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
Defined Benefit 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:

• Consumer Driven Plan Options: Section 125 Flexible Spending Account (FSA), Health Reimbursement Account (HRA), Retiree Reimbursement Account (RRA), Health Savings Account (HRA)
• Employer Defined Subsidy
• Default Benefits

Alternate Medical Plans
TML IEBP requires 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. Council is required to meet the 100% participation requirement.

2010-2011 Medication Therapy Management Program
TML IEBP's Pharmacy Benefit Manager is ReStat. TML IEBP and ReStat will work together to provide a progressive medication therapy management program for the Political Subdivisions in Texas. TML IEBP's Medication Therapy Management Program will enhance the covered individual's ability to be an educated consumer for evidence based prescription utilization. TML IEBP will work closely with RxResults to ensure the medication therapy management program is clinically supported by pharmaceutical alternatives based on the covered individual's choice.

Coverage for prescriptions and biotech prescriptions that are available through the Pharmacy Benefit Manager will be paid per the prescription schedule of benefits. Eligible Biotech prescriptions may be purchased from network providers per the prescription schedule of benefits. For eligible prescriptions purchased outside of the Pharmacy Benefit Manager or the Network Providers, the plan will pay at the out of network benefit percentage and will not, at any time, pay at 100% for any prescription services under the out of pocket provision of the Plan. The plan includes several copay options to benefit the educated consumer the option to manage their out of pocket expense.

Pharmacy Benefit Manager Administrative Services:

• Network/Value Tiered Network Access
  • Broad Network
  • Aligned Network
• Cost Effective Average Wholesale Pricing
• Tiered Copay Options to enhance the management of the covered individuals out of pocket expenses.
  • Over the Counter
  • Value Tier - Retail
  • Generic - Retail and Mail
  • Best Brand Price Drug List - Retail and Mail
  • Non Best Brand Price List - Retail and Mail
  • Cost Share Copay: Retail and Mail
  • Biotech - Mail 34 day dispensement

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 implement regulatory changes.

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.

Three 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.

The Dental 4 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. Mandatory and voluntary benefit options are available.

Two Vision Plans with Voluntary Options
Vision Plan A provides up to $65 for an annual eye examination and a scheduled amount for frames, lenses or contact lenses. 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 five supplemental benefit options:

• Cancer Supplemental Policy
• Accidental Supplemental Benefits
• Critical Care Supplemental Policy
• Long Term Care Policy
• Employee Assistance Program

Retiree Plan Options
TML IEBP offers Employer benefit options for the pre sixty-five (65) retiree population. The employer may include pre sixty-five employees within their manual underwriting criteria, extract the pre sixty-five retirees from the manual underwriting process and charge the pre sixty-five retiree a standalone rate with access to the active employee plan, or allow pre sixty-five retirees access to the TML IEBP Pre Sixty-five Pool that provides the option of four Medical Comprehensive Plans. Due to guidelines in Healthcare Reform, the Retiree Continuum of Care Plan will be deleted December 31, 2010.

TML IEBP offers two plan options for individuals post sixty-five (65) who are Medicare A and B eligible. Post sixty-five retirees have the option of a Medicare Advantage or Medicare Supplemental Plan that may be expanded to include a Medicare Part D prescription plan.