlrer 30,996 30.996 30.996 Toni Fixed 368,657 413,474 383,229 Expecmd: 1,665,620 1809,342 1847,352 Maximum: 1,989 860 2,158,309 2,213,383 Twal Fund Increaaam Cult asp ent ufcuttsol Expecsed Muknma NRA Patima8ed RaPSaa E 11,808.00 5 11,808.00 E 11,808.00 Indutletl in Atlmin Fee Indutled in AtlMn Fae Indudetl in Admi Fee FSA Fi4dmated Fiapeme myRSC -- A Resource Service Center for the Workplace < < Back to Managerial Reports Benefit Liability Report Line lsf Service: Section 105 .'' Plan Year: Group Results By: Claim Service End Date +' Pfan YearJEmptaper ~ Print Report r Select All tte Report Total Election $273,643.68 Paid in January 2008 $4,921.83 Paid in February 2008 $15,182.08 Paid in March 2008 $16,472.79 Paid in April 2008 $18,072.45 Paid in May 2008 $14,573.56 Paid in June 2008 $15,542.22 Paid in July 2008 $15,128.48 Paid in August 2008 $15,615.50 Paid in September 2008 $16,622.13 Paid in October 2008 $11,206.75 Total Paid ;143,337.79 Percent Paid: 52.38% Page 1 of 2 hops://secure.myrsc.com/tpa/services/mr benefitliabilityreport.asp 11/3/2008 w w a~ w o H w w O r n s w W W W ch c~ c~ ono ago n r~ N to iH !A n M ~ ~~ w w w 0 H O H w W W Q w °~ ~~ ~~ ~~ ^~ CV f9 fA fA f9 P- ~- £~ £`~ ~a` ~a '~ ~ c ~ ~ i-°~ ~~~ 3 LL ~ a .y ., y .~ v 'Q a ~ c c~ ~ c ~ c~ _ ~ U a~~ '~~ _ c ~ + + Y ~i'ac~ wwwLL N c0 N Q C ~_ ~~ C~7 e e c Q s ~~2 ` ~ ~ oW Q W 0 Z ~~ W N !_~±a 7 !r9 T IL p~ h p~ t ~ W ~ C H ~p << n O C ~~ ~~ W ~ u r H M i W ~ a h ~ Y = O W OC Q 4 ~ v ~ r W a c ~ d J V - , ~ M M ~ a n tp O> r M O~ ~ r M ~ C'O ~f r N tNC I OMD N Cr Crp O1 - N N G~ pp M ~ ~pp M pp ~ M tn7 ~ l~ ~ (~ r 4H 69 19 tH to vi to to di u9 ~w ~} ,` m N N N Ch N a N C7 N ~ N IA N t0 N 1A N In N ch chi ~ c~ 0~+~ c°9i c~+ tr') t+~ rNi r N a N ~ N ~ N ~ c~ ~ M M e9i M ~ N tD ~ CD tr0 ~ ~ tp tM0 ~{ 1 IF .~ r r r r `r ^ P ^ ~ ~ ~ 1~[ t~D 7 N h M ~ pp~ .- ~ 4C OrD r .n- 1n ~ M M tG O ~ppp Of r ~ ~ r T f0 C7 Op f7 ((, N r r r r r r r to K V 3 V- V! 69 tR H H H ~ ~ g ~ T °' ,Q "• ~ ~ y c~ g ~ ti Ono ~ ~ o ~n0 N ~ W ~ Oni r n O co tO i0 r r (ry M N r r to Vl ifl fA fR Y! d! d9 h $ 8 8 n ~ $ ~ ~ ;~ ~ ~ °rn ~ ~ n ~o ~ o ~ a $ a0 ~ ~ Of N I~ r 1 A fA (A 69 M fA (A h ~. 8 ~ ~ M Q~ ~ ~ N ~ ~ to N Y! c ~ ~ ~ j f0 ~ p t0 ~D r ~ ~ 8 ~ h ~ N ~ ~ ~ g ~ ~ M O O. ~ r r r r H H H H H H H H H ~ g m r ~ ~ ~ ~ ~ o ~ ~ x `c~ a rni a rni rni `e~ chi v w u> u~ ee~ v- ra w v- ur g v W ~ n a ~' o ~ cN+ ~ v n ham.. Op CMi QC ~ C '~ t p~ p tp ~C O~ Q i ~D O CO ~p CO , ~ p M ~ p M N . n 1~ tp r r r (( ~~ t~ r n ~ O r p~~ p O r r {~ O~ M M (A V! 19 fA f9 fA (A N W ~ n N ~, ~ ~ n °i O1v O ap OD r ~ N d ~ ~ a fH (A (A c~' o ~ g ~ n ~'og r ~ ~ ~ O LL d d a N a LL a w w c~ ch `~i o~o n W r r- r CV f9 fR !A n M ~ C '- d d! W W t- w r W W N W 69 0 w w O H W W W W QCD N~ O r N fA d9 fA fH Q ~ Q '~~ c~~ F°- F°- ~ -°- E°- ~ a o d N y~NMN tN~pp y ~ r N M (~ O a N r ~' l{S 7 ~ ~ Cy~~ V a~~ ~ L c~~ a U>. tL ~ W W W C ~c~ ~i Q c ~°~2 y `~ ~ .E oW Q ~l ~~~~ Kerr County A028 - Brand/Generic Comparison ~i~~PT ~~ L'1D A028_Rpt Report Criteria Group(s) = 151 Cycles between 1/1/2008 and 10/3112008 Ages 65 and Older Brand w/o Brand wl Generic Total Average Generic Generic Per Claim Number of Claims 368 11 561 940 % of Retail 39.15% 1.17% 59.68% 100.00% Retail from Phannacy w/o Script Care $63,347.71 $2,808.04 $28,706.45 $94,862.20 $100.92 Actual Drug Cosf $50,999.39 $2,124.14 $19,786.96 $72,910.49 $77.56 Pharmacy Fees $531.25 $4.25 $1,000.25 $1,535.75 $1.63 Prescription Price w/Script Care $51,530.64 $2,128.39 $20,787.21 $74,446.24 $79.20 Saving through your Script Care Plan $11,817.07 $679.65 $7,919.24 $20,415.96 $21.72 % Saved over Retail 18.65% 24.20% 27.59% 21.52°h Copay $9,607.60 $606.10 $5,213.12 $15,426.82 $16.41 of Total Drug Cost 18.64% 28.48% 25.08% 20.72% Tax $0.00 $0.00 $0.00 $0..00 $0.00 Your Prescription Cost $41,923.04 $1,522.29 $15,574.09 $59,019.42 $62.79 Total Employer CoeUClaim $113.92 $138.39 $27.76 $62.79 Page 1 of 1 11/04108 Kerr County ,~,,~y A030 -Retail/Mail Order Comparison A030_Rpt Report Criteria Group(s) = 151 Cycles between 1/1/2008 and 10/31/2008 Ages 65 and Older Retal~ Brand w/o Brand w/ Generic Total Average Generic Generic Per Claim Number of Claims 292 4 510 806 36.23% 0.50% 63.28% 100.00°k Prescription Price w/Script Care $31,250.75 $346.49 $15,563.71 $47,160.95 $58.51 Copay $6,197.60 $147.59 $4,305.78 $10,650.97 $13.21 of Total Drug Cost 19.83% 42.60% 27.67% 22.58% Tax $0.00 $0.00 $0.00 $0.00 $0.00 Your Prescription Cost $25,053.15 $198.90 $11,257.93 $38,509.98 $45.30 Total Employer CostiClaim $85.80 X9.73 $22.07 $45.30 Mail Order Brand w/o Brand w/ Generic Total Average Generic Generic Per Claim Number of Claims 76 7 51 134 °k 56.72% 5.22% 38.06% 100.00% Prescription Price w/Script Care $20,279.89 $1,781.90 $5,223.50 $27,285.29 $203.62 Copay $3,410.00 $458.51 $907.34 $4,775.85 $35.64 °~ of Total Drug Cost 16.81 % 25.73% 17.37°k 17.50% Tax $0.00 $0.00 $0.00 $0.00 $0.00 Your Prescription Cost $18,889.89 $1,323.39 $4,318.16 $22,509.44 ;187.98 Total Employer CostlClaim $221.97 5189.08 $84.83 $187.98 T0~ Brand w/o Brand w/ Generic Total Average Generic Generic Per Claim Number of Claims 368 11 561 940 °k 39.15% 1.17% 59.68% 100.00% Prescription Price w/Script Care $51,530.64 $2,128.39 $20,787.21 $74,446.24 $79.20 Copay $9,607.60 $606.10 $5,213.12 $15,426.82 $16.41 % of Total Drug Cost 18.64% 28.48% 25.08°k 20.72% Tax $0.00 $0.00 $0.00 $0.00 $0.00 Your Prescription Cost $41,923.04 $1,522.29 $15,574.09 $59,019.42 562.79 Total Employer Cost/Claim $113.92 $138.39 $27.78 $62.79 Page 1 of 1 11!04/08 Kerr County A029A -Top Utilized Drugs by Dollars ~~ ~~~ A029A_Rpt Report Criteria Group(s) = 151 Cycles between 1/1 /2008 and 1 0/31/2008 Ages 65 and Older Amt Paid! Ingred. CosU Desc # Scripts Amt Paid RX Inpred. Cosy 30 dav: Ind.. Maim Form Therapeutic Class NEXIUM 15 $3,468.61 $231.24 $3,854.61 $142.76 N N I ULCERDRUGS1PiobnPumplnfabibrs LYRICA 16 $3,292.28 $205.77 $3,612.28 $180.61 N Y I ANTIC~IVULSANTS/Anticonwlsanls-Misc. PLAVIX 26 $3,238.87 $124.57 $3,717.12 $132.75 N Y I HEMArOLOGICAI.AGENTS-MISCJThienoplrtidine PREVACID 18 $3,169.00 $176.06 $3,495.25 $194.18 N N I ULCERDRUGSIRobnPumpiNrihibis OXCARBAZEPIN 11 $2,570.16 $233.65 $2,660.91 $241.90 Y Y 1 ANTICONVULSANTSIAntioonwisanis-Misc. EVISTA 11 $2,352.22 $213.84 $2,770.47 $89.37 N Y I ENDOCRNJE AND METABOLICAGENTS - PANTOPRAZOLE 13 $2,072.72 $159.44 $2,212.97 $116.41 Y N I ULCERDRUGSIRobnPurplnhidbrs CELEBREX 12 $2,026.01 $168.83 $2.244.26 $187.02 N Y I ANALGESICS-ANTi- DETROL LA 5 $1,358.40 $271.68 $1,558.40 $103.89 N Y I URINARY ANTISPASMODICSIUrirraryAntispast~wdics AGGRENOX 5 $1,321.43 $264.29 $1,634.68 $132.54 N Y N HEMATOLOGICAL AGENTS-MISC.11'letelet LIPiTOR 20 $1,310.07 $65.50 $1,672.07 $83.60 N Y I ANTIHYPERLI~MICSIIiMGCoARedudase ACTONEL 7 $1,233.59 $176.23 $1,491.84 $79.64 N Y I ENDOCR~JEANDMETABOLICAGENTS- LEXAPRO 9 $1,180.14 $131.13 $1,450.89 $82.91 N N I ANTIDEPRESSANTS15elecliveSen~ninReuptelce OMEPRAZOLE 6 $1,079.65 $179.94 $1,154.40 $115.44 Y N I ULCERDRUGSIProbnPunplnhidbrs NASONEX 11 $1,078.32 $98.03 $1,326.57 378.03 N N I NASAL AGENTS-SYSTEMIC ANDTOPICAUNasai CLARINEX 11 $1,068.16 $97.11 $1,447.16 $96.48 N N N ANTIHISTAMNESIAr~istamires-NonSedatng SINGULAIR 5 $1,008.43 $201.69 $1,186.68 $96.22 N Y I ANTiASTFNuIATICANOBRONCHODiLArOR CYMBALTA 10 $998.40 $99.84 $1,177.40 $117.74 N N I ANTIDEPRESSANTSISeidonin-rbrepir~ephrine METOPROLOL 27 $984.54 $36.46 $1,198.10 $34.23 Y Y I BETABIOCKERS+eemBbdcersCa~dio-SelecMre ASACOL 7 $964.78 $137.83 $1,092.53 $156.08 N Y I GASTRaNTEST~,u.AGENrs-Mlsc.nmlammarory COZAAR 7 $909.74 $129.96 $1,092.24 $156.03 N Y I ANTIHYPERTENSNESIAngiolensnllRecepta VESICARE 3 $872.76 $290.92 $992.76 $110.31 N Y I URINARY ANTISPASMODICSIUrinaryAntispasmodics DIOVAN 10 $860.12 $86.01 $1,449.12 $60.38 N Y N ANTIHYPERTENSNES/Angi~ensinllReoepror FINASTERIDE 4 $805.24 $201.31 $885.24 $73.77 Y Y I GENITOUR~IARYAGENTS-MISCELLANEOUSJS HYDROCO/APAP 27 $707.37 $26.20 $843.34 $78.82 Y N 1 ANALGESICS-OPIOIDMydooodorreCambinations SKELAXIN 4 $669.46 $167.37 $799.46 $299.80 N N N MUSCULOSKELETALTHERAPVAGENTS/Central FENTANYL 3 $642.39 $214.13 $664.89 $221.63 Y N I ANALGESICS-OPIO~/OpioidAgonNts LORTAB 7.5 3 $595.02 $198.34 $805.02 589.45 O N N ANALGESICS-OPIgDMydocadoneCambinaGOr~s AMBIEN 2 $590.80 $295.40 $730.80 $121.80 O N N HYPNOTICSIrbrfeenmdiempine-GAGA-ReoaMor VYTORIN 8 $589.04 $73.63 $735.04 $91.88 N Y I ANTIHYPERLIP~EMICSIIntastGwlestAt~sapird~• NIFEDICALXL 12 $562.68 $46.89 $661.18 $55.10 Y Y I CALGIM~ICHANNELBLOCI~RSnG DIOVAN HCT 12 $555.98 $46.33 $951.73 $79.31 N Y N ANTIHYPERTENSNESIAngiotensin II Reoepior FEXOFENADINE 5 $542.93 $108.59 $619.43 $58.07 Y N I /~NTIHISTAMMES/AntiNsmmeres-NonSedating FOSAMAX + D 10 $536.96 $53.70 $779.46 $83.51 N Y I ENDOCRN~E AND METABOLICAGENTS - CRESTOR 8 $532.71 $66.59 $796.21 $99.53 N Y N ~~~~~~~~~~ 363 $45,748.98 $126.03 $53,764.51 $107.69 Pege 1 Of 1 'Indicator: M,N =Brand no generic available; O =Brand wRh generic available; Y =generic 11/04108 Si(` C;~~, Lm, Kerr County A019A -Age Range (All Groups) A019A_Rpt Report Criteria Group(s) = 151 Cycles between 1/1/2008 and 10/31/2008 Average Aae Ranae # T~tall Conav n P id ~y gay 12 and Under 199 $13,594.03 $3,018.77 $10,575.26 $15.17 22.21% 13-18 Years 119 $6,561.64 $1,467.93 $5,093.71 $12.34 22.37°h 19-30 Years 435 $30,007.53 $6,187.66 $23,819.87 $14.22 20.62% 31-45 Years 782 $59,815.06 $10,435.43 $49,379.63 $13.34 17.45% 46-49 Years 555 $73,408.56 $9,598.63 $63,809.93 $17.29 13.08% 50-59 Years 1522 $139,328.99 $27,959.74 $111,369.25 $18.37 20.07% 60-64 Years 640 $67,561.68 $11,128.86 $56,432.82 $17.39 16.47% 65 and Over 940 $74,446.24 $15,426.82 $59,019.42 $16.41 20.72% Total 5192 $464,723.73 $85,223.84 $379,499.89 $16.41 18.34°h Page 1 of 1 11/04/08 Formulary Utilization Summary ~~ ~~ i:m; Report for: Kerr County Effective Date: 01!01/2008 Group: 151: Kerr County This is a summary of your Script Care Prescription Plan from 1/1/2008 through 10/3112008 . Formulary Utilization Preferred Non- Generic Total Average Per Preferred Claim Number of Claims 1,676 609 2,907 5,192 °k of All Claims 32.28°k 11.73°k 55.99°r6 100.00°k Retail from Pharmacy w/o Script Care $364,664.03 $87,188.46 $136,796.23 $588,648.72 $113.38 Actual Drug Cost $293,674.98 $68,835.73 $93,544.62 $456,055.33 $87.84 Pharmacy Fees $2,964.40 $965.00 $4,739.00 $8,668.40 $1.67 Prescription Price w/ Script Care $296,639.38 $69,800.73 $98,283.62 $464,723.73 $89.51 Savings through your Scrlpt Care Plan 568,024.85 517,387.73 538,512.61 $123,924.99 523.87 Saved over Retail 18.65% 19.94% 28.15% 21.05°I° Copay $36,249.52 $23,236.95 $25,737:37 $85,223.84 $16.41 °k of Total Drug Cost 12.22% 33.29% 26.19% 18.34% Tax $0.00 $0.00 $0.00 $0.00 $0.00 Your Prescription Cost 5260,389.86 X46,563.78 ;72,546.25 $379,499.89 $73.09 Total Employer CostlClaim 5155.36 ;78.48 $24.96 $73.09 CostlPer Cardholder Per Month $102.72 $18.37 528.62 5149.70 Cost/Per Member Per Month $62.82 $11.23 517.50 $91.56 Enrollment Cardholders Dependents Total Monthly Average Enrollment 253.5 161.0 414.5 Retail and Mail Order Formulary Utilization Summary ~~C.'RIF'I' ~rd~l Report for: Kerr County Effective Date: 01/01/2008 Group: 151: Kerr County This is a summary of your Script Care Prescription Plan from 1/1/2008 through 10/31/2008 . Average Retail Preferred .Non- Generic Total per Preferred Claim Number of Claims 1,509 532 2,734 4,775 of Retail Claims 31.60% 11.14°~ 57.26% 100.00°~ Prescription Price w/ Script Care $243,818.94 $47,037.40 $79,315.74 $370,172.08 $77.52 Copay $29,657.79 $18,207.63 $22,693.61 $70,559.03 $14.78 of Total Drug Cost 12.16% 38.71 % 28.61 % 19.06% Tax $0.00 $0.00 $0.00 $0.00 $0.00 Your Prescription Cost $214,161.15 $28,829.77 $56,622.13 $299,613.05 $62.75 Employer Cost Per Claim $141.92 $54.19 $20.71 $62.75 Average Mail Order Preferred Non- Generic Total Per . Preferred Claim Number of Claims 167 77 173 417 of MO Claims 40.05% 18.47% 41.49% 100.00% Prescription Price w/ Script Care $52,820.44 $22,763.33 $18,967.88 $94,551.65 $226.74 Copay $6,591.73 $5,029.32 $3,043.76 $14,664.81 $35.17 % of Total Drug Cost 12.48°~ 22.09°~ 16.05°~ 15.51 °~ Tax $0.00 $0.00 $0.00 $0.00 $0.00 Your Prescription Cost $46,228.71 $17,734.01 $15,924.12 $79,886.84 $191.58 Employer Cost Per Claim 5276.82 $230.31 $92.05 $191.58 Average Total Preferred Non- Generic Total per Preferred Claim Number of Claims 1,676 609 2,907 5,192 of All Claims 32.28% 11.73% 55.99°k 100.00% Prescription Price wl Script Care $296,639.38 $69,800.73 $98,283.62 $464,723.73 $89.51 Copay $36,249.52 $23,236.95 $25,737.37 $85,223.84 $16.41 % of Total Drug Cost 12.22% 33.29°k 26.19% 18.34°k Tax $0.00 $0.00 $0.00 $0.00 $0.00 Your Prescription Cost $260,389.86 $46,563.78 $72,546.25 $379,499.89 $73.09 Employer Cost Per Claim $155.36 576.46 $24.96 $73.09 Pian Statistics Report for: Kerr County Effective Date: 01/01/200 Group: 151: Kam County This is a summary of your Script Care Prescription Plan from 1/112008 through 10/31/2008 . ~~ Fab 08 ~ r~ Mar ~ Jun 08 ~ Aua ~ 3aD 08 ~ N~ Dec 08 3LI Enrollment Summary Cardirokkrs 252.0 257.0 257.0 254.0 254.0 254.0 249.0 253.0 250.0 255.0 253.5 Dependents 157.0 .181.0 185.0 185.0 165.0 187.0 157.0 181.0 158.0 158.0 181.0 U6Y~np CaNhokers 129.0 142.0 153.0 148.0 133.0 131.0 138.0 128.0 141.0 137.0 230.0 UIBzeSm % 51.19% 55.25% 59.53% 58.27% 52.38% 51.57% 54.82% 50.98% 58.40% 53.73% 90.73% Claim Summary N 508 553 578 550 488 518 500 508 471 522 5,182 Avg Per Cardholder 2.02 2.15 2.25 2.17 1.91 2.03 2.01 2.01 1.88 2.05 20.48 Avg Par Member 1.24 1.32 1.37 1.31 1.18 1.23 1.23 1.23 1.18 1.27 12.53 Brand 195 238 238 220 193 200 213 203 182 205 2,098 Generic 284 298 328 313 271 287 270 287 282 301 2,907 &and •/Gerbric 29 18 18 17 22 19 17 18 17 18 189 Gerwic%ofAll 55.81% 53.53% 58.40% 58.91% 55.78% 57.58% 54.00% 58.50% 55.83% 57.88% 55.98% Ma90rda ~ 44 40 32 59 32 32 51 37 41 49 417 Mail Order%otAll 8.88% 7.23% 5.54% 10.73% 8.58% 8.20% 10.20% 7.28% 8.70% 8.39% 8.03% Claim Cost 3~mitledCod 558,888 551,925 358,288 388,182 352,887 380,388 580,581 581,254 555,381 587,114 3588,844 SalptCareCod 544,750 541,588 344,971 352,305 542,231 547,498 348,282 548,384 543,257 551,471 5484,72r 8avinga 512,118 310,339 511,287 S13,877 510,488 512,873 312,288 312,890 312,124 535,843 $123,92: Tax SO SO SO 50 SO SO SO SO SO SO 30 Total - 544,750 341,588 544,971. 552,305 542,231 547,488 548,292 548,384 543,257 351,471 5484,72r AverapeCleimCod 588.08 575.20 577.80 595.10 588.88 592.05 598.58 SB5.29 391.84 598.80 368.51 Average Brand Cod 5180.31 5129.30 5142.29 5182.31 5155.17 5172.78 5178.84 5189.85 5171.08 5193.81 5184.78 AverageGsnericCod 535.82 530.90 S31.t3 531.70 334.07 533.47 533.47 337.07 538.05 535.22 533.81 Average Br wlDsn Coe 5114.38 585.37 577.68 5133.88 3138.81 5157.85 S7D.84 5182.80 558.62 573.71 3111.40 Member Cost TotalCopey 58,291 59,283 59,410 S9,418 57,982 58,222 S6,4B1 57,885 57,740 58,542 585,224 Average Cldm Capay 318.32 518.75 518.26 517.12 518.42 315.83 518.98 515.48 518.43 518.38 318.41 Average Brand Copay 524.24 525.05 525.88 527.54 524.30 324.94 528.78 522.87 525.44 S25.B1 S25.31 Average Generic Copry 58.27 59.08 58.54 58.81 58.91 58.83 58.84 56.62 58.88 59.00 58.85 Average Br rWGen Copay 332.12 532.88 335.M 539.03 539.85 532.70 528.98 538.38 331.08 532.87 534.08 Copay%olTotalCod 18.53% 22.27% 20.83% 18.01% 18.x% 17.31% 17.58% 18.28% 77.88% 18.80% 18.34% Plan Cost Plan Cod 538,459 532,323 535,561 342,887 534,249 539,275 539,691 540,489 535,517 342,929 5379,50( AvregsCWmCat 571.77 558.45 581.52 377.98 570.47 578.11 378.80 379.72 575.41 382.24 373.08 Average Brand Cat. 5138.07 5104.25 5118.82 5154.78 5130.87 5147.84 5151.88 5148.78 5145.85 5187.89 5139.47 Avaraa Gearic Cat 528.55 521.82 522.58 ST3.09 525.18 524.84 524.83 528.25 527.17 528.23 524.98 Average BreYGsn Cod 582.24 552.70 542.24 594.88 598.78 5125.74 543.98 5144.24 525.53 541.04 577.35 Plan Cod%olTotalCod 81.47% 77.79% 78.07% 81.88% 81.10% 82.89% 82.42% 83.74% 82.11% 83.40% 81.88% Plwr Cod Per Cardholder 5144.88 5125.77 5138.37 5188.85 5134.84 5154.82 3158.84 5180.08 3142.07 5188.35 51,487.0 Plan Cod Per Member 588.14 577.33 584.27 3102.35 581.74 393.28 598.03 597.82 387.48 3104.45 39/5.58 Cardholders > 5500 22 19 20 23 17 22 20 21 18 23 124 Cadholdera > 5 Clagna 24 31 32 28 29 31 27 30 23 34 187 Top 10 Drugs by Plan Cost HUMRA PEN PRt:VAgD REBIF TITRTN EFFIXOR XR REBIF REBIF EFFD(OR XR REBIF HUMRA PEN HUMRA PEN IMTREX COPAXONE TAMFLU NEXIUM IMTRFX HUMRAPEN IMTREX ZYVOX IMTREX REBIF REBIF HUMRAPEN NEXIUM 81NGULAIR EFFEXORXR A&UFY IMTREX PR07AC NEXIUM PR07AC ENBREL IMTREX NEXIUM IMTREX NEXIUM FiUM1i11PEN REBIF NEXIUM ENBREL ENBREL ENBREL IMTRIX NEXIUM EFFEXORXR CELEBREX ADDERALLXR PREVAgD HUMRAPEN NIASPAN EFfD(ORXR HUMRAPEN NEXIUM ZYYOX El83REL REBIF PROIAC PLAVIX BY3TREX PREVAgD CELEBRD( PREVACID ABIUFY TCPAM4X NEXIUM HUMRA PEN PREVACID EFFIXOR XR LEXAPRO CYM3ALTA LIPITOR EFFEXOR XR LIPITOR IMTREX UDEPPo014 XL PREVAgD CELEBRD( CELEBREX TOPAM4X NOVOLOG Td>MMX 4~ERALLXR LYRICA NEXIUM PREVACID RD~RALLXR CELEBREX 1~8A9PAN LIPITOR PREVAgD LIPITOR NUI3PAN TOPAMN( CYM3ALTA SINGULAIR MA3PAN EFFFF~((ORXR TOPAMW( PREVACID ENBREL UPITOR EFFEXORXR PLAVIX PROIAC TOPAM4X LYRICA LYRICA LIPITOR EFFEXORXR LIPITOR CYM3ALTA Specialty Pharmacy Utilization Summary SCt~` Report for: Kerr County Effective Date: 01/01/2008 Group: 151: Kerr County This is a summary of your Script Care Prescription Plan from 1/1/2008 through 10/31/2008 . Number of Claims of All Claims Retail from Pharmacy w/o Script Care Actual Drug Cost Pham~acy Fees Prescription Price w/ Script Care Savings through your Script Care Plan Saved over Retail Copay of Total Drug Cost Tax Your Prescription Cost of Total Cost Specialty Pharmacy Utilization Average Average All S cia Pe nY Claims C~81m Eligible' CPaim 5,192 6 " 100.00% 0.12% $588,648.72 $113.38 $6,763.32 $1,127.22 $456,055.33 $87.84 $5,955.23 $992.54 $8,668.40 $1.67 $12.85 $2.14 $464,723.73 $89.51 $5,968.08 $994.68 5123,924.99 $23.87 $795.24 5132.54 21.05% 11.78% $85,223.84 $16.41 $155.00 $25.83 18.34% 2.60°k $0.00 $0.00 $0.00 $0.00 5379,489.89 ;73.09 55,813.08 $988.85 100.00% 1.53% Total Employer Cost/Claim ;73.09 5988.85 CosUPer Cardholder Per Month ;149.70 $2.29 CostlPer Member Per Month 591.56 $1.40 "Exdudes Spedalty Claims Enrollment Cardholders Dependents Total Monthly Average Enrollment 253.5 161.0 414.5 Specialty Average Claims Per Claim 27 "* 0.52% $58,362.93 $2,161.59 $42,889.79 $1,588.51 $54.00 $2.00 $42,943.79 $1,590.51 ;15,419.14 $571.08 28.42% $1,083.60 $40.13 2.52°k $0.00 $0.00 ;41,880.18 ;1,550.38 11.03% ;1,550.38 $18.51 $10.10 "Net Claims Kerr County A0 17 -Therapeu tic Class To tals ~RI~'T {aAR~, LTD, A017_ Rpt Group(s) = 151 Report Criteria Cycles between 1/1/2008 and 10!31/2008 Code Therapeutic Class # Scripts Billed Used Fee CopaY Tax Amt Paid 58 AntideoressanTS 384 565.973.02 $52.936.69 $6.80 $6.530.09 $0.00 $47.046.40 49 UlcerDnbs 312 551.601.72 542.025.95 $468.50 $5,130.62 $0.00 $37.363.63 66 Analgesics-Anti-Irfiammatorv 146 S48.967.61 $36.628.86 5241.00 52426.28 $0.00 $34.443.58 39 Antlhvoedioidem~ 354 549.520.82 $35.185.08 5593.50 $7.384.25 $0.00 $28.394.33 72 Anticonwlsant 190 529.147.87 $23.376.24 $32120 $3.020.00 $0.00 $20.677.44 62 Misc. Psvchotireraceuf~ and Neurological 41 $31.507.64 $23.380.71 578.20 $3.140.21 $0.00 $20.318.70 36 Antihvoertensive 421 534.001.12 $25.830.03 $676.50 $8.941.57 $0.00 517.564.96 67 Migriyne Products 54 $22,214.13 $18.072.05 $104.50 $1,047.85 $0.00 $17.128.70 44 Antiasthmatic 151 $22,667.19 $18,354.24 $293.55 $3,095.00 $0.00 $15,552.79 61 StimulanislAnti-Otx~sityAnorexiants 84 $18,971.36 $15,392.76 $179.65. $1,594.09 $0.00 $13,978.52 27 Antidiabetic 130 $16,987.17 $13,407.36 $154.50 $2,055.13 $0.00 $11,506.73 85 Misc. Hertratgbgkal 59 $11,224.79 $9,369.12 $97.50 $1,410.00 $0.00 $8,056.62 41 Antihistamines 172 $12,849.30 $10,326.35 $209.00 $2,927.46 $0.00 $7,607.89 30 Misc. F_ndorxine 57 $11,229.99 $8,977.79 $49.25 $1,663.24 $0.00 $7,363.80 42 $ystatnb And Topical Nasal Products 97 $11,002.78 $8,89022 $151.10 $2,135.55 $0.00 $6,905.77 60 59 Hyprrotics AntipsYChotics 84 9 $9,993.47 $6,907.72 $7,813.26 $5,758.35 $118.60 $14.85 $1,753.00 $220.00 $0.00 $0.00 $6,178.86 $5,55320 52 Misc. GI 35 $7,227.43 $5,857.96 $53.00 $512.04 $0.00 $5,398.92 25 ConUaoaptives 199 $9,422.54 $7,912.50 $308.15 $2,934.39 $0.00 $5,286.26 12 Antivir~ 55 $6,87,1.39 $5,564.30 $95.75 $884.96 $0.00 $4,775.09 65 Analgesics-Narcotic 219 $9,603.47 $6,037.04 $429.25 $2,168.96 $0.00 $4,297.33 54 UrinaryAntispasnrodics 33 $6,329.44 $4,885.20 $5275 $747.65 $0.00 $4,190.30 34 Cakdum Bbckers 73 $5,324.75 $4,627.21 $109.00 $990.00 $0.00 $3,746.21 16 Misc. An8-Infectives 48 $4,98260 $3,850.63 $95.00 $525.00 $0.00 $3,420.63 90 Dertrratdopical 78 $5,716.17 $4,135.56 $134.85 $1,022.29 $0.00 $3,248.12 75 Musrwbskelet~ Therapy Agents ~ $5,270.09 $4,018.66 $160.00 $1,117.40 $0.00 $3,06126 86 OpMhaimic 75 $5,250.58 $4,154.22 $13270 $1,43.9.57 $0.00 $2,847.35 24 Fstigslens 98 $6,064.31 $4,588.99 $163.85 $2,040.38 $0.00 $2,712.46 23 ArgrggerFAnaboGc 11 $3,746.78 $2,886.70 $17.50 $285.00 $0.00 $2,599.20 03 Maaolbe Antibiotics 94 $3,83272 $3,32`170 $158.50 $932.04 $0.00 $2,552.16 05 Fluoroqukrobrres 67 $4,817.79 $3,260.12 $117.10 $887.74 $0.00 $2,509.46 43 CoughrColdtAlkrgY 122 $5,261.32 $4,001.77 $215.85 $1,879.33 $0.00 $2,338.29 94 aaprrostic Prods 18 $2,972.95 $2,592.93 $38.00 $465.00 $0.00 $2,165.93 56 MisceNarreous Genitourinary Products 19 $2,845.30 $2,332.23 $31.00 $360.00 $0.00 $2,003.23 73 Antroarkinsonian 17 $2,726.43 $2,211.32 $33.50 $263.72 $0.00. $1,981.10 33 Beta Bbdcers 140 $4,255.67 $2,755.43 $243.75 $1,162.52 $0.00 $1,836.66 21 Antine~lastics 28 $3,542.04 $2,151.97 $27.00 $423.60 $0.00 $1,755.37 Oi Penicillins 71 $2,597.07 $1,981.52 $117.50 $611.03 $0.00 $1,487.99 02 Cedtalosporins 41 $2,385.57 $1,885.79 $7210 $474.01 $0.00 $1,483.88 55 Vagina Products 15 $1,722.41 $1,426.52 $27.00 $455.00 50.00 $998.52 40 Misc. Cardiovascular 14 $1,477.90 $1,313.34 $27.50 $400.00 $0.00 $940.84 57 AnfianxietyAgents 96 $2,65022 $1,464.78 $173.75 $847.75 $0.00 $790.78 35 Antiarthythm~ 12 $1,159.93 5936.02 $8.75 $245.00 50.00 $701.77 53 UrinaryAnti-Intectives 20 $792.97 $727.11 $41.25 $200.00 $0.00 $568.36 Page 1 of 2 11/03108 Kerr C ounty A0 17 -Therape utic Claaa To tals t~'T CLARE, Lam: A017_Rpt Group(s) = 151 Report Criteria Cycles between 1/1/2008 and 10/3 1/2008 Code Therapeutic Class # Saipts Billed Used Fee Copay Tax Amt Paid 87 Otis 16 51.033.05 $807.88 $32.00 $271.62 $0.00 $568.26 79 Minerals and ElectroNtes 36 59.64 5808.88 565.25 $356.60 $0.00 $517.53 88 Moutit and Throat ILOCaO 12 $833.02 $640.89 $25.85 $172.15 $0.00 $494.59 64 Anal~sics-Pbn Nar~otlc 15 $822.55 5650.99 S26.25 $275.00 $0.00 $402.24 37 Diuretics 186 $2.736.01 51.103.15 $353.25 $1.106.00 $0.00 $348.40 26 Thyroid 192 53.576.09 52.219.60 5347.95 52266.96 $0.00 $298.59 83 AnticoaoularKs 6 5406.24 5359.41 511.25 $85.00 $0.00 $285.66 46 Laxatives 13 5601.86 5424.28 $24.35 .5190.00 $0.00 $258.63 11 Antifunpuals 22 $587.87 $431.80 $33.75 $2'14.40 $0.00 $251.15 26 Progestins 10 $534.57 $365.48 $15.50 $165.06 $0.00 $215.90 13 Antimaleri~ 8 $216.56 $216.56 $0.00 560.00 $0.00 $156.56 50 Antiemetics 6 5261.41 $166.21 $10.00 $92.80 $0.00 $63.41 04 Tetracyclines 15 $247.14 $122.53 $29.50 $88.58 $0.00 $63.45 82 Hemalopoitic Aperds 30 $754.08 $473.69 $4675 $457.70 $0.00 $62.74 36 Pressors 1 SsS.~ Sso.fis 52.50 $10.00 $o.oo $53.36 09 Antimycobacledal A~rtls 22 Corticosterd~ 1 56 556.99 $77199 $47.89 $2.77 $2.00 $100.00 $10.00 5331.94 50.00 $0.00 $39.89 537.83 ~ Argreclel 4 5126.81 573.06 $8.50 $63.44 50.00 $18.12 80 Nutrier~ 1 557.69 $37.19 $1.75 $35.00 $0.00 $3.94 47 AntirkartheaL~ 4 $75.96 $15.23 $9.50 $24.73 $0.00 $0.00 sfi c«,t tD $13o.2s sas.a5 Stzso ss3.s5 $o.oo $o.oo 31 Cardatonics 10 $130.86 543.50 $17.50 561.00 $0.00 $0.00 97 Medipl Devices 5 560.45 $43.77 $9.25 553.02 $O.OD $0.00 78 Multivitamins 1 $20.69 $13.65 $2.50 $16.15 $0.00 50.00 Grand Total 5,192 5588,648.72 $456,05,.33 58,666.40 $85,223.84 $0.00 $379,499. Page 2 of 2 11/03/08 Kerr County Copay Analysis 1 ~~ (~ G1A: C0031_Rpt Report Criteria Group(s) = 151 CyGes between 1/1/2008 and 10!31/2008 Current Copay Proposed Retail Generics For Days Supply Up to 30: $10.00 Copay Retail Formularies For Days Supply Up to 30: $25.00 Retail Non-formularies For Days. Suppty Up to 30: $40.00 Mail Order Generics For Days Suppy Up to 90: $20.00 Mail Order Formularies For Days Supply Up to 90: $50.00 Mail Omer Nan-formularies for Days Suppy Up to 90: $80.00 Speaalty-Eligible NDC Generics For Days Supply Up to 30: $20.00 Speaalty-Eligible NDC Formularies For Days Supply Up to 30: $50.00 Speaalty-Eligible NDC Non-formularies For Days Supply Up to 30: $80.00 Proposed Grouo Cost Ranae #~' ~I Amnt Paid Co°av Co°av vin XQ 151 Less than $10.00 982 $5,736.57 $21.99 $5,714.58 $5,736.57 $21.99 $10.00 to $24.99 842 $13,684.32 $5,493.32 $8,191.00 $8,857.57 $666.57 $25.00 to $49.99 738 $26,393.44 $16,681.17 $9,712.27 $10,424.95 $712.68 $50.00 to $74.99 600 $36,237.78 $25,576.24 $10,661.54 $12,045.00 $1,383.46 $75.00 to $99.99 515 $42,513.65 $31,142.82 $11,370.83 $13,470.00 $2,099.17 $100.00 to $199.99 977 $127,613.03 $103,960.97 $23,652.06 $25,705.00 $2,052.94 $200.00 to $299.99 292 $66,253.51 $58,330.27 $7,923.24 $9,445.00 $1,521.76 $300.00 to $399.99 131 $41,651.07 $37,697.75 $3,953.32 $4,600.00 $646.68 $400.00 to $499.99 37 $16,116.17 $14,886.17 $1,230.00 $1,525.00 $295.00 $500.00 to $599.99 21 $11,669.49 $11,059.49 $610.00 $755.00 $145.00 $600.00 to $699.99 15 $9,898.15 $9,408.15 $490.00 $595.00 $105.00 $700.00 to $799.99 1 $725.95 $655.95 $70.00 $80.00 $10.00 $800.00 to $899.99 6 $5,218.30 $4,938.30 $280.00 $330.00 $50.00 $900.00 to $9ss.ss o $O.oo $o.oo $o.oo $o.oo $o.oo $1000.00 to $1099.99 1 $1,036.10 $966.10 $70.00 $40.00 ($30.00) $1100.00 to $1199.99 0 $0.00 $0.00 $0.00 $0.00 $0.00 $1200.00 to $1299.99 0 $0.00 $0.00 $0.00 $0.00 $0.00 $1300.00 or more 34 $59,976.20 $58,681.20 $1,295.00 $1,025.00 ($270.00) Group Total 5192 $464,723.73 $379,499.89 $85,223.84 $94,634.09 $9,410.25 Carrier Total 5192 $464,723.73 $379,499.89 $85,223.84 $94,634.09 $9,410.25 Page 1 of 1 11104/08 Kerr County Copay Analysis 2 ~w~~T~~ C0031_Rpt Report Criteria Group(s) = 151 Cycles between 1/1/2008 and 10/31/2008 Current Camay Proposed Retail Generics For Days Supply Up to 30: $10.00 Copay Retail Formularies For Days Supply Up to 30: $30.00 Retail Non-formularies For Days Supply Up to 30: $45.00 Mail Omer Generics For Days Supply Up to 90: $20.00 Mail Order Formularies For Days Supply Up to 90: $60.00 Mail Order Non-fomwlaries For Days Supply Up to 90: $90.00 Specialty-Eligible NDC Generics For Days Supply Up to 30: $10.00 Specalty-Eligible NDC Formularies For Days Supply Up to 30: $30.00 Specialty-Eligible NDC Non-formularies For Days Supply Up to 30: $45.00 Proposed Grouo Cost Range TAI AmM Paid CODBV Co°av Savings XO 151 Less than $10.00 982 $5,736.57 $21.99 $5,714.58 $5,736.57 $21.99 $10.00 to $24.99 842 $13,684.32 $5,493.32 $8,191.00 $8,857.57 $666.57 $25.OOto$49.99 738 $26,393.44 $16,681.17 $9,712.27 $11,091.15 $1,378.88 $50.00 to $74.99 600 $36,237.78 $25,576.24 $10,661.54 $13,405.00 $2,743.46 $75.00 to $99.99 515 $42,513.65 $31,142.82 $11,370.83 $15,635.00 $4,264.17 $100.00 to $199.99 977 $127,613.03 $103,960.97 $23,652.06 $29,825.00 $6,172.94 $200.00 to $299.99 292 $66,253.51 $58,330.27 $7,923.24 $11,005.00 $3,081.76 $300.00 to $399.99 131 $41,651.07 $37,697.75 $3,953.32 $5,365.00 $1,411.68 $400.00 to $499.99 37 $16,116.17 $14,886.17 $1,230.00 $1,820.00 $590.00 $500.00 to $599.99 21 $11,669.49 $11,059.49 $610.00 $900.00 $290.00 $600.00 to $699.99 15 $9,898.15 $9,408.15 $490.00 $700.00 $210.00 $700.00 to $799.99 1 $725.95 $655.95 $70.00 $90.00 $20.00 $800.00 to $899.99 6 $5,218.30 $4,938.30 $280.00 $380.00 $100.00 $900.00 to $999.99 0 $0.00 $0.00 $0.00 $0.00 $0.00 $1000.00 to $1099.99 1 $1,036.10 $966.10 $70.00 $45.00 ($25.00) $1100.00 to $1199.99 0 $0.00 $0.00 $0.00 $0.00 $0.00 $1200.00 to $1299.99 0 $0.00 $0.00 $0.00 $0.00 $0.00 $1300.00 or more 34 $59,976.20 $58,681.20 $1,295.00 $1,215.00 ($80.00) Group Total 5192 $464,723.73 $379,499.89 $85,223.84 $106,070.29 $20,846.45 Carrier Total 5192 $464,723.73 $379,499.89 $85,223.84 $106,070.29 $20,846.45 Page 1 of 1 11104108 Gary R. Looney, REBC 3201 Cherry Ridge Drive n Suite D 405 San Antonio, Texas 78230 INSURANCE GROUP, INC. phone: (210) 9306665 Fax: (210) 930-1838 Memorandum Date :November 5, 2008 TO :Kerr County Commissioners' Court From :Gary Looney ReBc RE :Annual Renewal for Medical Plan - 2009 Pat Tinley County Judge H.A. "Buster» Baldwin Commissioner Preanct One William "Bill" Williams Commissioner Precinct Two Jonathan Letz Commissioner Precinct Three Bruce Oehler Commissioner Precinct Four The County solicited bids Stop Loss Insurance and Group Term Life Insurance. We received two complete quotes. Even though the response only included two quotes the stop loss market was heavily solicited. The stop loss insurance quoting process requires that we release substantial underwriting information to potential bidding companies. After reviewing the information a number of companies declined to bid stating they were not competitive. The Third Party Administrator, F. A. Richard and Associates (FARA), has a three year contract which renews as is for 2009. I have attached a copy of a spreadsheet showing the results of the renewal and the proposals offered. I have attached a copy of the suggested funding rates for 2009. I recommend that the Court renew the stop loss contract with Monumental Life for the following reasons: 1. The renewal rates offered are co petitive and in line with the medical claim losses. - f -G a o o ~ s ~~~ ~°'~ 5 2. The offer from IV`onumental Life does not require any additional underwriting of large losses and therefore no additional deductibles will be applied to any individual claimant. 3. The PPO network is functioning properly to provide the County with significant discounts. 4. The Health Reimbursement Arrangement with Data Path through FARA is working as projected. The group term life insurance provided by Mutual of Omaha was also placed for bid. Mutual of Omaha offered a "no change" renewal for $.22/$1,000 for life insurance and 3201 Cherry Ridge Drive $.02/$1,000 for Accidental Death and Dismemberment. The closest bid to Mutual of Suite D405 Omaha was 25% higher in cost. I recommend renewal of the Mutual of Omaha San Antonio, Texas 78230 group term life insurance contract for 2009. V 210.930.6665 The current employee contributions for health insurance are sufficient to meet the F 210.930.1838 funding requirements for the medical plan for 2009. The County's budget will alomogrp~alamoinsgrp.com support the funding requirements for the medical plan for 2009. With all due respect to the age 65 and older retirees and active employees please consider the following information. 1. There are currently 14 retired employees who are charged $135 per month for the County's health insurance plan. 2. The reasons for the continuing the County's plan are: a. The cost is less than most Medigap plans available on the market. b. The co-ordination of benefits with Medicare provides excellent coverage for medical expense reimbursements c. Prescription Drug Expenses are covered through the County's co- payment program. Under Tab III all of the prescription drug charges are shown. Under Tab IV is a summary of all drug costs for active and retired employees over the age of 65. 3. There are an additional 15 active employees over the age of 65 and 8 who are 63 or above. The Kerr County employee population is ageing. The number of retirees on the plan will increase due to the advantages offered by the County to retiring employees that are in excess of the plans available in the open market. A retinae is required to pay $135 for the County's insurance. The County's plan co-ordinates with Medicare to pay deductibles and out of pocket expenses and provides a prescription program. Medicare Part A (Hospital expenses) is free; Medicare Part B (Physicians) premium is $96.40 per month on average. Medicare Part D (Rx) premiums range from $45/month to $90/month. A Medicare Supplement Policy that reasonably reflects the current coverage provided by the County ranges in price from $170 to $220 per month. I have attached a spreadsheet with a comparison of cost and coverage provided by the County and Medicare. The comparison shows that the County's cost per individual is budgeted at $620/mth. The exposure to an active County employee over the age of 65 includes the annual deductible difference between the HRA ($600) and the annual deductible of $1,000 or net $400. The maximum out of pocket which does not include co-payments is $2,000. The prescription drug plan co-pays ($10, 20, 35) and doctor office visit co-pays ($30) continue on an annual basis. Under Parts A,B,D of Medicare with Supplement G to Medicare the annual deductible for Part B is $136. If physicians accept Medicare in full there are no office visit co-pays. If they do accept the negotiated Medicare fee they are allowed to charge up to 15% more than Medicare allows. Supplement G pays 80% of the 15% excess. With Part D Medicare Plus Plan with Aetna, co-pays for preferred generics is $0, non-preferred generics is $10, preferred brand is $34, non-preferred brand is $74, and specialty meds is a 33% co-insurance. This information is for discussion purposes only. This is not a request for acceptance of an optional medical plan design. Prescription drug costs are approximately 28% of total plan claims. I have included options to change the prescription co-pay structure showing the savings generated by the changes. The changes generated by marginal increases in the co-pays are not significant enough to warrant the change. An increase from $10/20/35 to $10/30/45 would create approximately $24,000tyear in cost reductions. To impact the cost of medications the drug co-pays would need to increase significantly. I indicated on the spreadsheet showing the comparison between the County plan and Medicare that a Medicare Supplement plan and a Medicare Part D plan would cost approximately $220 per month. Retinses are currently paying $135.00 for a better program. I recommend an increase of $45.00 a month for plan year 2009. 1 sincerely appreciate your confidence in my efforts to provide a financially sound health insurance program for you and your employees. Gary R. Looney Risk Management Consultant, REBC glooney@alamoinsgrp.com >~ ~~°~. ~~Z~ ~~~m ~ g~~ ~~~~ ~°'~ B~ ~~~ a~ $ $' ~~~$ ~~ ~~~ ~o 0 ~~~ ~~~83 ~~~~ ~~~~. m~~ ~~ ~ p~a~y C ~ ~+ .~~~~~ ~~~e~ n~~~~ ~~~>' ~~~~~ ~~~ 2~ ~~m°~ ~~WO< .~ 4~ ~ -^ ~ +~ 8 ~ ~~~~ 0 ~$~^ a ~~ ~~~ d~~~~ °'o~~~gm ~~~~3 ,~~~.~ ~~~~~ t ~~5~8~~ ~~ ~~°~~~ L y t a~g~~~~ ~8~~~~ ~ ~ma~ ~~~~s®~ Q~L~o°~ "s.c N a`~~..~D r~ ~~~$oa ~~~~~o.~ m ~p S9 ~ v y'S0 a~a ~>. g~~~~$m ~U2;n£U m N „„. „„. a January 1, 2009 to December 31, 2009 Sur~trn ~Y of Benefits Aetna Medicare Rx~ Plan Texas 55810_7D_80706 (09{2008) Visit us www.aetnamedicare.com 1 1 Summary of Benefits: Aetna Medicare Rx~ Plan Section 1: Introduction Texas Thank you for your interest in Aetna Medicare Rx Plan. Our plan is offered by AETNA LIFE INSURANCE COMPANY/Aetna Medicare, a Medicare Prescription. Drug Plan that contracts with the federal government. This Summary of Benefits tells you some features of our plan. It doesn't list every drug we cover, every limitation, or exclusion. To get a complete list of our benefits, please call Aetna Medicare and ask. for the "Evidence of Coverage." You Have Choices In Your Medicare Prescription Drug Coverage As a Medicare beneficiary, you can choose from different Medicare prescription drug coverage options. One option is to get prescription drug coverage through a Medicare Prescription Drug Plan, like Aetna Medicare Rx Plan. Another option is to get your prescription drug coverage through a Medicare Advantage Plan that offers prescription drug coverage. You make the choice. How Can I Compare My Options? The charts in this booklet list some important drug benefits. You can use this Summary of Benefits to compare the benefits offered by Aetna Medicare Rx Plan to the benefits offered by other Medicare Prescription Drug Plans or Medicare Advantage Plans with prescription drug coverage. Where Is Aetna Medicare Rx Plan Available? There is more than one plan listed in this Summary of Benefits. If you are enrolled in one plan and wish to switch to another plan, you may do so only during certain times of the year. Please call Customer Service for more information. The service area for this plan includes the following: Texas. You must live in this area to join this plan. Who Is Eligible To loin? You can join this plan if you are entitled to Medicare Part Aand/or enrolled in Medicare Part B and live in the service area. Eligible individuals may only enroll in one Medicare Prescription Drug Plan at a time and may not be enrolled in a Medicare Advantage Plan (HMO, PPO), unless they are a member of Medicare Private Fee-for-Service plan or are enrolled in an 1876 Cost Plan. You cannot enroll in the Aetna Medicare Rx Premierb Plan if your current or former employer or union (or your spouse's current or former employer or union) helps pay for your drugs. Does My Plan Cover Medicare Part B Or Part D Drugs? Aetna Medicare Rx Plan does not cover drugs that are covered under Medicare Part B as prescribed and dispensed. Generally, we only cover drugs, vaccines, biological products and medical supplies that are covered under the Medicare prescription drug benefit (Past D) and that are on our formulary. Where Can I Get My Prescriptions? Aetna Medicare Rx Plan has formed a network of pharmacies. You must use a network pharmacy to receive plan benefits. We will not pay for your prescriptions if you use an out-of-network pharmacy, except in certain cases. Aetna Medicare Rx Plan has a list of preferred pharmacies. At these pharmacies, you may get your drugs at a lower copay or coinsurance. You may go to other network. pharmacies, but you may have to pay more for your prescription drugs. 2 I Visit us www.aetnamedicare.com 55810_7D_80706 (09/2008) January 1, 2009 to December 31, 2009 The pharmacies in our network can change at any time. You can ask for a Pharmacy Directory or visit us at www.aetnamedicare.com/ plan_choices/rx_find_prescriptions.fsp. Our Customer Service number is listed at the end of this introduction. If you or your spouse has, or is able to get, employer group coverage, you should talk to your employer to find out how your benefits will be affected if you join Aetna Medicare Rx Plan. Get this information before you decide to enroll in this plan. What Is A Prescription Drug Formulary? Aetna Medicare Rx Plan uses a formulary. A formulary is a list of drugs covered by your plan to meet patient needs. We may periodically add, remove, or make changes to coverage limitations on certain drugs or change how much you pay for a drug. If we make any formulary change that limits our members' ability to fill their prescriptions, we will notify the affected enrollees before the change is made. We will send a formulary to you and you can see our complete formulary on our website at www. aetnamedicare. com/plan_choices/ rx_find_prescriptions.fsp. If you are currently taking a drug that is not on our formulary or subject to additional requirements or limits, you may be able to get a temporary supply of the drug. You can contact us to request an exception or switch to an alternative drug listed on our formulary with your physician's help. Call us to see if you can get a temporary supply of the drug or for more details about our drug transition policy. What Should I Do If 1 Have Other Insurance In Addition To Medicare? If you have a Medigap (Medicare Supplement) policy that includes prescription drug coverage, you must contact your Medigap Issuer to let them know that you have joined a Medicare Prescription Drug Plan. If you decide to keep your current Medigap supplement policy, your Medigap Issuer will remove the prescription drug coverage portion of your polity. This will occur as of the effective date of your coverage in the Medicare Prescription Drug Plan and they will adjust your premium. Call your Medigap Issuer for details. How Can 1 Get Help With My Drug Plan Costs? If you qualify for extra help with your Medicare Prescription Drug Plan costs, your premium and costs at the pharmacy will be lower. When you join Aetna Medicare Rx Plan, Medicare will tell us how much extra help you are getting. Then we will let you know the amount you will pay. If you are not getting this extra help you can see if you qualify by calling 1-800-MEDICARE (1-800-633-4227). TTY/TTD users should call 1-877-486-2048. What Are My Protections In This Plan? All Medicare Prescription Drug Plans agree to stay in the program for a full year at a time. Each year, the plans decide whether to continue for another year. Even if a Medicare Prescription Drug Plan leaves the program, you will not lose Medicare prescription drug coverage. If a plan decides not to continue, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area. 55810_7D_8o706 (092008) Visit us www.aetnamedicare.com 13 Summary of Benefits.: Aetna Medicare Rx~ Plan As a member of Aetna Medicare lZx Plan, you have the right to request a coverage determination, which includes the right to request an exception, the right to file an appeal if we deny coverage for a prescription drug, and the right to file a grievance. You have the right to request a coverage determination if you want us to cover a Part D drug that you believe should be covered. An exception is a type of coverage determination. You may ask us for an exception if you believe you need a drug that is not on our list of covered drugs or believe you should get a non-preferred drug at a lower out-of-pocket cost. You can also ask for an exception to cost utilization rules, such as a limit on the quantity of a drug. If you think you need an exception, you should contact us before you try to fill your prescription at a pharmacy. Your doctor must provide a statement to support your. exception request. If we deny coverage for your prescription drug(s), you have the right to appeal and ask us to review our decision. Finally, you have the right to file a grievance if you have any type of problem with us or one of our network pharmacies that does not involve coverage for a prescription drug. What Is A Medication Therapy Management (MTM) Program? A Medication Therapy Management (MTM) Program is a free service we may offer. You may be invited to participate in a program designed for your specific health and pharmacy needs. You may decide not to participate but it is recommended that you take full advantage of this covered service if you are selected. Contact Aetna Medicare for more details. Please call Aetna Medicare for more information about Aetna Medicare Rx~ Plan. Visit us at vvww.aetnamedicare.com or, call us: Customer Service Hours: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, 8:00 a.m. - 8:00 p.m. Current members should call toll-free 1-877-238-6211. (TTY/TDD 1-888-760-4748) Prospective members should call toll-free 1-800-213-4599. (TTY/TDD 1-800-628-3323) For more information about Medicare, please call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You can call 24 hours a day, 7 days a week. Or, visit www.medicare.gov on the web. if you have special needs, this document may be available in other formats. 4 I Visit us www.aetnamedicare.com 55810_7D_80706 (092008) Summary of Benefits: Aetna Medicare Rx'° Plan Section 2 Texas Benefit Category 29 - Prescription Drugs Original 'Aetna Medicare '~ Medicare i Rx Essentials Plan I Most drugs are not j Drugs covered covered under 'under Medicare Original Medicare. Part D I You can add general prescription drug This p an uses a I coverage to Original formulary The plan Medicare by joining a will seriel you the Medicare Prescription ' formulary.: Yqu can i Drug Plan, or you also `see he can get all your .formulary at Medicare coverage, . www.aetnanredicare. including prescnption ~ comlplan choices! i drug coverage, by _ ,x find prescriptiorts: joining a Medicare __ _ jsp on the Neb. Advantage Plan or a Medicare Cost Plan Different out-af= that offers pcc.kct costs may " prescription drug people apply for coverage. who: • have limited ~, incomes, ', live in long term ears facilities, car have access to IndianlTriba4/Urbane (indian Heath Service}. $25.0 rnontr,~ly plane premium. The plan offers I ~ nationa; in-network prescription coverage (I.e., this would ' '~ inluriP 5~ St;~tP~ and ~ DC). This meanstl~at !. I you will pay the I ~ same cost-sharing 'amount for your prescription drugs if you get them a[ an j in-network pharmacy i ~ outside of the plan's ~ ~ service area (for I 'instance when you ~ travell. ~ TOta) yearly drug costs are the total I drug costs paid by both you and the plan. If you have any questions about this plan`s benefits or costs, please contact Aetna Medicare for details. Aetna Medicare -Aetna Medicare Rx Plus Plan Rx Premier Plan Drugs covered Drugs covered under Medicare under Medicare Part D :.Part D General .General This plan uses a This plan uses a formulary. The plan formulary. The plan ' will send you the will send yoU the formulary. You can ,formulary. You can also see the also see. ti,~e formulary at formulary at www.aetnamedicare. Uvwvd.aetnarnc,dicare eomlplan_choices/ corn/plan choices/ rx_fiind_prescriptions. rx_find_ prescriptions.. jsp on the web. jsp on the web. Different out-of- Different out-of- pocket costs may :pocket costs may apply for people `apply for people who: who: • have limited • have limited incomes, incomes, • live in long term • live in long terra care facilities, or care facilities, or • have access to • have access to IndianlTribal/Urban Indianll'ribal/Urban (Indian Health (Indian Health Service). Service). $53.10 monthly plan $80.50 monthly plan premium. pi erniuni, The plan offers The plan offers .national in-network 'national gin-network i prescription coverage ; _prescriplic~ri coverage ~~ (~.e ,this would (i.e., this would in.c-i i~P 5tl States and in.r 1i_idr~ ~,~ statr~~ ar~r~ DC). Tl~~is mcansthat DC). This means that.. you will pay the you will pay the sarr~e cost-sharing sairre cost-sharing amount foryour amount for-your I prescription drugs if prescription drugs if you getthematan you get tl~ern at an in-.network pharmacy in-network pl~~armacy outsiUeof the plan's.. outside ofi tl~ie plan's service area (fore service area (for instance when you- instance when you travelj. travel). Total yearly drug Total yearly drag costs are the total costs are the total drug costs paid by drug costs paid by both you and the both you and the plan. plan. S581o_7D_80706 (092008} Visit us www.aetnamedicare.com 15 Summary of Benefits: Aetna Medicare Rx' Plan Benefit Original Aetna Medicare ' Aetna Medicare Aetna Medicare' Category ;Medicare Rx Essentials Plan Rx'Plus Plan Rx Premier Plan 29 - ~ The plan ~~~ay require The plan may require The plan may require Prescription i~ you to first try one youto first tryone' ~~ou to first try one drugs ! drugto treat your drug to treat your drug to treat your (continued) ~ condition before it condition before it condition before it will cover ariother will cover another will. cover a~ot~er drug for that 'drug for that drug #car that condition.. - condition. condition. Some drugs have Some drugs. have . .Same drugs have quantity limits quantity Limits. ' quantity limits. Your provider must Your provider must Your provider must get prior get prior get prior i authorization from authorization from authorization frorr~- ', Aetna Medicare. ~x Aetna Medicare Rx Aetna Medicare Rx ' Essentials for certain ~ Plus for certain Premier for certain drugs. ~ drugs. ,drugs: You must go to You must go to ,You must go to certain pharmacies certain pharmacies ', certain pharmacies ~i ~ for a very limited ~ for a very limited ; far a very limited. number of drugs, number of drugs, number of drugs, due to special due to special 'due to special handling, provider handling, provider handling, provider coordination, or coordination, or ~ coorr~ination, or patient education patient education ::.patient education requirements for requirements for requiren-~cnts for these drugs that these drugs that these drugs thaf cannot be rnet by , cannot be met by ,cannot he met by most pharmaciF~s in most pharmacies m most phar~7~acies in j your network These your network: These your network. These ~~ dr~.ids are listed on .:drugs are listed on dn.uas a~e listF~d on' ~ thc~ plan's-website, the plan's website, the plan's website, ~~ formul~:ry, and formulary, and formulary, and ~ printed r7~aterials, as ~ printedrr7aterials,as printed materials, as well as on the swell as on the well as on the ~~~ Medicare Prescnpiion ' Medicare Prescnplion Medicare Prescription ' ~~ '~ Drug Plan Finder on '~ Drug Pfan Finder on Drug Plan finder on ~ Medicare gov. ' (vledicare.gov ' Medicare.gov. '~~ If the actual cost o` a ff the actuaf cost of a I~ the actual cost of a ~, drug is less than thr drug islessthan tl~e drug is less than the ', normal cost-sharinc7 .normal co,t-sharing normal cost-s}~~arfng '~ amount for that arnour~ffor that amount ?or t~~~at 'drug, you will pay drug, you will pay i drug, you will pay the actual cost, not i ~, the actual cost, not the actual cost, not the higher cost- ~ the higher cost- the higher cost- '~i '~ sharing amount. sharingamount. sharing amount. In-Network fn-Netv-tork In-Network $195 deductible ors $0 deductible. $U deductible. aII drugs except ~, generic drugs. I i~ 6 I Visit us www.aetnamedicare.com 55810_7D_80706 (092008) January 1, 2009 to December 31, 2009 _ Benefit ,Original _ _ Aetna Medicare _ ___ _ Aetna Medicare _ __ Aetna Medicare Category !Medicare Rx Essentials Plan ' Rx Plus Plan Rx Premier Plan 29 - You pay $0 copay for Sorne covered drugs Son~~e covered. drags Prescription ~, I Tier 1 -Preferred don't count toward don't count tov~ard Drugs ' Generic drugs and your out-of-pocket your out-of-p©ck.et (continued) $12 copay forTier 2 - drugcosts. drug costs. Non-Preferred ' Generic drugs until ~ ~ you reach the deductible. Initial Coverage Initial Coverage lnitiat Coverage After you,pay your You pay the Yo~_.i pay the ,.yearly deductible, following untii total following until total '~ o~_~ ~a the ' earl dru casts - ~ ~ earl. dru. costs ~ folio Ning until total $2,7Q0: reacfi reach $2,700:. yearly drug costs ~ reach $2,700: Retail Pharmacy Retail Pharmacy Retail Pharmacy Tier 1 -Preferred Tier 1 -Preferred 'Tier, 7 -Preferred ' Generic Generic Generic ~' ; • $0 copay fora $0 copay fora • $0 copay for a one-month ~ I one-month ' one-month (31-day)supply of ~ (31-day) supply of (31-day) supply of drugs rn this tier drugs in this tier drugs in this tier from a preferred from a preferred from a preferred pharmacy. pharmacy. pharmacy. '~, $0 copay fora ' • $0 copay fora • $0 copay for a three-month three-month three-month (90=day) supply of (90-day) supply of (90-day; supply of drugs In this tier drugs in this tier drugs ~n this tier ~ fmrn ~ preferred from a preferred '~ from a preferred I pharmacy. pharmacy. i pharmac_y. • $0 copay fora $O copay for a $0 copay fo~~~ a ~ one-month one-month one-month j (31-day) supply of ~ (31-day} su#aply of (31-day) supply of I drugs ~n tl~~is tier drugs in this tier drugs in this tier from other netv~,rork frort~ other network from other network ~ pharmacies. I pharr;~acies_ pharmacies. ', • $0 copay fora $0 copay far a $0 copay for a ~ t'~ree-month ~, .three-month three-month (90-day) supply of (90-day) supply of (90-day} supply of .drugs in this tier ~ drugs in this tier drugs in tf~is tier from other network . from other. network fiorn other networK ~I pharmacies. pharmacies. pl~~armacies. Tier 2 - ~ Tier 2 - Tier 2 - iNon-Preferred 'Non-Preferred Non-Preferred ~, Generic I Generic Generic ~ • $12 copay fior a ~ • $10 copay for a $10 copay f or a i ~ one-month one-monti-~ one-month (31-dayj supply of ~ (31-day) supply of (31-day} supply of drugs in this tier ', drugs ~tr~ this tier drugs in this tier from a preferred '~~ ~hom a prefen~ed prom a preferred ~I pharmacy. y_ ~ pharmacy. pharmacy- 5581 o_7D_80706 (09/2008) Visit us www.aetnamedicare.com 17 Surr7mary of Benefits: Aetna Medicare Rx`" Plan Benefit ~ Original Aetna Medicare Aetna Medicare ____ __ Aetna Medicare Category I Medicare ~ __ _ _ _ Rx Essentials Plan Rx Plus Plan Rx Premier Ptan 29 - • $3G copay fora $25 copay fora • $25 copay far a Prescription ~ three-month three-month three-m~nih Drugs ~, (90-day) supply of (90-day) supply of (90-day) s~~pply of (continued) ~, ~ drugs-in this tier drugs in this tier drugs in this tier from a preferred from a preferred from. a preferred pharmacy. ~ pharmacy. pharmacy. • $17 copay fora $10 copay fora • $10 copay fora one-ir~onth one-month pne-month ~I (31-day) supply of (31-day) supply of (31-day} supply of ~~ drugs m this tier drugs in this tier drugs in this tier fr or~n other network ~ .from other network ` from other nefiwark j I pharmacies. pharmacies: pharmacies. 'i $36 copay fora i • $30 copay fora • $30 cr~pay for a three-month three-month three-month (90-day) supply of (90-day) supply of (90-day) supply of drugs in this tier drugs in this tier drugs m thistier from other network ~ fromother network #rom other network l pharmacies. , pharmacies. pharmacies. i Tier 3 -Preferred Tier 3 -Preferred Tier 3 -Preferred Brand ~ Brand ' Brand • $27 copay fora ' • $34 copay fora , • $30 copay for a one-month one-month one-month (31-day) supply of (31-day) supply of (31-day) supply of drugs in this tier drugs in this tier drugs in this tier ', , from a preferred j from a preferred from a preferred pharmacy. pharmacy. pharmary. • $57.50 copay for a, , • $85 copay fora • $75 copay far a !, three-month three-month three-month (90=day} supply of (90-day) supply of (90-dav~ supl_~ly a( drt~gs,in 'this tier drugs m this tier drugs in ihs tier from a preferred from a lreferred I fre~m a preferred_ , pharmacy, pharmacy.. pl~~armacy. • $27 copay fora $34 copay fora $30 copay for a nnr~-r~~nnrh nnP-mnnfh nnr--rnnnth ', (31-day) supply of I (31-day)supplyof (31-day) supply of drugs in this tier drugs in this fier drugs in this tier .from oti~er netv~~oik from other network #rom other networK pharmacies_ pharmacies: pharmacies. • $81 copay fora $102 copay fora $90 copay fora three-month three-month three-month r90-day) supply of (90-day) supplyof (9Q-day) supply of ~ drugs in this tier .drugs in this taer drugs in this tier from other network ~ from o~t#~er network fror7i other network pharmacies. ~ pharmacies, pharmacies. 8 I Visit us www.aetnamedicare.com S581o_7D_8o706 (o9~z008) January 1, 2009 to December 31, 2009 - __ Benefit Category 29 - Prescription Drugs (continued) __ Aetna Medicare Rx Essentials Plan Tier 4 - I Non-Preferred Brand • $68 copay for. a one-month {31-day) Supply of I drugs in this tier from a preferred pharmacy; • $170 copay for a `three-month (90-day) supply of drugs in this tier from a prefen ed pharmacy. • $68 capay for a one-month (31-day) supply of drugs in this tier from other network j pharmacies, • $2~4 copay for a three-month I ~~p-day) supply of -drugs in this tier'.` fram other network pliarrmacies: Tier 5 -Specialty. •'~ZS°ro coinsurance for aone-month `(31-day) >upp{yof drugs in this tier.. ~ from a preferred ', pharmacy • 25°o coinsurance for athree-month (90-day) supply of drugs ~n this tier from d preferred pharmacy. • z5% coinsurance for aone-month (31-day) supply of ~i~ drugs in this tier from other netwark pharmacies. __ Aetna Medicare Aetna Medicare. Rx Plus Plan Rx Premier Plan Tier 4 - _Tier 4 - Non-Preferred 'Nnn-Preferred Brand ;Brand • $74 copay fora • $65copayfor a one-month one-month (31-day) supply of {31-day) supply=of drugs in this tier drugs m this tier from a preferred fron, a preferred pharmacy. pharmacy. • $185 copay fora • $16250 copay for three-month athree-month {g0-day) supply of (90-day) supply of drugs in this tier 'drugs in this tier from a preferred from a preferred pharmacy. pharmacy. • $74 copay fora • $65 copay for a one-month one-month (31-day) supply of {31-day) supply of drugs in this tier drugs in this tier from other network '' from other network pharmacies. pharmacies. • $222 copay fora ; • $195 copay for a three-month three-month {90-day) supply of {90-day) supply of drugs in this tier drugs in this trey from other network from other network pharmacies. pharmacies- Tier 5 -Specialty ....Tier 5 - Spedalty • 33% coinsurance • 33°lo;coinsurance for aone-month for aone-rmontn (31-day) supply of i l31 -day) supply of drugs in this tier drugs in this tier from. a preferred from a prefered pharmacy nh.armary. • 33% coinsurance 33% coinsurance for a three-month for athree-month (90-.day) supply of (90-day) supply of .drugs in this tier ~ drugs in this tier from a preferred from a preferred pharmacy. ~ pharmacy. • 33°l0 coinsurance 33°o coinsurance far aone.-month. for aone-monir~ {31-day) supply of` (31-day) supply of drugs ir~thrstiec ~ drugs in this tier from-other notwark prom other net~nrork pharmacies. pf~arrmacies_ 55810_7D_80706 (09/2008) Visit us www.aetnamedicare.com 19 Summary of Benefits: Aetna Medicare Rx" Plan Benefit ;Original Aetna Medicare Category I Medicare - -_ _. _ Rx Essentials Plan. ___ - - j 29 - I • 25% coinsurance Prescription for athree-month Drugs (9(7-day' supply of (continued) ~; drugs' in this tier "from other network pharmacies. Long Term Care Pharmacy ~i Tier 9 - Preferred Generic • $0 copay for a one-rnontlr (31 -day}.supply of druas in this tier. Tier 2 - ', Non-Preferred Generic • $12 copay for a one-month (31-day) supply of ', dr~rgs in.this tier..: Tier 3 -Preferred Brand • $27 copay fora one-month (31-d~~y}supply of drugs in this tier. .Tier 4 Non-Preferred i Brand • $68 copay for a ~ one-month j ~~ 1~ i-day"j uF;~piy O I ~ drugs in this tier. Tier 5 -Specialty I ` % coinsurance • 25 ` for a or~c-month (31-day) supply of drugs in this tier. Mail Order Tier 1 -Preferred ' Generic ' • $0 copay for a I t}-Tree-month j (90-day) supply of i drugs In this tier from a preferred ' mail order I pharmacy. Aetna Medicare Rx Plus Plan • 33°/o coinsurance for athree-month (90-day) supply of drugs in this tier from other netwo pharmacies. Long Term Care Pharmacy Tier 1 -Preferred Generic $0 copay for a i one-month (31-day) supply of drugs in this tier. Tier 2 - Non-Preferred Generic • $10 copay for a one-month (31-day) supply of drugs in this: tier. Tier 3 -Preferred Brand • $34 copay for a one-month (31-day)`supply of drugs in this tier. Tier 4 - Non-Preferred Brand • $74 copay for a ' one-month l3 i -day) supply or drugs in this tier. tier 5 _ Specialty • 33°lo coinsurance for aone-month (31-day) supply o drugs'in this tier. Mail Order Tier ? - Preferred ' Generic • $0 copay (or a three-month (90-day) supply of ' drugs in this tier from a preferred ', mail order pharmacy. Aetna. Medicare ` Rx Premier Plan • 33% coinsurance' far a three-month (Q~-clay) supply of drugs m this tier rk from other network pharmacies: Long. Term Care Pharmacy ' Tier 1 -Preferred Generic • $0 copay fora one-i~~onil~ (31-day) supply of drugs in this tier-. Tier 2 - Non-Preferred Generic • $10 copay for a one-month (31-day} supply of drugs m this trer;. .Tier 3 -.Preferred Brand • $30 copay for a one-month (31-days supply of drugs in tFristier, Tier 4 - !Non-Preferred Brand - $65 copay for a one-month r (3 i -uay!sujapiy of drugs in this tier. Tier S -Specialty • 33°,~o coinsurance for none-month f (31-day) supply of drugs in this Uer. Mail Order Tier 7 -Preferred Generic • $0 copay fora three-month (90-day} supply of drugs in this tier fiom a preferred mail order pharmacy. 10 I Visit us www.aetnamedicare.com 55810_7D_80706 (092008] January 1, 2009 to December 31, 2009 Benefit Category 29 - Prescription Drugs (continued) Original Medicare (Aetna Medicare Rx Essentials Plan • $0'copay (or a three-month (90-day) supply of drugs in this trer from a noh-preferred mail ::order pharmacy. Tier 2 - Non=Preferred Generic • $24 copay for a three-month (90-day) supply of drugs in this tier. from a_prefer~ed email order pharmacy. • $36 copay for a three-month (90-day) supply of drugs in this tier {torn a non-preferred mail .order pharmacy: Tier 3 -Preferred Brand i • $54 copay for a three-rr~ohth (90-day) supply raf drugs in tPiis tier 'from a preferred ~ mail order ~ pharmacy. • ~zs i copay i or a I three-month ~', (90-day) supply of drugs in this tier from a non-preferred ma,l order pharmacy. Tier 4 - Non-Preferred Brand • $13E copay (or a i three-month i (90-dav) supply of drugs in this tier fror7~ a preferred mail order ~ pharmacy, Aetna Medicare Rx Plus Plan • $0 copay. for a three-month (90-day} supply of drugs in this tier from a non-preferred mail order pharmacy. Tier 2 - Non-Preferred Generic $20 copay for a three-month' (90-day) supply of drugs in this tier from a preferred mail order pharmacy. • $30 copay for a three-month (90-day) supply of drugs in this tier from a non-preferred mail order pharmacy. Tier 3 -Preferred .Brand • $68 copay for a three-month (90-day) supply of drugs in this tier. from a preferred mail order ' :...pharmacy. T~~~ • x rug copay for a three-month (90-day} supply of drugs in this tier from a nan-preferred mail order,pharmacy. 'Tier 4'- 'Non-Preferred Brand • $148 copay for a three-month (90-dayi supply o~ ', drugs in this tier from a preferred mail order pharmacy, Aetna Medicare Rx Premier Plan $D copay for a three-month (90-day} supply of drugs in this tier from a non-preferred mail order pharmacy.. Tier 2 - Non-Preferred Generic • $20 copay for a three-month (90-day) supply of j drugs in this tier from a preferred mail order pharmacy: • $30' copay for a three-month (90-day) supply of drur~s in this tier trom a non-preferred mail order pharmacy.':. ': Tier 3 -Preferred Brand • $60 copay for a three-month (90-day) supplyof drugs in this tier fron~~ a preferred mail order pharmacy. • $90 copay for a three-month f90-day) supply of drugs in this tier from a non-preferred mail order pharmacy. Tier 4 - Non-Preferred Brand • $130 copay for a three-month (90-day} supply of drugs in this tier from a preferred mai( order pharmacy. 55810 7D 80706 {092008? Visit us www.aetnamedicare.com 111 Summary of Benefits: Aetna Medicare RxA Plan Benefit ~~ Original Category I Medicare _.__ 29 - Prescription Drugs (continued) Aetna Medicare Aetna Medicare Rx Plus Plane Rx Premier Plan Aetna Medicare Rx Essentials Pian :.$204 copay for a three-.month I (9d-day? supply of drugsin this tier from a non-.preferred mail .order pharmacy. Tier 5 -Specialty • 25°lo coinsurance fora three-month (90-day} supply of drugs in this tier ' from a preferred- mail order pharmacy. • 25% coinsurance for athree-month (90-day) supply of drugs in this tier 'i from a 1 non-preferred mail ~ orderpharmacy. Coverage Gap After your total yearly drug costs reach $2,700, you... pay 100% until your yearly out-of-pocket drug costs r-each $4,350... • $222 copay fora • $195 copay fora three-month ~~ three-month (90-day) supply of (90-d~~y? supplyof drugs in this tier drugs in this tier from a from a non-preferred mail non-preferred mail order pharmacy. order pharmacy. Tier 5 -Specialty -Tier S -Specialty • 33% coinsurance • 33% coinsurance for athree-month for a tP~ree-rnonfh (90-day) supply of ~' (90-day) supply of drugs in thrs tier dn~gs in this tier from a preferred from a preferred mail order mail order pharmacy. ~ pharmacy. • 33% coinsurance • 33°lo coinsurance for athree-month for athree-month (90-day) supply of (90-day) upply of drugs in this tier drugs in this tier from a from a non-preferred mail non-preferred mail order pharmacy. ~, tjrder ~harmaey. - Coverage Gap Coverage Gap The plan covers The plan covers Tier 1 -Preferred ~Tier 1 - Prefenred Generic drugs Generic drugs and.:. through the Tier 2 -Non- coverage gap. Preferred Generic da~ugs througi-~ the coverage gap. You pay the following lou pay t ~e following; Retail Pharmacy Retail Pharmarv Tier 1 -Preferred Tier 7 -Preferred Generic ' Generic $10 copay for a • $10 copay for a one-month one-month ~(31-day} supply of (31-day) s~_rpply of all drugs covered in all drugs covered in this tier from a this t er from a ~ preferred preferred , pharmacy. pharmacy. • $25 copayfor a • $25 copay for a three-month three-month (90-day) supply of (90-day) supply of ~, alldrugs covered in all drugs covered in '~~ thistier from a this tier from a '~, preferred preferred pharmacy. pharmacy. L____' ' - -- -- 12 I Visit us www.aetnamedicare.com 55810_7D_80706 (09!2008) January 1, 2009 to December 31, 2009 ,_ __ .._ Benefit ,Original Category i Medicare _ __ 29 - Prescription Drugs (continued} i Aetna Medicare Rx fssentia{s Plan Aetna Medicare Aetna Medicare Rx Plus Plan Rx Premier Plan • $10 copay fora • $10copay fo~~ a one-month 'one-n~onth~ (31-day) supply of (31-day) supply of all drugs covered in all drugs covered in this tier from other this tier from other - .network network ~ pharmacies. ph~rrriaaes. ~ • $30 copay fora • $30 copay fora three-month three-n~~onth i (90-day) supply of ? (90-day} su{..ply of alldrugs covered in ~ all dugs covered in this tier from other this tier from oti~er network netvv~~rk pharmacies. pharmacies: Tier 2 None-Preferred I Generic • $25 copay for a one-month ~i (31-day) supply of all drugs covered in ( thin-tier from a preferred pharmacy. ' • $62.50 copay