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16#-* &%6 "5*0/ &.1-0:&&4ũ )&"-5) */463"/ & 1-"/1IPOF 877.517.0020 or 334.517.7000'BY 877.517.0021 or 334.517.7001&NBJM .govGeneral InfoInvoices/BillingWellness InfoFlexible SpendingBecause email submissions are unsecured, do not include confidential informationlike your Social Security number. Please include your full name, employer, home mailingaddress, and daytime phone number.BJM8FCTJUFPublic Education Employees’ Health Insurance PlanP.O. Box 302150Montgomery, AL 36130-2150www.rsa-al.gov.FNCFS 0OMJOF 4FSWJDFT .04 -PHJOEnroll in PEEHIP coverage onlinehttps://mso.rsa-al.gov#VJMEJOH -PDBUJPO201 South Union StreetMontgomery, Alabama#VTJOFTT )PVST8:00 a.m.-5:00 p.m.Monday-Friday

Plan Administrator Contact InformationWellness ProgramsActiveHealth - Vendor for Wellness Coaching and Condition 0Alabama Department of Public Health (ADPH) - Vendor for Wellness Screenings and Flu cco Cessation Quitlinewww.quitnowalabama.com800.QUIT.NOW or 800.784.8669ALL Kids - administered by ADPH888.373.5437 or 888.373.KIDSwww.adph.org/allkidsBlue Cross Blue Shield of Alabama - Administrator of Hospital Medical & Supplemental Medical Plans450 Riverchase Parkway EastP.O. Box 995Birmingham, AL 35298Customer ServiceSubrogationRapid Response Baby Yourself Teladoc www.alabamablue.com/peehip/3UHDGPLVVLRQ &HUWL¿FDWLRQ 800.248.2342800.327.3994Fraud Hot Line205.220.2744800.824.4391800.248.5123 - to order ID cards, claim forms, and directories800.222.4379 - Maternity uity - Administrator of Flexible Spending Accountswww.healthequity.com/peehip877.288.0719 - available 24 hours/dayMedImpact - Administrator of Core Pharmacy and Specialty Pharmacy Programs10181 Scripps Gateway CtSan Diego, CA 92131Customer ServicePharmacy Help DeskStep Therapy Prior 727 - available 24 hours/day800.788.2949 - available 24 hours/day800.347.5841 - For Physician UseFax - 877.606.0728UnitedHealthcare - Administrator of Group Medicare Advantage (PPO) Planwww.uhcretiree.com/peehip9900 Bren Road EastMinnetonka, MN 55343Customer Service877.298.2341 - available 8 a.m.-8 p.m. TTY 711Nurse LineRenew RewardsAmwell and Doctors on Demand com/peehipVIVA Health Plan417 20th Street North, Suite 1100Birmingham, AL 35203Customer ServiceDelta Dental Customer ServiceTeladoc www.vivahealth.com/peehip205.558.7474 or 800.294.7780800.521.2651 - dental provider for VIVA Health Planwww.teladoc.com800.TELADOC (835.2362)6RXWKODQG %HQH¿W 6ROXWLRQV - Administrator of Cancer, Dental, Indemnity, & Vision Optional Coverage Plans2200 Jack Warner Pkwy, Suite 150P.O. Box 1250ZZZ VRXWKODQGEHQH¿W FRP SHHKLSTuscaloosa, AL 35401Customer Service800.476.0677www.rsa-al.gov1

PEEHIP Member Handbookwith Open Enrollment InformationIntroductionThe Retirement Systems of Alabama (RSA) is pleased to provide you with the PublicEducation Employees’ Health Insurance Plan (PEEHIP) Member Handbook with OpenEnrollment Information. This handbook is an important part of our commitment to provideRXU PHPEHUV ZLWK YDOXDEOH LQIRUPDWLRQ DERXW WKHLU KHDOWKFDUH EHQH¿WV DQG 2SHQ (QUROOPHQW 3OHDVH UHDG WKLV KDQGERRN WKRURXJKO\ DQG NHHS LW ZLWK \RXU RWKHU EHQH¿W PDWHULDOV RXU PHPEHU KDQGERRN LV D YHU\ XVHIXO WRRO ZKHQ \RX KDYH TXHVWLRQV DERXW \RXU 3(( ,3 EHQH¿WV ,W ZLOO KHOS you make informed decisions about your future.6XPPDU\ RI %HQH¿WV DQG &RYHUDJH YDLODELOLW\ RI 6XPPDU\ HDOWK ,QIRUPDWLRQThe Patient Protection and Affordable Care Act (PPACA) of 2010 created a new federal requirement for group healthSODQV WR SURYLGH WKH 6XPPDU\ RI %HQH¿WV DQG &RYHUDJH 6%& GRFXPHQW WR KHDOWK SODQ PHPEHUV HDOWK EHQH¿WV UHSUHVHQW D VLJQL¿FDQW FRPSRQHQW RI \RXU FRPSHQVDWLRQ SDFNDJH 7KH EHQH¿WV DOVR SURYLGH LPSRUWDQW SURWHFWLRQ IRU you and your family in the case of illness or injury.PEEHIP offers a series of health coverage options. Choosing a health coverage option is an important decision. To help\RX PDNH DQ LQIRUPHG FKRLFH 3(( ,3 PDNHV DYDLODEOH D 6XPPDU\ RI %HQH¿WV DQG &RYHUDJH 6%& ZKLFK VXPPDUL]HV important information about health coverage options in a standard format, to help you compare across coverageoptions available to you in both the individual and group health insurance coverage markets. The SBC is availableat ZZZ UVD DO JRY LQGH[ SKS PHPEHUV SHHKLS EHQH¿WV SROLFLHV . A paper copy is also available, free ofcharge, by calling 0HPEHU 6HUYLFHV WROO IUHH DW .1RWH The SBC is meant as a summary only and the coverage examples in the SBC on pages 2 and 7 are for illustrationpurposes only and may not be representative of the actual charges for copayments or out-of-pocket expenses forWKH 3(( ,3 SODQ )RU PRUH GHWDLOHG EHQH¿W LQIRUPDWLRQ VHH WKH 3(( ,3 6XPPDU\ 3ODQ 'HVFULSWLRQ 63' DW ZZZ UVD DO JRY LQGH[ SKS PHPEHUV SHHKLS SXEV IRUPV .The information in this handbook is based on the Code of Alabama, 1975, Title 16, Chapter 25A. Thishandbook is not intended as a substitute for the laws of Alabama governing PEEHIP nor will its interpretationSUHYDLO VKRXOG D FRQÀLFW DULVH EHWZHHQ LWV FRQWHQWV DQG &KDSWHU )XUWKHUPRUH WKH ODZV VXPPDUL]HG KHUH are subject to change by the Alabama Legislature. Do not rely solely upon the information provided in thisKDQGERRN WR PDNH DQ\ GHFLVLRQ UHJDUGLQJ \RXU KHDOWKFDUH EHQH¿WV EXW FRQWDFW 3(( ,3 ZLWK DQ\ TXHVWLRQV \RX PD\ KDYH DERXW \RXU KHDOWKFDUH EHQH¿WV 2877.517.0020

%HQH¿W 3ROLF\ DQG 3UHPLXP &KDQJHV (IIHFWLYH 2FWREHU . 4Updating Personal Contact Information . 6Insurance Eligibility .7Open Enrollment . 9New Employee Enrollment . 11Enrollment Procedures and Member Online Services (MOS) .13(QUROOPHQW 'RFXPHQWDWLRQ 5HTXLUHG .15HIPAA Special Enrollment Outside of Open Enrollment . 17Employer Contributions . 20PEEHIP Hospital Medical Plan Group #14000 . 24VIVA Health Plan .27PEEHIP Supplemental Medical Plan . 29Optional Coverage Plans . 30&RPSDULVRQ RI %HQH¿WV . 327HOHFRQVXOWDWLRQ %HQH¿WV .37&RRUGLQDWLRQ RI %HQH¿WV &2% . PEEHIP Wellness Programs . 39Premium Rates (Active, Leave of Absence, and COBRA Members) . 44ALL Kids Children’s Health Insurance Program (CHIP) . 45Premium Assistance Program . 46Flexible Spending Accounts (FSA) . Leave of Absence (LOA) & Family Medical Leave Act (FMLA) . 50COBRA .51Provision for Medicare-Eligible Active Members . 54Health Insurance Policies for Retired Members . 56PEEHIP Coverage for Medicare-Eligible Retired Members. 59Premium Rates (Retired Members) . 60Retiree Sliding Scale . 626XUYLYLQJ 'HSHQGHQW %HQH¿WV . 63Health Insurance Portability and Accountability Act (HIPAA) Notice of Privacy Practices . 64Important Notices .67Premium Assistance under Medicaid and the Children’s Health Insurance Program (CHIP) . Forms . 70www.rsa-al.gov3ContentsContents

%HQH¿W 3ROLF\ DQG 3UHPLXP &KDQJHV%HQH¿W 3ROLF\ DQG 3UHPLXP &KDQJHV (IIHFWLYH 2FWREHU (Unless otherwise notated)Teladoc Ƈ All members who are enrolled in the PEEHIP Hospital Medical Plan Group #14000 have access to Teladoc , whichSURYLGHV FRQVXOWDWLRQV ZLWK ERDUG FHUWL¿HG GRFWRUV YLD SKRQH RU YLGHR KRXUV D GD\ GD\V D ZHHN 7KLV VHUYLFH LV DYDLODEOH DW ]HUR FRSD\ DQG FDQ EH XVHG WR VSHDN ZLWK D GRFWRU DERXW D YDULHW\ RI LVVXHV VXFK DV FROG ÀX DOOHUJLHV infections, and more. Plus, when necessary, the doctor can even prescribe the appropriate medication needed forWUHDWPHQW 7KLV H[FLWLQJ QHZ EHQH¿W FDQ EH XVHG LQ SODFH RI WKH HPHUJHQF\ URRP RU XUJHQW FDUH IRU QRQ HPHUJHQF\ situations. Refer to the 7HOHFRQVXOWDWLRQ %HQH¿WV section of this handbook for more information about Teladoc IRU *URXS PHPEHUV DV ZHOO DV WKH RWKHU WHOHFRQVXOWDWLRQ EHQH¿WV IRU PHPEHUV HQUROOHG LQ HLWKHU RXU 9,9 Health Plan or UnitedHealthcare Group Medicare Advantage (PPO) Plan. SSOLHG %HKDYLRU QDO\VLV % 7KHUDS\ &RSD\ 5HGXFWLRQƇ 3(( ,3 FRYHUV SSOLHG %HKDYLRU QDO\VLV % 7KHUDS\ IRU FKLOGUHQ DJHV WKURXJK DW RI WKH %OXH &URVV Blue Shield of Alabama allowance, subject to a copay per visit and the annual dollar maximum limits of 40,000IRU DJHV WKURXJK IRU DJHV WKURXJK DQG IRU DJHV WKURXJK IRU LQ QHWZRUN DQG out-of-network enrolled providers, HIIHFWLYH UHWURDFWLYHO\ WR -DQXDU\ 7R ¿QG DQ % SURYLGHU YLVLW ZZZ EFEVDO RUJ ZHE SURYLGHU ¿QGHU (QWHU D ,3 &RGH DQG FOLFN 6HDUFK WKHQ QDUURZ \RXU VHDUFK WR ¿QG DQ LQ QHWZRUN % SURYLGHU QHDU \RX E\ XVLQJ WKH 5H¿QH 5HVXOWV IHDWXUH RQ WKH OHIW VLGH RI WKH SDJH 6HOHFW %HKDYLRUDO Health Providers, then select Behavior Analysts. The providers near you will display on the right side of the page. To¿QG D SURYLGHU E\ SKRQH FDOO )OH[LEOH 6SHQGLQJ FFRXQW )6 3ODQ &KDQJHVƇ The Flex debit card will be allowed for all eligible expenses for medical, dental, vision as well as pharmacy claims; theautomatic bump reimbursement option will be eliminated.Ƈ The annual maximum Health FSA contribution amount increased to EHJLQQLQJ ¿VFDO \HDU 2FWREHU 7KLV LV D EHQH¿W HQKDQFHPHQW Ƈ 7KH 'HSHQGHQW &DUH 5HLPEXUVHPHQW FFRXQW '&5 DQQXDO PD[LPXP FRQWULEXWLRQ UHPDLQV XQFKDQJHG DW HDFK LI PDUULHG ¿OLQJ VHSDUDWHO\ 9,9 HDOWK 3ODQ %HQH¿W &KDQJHVƇ PEEHIP members covered by the VIVA Health Plan have access to teleconsultation through Teladoc just likemembers covered under the PEEHIP Hospital Medical Plan Group #14000 administered by Blue Cross Blue Shieldof Alabama. The copay for VIVA members is increasing to SHU FRQVXOW HIIHFWLYH 2FWREHU Ƈ The combined medical and prescription drug in-network maximum annual out-of-pocket amounts will increaseto for individual and SHU IDPLO\ IRU WKH EHQH¿WV 0D[LPXP RXW RI SRFNHW DPRXQWV DUH D EHQH¿W WR PHPEHUV EHFDXVH WKH\ OLPLW WKH WRWDO DPRXQW PHPEHUV ZLOO SD\ RXW RI SRFNHW IRU WKHLU LQ QHWZRUN healthcare expenses.Ƈ 9,9 ZLOO DOVR EHJLQ FRYHULQJ % WKHUDS\ HIIHFWLYH 2FWREHU DQG FRYHUDJH ZLOO EH DW RI WKH DOORZHG amount after members meet the deductible. The calendar year deductible remains unchanged at 500 for individualDQG SHU IDPLO\ FRQWUDFW IRU WKH ¿VFDO \HDU % WKHUDS\ ZLOO EH DYDLODEOH WR WKRVH PHPEHUV ZLWK D diagnosis of autism, autism spectrum disorder, or pervasive developmental delay.Ƈ 9,9 EHQH¿WV KDYH DOZD\V LQFOXGHG 'LDEHWLF 6HOI 0DQDJHPHQW (GXFDWLRQ '60( ZLWK QR OLPLW 7KLV EHQH¿W ZDV previously billed by a hospital as an outpatient claim, causing the applicable member cost-sharing and deductible.'60( ZLOO QRW EH D QHZ EHQH¿W FDWHJRU\ ZKLFK LV D EHQH¿W HQKDQFHPHQW EHFDXVH WKH GHGXFWLEOH QR ORQJHU DSSOLHV 0D[LPXP QQXDO 2XW RI 3RFNHW PRXQWVƇ The combined medical and prescription drug in-network maximum annual out-of-pocket amounts will increase to per individual and per family per calendar year effective January 1, 2019. This is an enhancedEHQH¿W IRU RXU PHPEHUV HQUROOHG LQ 3(( ,3¶V RVSLWDO 0HGLFDO 3ODQ *URXS FRYHUDJH DV WKH\ ZLOO SD\ QR more than these annual out-of-pocket amounts for calendar year 2019.6XSSOHPHQWDO 0HGLFDO &KDQJHVƇ The annual maximum amount of claims paid under Group #61000 will increase to per individual and SHU IDPLO\ SHU FDOHQGDU \HDU HIIHFWLYH -DQXDU\ 7KLV LV D EHQH¿W HQKDQFHPHQW 4877.517.0020