Welcome City of San Diego Retirees

More benefits. Lower cost. Better value for City of San Diego retirees and their dependents April 8, 2016 | 2015-2016 plan year

Enjoy The Sharp Experience We believe San Diegans deserve the best

Quality you can count on • Two Sharp Healthcare hospitals earned “Outstanding Patient Experience Award” by Healthgrades in 2014 • Awarded “Best of San Diego” by The San Diego Union Tribune in 2014 for best hospital group, best hospital and best medical group

Local emphasis • Only locally based, commercial not-for-profit health plan in San Diego • Part of Sharp HealthCare, San Diego’s health care leader • When you call, you’ll speak to a local San Diegan

2 Many choices for care: Sharp Health Plan network Doctors and providers who San Diegans know and trust

1,000+ Physicians 6 Medical Groups 8 Hospitals 25+ Urgent Care Centers 500+ Pharmacies • Sharp Rees-Stealy • Sharp Chula Vista Medical Center • Sharp Community • Sharp Coronado Hospital Medical Group (SCMG) • Sharp Grossmont Hospital • SCMG-Arch • Sharp Mary Birch Hospital Health Partners • Sharp Memorial Hospital • SCMG-Graybill • Sharp Mesa Vista Hospital • SCMG-Inland North • Palomar Medical Center • Greater Tri Cities • Pomerado Hospital

PCP choice determines the medical group and specialists who members will see and the urgent care centers that can be used. 3 Sharp Health Plan City of San Diego plan options

Active Employees

COBRA

Non-Medicare Retirees

Medicare Retirees

4 Non-Medicare-eligible retiree plan information

5 Eligibility requirements for Non-Medicare retirees

• City of San Diego retiree and their spouse or dependents.

• Membership in MEA is not required to join the health plan.

• Live in Sharp Health Plan service area of San Diego and Southern Riverside Counties.

6 Introducing Sharp Health Plan

Non-Medicare 2015-16 benefits at a glance

Benefit Non-Medicare (HMO), City of San Diego Retiree Plan Plan Premium $1,094 Maximum Out of Pocket $1,500 Primary Care Physician $15 Specialist $15 Urgently Needed Services $15 Emergency Room $50 Inpatient $0/day Outpatient Surgery $0 Durable Medical Equipment $0 Retail 30 Day Prescriptions* $15 / $30 / $50 Mail 90 Day Prescriptions* $30 / $60 / $100 Lab Services $0 X-Rays $0 Advanced Imaging (MRI, PET, CT, etc.) $0 Routine Eye Exam (every 12 months) $10 Hearing Aid (per 36 months) $1,000 allowance

*Drug Tiers: Generic Formulary/ Brand Formulary/ Non-Formulary

7 Vision and hearing benefits included for Non-Medicare retirees

VSP Vision Coverage:

• Annual Routine Eye Exam - $0 for Non-Medicare members

Hearing Aid Allowance per 36 months:

• $1,000 maximum allowance (for one or two ears)

• To access this benefit, members should contact their PCP

8 Acupuncture and Chiropractic coverage for Non-Medicare retirees

• Self-refer to any chiropractor or acupuncturist in the American Specialty Health Network for any medically necessary need

• Up to 40 visits (combined for acupuncture/chiro) per plan year for $15 copay

• See American Specialty Health network chiropractors and acupuncturists at sharphealthplan.com/chiro

9 Sharp Advantage Medicare-eligible retiree plan information

Sharp Advantage is offered by Sharp Health Plan. Sharp Advantage is an HMO plan with a Medicare contract. Enrollment in Sharp Advantage depends on contract renewal.

10 Eligibility requirements for Medicare retirees

1.Medicare Beneficiary with Part A and enrolled in Part B. Must continue to pay the monthly Part B premium.

2.City of San Diego retiree and their spouse or dependent.

3.MEA membership is not required to join the health plan.

4.Resident of San Diego County.

11 Sharp Advantage For Medicare-eligible retirees • Sharp Advantage is a Medicare Advantage Prescription Drug plan (MAPD) • It combines all of the benefits of Medicare Part A and Part B, Part D prescription drug coverage, plus extra benefits, into one simple plan • 2015-2016 Premium: $166 per month

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and co-payments/co-insurance may change each year. Members must continue to pay their Part B premium.

12 Sharp Advantage Medicare

2015-16 benefits at a glance

Benefit Sharp Advantage (HMO), City of San Diego Retiree Plan Plan Premium $166 Maximum Out of Pocket $1,500 Primary Care Physician $10 Specialist $10 Urgently Needed Services $10 Emergency Room $50 Inpatient $0/day Outpatient Surgery $50 Durable Medical Equipment $0 Lab Services $0 X-Rays $0 Advanced Imaging (MRI, PET, CT, etc.) $0 Routine Eye Exam $20 Frames or Contacts (per 24 months) $130 allowance Hearing Aid (per 36 months) $1,000 allowance

Initial Coverage** Pay the standard copays or cost share percent until the member’s payments reach $4,700 for the year:

Retail 30-Day Prescriptions* Mail Order 90-Day Prescriptions* $10 / $10 / $20 / $20 / 25% $20 / $20 / $40 / $40 / not offered

Catastrophic Coverage** If the member’s payments reach $4,700 for the year, Catastrophic Coverage will continue through the end of the plan year at:

5% of the cost, or $2.65 for Generic / $6.60 all other drugs, whichever is greater

*Drug Tiers: Preferred Generic / Generic / Preferred Brand / Brand / Specialty ** MEA Medicare members have no coverage gap (aka Donut Hole)

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and co-payments/co- insurance may change each year. 14 Vision and hearing benefits included for Sharp Advantage Medicare members

VSP Vision Coverage:

• Annual Routine Eye Exam - $20 for Medicare members

• $130 allowance for frames or contacts for Medicare members

Hearing Aid Allowance per 36 months:

• $1,000 allowance (for one or two ears)

• To access this benefit, members should contact their PCP

15 Chiropractic coverage for Sharp Advantage Medicare members Chiropractic benefits for spinal subluxation treatment are offered at the regular specialist visit copay with referral from a member’s PCP.

Sharp Advantage also offers extra chiropractic benefits!

• Self-refer to any chiropractor in the American Specialty Health Network for any medically necessary chiropractic need • Up to 30 visits per year for $10 copay • See American Specialty Health network chiropractors at sharphealthplan.com/chiro

16 Free gym membership for Sharp Advantage Medicare members

• You select which club to join from a list of participating clubs

• Check the list of clubs near you at SilverAndFit.com

• You can switch clubs during the year

• At-home fitness options available too

17 Both Non-Medicare and Medicare retiree plans include extra benefits…

18 Routine care around the country

• Minute Clinics are walk-in clinics located in select CVS/pharmacy stores around the country

• Sharp Health Plan covers members at Minute Clinic for routine care for: $10 copay -- Medicare members $40 copay – Non-Medicare members

• There are Minute Clinics in most states and across California

• Find locations at MinuteClinic.com/locations

19 Worldwide emergency and urgent care coverage

• Full emergency and urgent care coverage anywhere in the world.

• When more than 100 miles from your home or out of the country, your care will be coordinated by Assist America.

• Assist America provides services including medical evacuation and prescription assistance and fosters prompt hospital admission by validating the member’s health insurance or advancing funds as needed to the hospital.

20 Free health coaching

For extra help reaching one’s health goals, try free health coaching!

Up to 30-minute confidential coaching sessions by phone, at the member’s convenience. The health coach will provide support, encouragement, motivation and accountability to help members make healthy changes and maintain successful, healthy habits. Choose from common health topics: • Healthy weight management • Smoking cessation • Healthy eating • Physical activity • Stress management

21 Questions? We’re here to help.

Sharp Health Plan is here to help you learn more about your plan with the City of San Diego.

Non-Medicare Questions Sharp Health Plan 1-888-840-4747

Medicare Questions Sharp Advantage 1-855-820-2112