Appendix A

TABLE OF CONTENTS

APPENDIX D
Comparator Plan Costs

EGI and Out-of-State Comparator Participant Costs

	EGI (Low)	EGI (High)	Alaska	Montana (Low)	Montana (High)	North Dakota (Basic)	North Dakota (PPO)	South Dakota (Low)	South Dakota (High)

Individual Monthly Premium ⁽¹⁾	$195.00	$169.94	$597	$245	$227	$349.72	$349.72	$268.95	$268.95
Employee Share of Individual Premium	$0	$0	$82	($40)	($58)	$0	$0	$0.00	$0.00
Employer Share of Individual Premium	$225	$225	$515	$285	$285	$349.72	$349.72	$268.95	$268.95
Percent Paid by Employer ⁽³⁾	115%	132%	86%	116%	126%	100%	100%	100%	100%
Deductible ⁽⁴⁾	$350	$750	$250	$200	$750	$200	$200	$500	$1,000
Co-Insurance⁽⁵⁾	85%	85%	80%	75%	75%	80%	85%	75%	75%
Co-Insurance Maximums⁽⁶⁾	$1,500	$1,500	$1,000	$950	$2,000	$1,250	$750	$1,500	$1,500
Co-Pays ⁽⁷⁾	NA	NA	$100	NA	$15	$20-$25	$10 - $25	NA	NA
Co-Pay Maximums ⁽⁸⁾	NA	NA	Unlimited	NA	$2,000	$200	$100	NA	NA
Prescription Co-Pays ⁽⁹⁾	$10,$20, $40	$10,$20, $40	$3, $11	$5-$45	$5-$45	$5-$10	$5-$10	$8, $18	$8, $18
Prescription Co-pay Maximums ⁽¹⁰⁾	Unlimited	Unlimited	Unlimited	$500	$500	Unlimited	Unlimited	$400	$400
Lifetime Maximums⁽¹¹⁾	$2,000,000	$2,000,000	Unlimited	$1,000,000	$1,000,000	$2,000,000	$2,000,000	$1,000,000	$1,000,000
Annual Maximum Paid by Employee ⁽¹²⁾	$1,850.00	$2,250.00	$2,234.00	$1,150.00	$2,750.00	$1,450	$950	$2,000	$2,500

	EGI (Low)	EGI (High)	Alaska	Montana (Low)	Montana (High)	North Dakota (Basic)	North Dakota (PPO)	South Dakota (Low)	South Dakota (High)

Family Monthly Premium ^{(1) (2)}	$451.28	$390.68	$597	$349	$314	$349.72	$349.72	$252.51	$176.51
Employee Share of Family Premium	$226.28	$165.68	$82	$64	$29	$0.00	$0.00	($16.44)	($92.44)
Employer Share of Family Premium	$225	$225	$515	$285	$285	$349.72	$349.72	$268.95	$268.95
Percent Paid by Employer ⁽³⁾	50%	58%	86%	82%	91%	100%	100%	107%	152%
Deductible ⁽⁴⁾	$700	$1,500	$500	$600	$1,500	$600	$600	$1,250	$2,500
Co-Insurance⁽⁵⁾	85%	85%	80%	75%	75%	80%	85%	75%	75%
Co-Insurance Maximums ⁽⁶⁾	$3,000	$3,000	$1,000	$2,100	$4,000	$2,500	$1,500	$1,500	$1,500
Co-Pays ⁽⁷⁾	NA	NA	$100	NA	$15	$20-$25	$10 - $25	NA	NA
Co-Pay Maximums ⁽⁸⁾	NA	NA	Unlimited	NA	$4,000	$400	$200	NA	NA
Prescription Co-Pays ⁽⁹⁾	$10,$20, $40	$10,$20, $40	$3, $11	$5-$45	$5-$45	$5-$10	$5-$10	$8, $18	$8, $18
Prescription Co-pay Maximums ⁽¹⁰⁾	Unlimited	Unlimited	Unlimited	$1,000	$1,000	Unlimited	Unlimited	$1,000	$1,000
Lifetime Maximums ⁽¹¹⁾	$2,000,000	$2,000,000	Unlimited	$1,000,000	$1,000,000	$2,000,000	$2,000,000	$1,000,000	$1,000,000
Total Maximum Paid by Employee ⁽¹²⁾	$6,415.36	$6,488.16	$2,484.00	$3,468.00	$5,848.00	$3,100.00	$2,100.00	$2,750.00	$4,000.00

⁽¹⁾ Montana includes core dental, core life, and vision coverage as part of its medical premium. The vision coverage includes an exam every 24 months with a $10 co-pay. The Alaska plan also includes vision coverage with no deductible, up to $350 in benefits annually for exams and lenses. Dental is included in Alaska�s plan, with a $25 single deductible, and a $75 family deductible. Dental and vision benefits are offered in South Dakota through the flexible benefits plan at an additional premium. It does not appear that dental is offered as part of the North Dakota plan.

⁽²⁾Montana has two family tiers that have not been included on this chart. There is an Employee+Spouse tier, and an Employee+Child(ren) tier, which offer lower monthly premiums than the family rate. South Dakota has seven tiers, and age rates premiums for spousal coverage. The chart reflects the highest tier (employee, spouse and two+ children) and takes the 45-49 age bracket, which is the midpoint on the premium schedule. Therefore, there are only three higher premiums than are listed on this chart and 20 tiers with lower premiums than those listed in the chart. South Dakota also adds another $30 per person per month for each participant who smokes.

⁽³⁾In Montana, the amount contributed by the employer above the premium is used for core dental coverage and core life coverage premiums. Excess above that can be used by participants for elective benefits. In Alaska, excess is deposited into an employee�s health care reimbursement account. It is unknown what is done with the excess is South Dakota.

⁽⁴⁾In North Dakota, all members must contribute to the deductible and coinsurance amounts. However, a member's contribution cannot be more than the single coverage amount. Deductibles are only for non-physician services. Office visits have co-pays. Alaska has a family deductible, with no requirement that each family member meet a certain portion. Alaska has a separate $25 individual deductible for dental benefits, and a $75 deductible for family dental benefits. South Dakota only requires the family deductible for families of three or more. Otherwise, each participant pays the individual deductible. In Montana, the family deductible is for the whole family, not per individual.

⁽⁵⁾In the EGI plans, co-insurance can drop to 80 percent for the use of in-state non-network providers and out-of-state network providers, and drops to 60 percent for out-of-state non-network providers. The out-of-pocket calculations were based on the highest level of co-insurance paid by the employer (85%). Under the South Dakota deductible plans, the plan pays only 65 percent co-insurance if using a non-network provider.

⁽⁶⁾Co-insurance maximums are the actual amount an employee pays in co-insurance on covered services before the plan pays 100 percent. In the EGI plan, individuals are liable for co-insurance up to $15,000, if they use out-of-state, non-network providers and families are liable for co-insurance up to $30,000 before the plan will pay 100 percent if they use out-of-state, non-network providers. Out-of-pocket calculations were based on the assumption that the EGI participants use network providers. Alaska co-insurance maximums are per person for the family maximum. South Dakota is also per person for the family maximum and the co-insurance limit is higher for individuals who receive care from a non-network provider. North Dakota�s out-of-pocket maximum is per family, but a certain amount must be paid by each participant. Montana�s co-insurance limit is per family.

⁽⁷⁾Co-pays in Alaska are for non-emergency room visits to the emergency room. Co-pays in the Montana high-deductible plan are only for office visits. These co-pays do not count toward the deductible, but do count toward the out-of-pocket maximum. Other provider visits are covered by co-insurance. In North Dakota, there is are varying co-pays on office visits, emergency room visits, and for diagnostic services. In North Dakota, co-payments do not apply toward meeting the deductible. The deductible is only for non-physician services.

⁽⁸⁾In North Dakota, there is an out-of-pocket limit on the co-payments for diagnostic services in a year, ranging from $50 to $200 per individual depending on the plan, and a limit of $100 to $400 per family, depending on the plan. Office visit and emergency room visit co-payments are unlimited.

⁽⁹⁾EGI has a carved-out prescription benefit plan and the co-pays do not apply toward the deductible or the out-of-pocket maximums. Participants pay a $10 co-pay for generic drugs, $20 for preferred drugs, and $40 for non-preferred drugs. Alaska participates in a "carved-out" prescription drug program, and if a participant uses a participating pharmacy, requires a $3 co-pay on generic drugs ($5 for cafeteria plan) and an $11 co-pay on brand-name drugs ($10 for cafeteria plan). Those who use the mail-order prescription programs for maintenance drugs only have to pay a $2 co-pay for brand-name drugs and no co-pay at all for generic drugs. The plan pays 100 percent of generic mail-order maintenance drugs. Alaska participants can also elect to purchase prescriptions on a co-insurance option, rather than a co-pay option, if they do not use a network pharmacy. The plan pays 60 percent for brand-name drugs and 80 percent for generic drugs. Montana also has a carved-out prescription program and requires a 10 percent payment on generic drugs ($5 minimum and $15 maximum) and a 30 percent payment on brand-name drugs ($15 minimum and $45 maximum). Montana also participates in a mail-order program with a $15 co-pay on generics, and $45 co-pay on brand-name drugs. South Dakota also participates in a carved-out prescription drug program, and participants can use a mail-order service to obtain lower co-pays on 90-day supplies of maintenance drugs. In North Dakota, which also has a carved-out plan, participants pay a $5 co-pay on generic drugs with 15 percent co-insurance, and a $10 co-pay on brand name or non-formulary drugs with a 25 percent co-insurance.

⁽¹⁰⁾The Montana plan also has a $500 individual and $1,000 family cap on out-of-pocket prescription expenses. South Dakota participants are liable for only $400 per person or $1,000 for a family of three or more on out-of-pocket prescription co-pays. After that point, the plan pays at 100 percent.

⁽¹¹⁾In North Dakota, South Dakota, and Montana the lifetime maximum is per member.

⁽¹²⁾ This is the calculation for the total out-of-pocket expenses a participant would be liable for in a plan year, before the plan starts paying at 100 percent. It includes annual premiums, deductibles, and co-insurance. Additionally, in states that do not have maximum co-pays, participants would be liable for whatever co-pays are in effect, in addition to the calculation listed here.

Sources: 2000 EGI Employee Benefit Booklets; summary of state contributions and premiums for EGI; Alaska website; Alaska plan summary; Montana website; information provided by South Dakota; South Dakota website; North Dakota plan summary; information provided by North Dakota.

EGI and In-State Comparator Participant Costs

	EGI (Low)	EGI (High)	City of Casper	City of Cheyenne	Laramie County	Laramie County Schools

Individual Monthly Premium	$195.00	$169.94	$154.75	$163.25	$218.86	$149
Employee Share of Individual Premium	$0	$0	$44.88	$21.00	$22.75	$11.92
Employer Share of Individual Premium	$225	$225	$109.87	$142.25	$196.11	$137.08
Percent Paid by Employer	115%	132%	71%	87%	90%	92%
Deductible ⁽¹⁾	$350	$750	$300	$150	$250	$200
Co-Insurance⁽²⁾	85%	85%	50%	80%	80%	50%
Co-Insurance Maximums ⁽³⁾	$1,500	$1,500	$1,000	$1,000	$1,000	$1,000
Co-Pays	NA	NA	NA	NA	NA	NA
Co-Pay Maximums	NA	NA	NA	NA	NA	NA
Prescription Co-Pays ⁽⁴⁾	$10,$20, $40	$10,$20, $40	$3, $8	$3, $8	$0, $5	$3, $8, $16
Prescription Co-pay Maximums	Unlimited	Unlimited	Unlimited	Unlimited	Unlimited	Unlimited
Lifetime Maximums	$2,000,000	$2,000,000	$1,500,000	$1,000,000	$1,000,000	$5,000,000
Annual Maximum Paid by Employee ⁽⁵⁾	$1,850.00	$2,250.00	$1,838.56	$1,402.00	$1,523.00	$1,343.04

	EGI (Low)	EGI (High)	City of Casper	City of Cheyenne	Laramie County	Laramie County Schools

Family Monthly Premium	$451.28	$390.68	$353.60	$526.52	$437.72	$497
Employee Share of Family Premium	$226.28	$165.68	$102.54	$66.00	$65.50	$39.76
Employer Share of Family Premium	$225	$225	$251.06	$460.52	$372.22	$457.24
Percent Paid by Employer	50%	58%	71%	87%	85%	92%
Deductible ⁽¹⁾	$700	$1,500	$900	$300	$500	$400
Co-Insurance⁽²⁾	85%	85%	50%	80%	80%	50%
Co-Insurance Maximums ⁽³⁾	$3,000	$3,000	$2,000	$2,000	$2,000	$2,000
Co-Pays	NA	NA	NA	NA	NA	NA
Co-Pay Maximums	NA	NA	NA	NA	NA	NA
Prescription Co-Pays ⁽⁴⁾	$10,$20, $40	$10,$20, $40	$3, $8	$3, $8	$0, $5	$3, $8, $16
Prescription Co-pay Maximums	Unlimited	Unlimited	Unlimited	Unlimited	Unlimited	Unlimited
Lifetime Maximums	$2,000,000	$2,000,000	$1,500,000	$1,000,000	$1,000,000	$5,000,000
Total Maximum Paid by Employee ⁽⁵⁾	$6,415.36	$6,488.16	$4,130.48	$3,092.00	$3,286.00	$2,877.12

Individual Monthly Premium (1)

Individual Monthly Premium

Individual Monthly Premium ⁽¹⁾