t3./3/2OL4

Open Enrollment20L5

UCLA Retiree Health Benefits Overview

J. Bridget Sheehan-WatanabeUCLA Health Care Facilitator

Nov.2014

Open rnroliment 2OfS l

Agenda

) Open Enrollment: when, how, who to call.

) Medical Plans Options, Summary of Changes,Non-Medicare Plans, Medicare Plans.

F Behavioral Health for all plan members.

)Other Plans (briefly): Optum Wellness, DentalVision, Legal

) Retirees outside of CA with Medicare.

1.1./3/201.4

Open Enrollment 2015 - When & How

> UC Open Enrollment* Begins Oct. 30 at 8 am> UC Open Enrollment Ends Nov. 25 at 5 pmF Changes effective Jan. L,2OLS ,& ,.*,.

F Changes made online: r ....,

http: 'cnet.universitvofcalifornia.edu e b6@F No Internet Access? Call Retirement

Administration Service Center (RASC)1-800-888-8267

4Medicore's Open Enrollment runs October 15 to December 7. This is not UC,s

. .,, openenrollment. You mustcomplywith UC'sOEdateswhenyou are making,changes to your UC plans, even if they are plans that work with Medicare,

: What Happens lf You Do Nothing?j

Flf you make no open enrollment changes, yourplan enrollments will remain the same.

)You should review information about planoptions and changes before deciding to donothing. Your plan may have some benefitdeductible and copay/coinsurance chang"r.Premiums also change each year.

71./3/20t4

2015 Retiree Plan OptionsNon-Medicare Plans. HMOS

. Health Net Blue & Gold (limited network plan)

'Kaiserr Western Health Advantage (Sacramento area only)

. PPOs. UC Care PPO. Health Savings PPO with HSA (restricted). Core (high-deductible plan)

Medicare Plans. Medicare Advantage HMOs

. Health Net Senioritv Plus

. Kaiser Senior Advantage. PPOs/Supplement (secondary to Medicare)

. Blue Shield Medicare PPO

. High Option Supplement to Medicare

. Blue Shield Medicare PPO without Rx (restricted)

2015 Split Family Partner Plans*^(Medicare and non-Medicare enrollees in one family)

Health Net Blue & Gold

Kaiser

UC Care PPO

Core

Health Net Seniority Plus

Ka iser Senior Adva ntage

Blue Shield Medicare PPO

Blue Shield Medicare PPO

*High Option and Health Savings PPO are not available to "split" families. High Optionrequires that all members in family have Medicare, Health Savings PPO requires that noone under the coverage have Medicare.

^lf you are in a non-Medicare plan and become Medicare-eligible during the year, youwilltransition to the Medicare partner plan (outside of Open Enrollment).

11,/3/2014

YOUR UC Plan Options

) Plan availability determined by zip code and Medicareenrollment status.

) Your premium costs determined by UCRP entry dateand years of service credit.

F Use Medical Plan Chooser to find costs and plans basedon your specific information.

) Medical Plan Chooser found linked from openenrollment website, and under Resources here:

ion-a nd-

2015 Chooser from Open Enrollment website (temporary link)https://u c20 L5_.lhoose r2, p beh. o rsl

tmlhttp://ucnet. u n iversi

Highlight of Changes for 2015D Non-Medicare Plans

' Chiropractic and acupuncture expanded under Health Net Blue & Gold and Kaiserthrough American Specialty Health Plan Network; 24 visit limit,

. Health Net and UC Care:90 day Rx with copay savings (90 days for 2x30 retail copay)at select retail pharmacies for maintenance medications,

. UC Care adding TeleDoc, changing ER and ambulance coverage

' UC Care, Health Savings PPO, Core: allowing members to obtain some vaccinations atpharmacies, under pharmacy benefits.

. Out-of-pocket maximums changing (some amounts and what applies).

' Health Savings PPO with HSA: in-network deductibles & HSA contribution limitsi ncreasi n g,

' OTC nicotine replacement products with prescription, 0 copay at network pharmacies.

' Women's preventive health benefits adding some breast cancer reducing Rx,0 copay.

F Medicare Plans

r HN Seniority Plus expanding coverage of medically necessary foot orthotics; addingSi lverSnea kers.

. High Option adding benefits for gender disorder.

D Optum Eehavioral Health: new prior auth requirement on non-standard outpatient visits.

Lrl3/2014

Retiree Non-Medicare Plans

Sq xrusrn FERMANENTE.

H.:,S*.n5{P Heatrh Net

r Uf,lvErsriV of Caltfoar,ta

blue S of colifornio

Non-Medicare HMO vs. PPO

HMO

' Restricted provider access(PCP/medical group or Kaiser).

. Care starts with PCP; PCPrefers to specialists; medicalgroup authorizes most careoutside of PCP's office,

. Fixed costs - most serviceshave flat copays.

' Must live in service area,. Only ER and urgent care

covered outside of medicalgroup,

. May have carve-out benefits(behavioral health,acupuncture, chiropractor),

PPOI Access to larger network of

doctors. Not assigned to a doctoror 8roup.Self-refer to doctors andspecialists; no authorizationrequirement to see doctors.Health plan must authorizesurgery and some services inadvance.

Costs vary depending on whetherprovider is participating with planand other factors. Out-of-networkproviders cost you more.

May have carve-out benefitsthrough separate specialty plan.

t1./3/2014

Retiree Non-Medicore Plan

Health Net Blue & Gold HMO:...

Health Net Blue & Gold (with Optum Behavioral Health)' Includes UCLA Medical Group, and other groups (limited

network).. Requires PCP assignment, referrals, medical group

authorizations,. Pay set copays for medical services and Rx (copays not

cha nging).. No out-of-network medical coverage except ER and urgent care.. OOP Max: 51000 individual/S3000 family (medical and Rx

copsys apply). New for 2075! Acupuncture and chiropractic coveroge through

American Specialty Heolth Plan Network. 24 visit limit. $20copoY.

. Copoy savings on 90-day maintenonce medications at CVSretail pharmacies (plus mailorder and IJC pharmocies),

Retiree Non-Medicore Plan

Kaiser HMO

D Kaiser (includes Optum Behavioral Health). Must use Kaiser providers and facilities (except

behavioral health (Optum or Kaiser) and in emergency). Pay set copays for medical services and Rx (copays not

cha ngi ng). OOP Max: $1500 individual/S3000 family (medical ond

Rx copays apply). New for 2015! Acupuncture and chiropractic coveroge

through Americqn Specialty Health Plan Network, 24visit limit. $lS copay. (Koiser members con olso useKoiser acupuncture, 520 copoy.)

1,1./3/2014

At a Glance

Non-Medicore HMOs

HealthNet Blue& GoldOOP max:

S10oo ind.

$3000 fam,

KaiserOOP max:

S15oo ind.)5UUU TAM.

520 57s S2s0

ss/$2sls40*retail $20 self-injectables

(1 nn)r"uu S1O/S5O/SB0

50% for infertllity

mail order, cVS and sexual

or uc pharmac dYsfunction Rx

$zo $zs s2s0 Sroo

Covered under Rx

))/)z) - copays.reta i I

- 50% for infertility510/$50 and sexuar

mail order dysfunction Rx

*Health Net Rx copays are for generic/brand name formulary/non-formulary.-Kaiser's Rx copays are for generic/brand name.

Reti ree N on -Me d icdre Plan

UC Care PPO

UC Care PPO - no PCP or medical group, no referrals or authorizations to seespecialists. Blue Shield processes claims.Select tier includes UC providers and set co-pays tor many services.

' $20 copays for office visits; 5200-250 ER; 5250 hospital and skilled nursing unit lnhospital admission; 51"00 outpatient surgery in hosirital.

' Some services not covered on select tier (including stand-alone skilled nursingfacility, home health, hospice, DME, prosthetics/orthotics, acupuncture,chiropractic, outpatient surgery at freestanding ambulatory surgery center).

Prefered tier includes Blue shield ppo network and worldwide coverage;deductibles and coinsurance apply, up to annual maximums.Services outside the US covered at the preferred ppO benelit tevel,Non-preferred providers covered; higher out-ot'-pocket costs.Set.co-pays for prescriptions, except specialty drugs.90-day Rx copay savings onmaintenance medications at select pharmacies, uc pharmacies, and mailoider.2015: Expanding care mqnagement progrqms, I,JCLA patient Centeredlntegrated Model, focus on coordinated services and qdherence to cqre plans.Reod summory.grid for more details ol plan coveroge, ond review lull ploncoverqge booklet on lJCNet.

Ltl3l2Ot4

Deductibles

Out-of-Pocket Maximums - medical

Out-of-Pocket Mdximums - Rx

Physician Office Visits / Urgent Care

ER Fdciilty & ER PhysiclonstAmbulance

S/A Ambulatory Surgery Center

Outpatient Surgery in Hospital

Hospital (non-emergency)

Durable Medlcal Equlpment

S/A Skilled Nursing FacilityHome Health

Chlropractlc'

Acupuncture*

Prescrlptlons (subject to Rx nlax)

Behavioral Health

^ S200 ER only; S250 if admitted to hospital.tPlan limit of 24 visits for chiropractic and acupuncture combined.3rlf preauthorized, coinsurance will be 20% for non-pref. home health.

None S2s0 / 5750 Ss00 / S1,s00

$1,s00 / 54,500 53,000 / se,000 ss,000 / s1s,000

53,600 / 54,200 (network phatmqcy copay only) No OOP max on AON Rx

szo zo% 50o/o

520A-525A^ $2A0-S250 h.d.ductrbt 9200-$2gO hod.du.tbre)N/A $200 fldt fee $200 fldt fee

Not covered 20% 50%L I

s100 20% s0%1 |t---$zso zo% 5oo/o2 I

Not covered 20o/o 50%

Not covered 20%l.L00 day limit) 50%2 (L00 days)Not covered 20% (100 visit llmii) 50%3 (100 visits)

Not covered 20% S0%

Not covered 20% 20%

S5/25la0 30.day; Sf0/50/80 90.day; 30% to some Rx not covered out ofS150/each Speclaltv Rx network; somo 50% of fetall

Carved out to Optum

Plan Pays maximum of:I 50% on S350/day

':50% on S600/day

Reti ree N o n -Mt e d i cdre Plan

UC Care PPO - Additional NotesServices with non-preferred providers (providers who are notcontracted and do not have a fee agreement with the plan) arepaid by plan based on allowed amounts (not billed charges).r Members are responsible for coinsurance and any qmounts in excess

of ollowed qmounts,. Amounts in excess of allowed amounts do not apply to deductibles or

o ut- of - poc ket m axi m u m s.

Services with day or visit limit accrue to the limit even if thedeductible has not been met.

} Reod summary grid for more details of plan coverdge,and review full plan coverage booklet online,

L1,13/20L4

Understunding Balance Billing

PPO Claim Processing Example

Example assumeslI Annualdeductible met, 80% benefit level for PPO

providers (20% coinsurance), 50% benefit level for non-

PPO providers (50%co I nsu ra n cel

Note: ln addition to differentbenefit levels for PPO andnon-PPO benefits, mostplans nave separatedeductibles and separatemaximum out-of,pockets onPPO and non-PPO benefits,

Amount Billed

Negotiated Rate

Allowed Amount

Plan Pays

Provider Write-off(lnsurance Adjustmont)

MemberCoinsurance(applied to max OOP)

Member may bebilled

$250

$1 00

$1 00

$80

$1 50

ozu

$20

$250

N/A

$1 00

QAN

NiA

$50

$200

Retiree N on- M ed icore plan

Health Savings PPO w/HSANot open for retiree enrollment. only retirees already enrolled can remain inplan until anyone in family becomes Medicare-eligible.Low premiums, High-deductibles.

PPO benefits after deductible, up to annual out-of-pocket maximums. Reodplan summory grid dnd full plan booklet for details of the coverdge,Health Savings Account allows both UC and enrollee contributions.HSA can be used to meet deductible and pay eligible health care expenses.After age 65, HSA can be used for non-eligible expenses (taxed but no penalty).Enrollee owns HSA; no use it or lose it rules, and yours if Vou leave UCcoverage.

Former Anthem Lumenos members may have pDHRA from Anthem HRA roll-over. once Medicare-eligible and move to Medicare plan, any pDHRA fundsmove to stand Alone HRA (SAHRA) and can be used for Medicare premiums.plan premiums, and qualified medical and Rx expenses, untilfund isexh a usted.

1,1/3/2014

At a Glance

Health Savings PPO w/HSA

Ssoo

Up to $2,8s0 (or$3,8s0 if ss+)

Slooo

Up to 95,650 (or$6,650 of 55+)

HSA contributionsare annual amountsand subject toIRS rules and limits.

*Services withno n-preferredproviders are paid

PreferredProviders

5 1,300

20%

s4,000

Non-Preferred*

(? cnn't

40%*

bv plan based on,i " - -"-'" -' Deductibles

ailoweo amounts.Members are Coinsurance-

responsible for Maximumcoinsuranceand Out-of_any amounts In Pocketexcess of allowedamounts. Amounts in excess of allowed amounts donot apply to deductibles or out-of-pocket maximums,

S8.00O* qA 4nn (1A nnn*/vr-vv I Lvtvvw

-Review summary grid for detailsand coinsurance variations.

Preferred : No.n-Providers Preferred*

52,600 s5,000 *

20% 40%*

Retiree N o n-Med i co re plan

Core

High-deductible - 53000 individual (applies to max OOp)Lowest premiumsMedical, mental health and Rx all subject to deductible andcoinsurance.20/80 PPo after deductible is met for both preferred andno n-preferred providers

D Maximum out-of-pocket: 56,350 individual; SI2,7OO family) single deductible and max oop applies to services with

preferred and non-preferred providers.

Y Reod plan summary grid ond full plan booktet fordetails of the coveroge.

10

t1,/3l2Or4

Retiree Non-Medicsre Plans

Prescription Drug Coverage*

30-day supply (network pharmacy/specialty pharmacy):

Health Net B&G Kaiser

GenericBrand Formulary S25,00Non-Formulary $40.00Specialty 30% to 5150

90-day SUpply (mait-order andselectnetworkphormqcieslormdintenancemedicotions):

UC Care PPO Health Net B&G Kaiser

Generic $ro.oo s10.00 s10.00Brand Formulary $so,oo $50.00 $50.00Non-Formulary 580.00 580.00 N/Aspecialty N/A N/A N/A

HSA pp1 * rand g.9!9** members: Rx subject to deductible and colnsuronce, up to OOP mox'

*Generic drugs mandatory on all UC p.lans unless medically necessary and authorized by plan.

*xSome odult vaccines covered under pharmacy benefits vrith no copaY (tetanus, pertussis,

pneumococcal, meningocaccol, HPV, shingles), Network pharmacies only'

UC Care PPO**ss.o0 $ s.oo

52s.00s40.o0Szo

s s.00s2s,00N/As2s

Retiree Non-Medicor€ Plans

Rx Coverage Enhancements

F Health Net Blue & Gold. 90 dav supplies, copay savings: UC-owned; CVS retail; cVS mailorder.. Rx included: specific medications listed on HN's maintenance drug list.*

hnps://www,healthrlet.com/static/general/unprotected/pdfs/calpharmacv/maint drus list 0dft

F UC Care. 90 day supplies, copay savings: UC-owned; participating retail pharmacies

(Safeway/Vons, Walgreens, Costco); PrimeMail.

' Rx included: Specific medications listed on Blue Shield of California Selected

Maintenance Medication list'*https://www.blueshieldca.com/bsca/documents/pharmacv/MaintenanceList.Odf

*

> UC Care, Health Savings PPO, Core. some adult vaccines (tetanus, whooping cough (pertussis) pneurnococcal,

ni.ningoio..rl, cerviial cancer (HPV) and shingles (herpes zoster)).covered underpftrir?iy benefits with no copay. Must use network pharmacies for this benefit

!Dtuglists subjecttochange. Collyourplonilyouhovequestionsdboutwhetheryoutdtug isonthemdintenoncedruglist

LT

tr/3/2014

Questions regardingNon-Medicare Medical Plans

(Medicare plans, and Behavioral Health for all

plan members still to come.)

Retiree Medicare

FQ xnrsrn PERMANENTE"

Pla ns

UC CAREVour raac. Your (horcg,

,ie :,::"::,1 ) :.:,",,,

"

blue S of colifornio

12

rt/3/2014

UC Rules Review - Retiree plan MembersMUST Enroll in Medicare tf Eltgible

l

) Enrollment in Medicare parts A & B - Required by uC if erigibre forpremium-free part A.) start Medicare enroilment process 3 months before 65 birthday(automatic if collecting sociat seiuritv)'.-z Look for packet *itlllJglrnat,ion and instructions from UC approx. E2% months before 65rh birthday. Corpf utu torm and return to rf_1nRASC. rv 'L'[u"' ru t.-q_.1

I lf Medicare-elieibre b,ut.fairto enroil -yourisk being permanentryde-enroled frdm uc,s A;;;it;i rvrloitir coverage.F Part,D - your UC medical plan coordinates you with part D (do notneed to enroil in part D oLtside otyour-uc pran, wiil cause confrict ifyou do).P

lou. p^ay la1} B premiums (amount based on.i.ncome) and may pay aPart D Medicare Income Rerated rvontrriy Adjustmerlinn.,"r,it

(IRMAA), if higher income. - " - -"':

Medicare HMO (w/Medicare assigned)

Medicare Advantage prescription Drug plan

) Health Net seniority prus (HNSp) and Kaiser senior Advantage) Medicare PartsA, p-(!nO D)assigned to ptan; Medicare willnotwork outside of HMO. -- '

> HNSP requires pCp.and. Medical Group assrgnment. Networksavailable may not be the same as in iion-Meaicare HMo. '--

) Care starts with pCp; pCp refers to_specia.lists; medicalgroupauthorizes most care outside of pCpls oftrce.Only ER and urgent care covered outside of medicalgroup/plan.Fixed costs - most services have flat copays, but somedifferences between non-Medicar" inl ffn'eAicare HMO.Must live in service area. Service areas may be different thannon-Medicare HMO servtce areas.

lhqnge to carve-out benefits you used under non_MedicareHMO.

13

Lt/3/2OL4

Retiree Medicare Advantogte HMO Plsn

Health Net Seniority Plus) UCLA Medical Group /imited ond restricted controct with HNSp

. Must be enrolled in Health Net AND assigned to UCLA Medical Group dt timeof transitioning into HNSP to remain in UCLA Medical Group under HNSp,

. Medicare members from other plans connot select UCLA Medical Groupunder HNSP, even if using UCLA providers under current plan.

) Not all medical groups available under Health Net are available under HNSp.

> HNSP not available in all areas where HN B&G is available (e,g. Ventura Co.).

) Cannot use Medicare outside of Medicare Advantage plan.

) Requires PCP assignment, referrals, medical group authorizations.D Pay set copays for medical services and most Rx (coinsurance for specialty Rx).

) No out-of-network medical coverage except ER and urgent care.'t New in 2075: Expanded coverage of medically necessary orthotics.z SifverSneakersl Sign up at: silversneal<ers.com or call 1-888-423-4632,

) Behavioral health though Managed Health Network (see plan booklet).

Retiree Medicare Advantage HMO Plsn

Kaiser Senior Advantage

F Must use Kaiser providers and facilities.) Cannot use Medicare outside of Kaiser (except for

emergency care).

) Pay set copays for medical services and Rx(copays not changing).

) Behavioral health only through Kaiser.

> All services (doctors, lab, imaging, pharmacy,hospital) under one roof.

L4

1.L/3/201.4

At a Glance; Retiree Medicare Advantage flMO plans

Health NetSenioritV Plus

Med Max OOP

s1s00

Rx Max OOP

s2000

Kaiser SeniorAdvantage

Med Max OOP

s1s00

Rx Max OOP

54 ^)0

5zo 52s0 5100

92s0 s100

25% self-injectiblesS5/S2s/$40* (up to 52000 annual

retail r:r,

510/550/580 25% for Part B drugsmail order up to S25 max

or UC

pharmacy 50% for infertility andsexual dysfunction Rx

Specia lty d rugs

55/525* covered under Rx

retail copays.

S10/550 50% for infertility andmail order sexual dysfunction Rx

tHealth Net Rx copays are for generic/brand name formulary/non-formulary.-Kaiser's Rx copavs are for generic/brand name.

Medicare PPO & High Option(Plans that Process Claims as Secondary to Medicare)

Blue Shield Medicare PPO, PPO w/out Rx, and High Option - Secondary toMedicare Fee for Service (similar to a Medicare Supplement)

F Medicare pays first; PPO/HO pays second, Secondary plan opplies itsbenefit to the bolonce remaining after Medicore poys.

F Must use Medicqre providers for services covered by Medicare. Notassigned to a doctor or group. Not restricted to plan's PPO network.

F Medicare must authorize surgery and some services in advance.Secondary plan only makes medical necessity decisions if Medicare coverage is

exhausted and plan is paying as primary, or if service is not eligible for coverage byMedicare but is eligible for coverage under secondary plan.

F For services not eligible for coverage by Medicare, best to use plan'sPPO providers (restricted to contracted rates),

F UC's retiree group plans that work as secondary to Medicare providebenefits beyond Medicare (e.9. hearing aids, acupuncture, outside US,

and more).

F UC's plans include Part D Rx coverage, Part D assigned to UC Rx plan.

15

L1,/3/2014

Medicare PPO/HO - Medicare providersTwo Types of Medicare providers

) Providers who occeptMedicsre assignment are limited to billine Medicareallowed amounts, must bill Medicare, and are paid directry by Medicare.

) Providers who do not qccept ossignment may charge L5% more (Medicarelimiting charge), must fire craims with Medicare, can coilect payment from youat time of service. Medicare reimburses you,

Private contract and opt out providers (for services Medicare would cover)> A "private contract" is a contract between a Medicare beneficiarv and a

physician or other practitioner who has "opted out" of Medicare, for arlservices the provider furnishes to Medicare beneficraries, In a privatecontract, the Medicore beneficiory qgrees to: give up Medicare payment forservices furnished by the physician or practitioner; ond poy the physician orproctitioner without regard to any limits thot would otherwise appty to whotthe physicion or proctitioner could chorge.

) Nuit,h"r M"di."r" norjh" UC plun *ill puv *h"n u prouid", hu, opt"d ort ofM"di."ru rnd

"nt"r"d into r oriuut" .ont..t *ith th" rvl"JGrru b*"fi.i*[

Retiree Medicare Plan

Blue Shield Medicare ppO

l Can use any Medicare providers for services covered by Medicare,> S100 annual deductible for services not covered by Medicare,) Plan covers Medicare part A and part B deductibles.! Medicare pays first; Blue Shield pavs second.> AIl"j Medicare pays, Blue Shield Medicare ppO pays g0% of remainder

or tvteotcare allowed amount.)> For services not covered by Medicare, best to use Blue shield providers to

contain costs. 20% coinsurance for most services not covered by Medicarebut covered under UC plan benefits (e.g. acupuncture, hearing aids,counseling with MFT or MFCC).

i Annual medical maximum out-of-pocket: S1500.

- lgqqllt-e.lart D Rx plan with set copays* SrO753675Ot rerail or520/560/590 mail order/UC pharmacy, up to g+200 annual max oop onRx copays (generic, brand name formulary and specialty drugs).

f Rx copays are for generic/brand name formulary and specialty/non_formularv.

l_o

rL/3/201"4

.P

Retiree Medicare Plan

Blue Shield High OPtion

Can use any Medicare providers for services covered by Medicare'

$50 annual deductible for services not covered by Medicare'

Plan covers Medicare Part A and Part B deductibles.

Medicare pavs first; Blue Shield pays second.

After Medicare pays, Blue shield High option pays 100% of remainder ofMedicare allowed amount'For services not covered by Medicare (e.g. acupunct_ure), best to use Blue

shield providers to contain costs. 20% coinsurance for most servlces noI

covered by Medicare but covered under UC plan benefits (e.g. acupuncture,hearing aids, counseling with MFT).

Annual medical maximum out-of-pocket: S1050.

New: Benefits for gender disorder - hormone therapy, psychotherapy, surgical

service; plan criterla, co-insurance and prior authorization requirernents.

seoarate Part D Rx plan, with set copays* 510/$30/545 retail or

S)b/Soo/Sgo mail order/UC pharmacy, up to 51000 annual max ooP on Rx

iopiyr (generic, brand name formulary and specialty drugs)'

' *Rx copavs are for generic/brand name formulary and specialty/non-formulary

Retiree Medicare Plan

Blue Shield Medicare PPO without Rx

Requires that retiree and all covered family members haveMedicare and be enrolled in a non-uc Medicare-coordinated plan

with Rx benefits (verification required)' CANNOT have a non-UCMedicare Advantage Plan.

can use any Medicare providers for services covered by Medicare.

S100 annual deductible for services not covered by Medicare'

Plan covers Medicare Part A and Part B deductibles.

Medicare pays first; Blue Shield pays second.

After Medicare pays, Blue Shield Medicare PPO pays 80% ofremainder of Medicare allowed amount.

F For services not covered by Medicare, best to use Blue Shield

oroviders to contain costs. 20% coinsurance for most services notlovered by Medicare but covered under UC plan bene-fits.(e g'

acupuncture, hearing aids, counseling with MFT or MFCC)'

P Annual medical maximum out-of-pocket: 51500'

L7

trl3/2oL4

Coordination of Benefits (COB)

Doctor visit

Medicare allowable

Medicare pays*

Plan pays

You pay

*Assuming Medicare deductible met, Both High Optionup Medicare deductible,

',1.). .,:t-l

Applies benefit (80%) tobalance remainlng afterMedicare pays

$1so

s120

524

56 (up to $1,500 annualmaximum out-of-pocket

and Blue Shield Medicare PPO plans pick

UC Plans and Medicare

Picks up balance ofMedicare allowed amountafter Medicare pays

S lso

$rzo

$so

0

Deductlble (applles to servlces not covered by Medlcare)

Out-of-Pocket Maxlmums - medlcar

Out-of-Pocket Maximums - Rx

Physician Servlces

Preventlve Care

Hospital Services (first 60 days - plan ptcks up Medicare deductlble)Hospital (days 61+)

Emergency Care and Ambulance

Rehabilltation Services (PL OT, ST)

S/A Skllled Nursing Facility (100 day limit/calendar year) Days 1-20Days 21-100Days 100+

Home Health {must be covered by Medicare)

Durable Medical Equipment {covered by Medtcare)Durable Medical Equipment (not covered by Medicare)

Hearin8 Aids (2 hearing aids every 36 months)

Chiropractlc* (Medicare must cover first)

Acupuncture I

Behavioral Health (with Medicare providers, N4Ds, phDs, LCSWS)

Behavioral Health (providers types Medlcare dogsn,t cover, MFTs, tvlFCCS)

)5U

s10s0

Slooo

No copay

No copay

No copayNo copay

No copay

No copay

No copayNo copayFull cost

No copay

No copay20%

20%

No copay

20%

No copay

20%

5100

Slsoo

$4700

20% of balance after Medlcare

No copay

No copay20% of balanqe after Medicara

20% of balance after Medlcare

20% of balance after Medicare

No copay20% of balance after MedlcareFull cost

20% of balance after Medicare

20% of balancE after Medicare

20%

20%

20% of balance after lVEdlcare

20./"

20% of balance after Medlcare

20%

Balance After Medicare=Remaining Medicare-eligible expenses after Medicare has paid

18

LLB/2AL4

Questions regardingMedicare PPO/HO plans

\

(Behavioral Health for all plan members next.)

Retiree Plans - HMOs

$10 group/)zu In0tv.

copay/visit

510 group/

$20 indiv.copay/visit

$10 group/S2o indiv.

copay/visit

Member cost foroutpatient officevisits reflected oncharts (slides 38-101

Behavioral healthplan deductibles,copays andcoinsurance trackto medical planplan deductibles,copays an0coinsurance forinpatient andoutpatient services.

not MHN.:l ll

Kaiser (?n

copay/visit{ftrst 3 no copay)

KaiserSenlorAdvantage

+ Review Evidence of Coveragei medtcat group may cover mental health through medlcal group,

BehavioraUMental Health Benefits

Health Net S2OBlue & Gold copay/visit

(flrst 3 no copay)

Health NetSeniorityPlus*

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L1,/3/2014

Retinee Plans - PPOs

Behavioral/Mental Health Benefits

Core

UC Care

Health Savlngs 20% afterPPO deductible

Blue Shield PPO &PPO without RX

(Medicare)

High Optlon(Medlcare)

iSome provider types not covefed by Medicare (e.g. MFTs) may be covered bV Blue shield, with 20% coinsurance after deductible,Call plan to verifv coverage of your provider who is not covered by Med icare and is not a Psychologist, Psychiatrist or LCSW.

ra The plans will cover non-preferred providers based on allowed amount, not billed charges; m€mber pays balance.

20% afterdeductible

)zu copay/vrsrI(first 3 no copay)

20%r aflerdeductible

20%* aft.el-- deductible

20% after* deductible

(Blue Shield)

50% after

- deductible(Optum-)

40% afte(

- deductible(Optum")

2Q%r afte.zu% oT oarance

0e0ucUoleafier tvteotcare

(BIue Shietd)4'

zQa/o* afte(No copay deductlble

(Blue Shield)**

Actions To Take After Flan Change

, Very lmportant: Complete Blue Shield Medicare Part D form ifyou are Medicare member moving to Blue Shield PPO or HighOption. Complete Medicare Advantage enrollment form ifyou are new to Health Net Seniority Plus or Kaiser SeniorAdvantage. UCOP must receive form by December 5,

- Read all plan materials to understand how plan works, andcall your plan with any questions.

- Check new plan lD card to verify enrollment, and your pCp

and medical group if enrolling in Health Net Blue & Gold. Callyour plan immediately with any issues. All plan membersexcept Kaiser current members will receive new lD cards.

20

tLl3/201.4

UC Living Well with Optum

F Wellness program with online and campus activities tohelp you improve and maintain your health.

F Retirees with and without Medicare, enrolled in any UC

medical pla,n, are eligible. Only subscriber is eligible.Flncentive for participation: SzS Cift Card

F Point System to earn Gift Card

F Organized campus and online activities available to earn points

FHealth Assessment available but not required for giftca rd,

http ://ucl ivi ngwe I l. ucop. ed u/

Dental and Vision

) Dental - no plan changes for 2015:http://ucnet. u n iversitvofca lifornia.ed u/com pensation-a n d-benefits/hea lth-pla ns/d enta l/

r Delta Dental PPO

t-800-777-5854. DeltaCare USA

I-800-422-4234

> VSP Open for 2015 - no plan or rate changeshttp://ucn et. u n iversitvofca I iforn ia,ed u/com pensation-a n d- ben efits/hea lth-pla ns/vision/index, htm I

. Look for mailer from VSP or call t-855-240-8344

' Retirees pay premium in full directly to VSP.. Enroll directly with VSP

' http://vsp.com/golucretirees

2L

LL/3/20L4

ARAG Legal

F Open for enrollmentF Legal plan that helps cover costs of legal needs,http://u cnet. u n iversitvofca lifornia. ed u/co m pen sation-a nd-be nefits/oth er-ben efits/lesa l-pla n. htm I

F The retiree pays the full premium (deducted from annuity),'r New in 2075, an expanded identity theft protection benefit

that includes:. Full service identity restoration. ldentity Theft Insurance up to S1-million. Lost wallet services. Credit monitoring service, internet surveillance of persona,

information and child identity monitoring> ARAG: 1-800-828-1395

Medicare MembersLiving Outside of California

OneExchange: Medicare Exchange in fieu "t

ri *",'r"" *"Ot.t,, Allfamily members are enrolled in Medicare*

- Living in the United States and outside of CA

> UC makes annual contribution to a Health ReimbursementAccount (HRA) that helps cover premiums and medical costs

. 53000 (in 2015) each for retiree and family member

. Contribution subject to graduated eligibility

. Retiree uses HRA to purchase Medicare plan (Advantage Plan

or Supplement + Part D) in retiree's area from OneExchange

. Retiree can use any extra HRA funds to pay medical expenses

and Medicare oremiums.* Retirees outside of CA with "split t'amilies" remoin under IJC retiree plons through the end of the

year in which oll non-Medicare family members hove become eligible Jor Medicore.

22

1,t/3/201.4

Questions?

!==:\

-

.(r**{t }-,['J4

Contqct RASC;

1-800-888-8267

or UCLA Retiree Hotline:3LO-794-8598

reti rees@ ch r. u cl a.ed u rResources for Retirees I

Health Net Blue & Gold

Health Net Seniority Plus

Kaiser

Kaiser Senior Advantage

alue Shield

UC Care Concierge

HSA - Health Equity

Optum Behavioral Health

Online plon links:

1-800-539-4072

1-800-464-4000

1-800-443-0815

1-855-201-837s

1-855-201-2087

1-866-346-5800

t-888-440-8225

http://ucnet. u niversitvofca liforn ia.edu/co ntacts/pla n-co ntacts.html

23

Lr/3/2014

Resources for Retirees

UC Retlrement Administration Service Center

Emeriti Retiree Relations Center

Medlcare

Social Security Administration

UCLA Health Care Facilitator (retiree dedicatedphone and email)

Open Enrollment Website:http://u cn gt. u n iversitvofcalifo rn ia. ed u/oe

UC Health Plan Booklets available Vear-round:h tt p ://u cn et. u n iversitvofca I ifo r n i a. ed u/fo r m s/catego rv. ht m I

(expand link for plan booklets)

1-800-888-8267

310-825-7456

l.SOO.MEDICARE

(1-800-633-4227)

L-800-772-12t3

1-310-794-8598reti rees@chr,ucla.edu

24