111/5/2014

UCSB Human Resources, Benefits

This presentation is intended for communication purposes only. Please see the UCnet website (http://ucnet.universityofcalifornia.edu) and plan documents for complete information.

Medical Plan Comparison

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Open Enrollment for 2015

• Ends Tuesday, November 25 at 5pm

• All changes effective on January 1, 2015

• No action needed if you like the plans you have, except for Health or Dependent Flexible Spending Accounts (must reenroll)

• ARAG legal is open for new enrollments

• Increase waiting period for Supplemental Disability, if currently enrolled

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How to make changes

• Go to Open Enrollment website on UCnethttp://ucnet.universityofcalifornia.edu/OE ◊ Select “Sign In”◊ Sign-in using your AYSO ID and

password◊ Select “Open Enrollment” link◊ Select the tab for the change you desire◊ Confirm your selection◊ Print your confirmation

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Resources Booklets mailed to home

Open Enrollment Websitehttp://ucnet.universityofcalifornia.edu/oe o Benefit Education Videoso Medical & Dental Plan Choosers

Insurance Plan Websites o Provider directorieso Plan booklets

Local Presentations and Events

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Topics

• Medical Terms and Concepts Video• Medical Plan Comparisons

◊ Residence requirements◊ Choice of physician◊ Cost of care & prescription drugs◊ Out of Pocket Maximum◊ Health Savings Account◊ Behavioral Health◊ Chiropractic and Acupuncture

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Benefits Videos on UCnet

Medical Terms and Conceptshttps://uc.a.guidespark.com/

2015 Medical Plans

HMO

Health Net Blue & Gold

Kaiser

PPO

UC Care

Blue Shield Health Savings Plan

Core

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What is your priority?

• Cost to enroll – monthly premium

• Cost of care ◊ Predictable, low cost copays◊ Pay a % of each service

• Choice of providers◊ HMO medical group physicians◊ PPO preferred network or any provider

• Effort to manage – coordinating care &

bills

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Preventive Care

• All medical plans cover preventive care at 100% with in-network providers

• Preventive care includes:◊ Annual well visit and labs◊ Well woman visits and labs◊ Preventive screening tests◊ Immunizations

• See list of preventive services on the plan websites

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Residence LimitationsHMO (Health Net, Kaiser)

• Employee must live in California

• PCP must be within 30 miles of where you live or work (in most cases)

Blue Shield Health Savings• Employee must live in US

• Employee may live anywhere

• Worldwide services

CORE

UC Care

• Employee may live anywhere

• Worldwide services

• Employee may live anywhere

• Worldwide services

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When traveling out of USHMO (Health Net, Kaiser)

• Limited to emergency and urgent care only

• No routine care when away from medical group

Blue Shield Health Savings• Limited to emergency and urgent care only

• No routine care

• Comprehensive coverage

• Plan pays Preferred/Tier 2 benefit.

CORE

UC Care

• Comprehensive coverage

• Plan pays out-of-network benefit.

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Choice of PhysicianHMO (Health Net,

Kaiser)• You select PCP• PCP coordinates care• PCP refers to specialists• Specialists limited to

physicians in medical group

Blue Shield Health SavingIn-Network

• You select Blue Shield PPO

Out-of-Network• You select non-Blue

Shield

In-Network – You select• UC Select• Blue Shield Preferred

PPOOut-of-Network• You select non-Blue

ShieldCORE

UC Care

In-Network • You select Blue Shield

PPOOut-of-Network• You select non-Blue

Shield

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UC Care Networks/Tiers

UC Select(Tier 1)

UC Medical Centers

&Select

Blue Shield PPO

Blue ShieldPreferred

(Tier 2)

Blue Shield PPO in CA

Out of CABlue Cross Blue

Shield

Non-PreferredOut-of-Network

(Tier 3)

Out of the UC Select

or Blue Shield Preferred

In Network Providers

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UC Care – Santa Barbara Network

Providers Status

Sansum Clinic UC Select/Tier 1

Quest Diagnostic LabUnilab

UC Select/Tier 1

Cottage Hospital Blue Shield Preferred/Tier 2

Pacific Diagnostic Lab Blue Shield Preferred/Tier 2

Pueblo Radiology Blue Shield Preferred/Tier 2

Santa Barbara Preferred Health Partners

Some physicians affiliated with SB Preferred Health Partners are in Blue Shield Preferred/Tier 2

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UC Care - UC Select near UCSB

• UC Select/Tier 1 providers in◊ Santa Barbara ◊ Santa Maria◊ Lompoc◊ Ventura

• UC Care Provider Directoryblueshieldca.com/uccareppo

Blue Shield Concierge 1-855-201-2087

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Plan Costs

• HMOs have predictable copays for services

• PPOs have deductibles and % coinsurance

◊ Your costs are based on the network that the provider is in and the service you receive

◊ You pay discounted rates for “in-network” providers

◊ You pay more for “out-of-network” providers

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PPO Allowed Amount – In Network

In-Network Example

Discounted rate that plan negotiates for each service with “preferred” or participating providers

• You pay the in-network coinsurance on the discounted rate.

• Provider can’t “balance bill”

20% Coinsurance

Provider charge: $200Allowed amount: $100

Plan pays 80%: $80

You pay 20% $20

Provider write-off:$100

PPO plans negotiate “allowed” rates to process claims.

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PPO Allowed Amount – Out of Network

Out-of-Network Example

Value that plan assigns to a service when provider is NOT a “preferred provider” (not participating)

• Plan pays out-of-network coinsurance on the allowed amount.

• Provider can “balance bill”

50% Coinsurance

Provider charge: $200Allowed amount: $100

Plan pays 50%: $50(50% of $100)

You pay 50%: $50

You pay balance: $100

PPO plans assign “allowed” rates to process claims.

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Office Visit Cost

Medical Plan Copay

Deductible Coinsurance

HMO $20 None None

UC Care PPOUC Select/Tier

1$20 None None

Preferred/Tier 2

$250 indiv $750 family

You pay 20%

Out-of-Network

$500 indiv$1,500 family

Plan pays 50% of allowed rate

You pay balance

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Deductible: Individual vs Family

$250 Individual / $750 Family

Coinsurance

Adult 1 Paid $250 20%Adult 2 Paid $100

Child 1 Paid $ 75

Child 2 Paid $250 20%

Adult 2 Paid $175 20%

20%

UC Care ExampleFamily Deductible

Blue Shield Preferred (Tier 2)

Office Visit Costs

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Blue Shield HSP

Preferred$1,300 single$2,600 family

You pay 20%

Out-of-Network

$2,500 single$5,000 family

Plan pays 60% of allowed rate

Full family deductible must be met before plan shares cost

COREPreferred

$3000 per individual

You pay 20%

Out-of-Network

Plan pays 80% of allowed rate

Medical Plan Copay

Deductible Coinsurance

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Hospitalization Costs

Medical Plan Copay

Deductible Coinsurance

HMO $250 None None

UC Care PPOUC Select/Tier

1$250 None None

Preferred/Tier 2

$250 indiv $750 family

You pay 20%

Out-of-Network

$500 indiv$1,500 family

Plan pays 50% of allowed rate

You pay balance

Hospitalization Costs

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Blue Shield HSP

Preferred$1,300 single$2,600 family

You pay 20%

Out-of-Network

$2,500 single$5,000 family

Plan pays 60% of allowed rate

Full family deductible must be met before plan shares cost

COREPreferred

$3000 per individual

You pay 20%

Out-of-Network

Plan pays 80% of allowed rate

Medical Plan Copay

Deductible Coinsurance

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Emergency Room Costs

Medical Plan Copay

Deductible Coinsurance

HMO $75 None None

UC Care PPOUC Select/Tier

1$100$200

None You pay 20% of ER

physician

Preferred/Tier 2

$100$200

Waived You pay 20% of ER physician

Out-of-Network

$100$200

Waived You pay 20% of ER physician

Emergency Room Costs

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Blue Shield HSP

Preferred$1,300 single$2,600 family

You pay 20%

Out-of-Network

$2,500 single$5,000 family

You pay 20%

Full family deductible must be met before plan shares cost

COREPreferred

Waived for facility fee

You pay 20%

Out-of-Network

You pay 20%

Medical Plan Copay Deductible Coinsurance

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Out-of-Pocket Maximum

• The most the insurance plan requires you to pay in a year

• Once you have paid this amount, the insurance plan pays 100% of future expenses.

• Includes deductible, copay, coinsurance for medical services and prescription drugs (2015).

• Does not include amounts “not allowed” by insurance plan when using out-of-network providers.

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Out-of-Pocket Maximum

Medical Plan OOPM

Medical & Rx

Notes

Health Net HMO $1,000 indiv$3,000 family

Family = 3 or more

Kaiser HMO $1,500 indiv$3,000 family

Family = 2 or more

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Out-of-Pocket Maximum

Medical Plan OOPM Medical

Notes

UC Care PPOUC Select/Tier

1$1,500 indiv

$4,500 family

Family = 3 or more

In-Network providerscross accumulate

Preferred/Tier 2

$3,000 indiv

$9,000 family

Out of Network

$5,000 indiv

$15,000 family

Family = 3 or more

Out-of-network accumulates separately

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Deductible, Coinsurance, OOPM

You pay You share cost with plan

Plan pays100%

$250Deductibl

e20% Coinsurance $3000

OOPM

UC CareIndividual Coverage

Blue Shield Preferred (Tier 2)

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Out-of-Pocket Maximum

Medical Plan OOPM Rx Notes

UC Care PPOIn-network pharmacy

$3,600 indiv

$4,200 family

Family = 3 or more

Medical and Rx do not cross

accumulateOut-of-network

PharmacyNone

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Out-of-Pocket Maximum

Medical Plan OOPM Notes

Blue Shield HSP

Preferred $4,000 indiv (single) $6,400 family

Full family OOPM must be met before plan pays 100% for

any enrollee

In & Out-of-network accumulate separately

Medical & Drug expenses apply

Non-Preferred(Out-of-Network)

$8,000 indiv (single)$16,000 family

CORE $6,350 indiv$12,700 family

Family = 2 or more

Medical & Drug expenses apply

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Deductible, Coinsurance, OOPM

You pay You share cost with plan

Plan pays100%

$1300Deductibl

e20% Coinsurance $4000

OOPM

Blue Shield Health Savings Plan Individual (Single)

Preferred Providers

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Deductible, Coinsurance, OOPM

You pay You share cost with plan

Plan pays100%

$2600Deductibl

e20% Coinsurance $6500

OOPM

Blue Shield Health Savings Plan Family

Preferred Providers

The full family deductible must be met before plan shares costs

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Prescription Drugs

HMOUC Care

Blue Shield HSP CORE

Retail (30 day)• Generic• Brand• Non-formulary

$5$25$40

You pay full cost of medication until you satisfy the deductible

After deductible, you pay 20% at preferred pharmacies

Mail Order (90 day)Selected Retail • Generic• Brand• Non-formulary

$10$50$80

Preferred Drug List (Formulary) is different for each carrier

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Blue Shield Health Savings Plan

High deductible medical plan paired with a Health Savings Account

Medical CoverageBlue Shield PPO

Health Savings AccountHealthEquity

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STOP – Consider HSA Limitations

To own an Health Savings Account (HSA):

• May not be enrolled in Medicare A or other medical plan

• Must have a $0 balance in Health FSA on December 31, 2014 (complete any claims reimbursement by Dec. 31, 2014)

• May not be claimed as a dependent on someone else’s tax return

• Consult with HealthEquity

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Health Savings Account

• You keep the money even if you change jobs or insurance plans

• You can make contributions at any time• It has triple tax advantage

• No Federal taxes on contributions • No taxes when funds are used• No taxes on earnings

• HSA funds rollover from year to year; no use it or lose it as with Health FSA

HSA can maximize savings

• UC Contribution (plan starting on 1/1/15) ◊ $500 individual ◊ $1000 family

• You can contribute up to (optional):

◊ Single-coverage: $3,350 – $500 = $2,850◊ Family-coverage: $6,650 – $1,000 =

$5,650 ◊ Catch-up contribution, age 55+: $1,000

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Use the HSA to pay for…

• Deductible• Coinsurance• Any IRS Publication 502 Expenses, including:

◊ Medical◊ Dental◊ Vision◊ Prescription drug◊ Long Term Care insurance premiums

How does HSA work?

• UC makes annual contribution for plans that start on January 1.

• You may contribute through payroll deduction or make post-tax contributions to HealthEquity

• Use a HSA debit card to pay for health expenses

• Use HealthEquity website to pay medical and other health claims

• Invest HSA dollars when account balance reaches $2000 – no fees to invest

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Lumenos Rollover from 2013

Lumenos Post-Deductible HRA can be used to pay 20% coinsurance or other eligible expenses after Blue Shield PPO deductible is satisfied

Example:• Single Deductible $1,300• UC Contribution to HSA $500• Remaining balance $750

◊ Pay with personal fundsorPay with your personal contributions to HSA

For more HSA information

HealthEquity Member Services is available every hour of every day

1.866.212.4729

www.healthequity.com/ed/uc

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Optum (formerly United Behavioral Health)

• Optum coordinates behavioral health care for all medical plans (except CORE)◊ psychiatrist◊ psychologist◊ therapist◊ substance abuse treatment

• No referral required from physician• Call Optum to notify prior to first visit

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Behavioral/Mental Health

Medical Plan

OPTUM Network

Out of Network

Health Net Blue & Gold

Visits 1–3 no copayVisits 4+ $20

$250 inpatient hospitalization

Emergency only

Kaiser

(Optum & Kaiser Providers)

Emergency only

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Behavioral/Mental HealthMedical Plan

OPTUM Network Out-of-Network

UC Care Visits 1-3 no copayVisits 4+ $20Inpatient $250

$500 deductiblePlan pays 50% allowed

You pay balance

Blue Shield HSP

Deductible:$1,300 indiv $2,600 family

You pay 20%

Deductible:$2,500 indiv$5,000 family

Plan pays 60% allowedYou pay balance

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Behavioral/Mental Health

Medical Plan

Blue Shield Network

Out of Network

Core $3000 deductible

You pay 20% Plan pays 80% allowedYou pay balance

Note for all plans:• The medical and behavioral health deductibles cross-

accumulate.• The medical and behavioral health coinsurance cross-

accumulate toward a common out-of-pocket maximum.• In-network and out-of-network deductibles and out-of-

pocket maximums do NOT cross accumulate.

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Chiropractic & AcupunctureMedical Plan Providers Costs

Health Net American Specialty Health

$20 copaySelf-referral24 visits/year combined

Kaiser American Specialty Health

$15 copaySelf-referral24 visits/year combined

Kaiser $20 copay acupuncture only

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Chiropractic & AcupunctureMedical Plan Providers Costs

UC Care Preferred Blue Shield

After deductible,You pay 20%

Out-of-Network

Non-Blue Shield After deductible,

Acupuncture:Plan pays 80% allowed

Chiropractic:Plan pays 50% allowed

Note: Benefit is limited to 24 visits per calendar year combined for Acupuncture and Chiropractic visits

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Chiropractic & AcupunctureMedical Plan Providers Costs

Blue Shield HSP

PreferredBlue Shield

After deductible,You pay 20%

Out-of-Network

Non-Blue Shield

After deductible,

Acupuncture:Plan pays 80% of allowed

Chiropractic:Plan pays 60% of allowed

Note: Benefit is limited to 24 visits per calendar year combined for Acupuncture and Chiropractic visits

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Chiropractic & AcupunctureMedical Plan Provider Out of Network

CorePreferred Blue Shield

After deductible,You pay 20%

Out-of-network

Non-Blue Shield

After deductible,

Acupuncture:Plan pays 80% allowed

Chiropractic:Plan pays 80% allowed

Note: Benefit is limited to 24 visits per calendar year combined for Acupuncture and Chiropractic visits

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http://ucnet.universityofcalifornia.edu• Resources

◊ Plan contacts◊ Plan rates

• Medical Plans◊ Benefit summaries◊ Links to provider directories◊ Links to plan websites

• Other plans◊ Dental, vision, FSA

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