Copyright, Valley Schools 2011

Valley Schools Employee Benefit TrustQuarterly Educational SessionMarch 27, 2012

Copyright, Valley Schools 2011

Agenda

Lunch 11:00 – 11:30

P.R.E.P – Sheri Gilbert, VSEBT 11:30 – 12:00

UnitedHealthcare Updates – Mark Baggot 12:00 – 12:15

HIPAA Compliance – Lisa Rafferty, Aon 12:15 – 12:30

VSEBT Claims Audit – Lisa Rafferty, Aon 12:30 – 1:00

Questions and Answers

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P.R.E.PPrevention Reward Employee Program2 + 1 Incentive Program

Primary Requirements•Completion of Annual Preventative Wellness Visit (Required for Reward)•Completion of Health Risk Assessment on myuhc.com (Required for Reward)

Employees must also complete 1 of the P.R.E.P. Items below to qualify for Reward: Additional P.R.E.P. Choices1.Enroll in DPCA Program if applicable (Diabetes Prevention & Control Alliance)2.Complete 8 months of Work it Off Exercise Program (10 hours of exercise per month)3.Complete a Smoking Cessation Program (state, county, or online with UHC coaching)4.Complete a UHC Health Coaching Program5.Attend 2 district sponsored Wellness Classes (Classes TBD by district) Implementation oSend communication to employees in April alerting them of the opportunity. Provide in OE materials.oEmployees have from 5/1/12 to 4/30/13 to complete the required action items to earn their additional deposit. oProof of services for Wellness Visit, Health Risk Assessment & UHC health coaching (including smoking cessation coaching) will be provided to VSEBT via reporting in June.oProof of completion for the Work it Off option will be provided to VSEBT via e-mail, fax or mail. oProof of smoking cessation certificate (other than UHC health coaching) shall be faxed, e-mailed or mailed to VSEBT.oProof of attendance for Wellness Classes will be verified by employee sign-in onsite and provided by district to VSEBT for confirmation. District should schedule classes between May and March to allow for recording of participation.

RewardsHDHP Members - $250 deposit in HSA in July 2013Traditional Plan Members: $50 to $75.00 Sprouts gift card in July 2013.

4

Pharmacy Benefit UpdateJuly 1, 2012 PDL and Benefit Plan UpdatesFor Self Funded Customers on the Advantage PDL

5

Summary of July 1, 2012 DecisionsWith the exception of Lipitor, no medications in the top 100 by utilization are affected.

Member impact should be minimal, but resulting savings should be significant.

Key Decisions # of Affected Drugs Effective Date

Down-tiers• Hormonal Contraceptives

8July 1, 2012 or earlier

4 Aug. 1, 2012

Up-tiers• Hormonal Contraceptives

3

4July 1, 2012

New Tier Placements 2July 1, 2012 or earlier

Exclusions 3 July 1, 2012

Continued Exclusions (confirmed from exclude at launch)

10 July 1, 2012

Select Designated Pharmacy 4 July 1, 2012

Notification Bulk Powders July 1, 2012

• New Supply Limits• Modified Supply Limits

10 July 1, 2012

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Lipitor Strategy Update

Generic Lipitor launched in November and is anticipated to decrease in price around June 1, 2012.

Upon the price drop of the generic, the following tier placements will be effective. The price will be monitored for eventual Tier 1 placement on the Advantage PDL.

Medication Name Tier Placement*

generic Lipitor (atorvastatin) or

Lipitor

At the Pharmacy

Point-of-sale messaging will direct the pharmacist to dispense the lowest

cost option for the member.

Additional Tier 1 generic alternatives available:

• lovastatin (generic Mevacor) • pravastatin (generic Pravachol)• simvastatin (generic Zocor)

*Final timing for this tier change is dependent on the price decrease of the generic, which is anticipated to be near June 1, 2012.

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Hormonal Contraceptives Health Care Reform Update for Pharmacy

Beginning Aug. 1, 2012, UnitedHealthcare will implement several tier changes as part of Health Care Reform.

We are required to provide coverage for medications:

in Tier 1

at $0 Cost Share

from each of these categories:• Emergency (e.g. Plan B)• Hormonal (e.g. Oral or other route)• Barrier (e.g. diaphragms)

8

Hormonal Contraceptives PDL Management Strategies

Azurette/Kariva, Balziva/Briellyn/Zenchent, Junel/Microgestin, Ogestrel (Branded Generics - Advantage PDL Only)

ella, Plan B One-Step (emergency contraceptives)

Natazia

Yasmin (Advantage PDL Only)

Decisions:

Numerous options in Tier 1 and Tier 2 provide members with affordable access. Approximately 50% of

prescription claims for hormonal contraceptives will process at $0 cost share when zero cost share is

implemented.

Each unique progestin contraceptive medication

will be represented in Tier 1, making sure

women have access to each type of

contraceptive.

Number of Tier 1 Contraceptive Options

Number of Tier 2 Contraceptive Options

Number of Tier 3 Contraceptive

Options

26* 9* 13*

*Count is based on the chemical or each unique product represented; there may be multiple medication names for each.

Copyright, Valley Schools 2011

HIPAA Compliance

• HIPAA compliance required for all entities.

• Current manual, forms, processes are being updated for any recent changes.

• Replace all current materials with the new materials.

• HIPAA training available soon.

VSEBT – UHC Audit Results

Quarterly Education SessionMarch 27, 2012

10Aon Hewitt - Health and Benefits

Consulting

Health Plan Audits — Aon Hewitt– Expertise and Experience—Aon Hewitt

has performed more audits than any other firm, uses full-time auditors, has extensive experience with UHC , as well as other significant administrators

– Aon Hewitt performs over 200 audits annually

– We have over 20 expert auditors that do this work full time

– Our auditors average 18 years of industry experience

– Aon Hewitt “scores” an administrator’s performance and capabilities, and consistently identifies “opportunities” to lower plan costs and improve service

– We focus on Process Improvement, Outcomes, and Results

11Aon Hewitt - Health and Benefits

Consulting

Sound Reasons for the Audit– Determine how accurately

and effectively VSEBTs medical plans are being administered by UHC

– Resolve plan service issues and benefits administration problems

– Show VSEBT districts that a comprehensive “due diligence” process has been performed and controls have been tested

– Indicate to UHC that VSEBT expects the plans to be administered accurately and effectively

12Aon Hewitt - Health and Benefits

Consulting

Claim Audit Process• Our claim assessment looks at

– VSEBT benefit intent– Eligibility of claimant– Application of provider data– Benefit calculation accuracy– Application of plan design

features– COB or TPL application, when

applicable– Claims/coding accuracy– Controls in place to manage

claims– Participant claim history– Documentation supporting final

benefit determination– Claim processing turnaround

time

13Aon Hewitt - Health and Benefits

Consulting

Aon Hewitt Audit Results• Aon Hewitt onsite @ UHC Florida facility – Week of

11/14/2011• Operational Assessment – 11/3/2011 in Green BaySpecific Objectives:

•Verify VSEBT medical benefits paid accurately and according to plan documents

•Assess overall quality of claim administration being delivered by UHC personnel

•Indentify opportunities and changes that will improve UHC overall performance on the account and increase level of service being provide to VSEBT participants

14Aon Hewitt - Health and Benefits

Consulting

VSEBT Performance Standards and Objectives for 2011

15Aon Hewitt - Health and Benefits

Consulting

VSEBT

UHC Claim Audit Results

UHC performed well in handling VSEBT medical claims

16Aon Hewitt - Health and Benefits

Consulting

Claim Processing Time

UHC is processing VSEBT claims on a very timely basis

17Aon Hewitt - Health and Benefits

Consulting

Call Resolution/Volume

UHC Green Bay team exceed first call resolution objective of 90%

VSEBT participants use of website varies by district: 44% to 83%

18Aon Hewitt - Health and Benefits

Consulting

Customer Service Responsiveness

We found the customer service tools, capabilities and recent performance results to be quite good compared to other administrators.

19Aon Hewitt - Health and Benefits

Consulting

Customer Service Call Quality

UHC personnel exceed the quality contract objective during the timeframe reported.

20Aon Hewitt - Health and Benefits

Consulting

Questions?

21Aon Hewitt - Health and Benefits

Consulting

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THANK YOU!