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Agenda Report - July 6, 2004 B-01 SM
AGENDA ITEM AM CITY OF LODI COUNCIL COMMUNICATION TM AGENDA TITLE: Presentation and Appropriate Direction Regarding CalPERS Medical Costs and Options for Consideration MEETING DATE: Tuesday, July 6th, 2004 PREPARED BY: Risk Manager RECOMMENDED ACTION: That Council hears the presentation regarding CaIPERS Medical Costs and Options for Consideration and provides any direction they deem appropriate. BACKGROUND INFORMATION: The City recently received medical insurance rates from CalPERS which will become effective January 1 st, 2005. While rates do vary by provider, the increase applicable to members of Blue Shield is 23.71% - most City employees (84%) are members of this HMO. These increases present the City with additional expenditures for active City employees in calendar 2005 that are approximately $724,332 greater than calendar 2004. A primary factor driving this increase is CalPERS new practice of 4regional ratingH- This effectively serves to drive rates up in northern California while lowering them in southern California. CaIPERS medical program members in the Los Angeles area will realize rate decreases of as much as 8.7%. The HMO premium increase for State employees will increase, but only by 11.4%, not the 23.71 % facing northern California cities. The City of Lodi's benefits broker, ABD Insurance & Financial Services, has located a potential alternative medical insurance provider, PacifiCare, which the City may wish to consider. PacifiCare's rates for active City employees in calendar 2005 represent additional expenditures for active City employees in calendar 2005 that are approximately $333,798 greater than calendar 2004. This is $390,534 less than the CalPERS increase. Meetings were conducted on 6128104 and 711 iO4 where representatives of the City's various bargaining groups and City employees were invited to learn about this potential change and ask questions. Representatives from ABD and PacifiCare will be present at this Council meeting to answer any questions Council members may have. Should the City of Lodi decide to withdraw from the CalPERS Medical Program, a resolution to this effect must be adopted by City Council by Monday August 16`h, 2004. The scheduled Council meeting prior to this deadline is August 4th, 2004. FUNDING: Not Applicable J. Evans Fisk Manager t' � Market Survey Analysis Prepared for City of Lodi Presented By Terri Ezaki & Lynette Kaminski Effective January, 2005 Sacramento Employee Benefits Division --? — (o -- a ARD Insurance & Financial Services License #OD56513 CITY OF LODI NEDICAL - Cost Comparison (Actives) - Effective January 1. 2005 Participation in the medical plans is based on current medical elections. Rates above are based on the census data provided by CITY OF 1.001. Final rates are subject to actual enrollment, plan design(s) selected, underwriting guidelines and approval. ' Kaiser rates outside of PERS are not confirtned. Prepared by A13D Insurance and Financial Services, License #OD58513 Confidential. Modification or reproduction is prohibited. 6/29/2004 KAISER KAISER KAISER' MF.D(GL Employee 15 M2 QV, Rr nuts. fl4ahel $305.42 M110V.sUli &SIO9tllrol $354.69 6100yihmn $354.69 Employee + 1 Dependent 6 $610.84 $709.38 $709.38 Employee + 2 or more Dep. 15 5794.09 5922.19 $922.19 MONTHLYPREMIUM $20,137.69 $23,469-49 $23,409.48 ANNUAL PREMIUM $241,892 $280,914 $,280,914 Annual S Increase ever Current N/A $39,021 $39,021 %Increase over Current: ......................_..................................................._ N/A ................._ ............._....._ 1613% . _.. ._.......... 16.13 % _............... _ _............_ .._.._ SLUE SHIELD BLUE SHIELD PACIFICARE - dJG 0V. Rcfd n5fJ5k ,.RxS5MM meoyyu ll am sli eNenl Employee 67 5315.22 $389.96 $349.68 Employee + I Dependent 78 5630.44 $779.92 $697.34 Employee + 2 or mom Dep. 205 5819.57 $1,013.90 $906.53 MONTHLYPREMIUM $238,305-91 $294,910,58 $263,542.73 ANNUAL PREMIUM $2,939,671 $3,537,127 53,163,113 Annual $ Increase over Current N/A $678,036 5303,442 %Increaseover Carry t. _NIA 2371% JA#J% PERSCARE PERSCARE PACIFICARE (PPO) (PPO) (PPO Plan U52 - Can) Employee 0 $544.77 $619.93 5407.38 Employee+ 1 Dependent 0 51,089.54 S1,239.86 $814.74 Employee +2 or more Dep. 0 51,416.40 $1,611.82 $1,059.17 MONTHLYPREMIUM U00 $0.00 $6.00 ANNUAL PREMIUM $0 SO $0 Annual S Increase over Current N/A $0 $0 % Increaseover Cxrrsnt: N/A _ .. _ . N/A ._ . ___.. _.. ........_.... -2X22% _........ _ ...... _....._..... _...................._................_........................ PERS CHOICE PERS CHOICE PACIFICARE (PPO) (PPO) (PPO Pian U53 - Choice) Employee 26 $349.41 5369.74 $332.05 Employee + 1 Dependent 0 $698.82 $739.48 5664.08. Employee + 2 Or more Dep. 0 $908.47 5961.32 $963.31 MONTHLYPREMIUM $9,084:66 $9,613.24 $8,633.30 ANNUAL PREMIUM $109,016 SI151359 $103,600 Annual S Increase over Current MA $6,343 451416 %Increase over Current: N/A 5 E2X...............................................-4.97%....................... ...................................I....................._..... ........... ...................... ........................._. �.......................... PORAC PORAC PACIFICARE (PPO) (PPO) (PPO Plan U53 - Choice) Employee 0 5399.00 $399.00 $332.05 Employee+ 1 Dependent 0 $733.00 $748.00 $664.08 Employee + 2 or more Dep. 4 $931.00 $950.00 $863.31 MONTHLYPREMIUM $3,724:00 $3,80OL00 $3,453.24 ANNUAL PREMIUM $44,698 $45,600 $41,439 Annual S Increase over Current N/A $76 43,249 % Increase over Current: N/A 2% -9.13% Participation in the medical plans is based on current medical elections. Rates above are based on the census data provided by CITY OF 1.001. Final rates are subject to actual enrollment, plan design(s) selected, underwriting guidelines and approval. ' Kaiser rates outside of PERS are not confirtned. Prepared by A13D Insurance and Financial Services, License #OD58513 Confidential. Modification or reproduction is prohibited. 6/29/2004 CITY 4F LODI MFn1CAL - Cnst Cmmnarisnn - Farly Retirees (Under 65) - Efiective Jalnuary 1. 2005 ` � KAISER KAISER # Covered(HMO)--HMO wm KAISER' (HMO) MEDICAL (S10 OV. R: S&M $10 ddre) 1$10 OV. R%W15 810 ddro) (S10 OV. R: $ells' Employee 3 $305.42 $354.69 $354.69 Employee+ 1 Dependent 3 $610.84 $709.38 $709.38 Employee + 2 or more Dep. 1 $794.09 $922.19 $922.19 MONTHLY PREMIUM $3,542.87 $4,114.40 $4,114.40 ANNUAL PREMIUM $42,514 $49,373 $'49,373 %Increase over Current: N/A N/A 0.00% ................................................................................................................................................................................................................................................................................................................................. BLUE SHIELD BLUE SHIELD PACIFICARE (619 OV. Rx VUSC31 (810 OV. Rx smsms1 (810 oy. Ra $Msft $10 drml Employee 13 $315.22 $389.96 $348.68 Employee + I Dependent 21 $630.44 $779.92 $697.34 Employee + 2 or more Dep. 6 $819.57 $1,013.90 $906.53 MONTHLY PREMIUM $21,154.52 $27,531.20 $14,616.16 ANNUAL PREMIUM $267,054 $330,374 $195,394 % Increase over Current:NIA 23.71% 10.61% ......................................................................................................................................................................................................_._....................................................................................................................... PERSCARE P19RSCARR PACIFICARE (PPO) (PPO) (PPO Plan U52 - Care) Employee 0 $544.77 $619.93 $407.38 Employee +l Dependent 0 $1,089.54 $1,239.86 $814.74 Employee + 2 or more Dep. 0 $1,416.40 $1,611.82 $1,059.17 MONTHLY PREMIUM $0.00 $0.00 $0.00 ANNUAL PREMIUM $0 $0 $0 %Increase over Current. N/A N/A -25.21% ............................................................................................................................... .......................................................................................................................................................................�........................... PERS CHOICE PERS CHdICE PACIFICAItE (PPO) (PPO) (PPO Plan U53 - Choice) . Employee 1 $349.41 $369.74 $332.05 Employee + I Dependent 3 $698.82 $739.48 $664.08 Employee + 2 or more Dep. 1 $908.47 $961.32 $863.31 MONTHLY PREMIUM $3,354.34 $3,549.50 $3,187.60 ANNUAL PREMIUM $40,151 $42,594 $38,251 % Increase over Current: N/A 5.81% -4.970 ........................ .......................................................................................................................................................................................................................................................................................................... PORAC PORAC PACIFICARE (PPO) (PPO) (PPO Plan U53 - Choice) Employee 1 $399.00 $399.00 $332.05 Employee+ 1 Dependent 3 $733.00 $748.00 $664.08 Employee + 2 or more Dep. 0 $931.00 $950.00 $863.31 MONTHLY PREMIUM $2,598.00 $2,643.00 $2,314.29 NNUAL PREMIUM $31,176 $31,716 $27,891 % Increase over Lament N/A 17396 -10.54% w'I��%3{; � ��,. � ;�' �§ "L •I e „N Participation in the medical plans is based on current medical elections. Rates above are based on the census data provided by CTTX OF LODI, Final rates are subject to actual enrollment, plan design(s) selected, underwriting guidelines and approval. Prepared by ABD Insurance and inancia��5eerrviiof ces, RS CeRSAM913. Confidential. Modification or reproduction is prohibited. 6(29/2004 CITY OF LODI MEDICAL - UPERS Medicare HMO Cost Corftoanson �' „ u CClRRIINT{ MaRCARB Rales Not Vd . s /ZA94011W. KAISER KAISER KAISER' # M HMO HMO OptlonL Employee 1 $273.86 $255.97 Employee +l Dependent 4 $547.72 $511,94 Employee + 2 or more Dependents 0 5821.48 $767.91 TOTAL MONTHLY PREMIUM $2,4"74 $2,303.73 $11W TOTAL ANNUAL PREMIUM $29157&88 $27,644.76 $0.00 % a ever C}Urent N/A -&5396 10000% ._... Y r^T a =..p E y C 1 l w r ! Mk' 'h 1 ',�A M" ; er•. ••"'n.;1��rpy y, �`FT'a i( n1�$ �• PACIFICARE - geWw Supplement BLUE SHIELD BLUE SHIELD Plain F COVERED (HMO ) (HMO ion) Employee 10 $319.97 $287.78 Employee +l Dependent 17 5639.94 $575.56 Employee + 2 or mote Dependeau 0 1959.91 $863.34 TOTAL MONTHLYPREMIUM S14,67W $12,662-32 $AM TOTALANNUAL PREMIUM 5168,944,16 $151,947,84 $0.00 %Change ower carrert NIA_ -10.06% Y00.0096 lt..• `Rw Y. L rjm' '6 5 7 tt 14r 14*4 PACIFICARE - Senior Supplement PERS Care PPO PERS Care PPO Phm F to COVERED (PPO 'on) (PPO 'on) (PP0 ion) Employee 5 $336.07 $289.32 Employee + t Dependent 5 $672.14 $578.64 Employee + 2 or more Dependents 0 51.008.21 $867.96 TOTAL MONTHLY PREMIUM $5,041.05 $4,339.80 $0.00 TOTAL ANNUAL PREMIUM $60,492.60 552,077.60 $0.00 %Clare over Current WA -13-91% 100.0% �. ,.,�. .. PACIFiCARE - Srppktne+rt PERS Choice PPO PERS Ch" PPO Plan F J!COVERED (PPO 'on) (PPO ) (indemnity) Employee 6 $305.67 $279.60 Employee + 1 Dependent 7 1611.34 $559.20 Employee+2ofmore Dependents 0 $917.01 $838.80 TOTAL MONTHLY PREMIUM $0.113.40 $5,592.00 $0.00 TOTAL ANNUAL PREMIUM $73,360.80 $67,104.00 $190 %Chaatt ower current NIA -R53% -100.00% Man wk&i� PACIFICARE - Senior Suppkment PORAC PORAC Plan F OCOVFAED (PPO tion) (PPO on) (indemnity) Employee 0 $351.00 $351.OD Employee + l Dependent I $701.00 $701.00 Employee + 2 or more Dependents 0 S 1.049.00 $1,049.00 TOTAL MONTHLY PREMIUM $701.00 $701.00 $0 00 TOTALANNUAL PREMIUM $8,412.00 5$lfZtA/ SQ00 %Change over 17urrear NIA 0.00% -100.00% NOPE: Quotes resume that aq redress averU love Medicare A & B. I Kaiser rates outside of PERS are not confirnkd. Prepared by ASD Insurance and Financial Services, License #01)58513 Confidential. Modification or reproduction is prohibited. 612912004 CITY OF LODI MEDICAL - PERN HMU Llasic Benetids (Actives & Carry Ketirees PIAN DIiLt1�7BS &l131,�1lMirJ s x a " BLUE SHIELD,1[{AISER, &WESTERN PACMCARE HEALTH ADVANTAGE Mmivall)edtttfiIb' None None CcwT�eurattrbC,, 100% 100% $1,500153,000 (Kaiser & WHA) $1,5001$3,000 Adult itdttiine;ty a $10 co-paylvisit S10 co-paylvisit pjcian $10 co-paylvisit $10 co-paylvisit l�t3c�iit tlt 10D% 100% st�Yi '1!all6 F..iri $50 max. co-pay/visit $35 max. co-paylvisit (tvaivCd if tuliitiit�) '% jgjg s t, 100% 100% t ItsiAa l�tl(&tIt- 100% 100% Sltillett 10096 100% 00 dacalendar 1year max} {100 da calendar max) 5hotit TCr�i Hospital: 100% Hospital: 100% Office & Home Visit: $10/visit Office & Home Visit: $101visit Durable Medical ipnient 100% 100% PrescriptiOn'Drag P* $5 Generic/ $15 Brand 1 S45 Non -Formulary` $5 Generic/ $t5 Brand / S30 Non-Formulary (tail Pltattllacy} . '' _ (30 days) (30 days) Ptrsuriptilltt,Ittg Cd $10 Generic / S25 Brand 1$75 Non -Formulary) $10 Generic 1$25 Brand / $45 Non -Formulary (141ai1 t�rdCr4'.401 l :,' $1,000 Out of pocket annual max per person $1,000 copay annual max for mail order In= anent Mental Il±,�tl 100%, up to 30 days/year 100%, up to 30 dayslyear Out-Pat�pt#uletttal il�tth $6 $10 co -pay, unlimited $10 co -pay, unlimited $20 co pay, 20 visits per year $I O co pay; 20 visits per year (Kaiser: $l0 co a !visit, 20 visits/year) e M ' Unlimited Unlimited Hgng a s $1,000 maximum benefit per 36 months $1,000 maximum benefit per 36 months S 10 co-pay/visit(Kaiser & WHA) Can be included as a Rider 01 c, Care 20 visits/per calendar yr Benefits TBD This is merely a summary of benefits for comparison purposes. Please refer to the plan proposal for details Prepared by ABI) Insurance and Financial Services, License #QD58513. Confidential - modification or reproduction is prohibited. 6f29/2004 CITY OF LODI WRnlrAL - rALPRRS PPO Oksir Benefit Summarvl - PERS Choice and Eauivalents Prepared by AMD Insurance and Financial Se vk4m. License flOD58513. 6I29r2004 rnnfiolnnrial - mndirwation or rcaroduction is 0rohibitad. PACIFICA PERS Choiee PPO U52 ke PERS(:ue PPO U53 (like PERS ('hake PPO fit Nun -PPO: Iedlvldod: 5300 ! Family: S 1,000 PPD & Neo -PPO: Indl+rWuU: 55(10 ! Fanny: 51000 PPO allon-PPO: Individual: 55110 !Family, 51000 „`< x PPO 8096 ppa. PPO: BD% 'i Non-PPO.60% Nor PPD:60% Non-PPQ 6D% C; � {F lEj h a Individual:53.000lfiamkly:SUM Ldividual:52,0001Pnmkly.31.000 lndtvidaal:53,000lFamily:SUM .. PPO: $20 eo-pay PPO: $20 co -pay PPO: $20 co -Pay r^ �AnW ., 4 N NDR.Ppp. Non -11M. W% Koh -PM. 6D% Adan Ea�11 PPO: 100% PM. $20 eo"y I Non -PPO: 60% PPO: $20 co -pry /Non -PPO: 6D% � ,: s r 5 Non -PM. 60% S300mWmmtokd yew $300madmanJed ym PPo:80% - PPO: 90% PPD: 80% Non -PPD: 60% Non -PPO: 60% filerS230tadmiuion Naf1R0:6096 PPO & Non -PPO: $50 co-psylvish, then 80% PPO $ Nan -PPO: $SD oo-psyhriait, then 90%A60% PPO fit NW -PPO-. i90 Co-prylviait, t?ien 80%"% a E PPO:80"Io PPQ80% PPD: 7D% i;i 1 r .. ,1N.7D% Non-pPo: 8W Non -PPO: &D% - Non -PPD: ��, tr,,,v'� PPD:SD%1Non.PPO:60'b PP690%l Non -PPO,. 60% - PP0:80%lNon-PP0:60% - .. l `, t .. U to 56.000 U to 100 visialcd U to 100 vlaiulud year PPQ80%1Non-PP0:60%,Ist10days FM 90%lNtm-PP0:60% PP0-0%lNon-PP0:6D% . TD b lNon-PP(7 60%, next 170 U to 180 U to 100 cal -e "C.c� PPD: BD%INan•PPO:6D%(80%for aacupstiond) PP0:90%1Noo-PP0:60% PPO: 80%1 mm-PPO:6D% W f5000llfphne for t U to 52.000kd Up to 55,000 while Imsurod z Y'4 PPO: BO%!Nan-PPO: 60% PPb" JNon-PPO: 60% PM. 80%!Nan-PPO: 6016 U to 53,000 ma U m S3,OpOk�l rear Up m $3.000 madoxl Participating PhrmreY: Participants Pbamaey: Panictpalkng Pharmacy a 5 $5 GorlaiC 1515 Brand! 545 Non-Ftmmnlary (30 days) SS Genetic ! f i5 eratd 15311Nan-Fntrttulay (30 days) $5 Geoteric 1 $15 Brand /$30 Nat 1 armulary (30 days) f 10 Generic! $25 Brwd 1$75 Non -Formulary (90 days) $10 Clencdc 1525 Bland 1515 Nam-Potmalry (90 days) $10 Genetic 1$25 Brand 1545 Non- Formulary (90 drys) 57,000 copay mukal year for retail order 61,000 cqW *tartest yew for [nail order S IM 00 of podwt aamad Max per pxmn PPO: 9D% PPO: 80% ftlwP�efa PM 80%I Non-PP0:60% Nott -PPO: M alter $250fdmission Nan -PPO: 60% after S2SWdmission MH: 20drtya SA:20 days MH: IS dayalcal yew MH: IS olaysrcal yew 512,000 lifetime mora torah services - SA: $5,000 rnukal ytw, 3 daysladmission SA: $5.000 mtathd year, 3 do*Wmission Girt=aadttllt PPO: 80% l Non -PPO: 60% PPO: 90% 1 Nott -PPO: 60% PPD: 80% I Non -PPO: 60% MH & SA: 24 visits Mol: 20 visits; SA: 24 visits MR 20 visna; SA 2A visits $2,000,000 Unlimited $2000,000 t53dfr -:; PPO: SD%I Non -PPO: 609b PPO: 9D% l Nat -PPO: 6096 PPO: 9D% J Nan -PPP, 60% $1,000 mat benerlt 36 months u 52,000 mbenefit while insured $2,000 ttant benefit white insueed PPO: 80°% 1 Non -PPO: 60% PPO: 9D% I NWPPO: 60% PPO: 80%1 Nom -PPO: 60% Up to 15 visits per yw Up to 20 vista per 31000 ulendw M maximum l>ene01 Prepared by AMD Insurance and Financial Se vk4m. License flOD58513. 6I29r2004 rnnfiolnnrial - mndirwation or rcaroduction is 0rohibitad. PacifiCare Win With PacifiCare A Presentation for the City of Lodi June 29, 2004 PacifiCare Health Systems Agenda Company Overview Honors & Recognition PacifiCate's value Proposition -- Health Care Coat Management - Data Driven Outcantas - Product Leadership - Provider Network • Our Winning Formula • Questions & Answers PacifiCare = largest purchaser of health care services in the western U.S. Honors & Recognition A Fortuu 200 eospasy wtlh • $11 billion in revenue • 2 4 million commercial lives • - 800,000 Medicare+Choice lives • - 9 million specialty lives NCAA Acefedilation: 90 perrent of Pari Karr membws are in Excdleal-accredited plant Only MCO in receive Paul Ellwood Award from FACCT for efforts in developing a consumer- driven health care system Awards from medical cmmewnity for program related to Dur Quality Initiatives Selected by local providers for being the bast performer among HMOs e•busitrcss innovator 6/29/2004 11:04 AM PacffiCare8 Health Systems Navigating the Future will Require Delivery on Four Value Propositions Healthcare Cost Management exrn+tv�r r.x�urae� Health & Disease Management Care Management Cost Management Disease Management — Spectrum Of Needs 6/29/2004 11:04 AM Cmwraphie Cur Managrnlent Complex case managrmeot speelal Topmmlon Care Frail members, PR fiegtem gars. P.—lastrophic care. Temarrallyill marrt s Chreoit Dimaee MeaagHma[ CFIF, CAD, a ke. COPD. ESRD Diabelee, DepenX a, AMI A.W. Eplaode M.-Ip—t I.-IOa-pt- Medical Menag—m Traagippnal. COnpautly of Care Peevamive Health Maeaheaaat Pmxmive care Msk redwlion I fakir iroprenxnrrn, Member educaann PacifiCare Health Systems Care Management Special Population Care frail M j-C0Wdin-%&vorAwId needs – End ofLifc Pads-CdnpaesiawR tae – C&r"armw national nowork of bmchmat quality Gdlitics and servioea Catwuq*ic Cam Management – Coonlmadan oteettplaa services – Inhgrastiar of multiple providers of can Health Management Programs Taking C7iarge of Diabetes Taking Charge of Depression Taking Charge of Your Heart Health F= & Clear Stop Smoking Pregnancy to Preschool Data Driven Outcomes C�+M�QUALITY IWDEV Profile z PAAX 6/29/2004 11:04 AM 3 PadfiCarw) Health Systems QUALITY INDEX® Profile Effective consumer information tool Effective provider managemem tool Expanded metrics fm 2001: 2001: 2002: Staying healthy, appropriate core, patient safety, affordability, service & satisfaction QUALITY INDEX - Profile for Women & enhanced core QUALITY INDEX- Profile Hospital QUALITY INDEX- Profile PacifiCare Positioned as Consumer Health Organization to Execute "Product Leadership" Through: Expanded Product Portfolio - Artay of Medical Choices that increase Consumer Engagetttent and Access Robust HMO Cost -Sharing and say -Doan Options National PPO with Complete ASO Capabilities Self -Directed Health Plan TieredlNarrow Network Products Front -End Decision Support! Quality index® profiles Integrated Disease Management Healthy option 8/29/2004 11:04 AM 4 PacifiCare Health Systems Industry Leading Products Women's Health Solutions IAtino Health Solutions 24 }lour Health lnformstiae Program Health Credits PacifiCare Perks Discamt ProVarns PacifiCam Behavioral Health Prescription Solutions' A Solution for Caregivers More than just "resource and referral" Centralized and nationwide field-based expertise and resources Caregiver team assists with needs assessment, resource review and coordination and follow up - Sawx employ« dare and energy. nducea saes and anRicly and improves decisia�matiog Employer-sponsored 6/29/2004 11:04 AM 5 PadfiCare@ Health Systems 24 -Hour Health Information Program 24 -Hour Nurse Line and Audio Library: 1 -866 -PHS -HEALTH (1-856-74711325) Interactive Web health content Live chat with Health Information Specialists Personal/Family Health Record PacifiCare PerkssM Discount Programs Healthy Moms & Kids Fitness & Weight Management Pharmacy & Personal Care Complementary & Alternative Care Vision & Hearing Healthy Home Child Safety Personal Safety HealthCredits8m New value-added program designed to help lower health care costs Available to all PacifiCare commercial medical members at no additional premium cost Encourages and rewards employees who actively participate in: Pacifica.,. vdnwlHra1dYMb- - Cmgledng a Heakh Rick Aearem=d — E mltmginhaftaid&semenmugement progmm 6/29/2004 11:04 AM 6 PacifiCare° Health Systems Women's Health SoludonssM A comprehensive suite of more than 35 programs and services to support women in their critical role Available at no additional premium cost PacifiCare Focussed on "Superior Service" - "Delighting the Customer" Through: ttt� rtA i'n �.r;ooa�w ��. Enhanced Provider Service Expanded Customer Service Hours (TAM To 8PM) New Member Welcome Call Program "First Call" Resolution Focus Customer Service Associates - Quality lnc tive Pros= Expanded Web Portals. Linking Quality Index, Disease Mmugerent Programs, Provider Dinectnries Customer Service Pledge To Provide Outstanding service Excellent Customer Service Dedicated Account Management Team in Sacramento P.ul T.— Dirertor, S.Y. a Snr.ww 3ecramenra/Frrna Heldl oe�n ar. own... M.n.yer I[nrn M, M— Tent. ereM Sr. Aeeo�nt M.n.per S.lea As.naNw 5uan Oro- fl.Nn aa., t Sr. Axwtrt M.n.yer Admin. Aaoc. L A Ahvootl lax. Aoet. M.naoer 6/29/2004 11:04 AM 7 PadfiCare° Health Systems Efficient, Consumer -Friendly Web Site HMO Provider Directory Formulary QUALITY INDEX* Profiles Taking Charge of Your Health HMO Member Portals "Contact Us" area Latino Specific Website Strong Provider Partnerships Comprehensive Network Network Stability Express Referral Program Ready Reply Local Network Management staff San Joaquin Provider contracts: - Mc" EwUps- Cwt**, - Hosp W3 - Fat for savior Central Valley HMO Providers Medical Groups: Medcore Medical Group Medical Group Delta IPA Sutler Gould Medical Foundation - San Joaquin & Modesto Central Valley Medical Group Hospitals: St. Josephs, Dameron, Memorial & Doctors Hospitals (Manteca, Modesto) 6/29/2004 11:04 AM 8 PacifiCare® Health Systems Our Winning Formula Excellent Customer Service Strong Provider Partnerships Cost Management and Accountability Unique Health Management Programs Industry Leading Products Comn*ted to Long Term Partnership At PacifiCare we believe, "Caring is good Doing something is better." 6/29/2004 11:04 AM 9 Summary PacifiCare reported net income of $67 million, driven by an 8% year-over-year increase in revenues, the addition of 35,000 new commercial members since the prior quarter and a. 130 basis point improvement in the commercial MLR. Medicare+Choice membership grew sequentially for the fust time in 3 years. The company raised full-year EPS guidance from $2.45-113.05 to $3.0743.17, which translates into a 5.5% increase in net income guidance. Additionally, estimated 2004 commercial membership growth was raised from 3-5% to 5.6%. ■ Reported Not Income = $67 million, which is up 45% from Q103 after excluding $25 million in favorable reserve adjustments that benefited the first quarter last year. ■ Reported EPS a $0.71, which was $0.08 ahead of the average Wall Street estimate, ■ Consolidated Mediat Loss Ratio IMLR) nose by 30 basis points over Q103 to 85.1%. The commercial MLR was down 130 basis points, but the M+C MLR was up 160 basis points as expected by management, reflecting a more sustainable level compared to last year's unusually low MLR. The MLRs were all within the range of previous 2004 guidance. ■ SQU Ratio increased 30 basis points, to 12.5%, compared to the first quarter of 2003, primarily due to increased stock based compensation expense. . Cash Plow From Operations was =164 million, e=luding the elect of the early receipt of the January '04 CMS payment, which was 2.4 times net income in the quarter. Cash Row in excess of net income is generally an indicator of the strength of the quarterly results. • Specialty and Other Income (primarily Pmocription Solutions•): — increased 28% compared with the same quarter last year. — Unaffiliated membership at Prescription Solutions, PaicifiCare's pharmacy benefit management company, was up approximately 35% (630,000) from the first quarter in the prior year. ■ Balance Sheet- — The debt-to-c apiad ratio = 2496. Fzmn statutory capital, which the rating agencies look at, stands at more than $600 million. - ntserm fer,&w inerosed IM mMon dufini the qvmwhowc= dT cWms parable (DCP) decreased .7 days to 40.6 days. EwJuding the capitated portion of our business that doesn't require reserves, our reserves were 69.5 days. Pa " Care Information contained in this document is summariwdfrom actual results for the period indicated. Complete financial results and other information about PbcijiCare's operations are included in the company's most recent ffibW witb the SEC, including Form IOQ as of Marcb 31, 2004 and Form IOK as of December 31, 2003, available on the PacifdCare Web site at tvwutpacUWcare.cons or the Securities and Ex cbaage Commission Web site at wmrusecgov. PacifiCare products and services are offered by one or more of the following PacifiCare family of companies: Health plan products and services are offered by PadfiCare of Arizona, Inc.; PacifiCare of California; PacifiCare of Colorado, Inc.; PacifiCare of Nevada, Inc.; PacifiCare of Oklahoma, Inc.; PacifiCare of Oregon, Inc.; PacifiCare of Texas, Inc.; PadfiC.Vr of Washington, Inc.; PaciSCare Dental of Colorado, Inc.; PacifiCare Behavioral Health of California, Inc., PacifiCare Health Insurance Company of Micronesia, Inc.; and PacifiCam Dental (in California). Indemnity insurance products (including PPO products) offered in California arc underwriaen by lwACare Life and HOdt 1 Insurance Company. Indemnity insurance products (including PPO prodixu) offered in Arizona, Colorado, Nevada, Washington, Oregon, R as and Oklahoma are underwritten by PacifiCare Life Assurance Company. Other products and services are offered by PacifiCare Health Plan Administrators, Inc.; PacifiCare Southwest Operations, Inc.; RxSolutions, Inc.; SeniorCo, Inc.; and PacifiCare Behavioral Health, Inc. PacifiCare• is a federally rrg cared trademark of PacifiCare Life and Health Insurance Company. CM -504-64869.5 PEWIi81-003 Rev.5/04 PaCf{ICme PacifiCare 7AY" I Ak- "Aft Public Sector Health Plan Options ri� Women's Health Solutionss" Women's Health Solutions"` reflects PacifiCare's commitment to improving the health and health care experience of women and the people they care about. Among the 30 value-added programs associated with Women's Health Solutions"' are Pregnancy to Preschool, 24 -Hour Health Information .program, and Menopause: Understanding Your Options. Together, these products and services reflect an integrated approach to help you juggle multiple roles, save time and money, and keep yourself and your family healthy. Convenient Access For those who have purchased an HMO Plan, our new physician (PacifiCare SignatureVaiuesM) networks offer you access to a large number of Primary Care Physicians eCP) and hospitals. Plus, Express Referrals* gives you access to a broad range of specialists in 15 different treatment areas. Your PCP can rcfer you directly to a specialist with no prior approwal. It's fast, easy and convenient. Extended Customer Our team of knowledgeable Customer Service Associates, including Service Hours Spanish-speaking representatives, is available to help you with prompt answers to your questions. We have extended hours Monday through Friday, from 7 a.m. to 9 p.m. (PST) to better serve your needs. Call us toll fire at 1-800-531-3341 or 1-800-442-8833 (TDHi). Web Site Visit wwwpacificare.com for interactive Web health information, access to our regularly updated doctor directory, information on the Prescription Solutions® Mail Service Pharmacy program or to view our online Formulary. Also available is a Resource Center featuring the online version of our member newsletter, informational tools on understanding your benefits, health tips, resource links and much more 24 -Hour Health The PacifiCare 24 -Hour Health Information program is a value-added Information Program program combining two features: Intomaive web Health concent with an online chat feature staled by Health Information Specialists and 24 -Hots Health Information Audio Ubmry with Nurw Line available at 14866-PHS-HI+ALTH (1-866-747-4325) or 14800-877-8044 if you are a hearing-impaired caller to the Nurse Line. *. Tt►is Pro9ca ii generaliarm©regard, hn. y haue a UfflUDWAM Specialist Office Visits $10 Copayment -i T. i Hospitalization Paid in full ': Emergency Services $35 Copayment, waived if admitted as an inpatient Urgently Needed Services (Medicatty Necessary $35 Copayment, waived if admitted as an inpatient services required outside of your Service Area) 4'.. Alcohol, Drug or other Substance Abuse or Paid in full Addiction Idetoxification only) Bone Marrow Transplants Paid in full Cancer Clinical Trials` Paid at contracted rate Balance Of any) is the responsibility of the Meter Hospice Care Paid in full Hospital Benefits Paid in full Mastectomy/Breast Reconstruction Paid in full y Maternity Care Paid in full Newborn Care Paid in fu x Physician Care Paid in full Reconstructive Surgery Paid in full i Rehabilitation Care Paid in full Skilled Nursing Care (100 -day Calendar Year limit) Paid in full Voluntary Interruption of Pregnancy Nedicaftedication and surgical) E 1st trimester $10 Copayment U2nd trimester (12-20 weeks) $10 Copayment a After 20 weeks Not covered (unless mothers life is in jeopardy) ■Mon Outpatient Benefits. Alcohol, Drug or Other Substance Abuse or Addiction Idetoxification only) Allergy Testing/Treatment (Serum is not covered unless an allergy rider was purchased by your employer) Ambulance Cancer Clinical Trials' Corrective Apptiances/Prosthetics Durable Medical Equipment Family Planning ■ Vasectomy • Tubal ligation' M IUD device ■ Removal of Norplant ■ Depo-Provera injection ■Depo-Provera medication (limited to one every 40 days) Hearing Screening Hemodialysis Home Care Hospice Care Immunizations Infertility Services Infusion Therapy Injectable Drugs Laboratory Maternity Care, Tests and Procedures Crisis Intervention Oral Surgery Services Outpatient Rehabilitation Therapy JPhysical, Occupational and Speech Therapy) Outpatient Surgery Periodic Health Evaluations Physician Care ■ PCP ■ Specialist ■ 08/GYN Paid in full $10 Copayment Paid in full Paid at contracted rate Balance (if any) is the responsibility of the Member Paid in full Paid in full $10 Copayment $10 Copayment $10 Copayment $10 Copayment $10 Copayment $10 Copayment $10 Copayment $10 Copayment Paid in full Paid in full $10 Copayment 50% cost of Copayment' Paid in full Paid in full Paid in full Paid in full $20 Copayment up to 20 visits per Calendar Year Paid in full $10 Copayment Paid in full $10 Copayment $10 Copayment $10 Copayment $10 Copayment Outpatient Benefits [continued) vision Refraction Paid in full Vision Screening $10 Copayment Welt -Baby Care Paid in full Well -Woman Care $10 Copayment Chiropractic (through ASHNI $10 Copayment up to 20 visits per Calendar Year (CT11 Hearing Aid Services Audiologicat exam - paid in full Hearing aid expenses - $1,000 coverage every 36 months for hearing aids and ear molds (HAV Mental Health and Chemical Dependency Services Inpatient Mental Health Services Paid in full Up to 30 days per Calendar Year Outpatient Mental Health Services $10 Copayment Up to 20 visits per Calendar Year Inpatient Treatment - Chemical Paid in full Dependency Services Outpatient Treatment - Chemical $10 Copayment Dependency Services Outpatient - Up to 20 visits per Calendar Year Inpatient Services for Severe Mental Paid in full Illness outpatient 5ervirn for 5eyere Mental VO Copayment Illness Pharmacy Benefit Options Generic Formulary $5 retail $10 mail order Formulary Brand Name $15 retail $25 mail order Non -Formulary $30 retail $45 mail order $1,000 Copayment annual maximum per Calendar Year per Member for mail order supply of up to 3 Prescription Units or up to 90 days. General Information Policy Maximum While Insured Calendar Year Deductible ■ Individual ■ Family Maximum Coinsurance Maximum ■ Individual 11 Family Maximum 12x Individual} Hospital and Facility Services Additional Deductibles (per occurrence] ■ Inpatient Services ■ Outpatient Surgical Services ■ Emergency Room Services [waived if admitted) ■ Failure to obtain Preauthorization of Services Inpatient Hospital and Facility Services Transplant Services Skilled Nursing Facilities Hospice Care Outpatient Surgical and Facility Services $2,000,000 Unlimited $500 $1,000 $3,000 $6,000 Not applicable $250 Not applicable $250 $50 per visit Not applicable $S00 80% after 60% after Deductible Deductibles 80% after Not covered Deductible Maximum benefit Not covered white insured: ■ $5,000 Donor Maximum ■ Covered under Policy Maximum up to $2 million 80% after 609 after Deductible Deductibles Maximum benefit while insured: Up to 100 days Inpatient per Calendar Year 80% after 60% after Deductible Deductibles Maximum benefit white insured: $10,000 Maximum Benefit while insured 80% after 60% after Deductible Deductibles $500 $1,000 $2,000 $4,000 Not applicable $250 Not applicable $250 $50 per visit Not applicable $500 90% after 60% after Deductible Deductibles 90% after Not covered Deductible Maximum benefit Not covered while insured: ■ $5,000 Donor Maximum ■ Covered under Policy Maximum 90% after 60% after Deductible Deductibles Maximum benefit while insured: Up to 180 days Inpatient per Calendar Year 90% after 60% after Deductible Deductibles Maximum benefit white insured: $10,000 Maximum Benefit while insured 90% after 60% after Deductible Deductibles Outpatient Provider Services Physician Office Visits"' (services include the detection and treatment of an Injury or Sickness during a Physician Office Visit including associated covered diagnostic X-ray and Laboratory Servicesl i, Preventive Care for children, including immunizations (through age 181 ■ Mammogram Screening ■ Breast and Pelvic Exams ■ Prostate Cancer Screening ■ Detection of Osteoporosis Periodic Health Evaluations lage 19 or over) Maternity Care Prenatal, Postnatal and Childbirth Expenses ■ Physician Services' ■ All X-ray Services' ■ All Laboratory Services' ■ Diagnostic Testing' Other Outpatient Provider Services Ambulance tMedically Necessary transport) Chemical Dependency" Inpatient Services Outpatient Services Severe Mental Illness' Specified Diagnosis only 100% after $20 60% after 100% after $20 60% after Copayment Deductible Copayment Deductible (Participating {Participating Outpatient lab and Outpatient lab and X-ray in conjunction X-ray in conjunction with a Physician with a Physician office visit covered office visit covered at 100%1 except as at 100%1 except as noted in footnote 1. noted in footnote 1. 100% after $20 60% after Copayment Deductible (Participating Outpatient lab and X-ray in conjunction with a Physician office visit covered at 100%1 except as noted in footnote 1. $300 Combined Maximum per Calendar Year $20 Copayment 60% after for initial visit, then Deductible 80% Coinsurance after Deductible 80% after 60% after Deductible Deductible 90% after Deductible 80% after 60% after Deductible Oeductibte Detoxification up to 3 days per admission $5,000 Inpatient Maximum per Calendar Year 80% after 60% after Deductible Oeductibie 24 Visits Combined per Calendar Year 80% after Not covered Deductible 100% after $20 60% after Copayment Deductible (Participating Outpatient lab and X-ray in conjunction with a Physician office visit covered at 100%) except as noted in footnote 1. $300 Combined Maximum per Calendar Year $20 Copayment 60% after for initial visit, then Deductible 90% Coinsurance after Deductible 90% after 60% after Deductible Deductible 80% after Deductible 90% after 60% after Deductible Deductible Detoxification up to 3 days per admission $5,000 Inpatient Maximum per Calendar Year 90% after 60% after Deductible Deductible 24 Visits Combined per Calendar Year 90% after Not covered Deductible Other Outpatient Provider Services [continued) Durable Medical Equipment Outpatient Rehabilitation Services' Speech Physical, Occupational Home Health Care i Neuromuscular Skeletal Disorders' Prosthetic Devices $3,000 Combined Calendar Year Maximum $3,000 Combined Calendar Year Maximum 80% after 60:after 90% after 60% after Deductible Deductib a Deductible Deductible $2,000 Combined Calendar Year Maximum 90% after 60% after Deductible Deductible 100 Visits Combined Calendar Year Maximum 90% after 60% after Deductible Deductible $1,000 Combined Calendar Year Maximum 90% after 60% after Deductible Deductible $2,000 Combined Calendar Year Maximum Pharmacy Benefit Options T Generic Formulary $5 retail $10 mail order Formulary Brand Name $15 retait $25 mail order Nan-Formutary $30 retail $65 mait order $1,000 Copayment maximum for mail order per Covered Person per Calendar Year. Mail order supply of up to 3 Prescription Units or up to 90 days. Copayment -based services do not apply to neuromuscutar skeletal disorders, outpatient rehabilitation services other than a Physician Office Visit, chemical dependency:services, rnentat illness services, diagnostic services, including, but not limited to, MRI, PCT. CAT scans, ultrasounds except for maternity care, nuclear medicine studies, EKG, ECG, EMG or EEG services and surgery performed in the Physician's office. 'Coinsurance for this type; of Covered Expense does not apply toward the Coinsurance Maximum, and the percentage payable for the type of Covered Expense does not increase to 100% due to satisfaction of any Coinsurance Maximum. 'other than physician office visit. `lMith generic edit - Brand-name drugs which have Generic equivalents are considered non-Formutary, and Covered Person pays the non -Formulary Copayment. Suppiemehtal Rider Options Acupuncture Calendar Year Maximum $5,000. The percentage payable for Covered Expense is subject to the Coinsurance percentage shown in the Schedule of Benefits. Hearing Aid Services Benefit maximum while insured is $2,000. The percentage payable for Covered Expense is subject to the Coinsurance percentage shown in the Schedule of Benefits. The Physician Office Copayment does not apply to Mental Itlness. The percentage payable for Covered Expense is subject to the Coinsurance percentage shown in the Schedule of Benefits. Mental Illness _ texcept Severe Mental Illness) Inpatient - 15 days per Calendar Year combined Maximum leach inpatient day may be substituted for 2 half -days of outpatient treatment). Outpatient - 20 visits per Calendar Year Maximum. -- _ ----- _ .- .... __...... - .... The. following mandated offer riders are also available in the plans: Specialized Footwear, Infertility Treatment and Orthotic Device. Ptease ask your PacifiCare Sales Representative for more information. Genera! Informationwrit Plan F with Ridt:ls Senior Supplen Plan Year DeductibleP pays a s Medicare Part A & B Deductible Lifetime Maximum Benefit Unlimited Medicat genefllts Hospital No charge, if Medicare approved - ■ inpatient plus additional 365 lifetime days beyond Medicare ■Outpatient No charge, if Medicare approved Emergency Services • Inside the U.S. No charge, if Medicare approved B Outside the U.S. $250 Deductible; 20% and amounts over the $50,000 lifetime maximum Skilled Nursing Facility ■ Up to 100 days each benefit period in a Medicare- No charge, if Medicare approved approved facility ■ From 101 - 365 days Not covered Acupuncture Not covered , Hospice care Not covered by plan; virtually covered in-fust by Medicare ■ Physician/Preventive Care No charge, if Medicare approved IN Office/Home Hospital Visits ■ Gynecological Exam (Pap test) ■ Allergy Testing/Treatment ■ Immunization/Inoculation ■ Diagnostic X-ray/Lab ■Ambulance ■ Home Health Care Services 0 Mlentat Health Inpatient ■Mental Health Outpatient a 5peefh Therapy ■ Physical Therapy ■Occupational Therapy ■ Biofeedback ■ Chiropractic ■ Durable Medical Equipment ■ Heart Transplants ■ Kidney Dialysis and Transplants ■ Podiatrists' Services ■ Christian Science Treatment ■ Unreplaced Blood and Blood Products ■Diabetes Services (includes diabetes self-management training, glucose monitors, test strips, Lancets, etc.l Scnior Supplcmcnt Plan F• %bili hiders Benefits Summary Annual Maximum Hospitalization ■ Inpatient e Outpatient Office Visit Copay Skilled Nursing Home Health Care Mental Health Inpatient Substance Abuse Mental Health Outpatient Substance Abuse Emergency/Urgent Services Vision ■ Refractive Exam Eyewear Hearing. • Exam a Aids Chiropractic Rx Retail Copay J30 -day supply) a �ieneric ■ grand ■ Non -Formulary Rx Mail Order 190 -day supply) ■ Generic ■ grand ■ Nan -formulary Transportation Dental Allergy Testing, Treatment, Serum NIA Covered in full Covered in full $10 Covered in full up to 100 days/benefit period Covered in full Covered in full 190 days lifetime $10 visit, unlimited visits through PCP referrat Covered in full worldwide S1U Covered in full at contracting providers, tenses every year, frames every year if needed 1$75 allowance max) Covered in full $300 per Member every 24 months $10 visit, 12 visits *wary 12 months - self referral through ASHD $5 $15 $30 $10 $25 $45 $1,000 Copayment maximum per Member per Calendar Year for mail order supply of up to 3 Prescription Units or up to 90 days. Not covered Optional discount plan or PPO $10 Family Planning ■ IUD - Device Per Medicare guidelines ■ IIID insertion or removal ■ Infertility services • GiFT/ZIFT • Vasectomy ■ Tubal ligation ■ In}ectable contraceptives (Depa-Provera - 90 -day SUPPLY) ■ Implantable contraceptives (Norplant) Blood and Blood Products Covered in full - no limit d in felt when Medically Necessary or for occupational risk Hepatitis 9 Vaccine Covere immunizations, including for travel X10 At PacifiCare, we offer health care coverage with a choice of features to suit everyone. The plans here are a sampling for your consideration. PaCifiCare ° Contact your Account Representative for more information, CM -603-46751.1.5 PC3876-001 Rev. 6/03 Healthy Moms & Kids PacifiCare cares about mothers and children. We want them to be happy and healthy. With PacifiCare Perks!" our members have access to discounts for: ■ Gymboree• Play and Music programs ■ Safe Beginnings® family safety products • ClearPlan Easy" fertility monitor rebate ■ Bmast-feeding accessories ■ LifeSign" smoking cessation products Weight & Fitness Part of staying healthy is redwing stress, watching your weight and engaging in exercisc. Through PacifiCare Perks' you have access to discounts on: • Weight Watchers programs • Heath club memberships ■ DietMate® weight loss aid • Spa Wish gift certificates Pharmacy & Personat Care As part of the PacifiCare Perks" program, through Prescription Solutions® discounts are available for pain relievers, cold and cough remedies, children's vitamins, and much more! • Discounts on nearly 500 top-selling name brand pharmacy and personal care products • Shipping at no additional charge with a mail -service prescription ■ Convenient home delivery (within 5-7 days) ■ Order by phone, fax, mail or online • Pharmacist available to answer questions Complementary & Alternative Care Through our special arrangement with American Specialty Health Networks' Affinity program, you'll have access to. • Discounts on usual and customary fees for participating chiropractors, massage therapists and acupuncturists • Health and Wellness products offered at up to 40 percent below the suggested retail price, including: — Vinamins, minerals and daily formulas Haw and dietary Supplcmcnts — Sports nutrition products Natural body care products Audio and video tapes on yoga, Tai Chi, massage and more Hearing Care & Services PacifiCare is offering members a program that will provide special discounted rates on. hearing exams; products and servcxs; Through a vendor arrangement with Newport Audiolog Centers the hollowing discounts apply thearing care services currently not available in Oklahoma): * $25 for comprehensive hearing test ■ Hearing aid evaluation at no additional charge .■ 35 percent discount on hearing aids ■ 2 -year comprehensive warranty, including loss and damage coverage ■ Patient education on products purchased through Newport Audiology Centers ■ Hearing aid service ■ Written report and audiogram may be sent to your contracted physician upon request Healthy Home PacifiCare is committed to helping you provide a safe and healthy home environment for your family. Through vendor arrangements we are able to offer discounts on: ■ Air purifiers ■ Water filters ■ Allergy -free bedding ■ Fire extinguishers Crib: mattt+esses • Safety grates • Outlet comers ■ Door locks ■ Smoke detectors Personat Safety PacifiCare is pleased to offer information, products and services that may help you live a safes lifrstyk, as well as provide suggestions for a safe environrymet for you and your family. Through vendor arrangements, we offer discounts on selected products such as: ■ First-aid kits ■ Extra water storage equipment ■ Emergency and disaster preparedness kits . Home test kits Start. living healthier today - take advantage of health products, services and programs through PacifiCare Perk` 1-800 531-3341 or www.pacificare.com If you are hearing impaired, please call one of the following numbers as appropriate: California: 1-800-442-8833 Colorado: 1-800-659-2656 Arizona, Nevada-. .1-800-360-1797 Texas, Oklahoma: 1-800-557-7595 Oregon, Washington: 1-800-786-7387 Special arrangements are only for PacifiCare enrollees whose plan benefits do not include products/services described or whose AacifiCare plan benefats covering these products/services bane reached the allowable maxirrium. Vendor participation and actual, usual and customary charges may vary, exclude certain items or require additional charges. PacifiCare does not endorse or guarantee products noted. PacifiCare products and services are offered by one or more of the following PacifiCare Edmily of companies: Health plan products and services are offered by PacifiCare of Arizona, Inc., PacifiCare of California, PacifiCare of Colorado, Inc., PacifiCare of Nevada, Inc., PacifiCare of Oklahoma, Inc., PacifiCare of Oregon, Inc., PacifiCare of Teams, Inc., PacifiCare of Washington, Inc., PacifiCare Behavioral Health of California, Inc. and PacifiCare Health Insurance Company of Micronesia, Inc. Indemnity insurance products offered in California are underwritten by PacifiCare Life and Health Insurance Company. Indemnity insurance products offered in Arizona, Colorado,'Nevada, Washington, Oregon, Texas and Oklahoma are underwritten by PacifiCare Life Assurance Company. Other products and services are offered by PacifiCare Health Plan Administrators, Inc., IxSolutions, Inc., and PacifiCare Behavioral Health, Inc. PacifiCare® is a federally registered trademark of PacifiCare Life and Health Insurance Company. 02003 by PacifiCare Health Systems, Inc. CM -1203-57468.325 PEW7209-004 Rev. 11103 Call PacifiCare if you Receive a bill from a provider Need to obtain a new ID card 3. Need help in finding a local pharmacy 4. Want assistance with getting a referral to a specialist 5. Have questions about what is or is not a covered benefit 6. Want to change your primary care physician or medical group (if applicable) 7. Would like to enroll in a Health Management program, such as: ■ Stop Smokine ■ Taping Charge of Diabetes® ■ Taking Charge of Your Heart Health® 8. Want to inform PacifiCare that you accessed emergency medical care services 9. Wmt to know what prescription medications are included on the PacifiCare Formulary 10. Want health-related information in Spanish, visit www paeificarelatino.com Thank you for being a PacifiCare Member! If you are hearing impaired, please call one of the following numbers as appropriate: California: 1-800-442-8833; Colorado: 1-800-659-2656; Arizona, Nevada: 1-800-360-1797; Texas, Oklahoma: 1-800-557-7595; Oregon, Washington: 1-800-786-7387 PacifiCare products and services are offered by one or more of the following PacifiCare family of companies: Health plan products and services are offered by PacifiCare of Arizona, Inc., PacifiCare of California, PacifiCare of Colorado, Inc., PacifiCare of Nevada, Inc., PacifiCare of Oklahoma, Inc., PacifiCare of Oregon, Inc., PacifiCare of Texas, Inc., PacifiCare of Washington, Inc., PacifiCare Dental of Colorado, Inc., PacifiCare Behavioral Health of California, Inc., PacifiCare Health Insurance Company of Micronesia, Inc. and PacifiCare Dental din California). Indemnity insurance products (including PPO products) offered in California are underwritten by PacifiCare Life and Health Insurance Company. Indemnity insurance products (including PPO products) offered in Arizona, Colorado, Nevada, Washington, Oregon, Texas and Oklahoma are underwritten by PacifiCare Life Assurance Company. Other products and services arc offered by PacifiCare Health Plan Administrators, Inc., RxSoludons, Inc., SeniorCo, Inc. and PacifiCare Behavioral Health, Inc. PacifiCare" is a federally registered trademark of PacifiCare Life and Health Insurance Company. PacifiCare si Recibe una facture de un prowedor Necesita obtener una nueva tarjeta de idendficaci6n 3. Necesita ayuda para encontrar una farmacia en su localidad 4. Desea asistencia para obeener una referencia a un especialista 5. Tien dudas sobre si un beneficio esti cubierto o no to esti 6. Desea cambiar su doctor de atenci6n primaria o su grupo rn"co 7. 1& gustarfa registrarse en un programa de Mejoramiento do la Salud, como por ejemplo: ■ Stop Smoking'm (Programa "Deje do Pumar") ■ Taking Charge of Diabetes* (Programa "Trate du Diabetes") ■ Taking Charge of Your Heart Health* (Programa "Guide la Salud do su Coraz6n") 8. Desea informar a PacifiCare que recibio servicios de atenci6n m6dica de ernergencia 9. Desea saber codes medicatnentos de prescripci6n estin incluidos en el formulario de PacifiCare 10. Si desea informacion en espafiol, visitenos en wwa.pacifiicarelatino.com iMuchas gracias por ser Miembro del Plan de SaLud de PacifiCare! Si tiene incapacidades auditivas, por favor flame a uno de los siguientes numeros: California: 1-800-442-8833; Colorado: 1-800-659-2656; Arizona, Nevada: 1-800-360-1797; Texas, Oklahoma: 1-800-557-7595; Oregon, Washington: 1-800-786-7387 Exenci6n de responsabilidades - Los productos y servicios de PacifiCare se ofrecen a tray& de una o mis de las siguientes familias de compafiias de PacifiCare: Los productos y servicios del Plan de Salud se ofrecen a [raves de PacifiCare of Arizona, Inc., PacifiCare of California, PacifiCare of Colorado, Inc., PacifiCare of Nevada, Inc., PacifiCare of Oklahoma, Inc., PacifiCare of Oregon, Inc., PacifiCare of Texas, Inc., PacifiCare of Washington, Inc., PacifiCare Dental of Colorado, Inc., PacifiCare Behavioral Health of California, Inc., PacifiCarc Health Insurance Company of Micronesia, Inc. y PacifiCare Dental (en California). Los productos de seguros de indemnizad6n (induso los productos PPO) que se ofrecen en California son suscritos por PacifiCare Life and Health Insurance Company. Los productos de seguros de indemnizaci6n {incluso los productos PPO) que se ofrecen en Arizona, Colorado, Nevada, Washington, Oregon, Texas y Oklahoma son suscritos por PacifiCare Life Assurance Company. Otros productos y servicios se ofrecen a trav6s de PacifiCare Health Man Administrators, Inc., RxSolutions, Inc., y PacifiCare Behavioral Health, Inc. PacifiCare' es una marca registerea federalmente de PacifiCare Life and Health Insurance Company. PacifiCare VirtualHealthClub m Personalized Plans Whether you want to lose weight permanently, build muscle, have more energy, become more optimistic or just simply get more out of life, PacifiCare's VirtualHealthClub"' can help you. Utilizing some of the latest innovative Web -based technology, this program takes into consideration your unique needs, lifestyle and personal preferences and creates a plan customized exclusively for you. By bringing together the combined expertise of doctors, psychologists, athletic coaches and nutritionists, the NcIACare Vtrtua H,altltC1ASM unites aspects of �Seaith dnd wellness to help you make a plan to find the lifelong results you have been searching for. And, while you are moving along the road to better health, you can earn credits toward quarterly drawings and special values on health and fitness items to help encourage you to stay committed to your plan. Get Started! In order to help you determine your goals, take our Health Risk Assessment before you get started. The Health Risk Assessment will help you identify any specific health risks, determine your readiness to change, evaluate your lifestyle or behaviors, and provide you with suggestions and information about your own specific needs. Armed with this important baseline information, you're ready to set your goals and get started. Visit www.pacificare.com to take the Health Risk Assessment. PacifiCare's VirtualHealthClub$" gives you the ability to design and customize aspects of your roadmap to address your own personal health and fitness goals. Customized Fitness Program PacifiCare's VirtualHealthClubs"s can give you the boost you need to start — and stick with — a progressive exercise plan- e Build a cunoinizcd workout program that fits your own personal needs and works best for you. ■ Use the Virtual Exercise section for an online demonstration for hundreds of exercises to make sure you are using the proper technique and getting the most benefit out of your personal workout plan. Interactive Meal Planner Regardless of your specific health and wellness needs, PacifiCare's VirtualHealthClub'"' has a fun, interactive Meal Planner that offers expertise to meet your specific diet or nutritional goals. ■ Easily track your daily caloric intake and food servings. A Plan meals and create shopping lists specific to your individual needs and preferences. Life Skills Pians A truly effective health and wellness plan just wouldn't be complete without addressing the importance of mental and emotional well-being. The life skills plans help you deal more effectively with the inevitable challenges of everyday life, such as school issues, Financial concerns or relationship matters. r Take a quick life skills assessment to help you discover your strengths and weaknesses. ■ Choose from a selection of plans offered in the areas where you would like to see improvement in your personal life. More HealthCredits m In addition to the credits you can earn in the PacifiCare VirtualHealthClub;M HealthCreditslm also awards credits for participating in Health and Disease Management programs specific to your unique needs. To join the PacifiCare VirtualHealthClublm visit wwwpacificare.wm. You will need a password to access the PacifiCare VirtualHealthClub" and HealthCredi&m To get a password, you should logon to MyPacifiCare member portal, which also requires a password. Once you have access you may view your credit totals and all of the features within the PacifiCare VirtualHealth Clubs' Access to Personal Coaches Remember, in addition to the potential rewards of enhanced PacifiCare's VtrtualHealthClub" offers access to a nationwide health, higher energy levels and personal satisfaction you can team of qualified coaches with professional expertise in exercise, achieve through this program, there's also the added incentive nutrition and life -management issues. of quarterly drawings and special values on health and fitness ■ Ask questions anytime and get fast, personalized responses pets to keep you motivated. from expert coaches. . You can also get information from registered dieticians, nutritionists, doctors and psychologists. PacifiCare HealthCreditss" is offered by PacifiCare Health flan Adminstrators, Inc. Programs subject to availability by state; components may change. HealthCreditss" is available to PacifiCare members. Physicians must direct enrollment in Disease Management programs; other requirements may apply. Other PacifiCare products and services are of Bred by one or more of the following PacifiCare family of companies: Health planproducts and services are offered by PacifiCare of Arizona, Inc., PacifiCare of California, PacifiCare of Colorado, Inc., PacifiCare of Nevada, Inc., PacifiCare of Oklahoma, Inc., PacifiCare of Oregon, Inc., PacifiCare of Texas, Inc., PacifiCare of Washington, Inc., PacifiCare Dental of Colorado, Inc., PacifiCare Behavioral Health of California, Inc., PacifiCare Health Insurance Company of Micronesia, Inc. and PacifiCare Dental (in California). Indemnity insurance products offered in California are underwritten by PacifiCare Life and Health Insurance Company. Indemnity insurance products offered in Arizona, Colorado, Nevada, Washington, Oregon, Texas and Oklahoma are underwritten by PacifiCare Life Assurance Company. Other products and services are offered b PacifiCare Health Plan Administrators, Inc., RxSolutions, Inc., SeniorCo, Inc. and PacifiCare Behavioral Health, Inc. PacifiCare® is a federally registered trademark of PacifiCare Life and Health Insurance Company. 02003 by PacifiCare Health Systems, Inc. RAPDO30908_LB01 CM -1003-54b54.100 PEW1197 PacifiCare