Finance Committee (Meets 4th Tuesday of each month at 4:30 p.m.)

SPECIAL FINANCE COMMITTEE Meeting Minutes September 26, 2024, Special Meeting The meeting was called to order by Chair S w e e ne y at 4:30 pm on September 26, 2024, in Government Center Room 300. 1. ROLLCALL PRESENT: Jack Sweeney, Tylor Elm, and Mike Herrick, VIRTUAL: Bob Zimmerman, & Cammi Janigo CITY STAFF PRESENT: Nick Rhinehart, Renee Hoff, & Lee Sandok Baker OTHERS PRESENT: Bob St.Arnold, Jen Champa, Dan Badger, Amber Marshall, Nancy Jagatnarain, Daniel Plocker, Erica Champaigne, & John Ramos 2. APPROVAL OF MINUTES 3. OLD BUSINESS 4. NEW BUSINESS 4.1 Health Insurance Renewal Finance Director Nick Rhinehart opened the discussion on the city’s health insurance proposals, recommending a change in the Third Party Administrator (TPA) from Health Partners to Medica, following the health insurance bid process conducted in 2024. Following this, Bob St. Arnold, representing Marsh & McLennan Agency (MMA), outlined the benefits of this transition, supporting MMA’s recommendation for the switch. Next, the Medica team delivered a comprehensive presentation to the Finance Committee. The session concluded with a Q&A, where committee members and attendees addressed key questions and concerns. Motion was made by Mike Herrick, seconded by Tylor Elm, and carried to hold in committee. 5. RECURRING BUSINESS 6. ADJOURNMENT The meeting was adjourned 6:30 p.m. Minutes respectfully submitted by Nick Rhinehart  Presentation and handouts for item 4.1 © Medica Business Confidential 1  Director of Agency Relationship Account Manager Commercial Sales Manager Sr. Account Manager © Medica Business Confidential 2  Why Medica? Our commitment to City of Superior Service excellence Engagement and Population Health through innovation © Medica Business Confidential 3  3,000 team members 12 Not-for-profit states Our focus is on the communities we serve 24 Accountable Care Organization (ACO) Partnerships $6 billion Annual revenue Medica Nearly 1.5 million members Foundation Support for customers and the greater community 177k 246k 1M Individual + Family Medicare/Medicaid Commercial © Medica | Business Confidential 4  Personal. Connected. Cared for. More than 400 public sector clients • Managing costs • Cities, counties, school districts and other governmental agencies • More than 154,000 members • Understand unique needs within public sector Results Driven Innovative + Collaborative Leader Committed to • Managing costs • Promoting health • Exceptional service © Medica Business Confidential 5  Rate Guarantees/Caps 2026 and 2027 Excellent network access Admin Fee Guarantee 0% for 2026 and 2027 Specific Stop Loss Cap < 17% for 2026 Essentia Claims Guarantee 25% Lower than Passport Innovative solutions Implementation & Wellness Credits 2025 & 2026 $100,000 Implementation Credit, 1/1/2025 $50,000 Wellness, 1/1/2026 Value-added services Additional Features My Health Rewards $90,000 in Available Medica Funded Rewards Pharmacy 2 years of Minimum Service excellence Discounts & Maximum Dispensing Fees Guaranteed © Medica Business Confidential 6  • Long-term partnership • Specific Stop Loss Premium: -7.8% to current • 17% year-two rate cap • Lowers to 15% year-two rate cap if 30% or more enroll in Essentia ACO • Administrative Fee: $0 • Administrative Fee: 0% cap for 2026 & 2027 • Aggregate Stop Loss Premium: -23.3% to current • Total Fixed Costs: -10.7% to current • Claim Factors: -10.7% to current • Implementation Credit: $100,000 • 2026 Wellness Credit: $50,000 © Medica Business Confidential 7  Claims EPM with 100% Passport enrollment Single $78,427 Projected 10.7% savings in claims with Dual $99,189 100% Passport (Open Access) Enrollment, Family $223,414 compared to current (2024) Total $401,030 Claims EPM with 10% Essentia EPM with 38% Essentia ACO enrollment ACO enrollment Single $76,858 $72,466 Projected 17.4% savings in claims with 38% Essentia ACO Enrollment, Dual $97,205 $91,651 compared to current (2024) Family $218,945 $206,434 Total $393,009 $370,551 EPM = expected monthly claims © Medica Business Confidential 8  Medica Choice Passport Network • Quick and easy access to nationwide benefits • One dedicated call center for all members no matter where they live • Direct access to any primary or specialty care provider in the Medica Choice Passport network without a referral • Convenience and urgent care Medica Choice Passport Network 7,300+ Hospitals 1,500,000+ Physicians © Medica Business Confidential 9  Quick facts 15,000 colleagues 6 ambulance services 14 hospitals 1 research institute 78 clinics Serving over 500,000 12 long-term care unique patients and assisted living facilities Includes Travel Program for those ECC members traveling outside of the Medica Service Area, incl students In Network benefits when accessing a Travel © Medica Business Confidential Program provider 10  Accountable for results, to the people we serve, to each other, and to our communities. Data Support Partnership Growing Excellence Data leveraged to Stratification of the A focus on high-priority Collaborative with care develop specific and defined populations to areas that drive medical system partners, actionable cost identify and manage trend and spend developing and sharing containment and health emerging and reversible best practices improvement strategies risk 400+ reports annually 100+ touchpoints Joint annual strategy Annual ACO Summit quarterly ECC is Priced at 20% less than the equivalent Passport plan – Self Insured ECC Includes 25% claims discount guarantee © Medica Business Confidential 11  Essentia ACO has lower inpatient PMPMs compared against commercial open access for 2023. 2023 Milliman ECC Essentia ACO Open Access HCG compared (ECC) (OA) Categories to OA Risk Adjusted PMPM Medical $19.03 $29.22 -34.8% Surgical $37.98 $51.20 -25.8% Psychiatric $2.73 $3.16 -13.6% Inpatient $78.34 $110.81 -29.3% Total * Essentia ACO excluding Essentia employees © Medica Business Confidential 12  24/7 resources to help you find a behavioral health provider to meet your needs Medica’s Behavioral Health network includes more than Resources at-a-glance 345,000+ practitioners nationwide. When you need to find a Medica Behavioral Health behavioral health provider: Medica Optum Emotional Wellbeing Solution Call Medica Behavioral Health at 1 (800) 848-8327 (EAP) • Specially trained staff can help you get the right care when you need it, 24-hours a day. Live and Work Well Website Use the Online Directory Self Care by AbleTo • It offers an easy way to connect with providers and clinics specializing in mental health and substance abuse. AmWell, 24/7 Online Clinic Talkspace (Coordinates with EAP) My Health Rewards Live Coaching (no charge) © Medica Business Confidential 13  Virtual care brings convenience and affordability to your health needs. Clinic-based options: Amwell: • Numerous clinics offer virtual care or online visits • 24/7 online clinic serving all states • Prices vary, so check your clinic's offerings • Covers medical and behavioral health services • Connect with your provider through the clinic's website • Medical visits: $67 or less K Health: • Behavioral health prices vary • 24/7 in 48 states (excludes AK & HI) • Visit Amwell.com • Covers virtual and primary care Virtuwell: • Symptom checker that suggests potential • 24/7 online clinic available in select states diagnoses • Each medical visit: $79 or less • Ages 18+ on Passport network • Consult certified nurse practitioners • Visit Khealth.com/Medica • Visit Virtuwell.com • Excludes VantagePlus network © Medica Business Confidential 14 © Medica Business Confidential 15  One team from Pre-enrollment implementation site going forward Employer support Engagement timeline Open enrollment meeting support © Medica | Business Confidential 16 © Medica | Business Confidential 17  No. Event Responsible Party Due Date Notes Confirmation of purchased programs Medica, City of Superior, Review and approve programs; establish 1 10/11/2024 and/or services MMA group structure Medica, City of Superior, Discuss required implementation 2 Implementation meeting 10/17/2024 MMA information Medica, City of Superior, 3 Approve benefit design 10/17/2024 Approve SBCs MMA Member resources for open Medica, City of Superior, 4 10/28/2024 enrollment MMA Medica, City of Superior, Review setup progress; Administrative 5 Review administrative processes 10/28/2024 MMA Guide Medica, City of Superior, 11/1- 6 Open enrollment meetings MMA 11/25/2024 Medica, City of Superior, 7 Open enrollment file ready 12/1/2024 ID cards sent after file is applied MMA Medical and pharmacy systems 8 Medica 1/1/2025 ready 9 Online member resources available Medica 1/1/2025 © Medica | Business Confidential 18  Member portal Health and Product medica.com/signin wellness fair training support Member Talk to a Health Plan Specialist Virtual Care, AbleTo, and My Health Rewards CallLink © Medica | Business Confidential © Medica Business Confidential 20  Guiding members to appropriate resources Continuum of health Living with illness Getting better Staying healthy Our whole- Transitions of care person care High-need/ approach is Care management High-cost Member risk stratification Centers of excellence guided by a person- Condition management/Omada centered focus Emerging Medical pharmacy programs that uses risk Integrated behavioral health varying OVIA pregnancy approaches to At risk Self Care by AbleTo engagement My Health Rewards Coaching and care coordination, wellness, and Low risk My Health Rewards prevention. Call Link/EAP © Medica Business Confidential 21  Enjoy 24x7 access to all your health plan needs with our mobile app Mobile App Highlights: • Instant access to health plan data • Download your ID card to your mobile wallet • Check claim status • Find providers and clinics • Explore wellness benefits • Access documents and forms Go Green: • Opt for electronic plan materials and help the environment Search for Medica Member in the iOS and Android app stores © Medica Business Confidential 22  Estimate Your Costs Panel The cost estimator is included in the Find Care provider search tool. The Estimate your costs panel is available on the main Find Care dashboard The easiest way to access Find Care is to follow these steps: Sign in to Medica’s member website at 1 Medica.com/SignIn Choose the Find Care dropdown menu at 2 the top 3 Choose Providers + Facilities Select Find a Provider or Facility lower down 4 on the page © Medica Business Confidential 23 Useful features of the search results panel By default, the Cost Estimator arranges search results by a combination of factors through the Best Match setting. Members can sort their results alphabetically, by distance, or by cost. You can apply more filters from the search results page by using the More filters button at the top. The More details link displays more information about the cost listed above. Members can select up to three provider listings to compare them side-by-side. © Medica Business Confidential 24  Rewards Overall goal Get rewarded for using the tools and programs that work for you. • Earn points and get rewards with My Health • Track physical activities and daily steps Rewards, an online tool that helps you take small steps to reach your health goals. • Complete activities to foster healthy habits (Journeys®) Eligibility • Read daily learning cards • Medica members 18 years and older • Track sleep • Explore more ways to earn rewards City of Superior members could earn up to $90,000 in rewards © Medica Business Confidential 25  We can help • Fully vetted Family health and • Contract and Nutrition Fitness Sleep billing • Pricing • Communication • Program management MSK and chronic Mental health conditions © Medica Business Confidential 26 Helps members reduce the risk of diabetes onset and other chronic conditions by providing guidance and a program backed by science Program Benefits Program Features Lose weight with small, lasting • A personal health coach lifestyle changes • A personalized care plan Learn ways to eat healthier, be • Weekly lessons more active, sleep better and • Tools for managing stress manage stress • Online peer group and Reduce the risk of Type 2 communities diabetes, heart disease and • A smart scale to track progress stroke 27  A program to help members living with diabetes manage their condition by shifting the way they think about their health • You’ll build problem-solving skills and promote confidence to self-manage diabetes and/or cholesterol medications • Program helps you reduce the risk of diabetes complications and decrease diabetes distress and is available at no additional cost What you get: • 1-on-1 support from your health coach and diabetes specialist • Digital tools to help manage your diabetes and improve blood glucose control • A plan built for you, and proven to work © Medica | Business Confidential 28  Medica® Optum® Emotional Wellbeing Solutions, our employee assistance program (EAP)* is here for your employees through life’s challenges. They can get answers and resources to tackle the tough issues. Program Features: • 24/7 support from trained professionals • Free counseling sessions (five sessions per issue, per year) • Free 30-minute legal consultation and 25% off if they decide to work with a lawyer. Get help with child support, divorce, adoption, wills and trusts, and more. FOR 24/7 ASSISTANCE: • Access to financial advisors who can help with issues like debt, saving money, foreclosure, and more. 1-800-626-7944 • 150 hours of Management Services/Trainings/Critical Incident Response (CIR) © Medica Business Confidential 29  Ovia Parenting Three mobile apps that span the reproductive • Learn about child development, and health health and parenting spectrum. • Track baby’s feedings, diapers, and sleep • Get guidance and support for mental health and wellness • Access thousands of parenting articles and tips Ovia Pregnancy • Unlimited in-app coaching with nurse health • Weekly baby development summaries coaches • Daily articles and tips • Supportive weekly videos • Return-to-work planning tools and support Ovia • Unlimited in-app coaching with nurse health • Enter a personalized journey based on coaches three key areas of reproductive health: trying to conceive (TTC), not trying to conceive (non-TTC), and menopause • Get support for overall reproductive health, including pre-conception, looking to conceive, conception, and perimenopause/menopause © Medica Business Confidential 30 T H A N K YO U  SELF FUNDED COST ILLUSTRATION * Company Name Proposed Effective Date City Of Superior 1/1/2025 @ Medica . I Contract Basis 18/12 Specific Stop Loss Deductible $150,000 Aggregate Attachment Point 125% Proposed Monthly Administration Fee •• Subscribers Members Rates Proj. Cost Single 104 104 $0.00 $0 Dual 63 126 $0.00 $0 Family 93 383 $0.00 $0 Total 260 613 $0.00 $0 Specific Stop Loss Single $109.78 $11,417 Dual $229.66 $14,469 Family $349.98 $32,548 Total $224.75 $58,434 Aggregate Stop Loss Single $2.76 $287 Dual $5.77 $364 Family $8.79 $817 Total $5.65 $1,468 Broker Fee (PSPM) $0.00 $0 Total Fixed Costs Single $112.54 $11,704 Dual $235.43 $14,832 Family $358.77 $33,3 66 Total $230.39 $59,902 Total Claim Costs Maximum Expected Single $98,034 $78,427 Dual $123,987 $99,189 Family $279,267 $223,414 Total $501,287 $401,030 • This page serves as a monthly cost illustration and may not reflect the costs of all optional services/programs. Please refer to our financial proposal for the terms of our offer. •• Administration fee does not include optional services and buy-ups. ---------- Proposed Rates----------- Claim Costs : Expected Monthly Monthly Claim Attachment Expected Subscribers Rates Factors Claims Plan 1: MSI PP ASO 3300-0% HSA Single 104 $754.10 $942.63 $78,427 Dual 63 $1,574.43 $1,968.04 $99,189 Family 93 $2,402.30 $3,002.87 $223,414 Total 260 $1,542.42 $1,928.03 $401,030 Plan 2: MSI ECC ASO 3300-0% HSA Single 0 $603.29 $754.11 $0 Dual 0 $1,259.54 $1,5 74.43 $0 Family 0 $1,921.84 $2,402.30 $0 Total 0 $0.00 $0.00 $0 Essentia Choice Care ACO Savings Guarantee City of Superior January r, 2025 to December 31, 2025 Medica is pleased to provide a medical claim pmpm savings guarantee in conjunction with our self-insured quote for the Essentia Choice Care (ECC) ACO Network performance compared to performance of the Medica Choice ® Passport network performance. Savings Guarantee Assumptions: This guarantee is effective during the contract period of: 1/1/25 -12/31/25 Assumed Number of Employees: 260 Minimum Number of Employees required to live in Essentia service area and enroll in either a ECC ACO plan or a Medica Choice Passport plan: 50 Target Essentia Choice Care ACO Claim Savings vs . Medica Choice Passport 25.0% Sample Savings Reconciliation: @Medica SAMPLE ECC ACO CLAIM PMPM SAVINGS GUARANTEE RECONCILIATION • ACO Membership A Members 400 8 Member Mont hs 4,800 C Target ECC ACO Savi ngs % v s Cho ice Passport 25% 1 Medic.al Expense D Choi ce Passport Incurred Cl aim PMPM $650.C0 E ECC ACO Incur red Cl ai m PMPM $585 .25 Savings Target F Target ECC ACO Cl ai m PMPM (1 - C) x D $487.50 G ECC ACO Incurred Cl aim PMPM v ar i ance to arget ECC ACO Cl aim PMPM (E - F) $97 .75 H Un adj ust ed Sav ings Target Shortfa ll [MAX (G, O)] $97 .75 Savings Adju st ment Max imum Savi ngs Target Shortfall (D - F) $162.50 Ad j usted Savi ngs Target Shortfall [M IN (H, I)] $97 .75 Risk Sharing K Ri sk Shar i ng Perce ntage 50% L Refund Amou nt PMPM (J * K) $48.88 M Tota l Refun d Di str ibuti on to Emp l oyer (L * B) $234,600 Member claims are truncated at $125,000 annual/},. Page 1 of 2 • The total incurred claims are equal to the amount paid to providers minus the member liability (e.g., copays, coinsurance, deductibles), and include hospital inpatient, hospital outpatient, physician and pharmacy claims, for both in and out of network providers. Network management fees and member claims· in excess of $125,000 are excluded from total incurred claims. • The total incurred claims PMPM will be calculated as [total incurred claim dollars divided by total member months] for each network. • The Target ECC ACO Claim PMPM will be calculated as [Medica Choice Passport total incurred claim PMPM multiplied by (1- 25%) ]. • The ECC ACO Incurred Claim PMPM variance to Target ECC ACO Claim PMPM will be calculated as [ECC ACO incurred claim PMPM minus Target ECC ACO Claim PMPM]. • The Unadjusted Savings Target Shortfall will be calculated as [the Maximum of ECC ACO Incurred Claim PMPM Variance to Target ECC ACO Claim PMPM and $0]. • The Maximum Savings Target Shortfall will be calculated as [Choice Passport Incurred Claim PMPM minus Target ECC ACO Incurred Claim PMPM]. • The Adjusted Savings Target Shortfall will be calculated as [the Minimum of the Unadjusted Savings Target Shortfall and the Maximum Savings Target Shortfall] . • The Refund Amount PMPM is calculated as [Risk Sharing Percentage * Adjusted Savings Target Shortfall]. • The total Refund Distribution to Employer is calculated as [Refund Amount PMPM * ECC ACO Member Months]. • The calculation will include claims incurred in the contract year with three months of paid run-out. • Savings results will be reported, and any payable risk amounts settled annually. Medica will aim to provide the discount results within 5 months following the end of the savings guarantee period. Revising or Voiding This Quote: Medica reserves the right to revise or void this quote under the following circumstances: • The total number of employees who live in the Essentia service area and are enrolled in the ECC ACO plan or Medica Choice Passport plan is less than 50 • If the administrative services agreement terminates prior to the end of the contract year, the performance guarantee will be voided for the entire contract period. This guarantee will only be in place for the contract year stated above . Page 2 of 2  @ Medica~ Medica Pharmacy Discounts and Dispensing Fees City of Superior Contract Periods : January 1 - December 31, for contract periods ending in 2025 and 2026 Aggregate Annual Minimum Discount Guarantee 2025 2026 Retail 30 Brand 19.50% 19.75% Retail 30 Generic 85.00% 85 .25% Retail 90 Brand 22.60% 22.70% Retail 90 Generic 86 .10% 86.30% Mail Order Brand 23 .25 % 23 .25% Mail Order Generic 86.75 % 87 .00% Specialty 20.25% 20.50% Aggregate Annual Maximum Dispensing Fee Guarantee 2025 2026 Retail 30 Brand $0.50 $0.50 Retail 30 Generic $0.50 $0.50 Retail 90 Brand $0.00 $0.00 Retail 90 Generic $0.00 $0.00 Mail Order Brand $0.00 $0.00 Mail Order Generic $0.00 $0.00 Specialty $0.00 $0.00 Pharmacy Discount and Dispensing Fee Guarantee Predications and Definitions City of Superior's pharmacy plan will be administered by Medica and its contracted pharmacy benefits manager(s) ("PBM") . The guarantees apply to drug claims eligible under the pharmacy benefit plan incurred during the contract period(s) specified above, unless otherwise noted as an exclusion . Annual reconci liation will be based on claims a) incurred during each contract period and b) paid during each contract period or within one month following that contract period . Page 1 of 4 Year-end guarantee reconciliations and any related payments due to City of Superior will be made within 90 days from the end of each contract period . Notwithstanding the above, if the Agreement is terminated prior to the end of the Contract Period, no reconciliation of this guarantee will be made for the contract year in which termination occurs . Guarantees will be measured and reconciled separately for each of the Contract Periods included in this agreement as defined above (typically 12 months per Contract Period), if guaranteeing for more than one Contract Period. Discounts are based on published AWP and apply to drug ingredient costs (excluding dispensing fees/ancillary charges) . Actual discount percentage, on an aggregated basis, will be calculated based on claims eligible under the guarantee terms using the following formula for all drug classes: (Total Undiscounted AWP Ingredient Cost-Adjudicated Ingredient Cost prior to application of member cost share)/ Total Undiscounted AWP Ingredient Cost. Actual dispensing fee per claim, on an aggregated basis, will be calculated based on claims eligible under the guarantee terms using the following formula for all drug classes: total adjudicated dispensing fees/ total number of claims. Retail 30 drugs are considered to be any drug where a 1-83 days' supply is dispensed . Retail 90 drugs are considered to be any drug where a 84+ days' supply is dispensed. Zero balance claims are included in the discount guarantee prior to the application of member co payment. Single source generics are included in the generic discount guarantee. All discount and dispensing fee guarantees included in this offer are reconciled based an annual results, aggregated for all guarantee categories. Any performance shortfalls in one drug or guarantee category will be offset by performance excesses in another category. Guarantees are not applied at the individual claim level. Performance will be measured by comparing actual City of Superior results to the guaranteed level on an aggregated basis. On a total dollar cost basis, Medica will pay City of Superior the difference between (a) actual City of Superior results and (b) the guaranteed level, if (b) is higher than (a). The following claim types are excluded from the discount and dispensing fee guarantee calculations : Coordination of benefit prescription drug claims, no bill/no remit claims, claims from 340b pharmacies, limited distribution drug claims, claims dispensed from a customer on-site pharmacy or owned pharmacy if such pharmacy does not have a contract with Medica's PBM or has a unique pricing contract, claims filled at a military pharmacy or pharmacy of Veterans Affairs, member-submitted claims, compound drug claims, vaccine claims, long-term care pharmacy claims, home infusion claims, I/T/U pharmacy claims, Indian Health services and tribal claims, claims filled in Puerto Rico, Guam, Northern Mariana Islands, Virgin islands, Hawaii, Massachusetts, Alaska, and Georgia, and fraudulent claims. In the event one or more of the events below occur, Medica will have the right to modify the terms of this document with prior written notice to City of Superior: a) If the number of covered subscribers decreases by more than 10% from 260 subscribers. Page 2 of 4  b) If the benefit plan designs and/or services to be performed change from what was considered when this guarantee was offered. c) If City of Superior elects to implement OTC plans, clinical, utilization management, or trend programs, elects to use owned clinics or pharmacies to dispense prescription drugs to members, and/or takes other actions that have the effect of changing financial results from what was considered when this guarantee was offered . d) If any Brand Drugs move off-patent, have generic or over the counter substitutes that become available, and/or change status due to another action by a manufacturer. e) If there is a change in federal, state, or local laws or interpretation thereof, other applicable legislative changes or government action, pharmaceutical manufacturer action, and/or any industry wide changes that have the effect of changing expected financial results from what was considered when this guarantee was offered, or that make this provision illegal or commercially unreasonable. f) If Medica contracts with a new pharmacy benefits manager g) If the Administrative Services Agreement terminates prior to the end of the any contract year, the guarantees herein will be voided for the contract year at issue and any subsequent years . Definitions Average Wholesale Price (AWP) : Average Wholesale Price (AWP) means the average wholesale price for a standard package size of a prescription drug or supply from the most current information identified and provided by the Pricing Source. The standard package size applicable to a participating Mail Pharmacy shall mean the actual 11 digit NOC of the package size used to fulfill the quantity dispensed. The standard package size applicable to a participating pharmacy shall be the actual package size dis·pensed from a participating pharmacy as reported by such participating pharmacy Brand Drug: Brand drug discount and dispensing fee guarantees will include only those prescription drug claims that processed to City of Superior for payment where the underlying prescription drug product was identified by Medi-Span as having a Multi-Source Indicator code identifier of "M", "N", or "O" on the date dispensed (except in cases where the underlying prescription drug product was so identified, but was substituted and dispensed by the pharmacy as its "house generic," in which case the prescription drug claim will be processed as a generic drug and reconciled in the generic drug ingredient cost guarantee), unless otherwise noted as an exclusion . Generic Drug : Generic drug pricing discount and dispensing guarantees will include only those prescription drug claims that processed to City of Superior for payment where the underlying prescription drug product was identified by Medi-Span as having a Multi-Source Indicator code identifier of "Y" on the date dispensed (or was identified by Medi-Span as having a Multi-Source Indicator code identifier of an "M," "N," or "O" on the date dispensed, but was substituted and dispensed by the Medica mail pharmacy as its "house generic"), unless otherwise noted as an exclusion . Mail Order: A pharmacy contracted by Medica where prescriptions are filled and delivered to members via mail delivery service, other than a Specialty Pharmacy. Mail order pricing guarantees require an average days' supply of at least 83 days in the aggregate or the guarantee does not apply. Page3 of4 Participating Pharmacy (Retail): Participating Pharmacy (Retail) means any licensed retail pharmacy, including a long term care facility pharmacy, and home infusion pharmacy. Participating Pharmacy shall not include any mail order or specialty pharmacy affiliated with any such Participating Pharmacy. Pricing Source : Medi-Span or any other nationally available reporting source recognized in the retail prescription drug industry selected by Medica's PBM. Specialty Pharmacy: A pharmacy contracted by Medica to dispense Specialty Product prescriptions for members. Specialty Products : Those injectable and non-injectable drugs on the Medica Specialty Product List for claims adjudication purposes and ingredient cost discount and dispensing fee guarantee reconciliation . Specialty Products, which may be administered by any route of administration, are typically used to treat chronic or complex conditions, and typically have one (1) or more of several key characteristics, including frequent dosing adjustments and intensive clinical monitoring to decrease the potential for drug toxicity and increase the probability for beneficial treatment outcomes; patient training and compliance assistance to facilitate therapeutic goals; limited or exclusive product availability and distribution (if a drug is only available through limited specialty pharmacy distribution it is always considered a Specialty Product); specialized product handling and/or administration requirements. Page 4 of 4