1 11/5/2014 ucsb human resources, benefits this presentation is intended for communication purposes...
TRANSCRIPT
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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