Joint Insurance Committee

By The City of Oklahoma City Office of the City Clerk at 3:14 pm, Jun 04, 2025 THE CITY OF OKLAHOMA CITY JOINT INSURANCE COMMITTEE Joanna McSpadden Isaac Locke Jeff Cooper Donna Skidmore Larry Slaff Phil Smith 420 W Main Ste 110, Oklahoma City, OK 73102 Basement Conference Room June 11, 2025 8:30 a.m. It is the policy of the City to ensure that communications with participants and members of the public with disabilities are as effective as communications with others. Anyone with a disability who requires an accommodation, a modification of policies or procedures, or an auxiliary aid or service in order to participate in this meeting should contact the ADA Personnel Department Coordinator at 297-2861 or TDD 297-2020 as soon as possible but not later than 48 hours (not including weekends or holidays) before the scheduled meeting. The department will give primary consideration to the choice of auxiliary aid or service requested by the individual with disability. If you need an alternate format of the agenda or any information provided at said meeting, please contact the ADA department coordinator listed above 48 hours prior to the scheduled meeting.  CITY OF OKLAHOMA CITY JOINT INSURANCE COMMITTEE AGENDA and MEETING NOTICE DATE: June 11, 2025 TIME: 8:30 a.m. PLACE: 420 W Main Ste 110, Oklahoma City, OK 73102 Basement Conference Room AGENDA: I. Call to Order II. Approval of Minutes A. March 5, 2025 III. Information from Vendors IV. Information from Employee Benefits Division A. Plan Performance  AGENDA ITEM II. Approval of Minutes  CITY OF OKLAHOMA CITY JOINT INSURANCE COMMITTEE MINUTES March 5, 2025 The Joint Insurance Committee meeting was held on March 5, 2025 at 8:30 a.m. in the City Municipal Building, 420 W Main, Ste 110 Basement Large Conference Room Those in attendance were: Members Present: Donna Skidmore, Retiree Member Jeff Cooper, FOP Lodge 123 Member Joanna McSpadden, City Manager Designee Phil Smith, Citizen Member Larry Slaff, Citizen Member Members Absent: Isaac Locke, AFSCME Representative Staff Present: Jason Long, Total Rewards Manager Richard Mahoney, Asst Municipal Counselor III Taylor Atherton, Benefits Systems Specialist Lolly Landgraf, Sr. Human Resources Analyst Citizens Present: George Fina Larry Finch I. Call to Order Jason Long, called to order the Joint Insurance Committee Meeting at 8:33 AM II. Approval of Minutes The minutes of the September 4, 2024 meeting were approved with no objection.  III. Information From Vendors IV. Information from Employee Benefits Division: Lockton presemted performance through December 2024. Review minutes .frrom previous meeting. Motion to approve minutes from September 4, 2024 -Motion approved; no quorum/or December 2024 meeting. Jason Long: asked if there were any questions - none were asked Morgan Young: reviewed plan performance materials and presentation structure, by covering medical, pharmacy, clinic performance, EAP utilization, and wellness plan highlights. Morgan Young: Overall Loss Ratio: Combined health plan had a 94% loss ratio for Jan-Dec 2024. Plan-Specific Performance: EPO plan ran at 82%, PPO at nearly 100%, and retiree plan at 125% loss ratio. Committee Member: Are the EPO & PPO ERISA plans selffunded? Do they both have the same stop loss contract? Are there any carve outs on top of stop loss? Jason Long:indicated that is correct, both are selffunded Morgan Young: High-Cost Claimants: 129 members exceeded $100,000 in claims; 11 reached the $300,000 stop loss threshold. Stop Loss Coverage: EPO and PPO plans share the same stop loss contract, with no carve-outs or lasers. Reimbursements: City received nearly $1.8 million in stop loss reimbursements in 2024. Enrollment Impact: Enrollment increased due to EPO plan adoption; population otherwise stable. Plan Comparison: EPO slightly more popular than PPO; loss ratio spiked in August due to delayed claim adjudication. Historical Costs: Per employee per year cost was $18,706 in 2024, compared to $18,352 in 2023. Claim Timing Trends: Higher claims typically occur in July-December as members meet deductibles. Platform Alignment: 2024 was first full year with both EPO and PPO on the same Blue Cross platform, improving data comparisons. Jason Long More apples to apples in comparison of plans info 2026 b/c 2024 was first year of the EPO, making both the PPO and EPO on same platform and both self funded. Ms. Young Pharmacy Performance: Despite increased membership, per member pharmacy costs decreased due to generics and drug cost shifts. Pharmacy Drivers: Spend on inflammatory disease and diabetes surprisingly decreased; under further review. Plan Shift Insights: Some employees moved from PPO to EPO due to broader network and no deductible/coinsurance. Committee Member Have we considered haveing BCBS do an analysis on networks and discounts available. Ms. Young They did during the RFP process and found that the network that they're on has th best discounts with broadest network. Morgan Young: we are going to moving into information for the employee medical clinic. Clinic Performance: Clinic met or exceeded utilization benchmarks; ongoing review via upcoming RFP. Appointment Access: Slight decline in same-day appointment access noted; monthly reviews held with clinic vendor. Clinic Utilization Concerns: Visits were previously inflated by prescription pickups; shift to mail­ order addressed this. Cost Efficiency: Most prescriptions dispensed are generics; average cost ~$20 per script, contributing to overall plan savings. Committee Member There are no co-pays, right? Jason Long: Correct, the clinic is free of charge. They have options schedule on line/app, and are part of the EPIC charting/billing system. Clinic Expansion: There's no immediate plan to expand the current downtown clinic due to budget constraints, but expansion may be considered as utilization increases. Morgan Young: EAP Utilization: The Employee Assistance Program (EAP) utilization is at 8%, higher than the national average (3-6%), and supports short-term counseling needs with an average of 5 visits per user. EAP Perks: The EAP includes underutilized benefits like a free annual Safe Ride (cab/Uber) service, which will be more actively promoted. EAP Data Privacy: Encounter types by category are available but were excluded from the current presentation to protect personal health information (PHI). Morgan Young: From a wellness perspective, we have the following for you. Wellness Benefits for Retirees: United Healthcare offers wellness programs like Silver Sneakers, Let's Move (on-line fitness and mental health), and in-home clinician visits at no extra cost. Reward Program: The RENU program allows retirees to earn gift cards by completing routine health screenings; participation is tracked automatically via claims. Fitness Access: Blue Cross Blue Shield's "Well on Target" provides wellness tracking, chronic condition management, and on line fitness classes for PPO plan members. Pharmacy Integration: A new mobile app will integrate pharmacy and medical benefits, making drug price comparisons and prescription management more accessible. Committee Member: Would be nice to have summary of benefits. It would be interesting to see if you can provide. Morgan Young: Absolutely, we can provide and high level overvier of what you've mentioned. Morgan Young: Upcoming RFPs: Requests for Proposals (RFPs) are planned for the Nearsight Clinic and dental benefits, with results expected in May. Plan Structure Transparency: A request was made to provide a basic summary of benefit structures (EPO, PPO, Advantage plans) and employee cost sharing for better understanding. Self-Funded EPO Benefits: The shift to a self-funded EPO saved the city money by avoiding insurer profit margins (15-20%), and early savings aligned with projections. Committee Member: But it really seems to have shifted dramatically. Your performance. Jason Long: Yeah. How's the annual stop loss reimbursement? That 1.7, 1.8 million, how does that. Committee Member: Compare to previous years? Morgan Young: It's a little bit higher than what we've seen in previous years. Jason Long: We had more high cost claimants last year. But also we have to take into account it was the first year of the EPO plan. So we anticipated a higher stop loss just simply because we took on that higher population. So I would probably say we'll have to give it a couple more years to kind of see what impact the EPO plan and see the overall trends as a population as a whole will look like. Morgan Young: We can see what the loss ratio was for stop loss. How much we paid in on premium versus how much they paid out? We can have that for the next meeting. Jason Long: From a historical perspective, I think within our local market, a lot of the Blue Cross Blue Shield contracts got negotiated right before COVID And so we kind of benefited from pricing and guarantees through the COVID time that were advantageous for us as opposed to if the contracts have been negotiated, say, for instance, in 2021 or 2022. So we kind of rode that a little bit. Morgan Young: Pull in the stop loss ratio for this last year, so you can have a better idea of how it performs. Jason Long: And we'll see if we can kind of factor it by population, too. Just so you know, it'll still be a little bit of comparing apples and oranges just simply because it's a PPO versus EPO plan. But if we can kind of break it down by population, it's some sort of factor that might kind of give an overall idea of what we're looking at. Morgan Young: Those are the key takeaways for today. Jason Long: Is there any other items from the committee? We should have a lot more information in regards to plan performance, what the projected premium equivalents will look like for 2026 at our June meeting. I will likely try to have Blue Cross and Blue Shield come and do a presentation containing greater detail. Committee Member: When you go out for rfp, are you obligated to go out on all aspects of the plan, like the medical or can you say we're actually just going to leave it with lube? We're going to bid the stop loss? Jason Long: We do not do a formal bid for Stop Loss. We do market research to gauge and forecast our SL. Morgan Young: Lockton goes to the market without doing a formal RFP. Lockton goes to all of the different Stop Loss vendors and obtains quotes based on the claims that we have and then package that up and bring it to the city. But it's not a true RFP that's out there on the website. Jason Long: Thank you Morgan. Any further questions? Jason Long: No additional questions. The meeting is adjourned at 9:16am. Thank you. City of Oklahoma City Joint Insurance Committee June 2025 LOCKTON COMPANIES | 1 Agenda 01 Health Plan Performance 02 2026 Projections of Cost 03 Cost Drivers / Trends – BCBS Presentation LOCKTON COMPANIES | 2 Health Plan Performance 2025 Plan Year (claims through March 2025) 2025 Health Plan Overview (All Plans – Actives and Retirees) LOCKTON COMPANIES | 4 Rolling 12 Health Plan Overview (All Plans – Actives and Retirees) LOCKTON COMPANIES | 5 2025 Plan Performance Overview (All Actives and Retirees) LOCKTON COMPANIES | 6 EPO – Actives Only for 2024 LOCKTON COMPANIES | 7 EPO Plan – Actives Only for 2025 LOCKTON COMPANIES | 8 PPO – Actives Only for 2024 LOCKTON COMPANIES | 9 PPO Plan – Actives Only for 2025 LOCKTON COMPANIES | 10 EPO Plan – All Retirees for 2024 LOCKTON COMPANIES | 11 EPO Plan – All Retirees for 2025 LOCKTON COMPANIES | 12 PPO Plan – All Retirees for 2025 LOCKTON COMPANIES | 13 PPO Retirees < 65 Only for 2025 LOCKTON COMPANIES | 14 PPO Retirees > 65 Only for 2025 LOCKTON COMPANIES | 15 Projections of Cost 2026 Forecast  Executive Summary Overall Projection • Based on claims through January 2025, Lockton is estimating an 8.3% overall increase to funding for the active plans. • Increase applies to both the active EPO and PPO plans. • Active plans ran at a 98.6% loss ratio in 2024; however, the claims for the EPO group migrating to self funding in 2024 were immature. An adjustment has been made in the projection to convert these claims to a mature basis. Key Assumptions: • The most recent 12 months of experience weighted at [February 2024 thru January 2025]=100% • The claims experience credibility is 100.0%. • Claims experience is trended to the projected time periods based on the historical S&P trend data and Lockton's prospective trend assumptions. • The effective trend for medical was 6.3% and prospective medical trend is 6.0% • The effective trend for Pharmacy including Specialty Rx was 12.2% and prospective Pharmacy trend (excluding Specialty Rx) is 11.5%. LOCKTON COMPANIES | 17 Estimated Premium Increases for 2026 Employee Premium Net 2026 Contract Contribution Employee 2026 Enrollment 2026 EPO Plan Rate 2026 Change Estimate 2026 Gross Cost Contributions 2026 Employer Employee $ 965.94 $144.89 $11.10 1,036 $12,008,548 $1,801,282 $10,207,266 Employee + Spouse $ 2,173.58 $326.04 $24.99 413 $10,772,267 $1,615,840 $9,156,427 Employee + Child $ 1,690.56 $253.58 $19.43 185 $3,753,050 $562,957 $3,190,092 Employee + Children $ 2,076.99 $311.55 $23.88 165 $4,112,437 $616,866 $3,495,571 Employee, Spouse + Children $ 2,994.75 $449.21 $34.43 876 $31,480,864 $4,722,130 $26,758,734 2,675 $62,127,166 $9,319,075 $52,808,091 Employee Premium Net 2026 Contract Contribution Employee 2026 Enrollment 2026 PPO Plan Rate 2026 Change Estimate 2026 Gross Cost Contributions 2026 Employer Employee $ 902.31 $180.46 $13.83 412 $4,461,031.91 $892,206.38 $3,568,825.53 Employee + Spouse $ 1,705.38 $341.08 $26.14 187 $3,826,869.22 $765,373.84 $3,061,495.38 Employee + Child $ 1,263.24 $252.65 $19.36 89 $1,349,144.26 $269,828.85 $1,079,315.41 Employee + Children $ 1,624.16 $324.83 $24.89 61 $1,188,888.25 $237,777.65 $951,110.60 Employee, Spouse + Children $ 2,300.90 $460.18 $35.27 340 $9,387,665.80 $1,877,533.16 $7,510,132.64 1,089 $20,213,599.44 $4,042,719.89 $16,170,879.55 Total $82,340,765 $13,361,795 $68,978,970 Change $6,310,511 $1,024,034 $5,286,477 LOCKTON COMPANIES | 18 Cost Drivers / Trend BCBS of Oklahoma Presentation LOCKTON COMPANIES | 20  City of Oklahoma City JIC Meeting June 11, 2025 Blue Cross and Blue Shield of Oklahoma, a division of Health Care Service Corporation, a Mutual Some visuals taken from visitokc.com solely for the Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association purpose of this presentation and no other purpose. Confidential and Proprietary 1  Market Cost Trend & Future Outlook Deflators Constant / Inflators Other Factors Declining Population Health Humira Biosimilars Respiratory Illnesses • Increase in high-cost claimant spend. • Anticipated shifting of utilization • Flu/RSV has returned to normal towards lower-cost biosimilars. patterns. • Higher cancer prevalence and cost. • COVID is less seasonal than Flu • Mental health utilization continues at Service Mix and driven more by variant waves. an elevated level and trending faster • Continued shift of procedures from than most categories. the Inpatient Setting to the Outpatient Cyber Attacks Gene and Cell Therapies setting. • Have seen no impact on incurred • Continued FDA approval of new • Consumers continuing to embrace claims but disrupts paid patterns. therapies. lower cost sites of care; e.g., • Highly variable by employer due to Ambulatory Surgical Centers. provider exposure. • Potential increased utilization for some previously approved. GLP-1 • Non-diabetic diagnoses such as weight loss contributing more to the trend. • Risk from new FDA approved indications, such as sleep apnea A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. © Copyright 2025 Health Care Service Corporation. All rights reserved. Proprietary and Confidential Information. Not for use or 2 disclosure outside of HCSC except under written agreement from HCSC. Executive Summary Dashboard – Full Population Key Metrics Mar 2023 - Feb Mar 2024 - Feb 2024 2025 % Change Benchmark Allowed $95,982,067 $151,332,995 57.7% Paid $46,373,179 $97,559,577 >100% Paid PMPM $719.95 $752.77 4.6% $598.37 Medical Plan Performance Plan Share 89.3% 93.4% 82.2% In-Network Paid % 99.5% 99.7% 98.6% Discount % 43.5% 56.2% 65.5% Members 5,368 10,800 >100% Subscribers 2,688 4,913 82.8% Dependents 2,680 5,887 >100% Claimant Distribution . Paid % of Total Paid % of Total Unique Members PMPM Dollar Range Prior Current Benchmark Prior Current Benchmark Utilization 4.6% Non-Utilizers 0.0% 0.0% 0.0% 23.7% 9.9% 20.8% $0-$50K 62.5% 57.3% 55.6% 74.9% 87.1% 77.6% Cost and Case Mix $50K-$100K 16.0% 16.3% 16.7% 1.0% 1.9% 1.0% $100K-$300K 15.1% 20.1% 18.4% 0.4% 1.1% 0.5% High Cost Claimants $300K and + 6.4% 6.3% 9.4% 0.1% 0.1% 0.1% HCC Subtotal 37.5% 42.7% 44.4% 1.4% 3.1% 1.6% 3 CITY OF OKLAHOMA CITY: ALL A Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. © Copyright 2025 Health Care Service Corporation. All rights reserved. Proprietary and Confidential Information. Not for use or 3 disclosure outside of HCSC except under written agreement from HCSC.  Musculoskeletal and Connective Tissue Common Inpatient Musculoskeletal Surgical Procedures Paid PMPM Mar 2023 - Feb Mar 2024 - Feb Benchmark Reporting Period 2024 2025 % Change Benchmark Variance Inpatient Paid PMPM Paid PMPM $12.83 $8.11 -36.8% $6.45 25.7% Admissions/1,000 5.6 3.0 -47.0% 2.3 29.6% Paid/Day $9,184 $7,962 -13.3% $7,269 9.5% Paid/Admission $27,552 $32,844 19.2% $33,853 -3.0% Outpatient $0 Spinal Fusion Knee Replacement Hip Replacement Paid PMPM $24.34 $33.50 37.7% $20.95 59.9% Prior $10.79 $0.02 $0.04 Visits/1,000 454.6 382.8 -15.8% 272.3 40.6% Current $6.82 $0.35 $0.00 Paid/Visit $642 $1,050 63.5% $923 13.8% Benchmark $4.77 $0.21 $0.09 Professional Paid PMPM $29.20 $29.20 0.0% $18.08 61.5% Musculoskeletal was the most costly diagnostic category in increased 6.7% from last Services/1,000 6,575.3 5,580.8 -15.1% 3,502.5 59.3% year’s reporting period. The paid PMPM accounted for 15.8% of the total medical paid PMPM. Paid/Service $53 $63 17.8% $62 1.4% Total Medical Paid PMPM $66.37 $70.82 6.7% $45.48 55.7% Non High Cost $39.99 $41.07 2.7% $27.80 47.7% High Cost $26.38 $29.75 12.8% $17.68 68.2% Paid/Claimant $1,683 $2,380 41.4% $1,330 79.0% Claimants/1,000 473.2 357.0 -24.6% 337.5 5.8% % of Total Medical 17.8% 15.8% 11.4% Paid CITY OF OKLAHOMA CITY: ALL A Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. © Copyright 2025 Health Care Service Corporation. All rights reserved. Proprietary and Confidential Information. Not for use or 4 disclosure outside of HCSC except under written agreement from HCSC. Emergency Room Overview Top ER Diagnoses for Mar 2024 - Feb 2025 %Visits Potentially ER Diagnosis Paid Claimants Visits Non-Emergent * • 27.2% of ER visits were potentially non-emergent in the Injury/Poisoning $584,235 602 678 3.7% current reporting period compared to 30.6% in the prior Symptoms/Ill-Defined $736,666 495 599 33.1% reporting period and 28.8% for the benchmark. Respiratory $254,184 304 353 65.7% • ER paid PMPM increased by 50.5% between the two Circulatory $546,465 270 323 10.5% reporting periods and was 39.8% higher than the Musculoskeletal $211,329 246 274 52.6% benchmark. Genitourinary $377,559 201 241 41.5% Digestive $422,784 182 212 32.1% • Employees had the highest ER visits/1,000 rate in the Infectious/Parasitic $106,969 146 158 16.5% current period. Nervous $162,777 110 130 16.9% • The conditions with the highest volume of ER visits in the Skin $52,939 87 91 12.1% current reporting period were Injury/Poisoning, All Others $389,315 357 407 21.1% Symptoms/Ill-Defined, and Respiratory. * Not reflective of benefit design Summary $3,845,222 2,294 3,447 27.2% CITY OF OKLAHOMA CITY: ALL A Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. © Copyright 2025 Health Care Service Corporation. All rights reserved. Proprietary and Confidential Information. Not for use or 5 disclosure outside of HCSC except under written agreement from HCSC. 6 7  Adult Chronic Conditions Analysis Per the American Heart Association, three of the seven key health factors that increase the risks for heart disease and stroke include: High Blood Pressure (Hypertension), High Cholesterol (Hyperlipidemia) and High Blood Glucose (Diabetes). The below chart and bar graphs show key metrics for CITY OF OKLAHOMA CITY: ALL for five types of chronic conditions* along with comparative data for members who did not have any known type of chronic condition. All data reflects members aged 18 and above. Mar 2024 - Feb Benchmark 2025 Benchmark Variance CHF 29.8 24.5 21.7% CAD 86.7 69.2 25.3% Claimants/1,000 Diabetes 134.0 155.6 -13.9% Hyperlipidemia 253.8 298.9 -15.1% Hypertension 310.2 354.1 -12.4% No Chronic Conditions 649.6 686.8 -5.4% CHF $22,842 $32,919 -30.6% CAD $18,682 $16,720 11.7% Paid/Claimant Diabetes $21,675 $12,393 74.9% Hyperlipidemia $14,305 $8,439 69.5% Hypertension $15,190 $9,607 58.1% No Chronic Conditions $4,117 $2,334 76.4% CHF $56.72 $60.69 -6.6% CAD $134.91 $113.02 19.4% Paid PMPM Diabetes $242.07 $207.71 16.5% Hyperlipidemia $302.55 $287.40 5.3% Hypertension $392.64 $365.00 7.6% No Chronic Conditions $222.88 $136.69 63.1% * For a member to be included in one of these chronic condition categories, they must be 18 years or older and have had at least two claims for one of the chronic condition categories that were incurred within 180 days of each other and paid within the last 39 months. Paid per claimant and Paid PMPM rates are for those members in each chronic condition category for the • Hypertension was the most prevalent chronic condition and most current reporting period. Costs include the total claimant cost and are not limited to the cost of the chronic condition. This report includes medical and pharmacy claims where applicable. Claimants and their claim spend can be was below the benchmark. counted in more than one chronic condition category in this report. CAD: Coronary Artery Disease; CHF: Chronic Heart _ Failure. CITY OF OKLAHOMA CITY: ALL A Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. © Copyright 2025 Health Care Service Corporation. All rights reserved. Proprietary and Confidential Information. Not for use or 8 disclosure outside of HCSC except under written agreement from HCSC. Chronic Conditions Do Not Exist in Isolation Of those with these conditions, a significant number also have at least one additional chronic health condition. DIABETES PREDIABETES CARDIOVASCULAR RISK 6% of adults 34% of adults 14% of adults 85% WEIGHT 38% HYPERTENSION 65% WEIGHT 56% HYPERTENSION 18% MENTAL HEALTH 22% MENTAL HEALTH 21% MENTAL HEALTH Sources: Data on file for diabetes, hypertension and behavioral health prevalence (DS-4266); Note: behavioral health prevalence is based on medical claims. The 2017 National Survey on Drug Use and Health found that prevalence of behavioral health conditions was 25% for clinical conditions and an additional 35% for sub-clinical conditions. Overweight and dyslipidemia prevalence from Kaiser Family Foundation 2018 and 2017 State Health Facts respectively. Overweight prevalence for people with diabetes from CDC. 9 Teladoc Chronic Condition Management Plus –Comprehensive Support to Address the Whole Person Diabetes CCMP Prediabetes CCMP Cardiovascular CCMP Solution Solution Solution Target population Members with diabetes Members with prediabetes Members with hypertension (anchor condition) Additional areas of • Hypertension • Hypertension support (based on • Weight Management • Weight Management • Weight Management individual member • Mental Health • Mental Health • Mental Health need) Standard platform Effortless Data Personalized Health Signals Human-Centered Approach features (available Collection Lifestyle change, medication Digital and expert coaching adapts across all solutions) Apps and cellular devices per adherence, emotional support to member needs conditions covered A Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. © Copyright 2025 Health Care Service Corporation. All rights reserved. Proprietary and Confidential Information. Not for use or 10 10 disclosure outside of HCSC except under written agreement from HCSC.  Pharmacy Executive Summary Key Performance Indicators Demographics Financial Traditional Drug $42.6M 8,998 22.4% Represents 99.3% of total Pharmacy Total Cost Utilizing Increase in claims and accounts for 61.7% Utilization of total cost. Members Specialty Drug Inflation Mix Trend 240 31.1% Represents 0.7% of total claims ($4.91) $54.46 ($30.52) Utilizing Increase in and accounts for 38.3% of total Members Utilization cost. Cost Indicators Top Core Categories by Plan Paid Benefit Program Savings Total Savings $1,381,336 • Diabetes $12,218,837 Advantage Network = $204,000 • Autoimmune $9,345,793 • Cancer $2,661,516 Utilization Management (PA, ST, QL) = $885,897 • Other $2,404,312 FlexAccess (Jan – Mar 2025) = $291,439 • Anticoagulants $1,478,920 Reporting Period: April 2024 - March 2025 Comparison Period: April 2023 – March 2024 A Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. © Copyright 2024 Health Care Service Corporation. All rights reserved. Proprietary and Confidential Information. Not for use or 11 11 disclosure outside of HCSC except under written agreement from HCSC.  Specialty Pharmacy and Biosimilar Management Specialty is 46.5% of overall cost with autoimmune and cancer driving more than Provides consistency 75% of the specialty spend* across drug lists and minimal disruption to members Our Guiding Principles • Maintain clinical rigor in product evaluation • Aligned medical and pharmacy management Meets marketplace supply demands and aligns • Offer choice and flexibility based on incentives with clients unique member needs • Drive down member and employer costs through biosimilar market competition • Ensure biosimilar supply stability from selected manufacturers Integrates medical and • Minimize patient disruption while supporting pharmacy management increased adoption of low cost biosimilars to better support member • Position for future shifts in specialty and the engagement, appropriate introduction of additional biosimilar offerings use, minimize waste and promote better outcomes 12 *Internal Book of Business (Fully Insured and ASO) A Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. © Copyright 2025 Health Care Service Corporation. All rights reserved. Proprietary and Confidential Information. Not for use or 12 12 disclosure outside of HCSC except under written agreement from HCSC. Approved Biosimilar Products # of Biosimilar Reference Product Indication Anticipated Launch Products Approved Eylea (aflibercept) Ophthalmic 5 2024 occurred Actemra IV/SC (tocilizumab) Autoimmune 2/1 2024 occurred Novolog (insulin aspart) Diabetes 0 2024 occurred Tysabri IV (natalizumab) Autoimmune 1 2025 Prolia/Xgeva (denosumab) Osteoporosis 1/1 2025 Stelara IV/SC (ustekinumab) Autoimmune 5/3 2025 Soliris (eculizumab) C5 inhibitor 2 2025 Simponi (golimumab) Autoimmune 0 2025 Xolair (omalizumab) Anti-IgE antibody 0 2025 Perjeta (pertuzumab) Breast cancer 0 2025-2031 Entyvio IV/SC (vedolizumab) Gastroinestinal 0/0 2026-2032 Enbrel (etanercept) Autoimmune 2 2029 Cosentyx IV/SC (secukinumab) Autoimmune 0/0 2029 Third-party brand names are the property of their respective owners. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. © Copyright 2024 Health Care Service Corporation. All rights reserved. Proprietary and Confidential Information. Not for use or 13 13 disclosure outside of HCSC except under written agreement from HCSC. GLP-1 Agonists Overview Diabetes Weight Management Coverage Required Coverage Optional Prior Authorization with Quantity Limit (Recommended) Utilization Management Optional (Recommended) BYDUREON BCISE injection (exenatide) SAXENDA injection (liraglutide) MOUNJARO injection (tirzepatide) ZEPBOUND injection (tirzepatide) OZEMPIC injection (semaglutide) WEGOVY injection (semaglutide) RYBELSUS oral tablet (semaglutide) TRULICITY injection (dulaglutide) Plan Strategy GLP-1 New To Therapy (NTT) Program*: Anti-Obesity Medications Coverage Options: • Opt-in pharmacy program • Cover Weight Management drugs only • Applies to initial fill(s) of a GLP-1 drug ▪ Saxenda, Wegovy, Zepbound • Reduces costs by limiting fills to minimize drug waste associated • Cover Weight Loss drugs only with early discontinuation or dose modifications​ ▪ Lomaira, Xenical, phentermine, Orlistat, Qsymia • Cover both Weight Management and Weight Loss drugs *applies to diabetes and/or weight management GLP-1 30-Day Max Program*: Anti-Obesity Medications UM Options: • Opt-in pharmacy program • Cover Weight Management with or without a PA • Applies to all fills of a GLP-1 drug • Cover Weight Loss with or without a PA • Reduces costs by limiting fills to minimize drug waste associated • Cover Anti-Obesity Medications with or without 30-day supply with early discontinuation or dose modifications​ maximum *applies to diabetes and/or weight management A Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. © Copyright 2024 Health Care Service Corporation. All rights reserved. Proprietary and Confidential Information. Not for use or 14 14 disclosure outside of HCSC except under written agreement from HCSC. Impact of GLP-1 Drugs Trend impact of GLP-1s to the marketplace Addition of EPO full population data. 2020-2023 is PPO only. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. © Copyright 2024 Health Care Service Corporation. All rights reserved. Proprietary and Confidential Information. Not for use or 15 15 disclosure outside of HCSC except under written agreement from HCSC.  GLP-1 Trends Reporting Period: April 2024 - March 2025 Comparison Period: April 2023 – March 2024 A Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. © Copyright 2024 Health Care Service Corporation. All rights reserved. Proprietary and Confidential Information. Not for use or 16 16 disclosure outside of HCSC except under written agreement from HCSC.  Balanced Drug List Member access with financial value • Lowest member disruption and highest configurability amongst managed drug lists • Easy transition while retaining cost controls • Optimizes brand rebates through select formulary exclusions with clinically appropriate formulary alternatives • Enhances member access by covering more brands and drugs with OTC alternatives • Includes tailored utilization management programs PROGRAM SAVINGS MEMBERS AFFECTED $2,098,456 296 17 A Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. © Copyright 2025 Health Care Service Corporation. All rights reserved. Proprietary and Confidential Information. Not for use or 17 17 disclosure outside of HCSC except under written agreement from HCSC. Appendix 18  Chronic Condition Management Plus by Teladoc Health ® Empowering People with Chronic Conditions to Live Better, Healthier Lives Available for Wellbeing Management and Health Advocacy Solutions or stand-alone to groups with multiple health carrier plans. For Large Group Administrative Services Only, Cost Plus and Minimum Premium Program with Preferred Provider Organizations networks. Not available for Health Maintenance Organizations. Teladoc Health is an independent company that has contracted with Blue Cross and Blue Shield of Oklahoma to provide chronic disease management for members with coverage through BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them. Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 612416.1223 Streamlined Enrollment Easy access to multiple programs Proven Enrollment Practices • Members enroll through a single interface • Condition support tailored based on individual needs Multi-Channel Thoughtful Outreach Member Journey 85%+ Engagement rates in chronic condition programs Behavior- Data Science and Based Levers Experimentation [DS-8089] BoB Business Review. Teladoc Health is an independent company that has contracted with Blue Cross and Blue Shield of Oklahoma to provide chronic disease management for members with coverage through BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them. 23 Teladoc Health CCMP Pricing ® DIABETES SOLUTION $95 PPPM* PREDIABETES SOLUTION $77 PPPM* (Year 1) $54 PPPM* (Year 2) CARDIOVASCULAR SOLUTION $55 PPPM* *Per Participant Per Month. Includes remote monitoring device(s ) – cellular connected glucometer, blood pressure monitor, scale as indicated for member’s chronic condition(s). Teladoc Health is an independent company that has contracted with Blue Cross and Blue Shield of Oklahoma to provide chronic disease management for members with coverage through BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them. 24 Advantages of Blue Cross and Blue Shield of Oklahoma and the Teladoc Health Collaboration ® Teladoc Health and Teladoc Health Teladoc Health Billed Easy Contract and BCBSOK Product Packaging through Claims Launch Process Care Coordination • Solution evaluated and vetted by • No additional invoicing/billing • Increased clinical data integration • Simply select Teladoc Health as BCBSOK prior to selection to supports coordinated part of benefit package. Turnkey • Costs directly attributed to assure integration of best-in-class communication and seamless implementation and seamless data medical spend digital health programs member management, whether integration • Employers can cover their entire interacting with Teladoc Health • Included in Wellbeing Management • Teladoc Health and BCBSOK population through BCBSOK, even coaches or BCBSOK clinicians and Enable, Empower+ and Health work together to identify members those without BCBSOK medical advocates Advocacy Solutions packages health plan • Teladoc Health builds marketing • Align with BCBSOK • Bundle buy-up for CCMU, Mercer materials and is responsible for Care Management Health Advantage and Consultant communications Products1 • Cross referral process by trained • Can implement off-cycle at any • Ability to include group’s full customer service and clinical staff time of the year2 population – including members in split-business situations 1Mercer Health Advantage and Custom Care Management Unit are offered by independent companies and are administered by Blue Cross and Blue Shield of Oklahoma. 2Some packages may have off-cycle restrictions. Check with your BCBSOK Account Representative. Teladoc Health is an independent company that has contracted with Blue Cross and Blue Shield of Oklahoma to provide chronic disease management for members with coverage through BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them. 25 ROI & VOI Analysis CITY OF OKLAHOMA March 14, 2025 Teladoc Health's Proposed Solutions for City of Oklahoma • Chronic Condition ✓9,112 eligible members (age 18+) Management Plus ✓Multi-condition support for those Diabetes - $95 PPPM living with Diabetes, Prediabetes, Prediabetes - $77 PPPM Y1 & $54 PPM Y2/Y3 and Hypertension Hypertension - $55 PPPM 27 Cardiometabolic Health Value Analysis for City of Oklahoma • DRIVING VALUE ON INVESTMENT WITH TELADOC HEALTH’S CHRONIC CARE SOLUTIONS CHRONIC CONDITION MANAGEMENT PLUS PRODUCTS 9,1 1 2 ELIGIBLE LIVES (1 8+) 557 AVERAGE ENROLLED Cumulative Cumulative 1-Year 2-Years 3-Years $4.7M $1.1M $3.5M 1-Yea r Hea l t h Sa v in gs 3-Yea r Net Hea l t h Sa v in gs $3 .2M 3.6 ROI 4 ROI $1 .5M $2 .4M $357.6K $1.7M $1.2M 1-Yea r Net Med+Rx Sa v in gs $778.4K 3-Yea r Net Med+Rx Sa v in gs $1 .2M 1.8 ROI $844.5K 2.1 ROI $4 2 0.8K Indirect Savings Med + Rx Savings Program Cost Notes : 1. Gross savings based on Teladoc Health’s Cardiometabolic Health Value Model, including national prevalence expectations, national average annual salary expectations, and Teladoc Health’s optimized enrollment expectations averaged over 3-years. Refer to previous slide for more details on the Cardiometabolic Health Value Model methodology used to estimate savings and how the methodology was reviewed by Milliman. Read full Milliman report here. 28  Biosimilars Connected strategies as opportunities grow Increases in number of drugs and indications for use impact Cost Containment trend on both pharmacy and • Active pipeline management to anticipate clinical medical benefit and financial impact of new-to-market drugs • Promote active steerage to lower-cost biosimilars FDA-approved biosimilars are when clinically appropriate and cost-effective available in the oncology, diabetes • Coverage for preferred biosimilar options to offer the best and autoimmune categories with clinical value while aligning with chosen Drug List strategy additional products expected in 2025 Clinical Management In 2025, biosimilar launches are • Clinical management aligned between medical policies expected in autoimmune and and pharmacy drug utilization management programs osteoporosis categories • Ensure appropriate use and minimize waste Total Person Care Competition drives prices down, • Targeted care management that focuses on improving outcomes either by lowering net cost or reducing ingredient cost • Proper channel management to ensure best overall care and cost across medical and pharmacy benefits A Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. © Copyright 2025 Health Care Service Corporation. All rights reserved. Proprietary and Confidential Information. Not for use or 29 29 disclosure outside of HCSC except under written agreement from HCSC. Independence changes everything. © 2024 Lockton Companies. All rights reserved. D: 2859452