What Benefits are available through TML IEBP?

Comprehensive Major Medical Plans
Comprehensive Major Medical Preferred Provider Network (PPN) Plans with a number of deductible, copayment, benefit percentage and out of pocket options.

Defined Benefit Plans vs. Traditional Benefit Plans
Consumer-Directed Health Care Plans vs. Traditional Plans focus on the development of a Healthier Employee Population which creates a Healthier and more Productive Workforce. This program incorporates the following:

• Customizing Compensation Plans
• Employer Defined Subsidy
• Default Benefits

Two Foundation Benefit Plan Options
"Foundation" Benefit Plans that provides catastrophic medical coverage at a managed contribution.

Alternate Medical Plans
TML IEBP requires a 100% employee participation for healthcare benefits except for employees who have health coverage through a spouse, the military or through a retirement plan. This plan is for the employees only and not for their dependents. TML IEBP offers four Alternate Plan options. The Alternate Plan must coordinate with the Employee's core benefit plan. Covered Individuals that are covered under the TriCare Plan cannot access the alternative plan but will not be required to meet the 100% participation requirement, employees that maintain documented coverage under their spouse's plan will not be required to meet the TML IEBP's Benefit's 100% participation requirement. If an individual is hired to work for a political subdivision and can provide the employer with documentation of benefits from prior employment due to retirement, the individual will not be required to obtain TML IEBP benefits to meet the 100% participation requirement. Council is required to maintain 100% participation regardless of the above guidelines. The following individuals shall not be eligible to enroll in the Alternate Plan: (1) TRICARE-eligible employees; (2) Spouses of TRICARE-eligible employees; (3) Medicare-entitled employees; and (4) Spouses of Medicare-entitled employees.

Prescription Card Program
To improve the quality and cost management of pharmacy care, some innovative services may capitalize on clinical strengths, data capabilities and provider partnerships. The prescription therapeutic service specializes in prescriptions and supplies for medical diagnoses. TML IEBP administers a multitude of prescription programs that include a brand/generic copay plan, three-tiered copay plan, benefit percentage plan, and generic incentive plan. TML IEBP's Pharmacy Benefit Manager is CVS/Caremark. Ineligible prescription drugs may receive Pharmacy Benefit Manager's discount, reducing the covered individual's out of pocket expenses.

Through the CVS/Caremark Value Tiered Network, TML IEBP members access a CVS/Caremark pharmacy for retail generic 34-day dispensement of prescriptions for no out of pocket expense and/or a 90-day retail generic dispensement for a $9.00 copay.

The Integrated Mail Service Program offers Covered Individuals the convenience of home delivery of a three-month maintenance prescription. Covered Individuals may reorder their mail service prescriptions through the TML IEBP website pharmacy link, by mail or by calling the toll free number.

SpecialtyRx makes injectable prescriptions that are available through CVS/Caremark. The list of SpecialtyRx injectable prescriptions is available on TML IEBP's website www.tmliebp.org. SpecialtyRx is the most cost-effective way to purchase medications for Covered Individuals with chronic illnesses requiring life-sustaining medications. SpecialtyRx provides covered individuals with a cost-effective benefit to purchase specialty prescriptions. With SpecialtyRx, the covered individual will receive easy ordering and fast delivery from the Pharmacy Benefit Manager. In addition, the covered individual will receive an informative care management packet. The SpecialtyRx prescription may be delivered to the physician's or covered individual's address.

Continuation of Coverage Administration
TML IEBP offers Continuation of Coverage (COBRA) administration and will mail notification letters, provide participant direct billing services, maintain records and monitor and implements changes in regulations.

The American Recovery and Reinvestment Act of 2009 (ARRA) assists with the cost of Continuation of Coverage Benefits and provides additional election opportunities to certain individuals. Eligible individuals pay thirty-five (35) percent of their required monthly contributions for Continuation of Coverage. The remaining sixty-five (65) percent is paid by the federal government.

Consumer Driven Health Plans
TML IEBP sponsors Health Reimbursement, Retiree Reimbursement and Health Savings Accounts. Employers may use the plans to drive changes in consumer education, personal health engagement and consumer benefit utilization.

Section 125 (Flexible Spending Account)
TML IEBP offers HIPAA Title III compliant paper and/or debit Section 125 administration services for premium only plans, dependent childcare and unreimbursed healthcare expenses. Discrimination Testing is also available.

Two Dental Plans
The Dental 2 Plan is a scheduled benefit plan with no deductible for preventive services and a $50 accumulated calendar year deductible for basic and major services. The maximum benefit is $1,200 per Covered Individual per calendar year. Mandatory and voluntary benefit options are available.

The Dental 3 Plan includes coverage for preventive services at 100% with no deductible. Basic services are paid at 80% and major services at 50% subject to a $50 calendar year deductible and a $2,000 per year maximum. Orthodontic coverage is included for dependents under the age of 19 with a $1,500 lifetime maximum.

Two Vision Plans
Vision Plan A provides up to $65 for an annual eye examination and a scheduled amount for frames, lenses or contact lenses. Mandatory and voluntary benefit options. Vision Plan B provides up to $85 for an annual eye examination and a scheduled amount for frames, lenses or contact lenses. Mandatory and voluntary benefit options are available for both Vision plans.

Group Term Life, AD&D and Voluntary AD&D
Group Term Life and Accidental Death and Dismemberment coverage for employees and their dependents is available to TML IEBP Members. Basic Life includes an Accelerated Death Benefit. Optional Life Benefits include additional life, dependent life, and retiree life benefits.

Long Term and Short Term Disability
TML IEBP also offers long term and short term disability benefits that provide protection from loss of income when an employee can no longer work.

Voluntary Supplemental Benefit Options
TML IEBP offers three supplemental benefit options:

• Accident Supplemental Benefit options and riders
• Cancer Supplemental Benefit options and riders
• Critical Care Supplemental Benefit options and riders

Retiree Plan Options
TML IEBP offers benefit options for the Pre-sixty-five (65) retiree. The early retiree has the option of the Medical Comprehensive Plan at a percentage greater than the active employee rate or the Retiree Continuum of Care Plan, a cost-effective Mini-Medical Plan option.

TML IEBP offers two plan options for individuals Post-sixty-five (65) who are Medicare A and B eligible. The retiree would have the option of a Medical Only Plan or a Medical and Creditable Coverage Part D Prescription Plan. The employer will have the options of a Medicare Advantage and/or a Medicare Supplemental Plan.