1 11/5/2014 UCSB Human Resources, Benefits This presentation is intended for communication purposes only. Please see the UCnet website ( and plan documents for complete information. Medical Plan Comparison

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 2

Go to Open Enrollment website on UCnet ◊ ◊ 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 3

  Booklets mailed to home   Open Enrollment Website o o Benefit Education Videos o o Medical & Dental Plan Choosers   Insurance Plan Websites o o Provider directories o o Plan booklets   Local Presentations and Events 4

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 5

Medical Terms and Concepts 6

2015 Medical Plans HMO Health Net Blue & Gold Kaiser PPO UC Care Blue Shield Health Savings Plan Core

8 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

All medical plans cover preventive care at 100% with in-network providersAll medical plans cover preventive care at 100% with in-network providers Preventive care includes: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 websitesSee list of preventive services on the plan websites 9

10 HMO (Health Net, Kaiser) Employee must live in CaliforniaEmployee must live in California PCP must be within 30 miles of where you live or work (in most cases)PCP must be within 30 miles of where you live or work (in most cases) Blue Shield Health Savings Employee must live in USEmployee must live in US Employee may live anywhereEmployee may live anywhere Worldwide servicesWorldwide services CORE UC Care Employee may live anywhereEmployee may live anywhere Worldwide servicesWorldwide services Employee may live anywhereEmployee may live anywhere Worldwide servicesWorldwide services

11 HMO (Health Net, Kaiser) Limited to emergency and urgent care onlyLimited to emergency and urgent care only No routine care when away from medical groupNo routine care when away from medical group Blue Shield Health Savings Limited to emergency and urgent care onlyLimited to emergency and urgent care only No routine careNo routine care Comprehensive coverageComprehensive coverage Plan pays Preferred/Tier 2 benefit.Plan pays Preferred/Tier 2 benefit. CORE UC Care Comprehensive coverageComprehensive coverage Plan pays out-of-network benefit.Plan pays out-of-network benefit.

12 HMO (Health Net, Kaiser) You select PCPYou select PCP PCP coordinates carePCP coordinates care PCP refers to specialistsPCP refers to specialists Specialists limited to physicians in medical groupSpecialists limited to physicians in medical group Blue Shield Health Saving In-Network You select Blue Shield PPOYou select Blue Shield PPO Out-of-Network You select non-Blue ShieldYou select non-Blue Shield In-Network – You select UC SelectUC Select Blue Shield Preferred PPOBlue Shield Preferred PPO Out-of-Network You select non-Blue ShieldYou select non-Blue Shield CORE UC Care In-Network You select Blue Shield PPOYou select Blue Shield PPO Out-of-Network You select non-Blue ShieldYou select non-Blue Shield

13 UC Select (Tier 1) UC Medical Centers & Select Blue Shield PPO Blue Shield Preferred (Tier 2) Blue Shield PPO in CA Out of CA Blue Cross Blue Shield Non-Preferred Out-of-Network (Tier 3) Out of the UC Select or Blue Shield Preferred In Network Providers

14 ProvidersStatus Sansum Clinic  UC Select/Tier 1 Quest Diagnostic Lab Unilab  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

UC Select/Tier 1 providers in ◊ ◊ Santa Barbara ◊ ◊ Santa Maria ◊ ◊ Lompoc ◊ ◊ Ventura UC Care Provider Directory blueshieldca.com/uccareppo Blue Shield Concierge

HMOs have predictable copays for servicesHMOs have predictable copays for services PPOs have deductibles and % coinsurancePPOs 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 16

In-NetworkExample that plan negotiates for each service with “preferred” or participating providers Discounted rate that plan negotiates for each service with “preferred” or participating providers You pay the in-network coinsurance on the discounted rate. You pay the in-network coinsurance on the discounted rate. Provider can’t “balance bill” Provider can’t “balance bill” 20% Coinsurance Provider charge:$200 Allowed amount:$100 Plan pays 80%:$80 You pay 20%$20 Provider write-off:$100 PPO plans negotiate “allowed” rates to process claims. 17

Out-of-NetworkExample to a service when provider is NOT a “preferred provider” (not participating) 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. Plan pays out-of-network coinsurance on the allowed amount. Provider can “balance bill” Provider can “balance bill” 50% Coinsurance Provider charge:$200 Allowed 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. 18

Medical PlanCopayDeductibleCoinsurance 19 HMO$20None UC Care PPO UC Select/Tier 1$20None 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

20 $250 Individual / $750 FamilyCoinsurance Adult 1Paid $250 20% Adult 2Paid $100 Child 1Paid $ 75 Child 2Paid $250 20% Adult 2Paid $175 20%20% UC Care Example Family Deductible Blue Shield Preferred (Tier 2)

21 Blue Shield HSP Preferred $2,600 family $1,300 single $2,600 family You pay 20% Out-of-Network $5,000 family $2,500 single $5,000 family Plan pays 60% of allowed rate Full family deductible must be met before plan shares cost CORE Preferred $3000 per individual You pay 20% Out-of-NetworkPlan pays 80% of allowed rate Medical PlanCopayDeductibleCoinsurance

Medical PlanCopayDeductibleCoinsurance 22 HMO$250None UC Care PPO UC Select/Tier 1$250None 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

23 Blue Shield HSP Preferred $2,600 family $1,300 single $2,600 family You pay 20% Out-of-Network $5,000 family $2,500 single $5,000 family Plan pays 60% of allowed rate Full family deductible must be met before plan shares cost CORE Preferred $3000 per individual You pay 20% Out-of-NetworkPlan pays 80% of allowed rate Medical PlanCopayDeductibleCoinsurance

Medical PlanCopayDeductibleCoinsurance 24 HMO$75None UC Care PPO UC Select/Tier 1$100 $200 NoneYou pay 20% of ER physician Preferred/Tier 2$100 $200 WaivedYou pay 20% of ER physician Out-of-Network$100 $200 WaivedYou pay 20% of ER physician

25 Blue Shield HSP Preferred $2,600 family $1,300 single $2,600 family You pay 20% Out-of-Network $5,000 family $2,500 single $5,000 family You pay 20% Full family deductible must be met before plan shares cost CORE Preferred Waived for facility fee You pay 20% Out-of-NetworkYou pay 20% Medical PlanCopayDeductibleCoinsurance

The most the insurance plan requires you to pay in a yearThe 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.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).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.Does not include amounts “not allowed” by insurance plan when using out-of-network providers. 26

Medical PlanOOPM Medical & Rx Notes 27 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

Medical PlanOOPM MedicalNotes 28 UC Care PPO UC Select/Tier 1$1,500 indiv $4,500 family Family = 3 or more In-Network providers cross 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

29 You pay You share cost with plan Plan pays 100% $250 Deductible 20% Coinsurance $3000 OOPM UC Care Individual Coverage Blue Shield Preferred (Tier 2)

Medical PlanOOPM RxNotes 30 UC Care PPO In-network pharmacy $3,600 indiv $4,200 family Family = 3 or more Medical and Rx do not cross accumulate Out-of-network PharmacyNone

Medical PlanOOPMNotes 31 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

32 You pay You share cost with plan Plan pays 100% $1300 Deductible 20% Coinsurance $4000 OOPM Blue Shield Health Savings Plan Individual (Single) Preferred Providers

33 You pay You share cost with plan Plan pays 100% $2600 Deductible 20% Coinsurance $6500 OOPM Blue Shield Health Savings Plan Family Preferred Providers The full family deductible must be met before plan shares costs

HMO UC Care Blue Shield HSP CORE Retail (30 day) Generic Generic Brand Brand Non-formulary 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 Generic Brand Brand Non-formulary Non-formulary$10$50$80 34 Preferred Drug List (Formulary) is different for each carrier

35 High deductible medical plan paired with a Health Savings Account Medical Coverage Blue Shield PPO Health Savings Account HealthEquity +

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

37 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

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

Deductible Coinsurance Any IRS Publication 502 Expenses, including: ◊ ◊ Medical ◊ ◊ Dental ◊ ◊ Vision ◊ ◊ Prescription drug ◊ ◊ Long Term Care insurance premiums 39

UC makes annual contribution for plans that start on January 1. You may contribute through payroll deduction or make post-tax contributions to HealthEquity HSA debit cardUse a HSA debit card to pay for health expenses HealthEquity websiteUse HealthEquity website to pay medical and other health claims Invest HSA dollarsInvest HSA dollars when account balance reaches $2000 – no fees to invest

41 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$1,300Single Deductible$1,300 UC Contribution to HSA$500UC Contribution to HSA$500 Remaining balance$750Remaining balance$750 ◊ Pay with personal funds or Pay with your personal contributions to HSA

HealthEquity Member Services is available every hour of every day

43 Optum coordinates behavioral health care for all medical plans (except CORE)Optum coordinates behavioral health care for all medical plans (except CORE) ◊ ◊ psychiatrist ◊ ◊ psychologist ◊ ◊ therapist ◊ ◊ substance abuse treatment No referral required from physicianNo referral required from physician Call Optum to notify prior to first visitCall Optum to notify prior to first visit

44 Medical Plan OPTUM Network Out of Network Health Net Blue & Gold Visits 1–3 no copay Visits 4+ $20 $250 inpatient hospitalization Emergency only Kaiser (Optum & Kaiser Providers) Emergency only

Medical PlanOPTUM NetworkOut-of-Network UC CareVisits 1-3 no copay Visits 4+ $20 Inpatient $250 $500 deductible Plan pays 50% allowed You pay balance Blue Shield HSPDeductible: $1,300 indiv $2,600 family You pay 20% Deductible: $2,500 indiv $5,000 family Plan pays 60% allowed You pay balance 45

46 Medical Plan Blue Shield Network Out of Network Core $3000 deductible You pay 20% Plan pays 80% allowed You 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.

Medical PlanProvidersCosts Health Net American Specialty Health $20 copay Self-referral 24 visits/year combined KaiserAmerican Specialty Health $15 copay Self-referral 24 visits/year combined Kaiser$20 copay acupuncture only 47

Medical PlanProvidersCosts UC Care PreferredBlue Shield After deductible, You pay 20% Out-of-NetworkNon-Blue ShieldAfter 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 48

Medical PlanProvidersCosts Blue Shield HSP PreferredBlue Shield After deductible, You pay 20% Out-of-NetworkNon-Blue ShieldAfter 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 49

50 Medical Plan Provider Out of Network Core PreferredBlue Shield After deductible, You pay 20% Out-of-networkNon-Blue ShieldAfter 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

ResourcesResources ◊ Plan contacts ◊ Plan rates Medical PlansMedical Plans ◊ Benefit summaries ◊ Links to provider directories ◊ Links to plan websites Other plansOther plans ◊ Dental, vision, FSA 51

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Medical Plan Design 101 HMOPPOPLUS

Insurance plan delegates your care to a “medical group” (e.g. Sansum, SB Select IPA) Care is coordinated by a Primary Care Physician (PCP) and medical group Member selects PCP, PCP refers to specialists Predictable, low cost, copay for services - no deductibles Emergency and urgently needed care when away Health Net Blue & Gold HMO Kaiser HMO 54

55 You receive services You pay nothing at the time of service for in-network care Provider sends claim for services to health plan Health plan sends EOB Explanation of Benefits (EOB) outlines allowed charges, deductible and co-insurance. “This is not a bill”. Provider sends bill The bill should match the EOB. It should reflect the in-network discount and any payments received from health plan. You pay provider

Fair Health Consumer Health Care Blue Book Good Rx – drug costs 56

The HSA is NOT like the Health FSA where you have access to the entire annual contribution starting on January 1The HSA is NOT like the Health FSA where you have access to the entire annual contribution starting on January 1 The HSA is like a checking account – the money must be in the account before you can spend itThe HSA is like a checking account – the money must be in the account before you can spend it ◊ You make monthly contributions through payroll deduction, you can change the contribution amount during the year ◊ You can make one time contributions through Health Equity 57

Go to your doctor Later – check your HealthEquity account online to see required payment to the doctor Pay with your HSA funds through your HealthEquity online account. OR Pay with another source (e.g. check, credit card) Give doctor’s office your Blue Shield card so BSC can…   process the claim and get you their special provider discounts and   send info about your amount of claim responsibility to Health Equity

59 Primary Care Physicians Specialists Labs Radiology Durable Medical Equip Urgent Care Hospitals When you need care go to your PCP PCP refers you to specialist, x-ray, lab, hospital HMO Medical Group Medical Group authorizes referrals to some specialists and treatment Access to Care

You direct your own care, you decide where to receive services You pay annual deductibles before plan pays After deductible, you share the cost of each service with the plan - coinsurance Your costs are lower if you select preferred providers “Out-of-pocket Maximum” limits your financial liability 60

January Calendar Year December Deductible You pay CoinsuranceCopay You share cost with plan Out-of-Pocket Maximum Plan pays 100% 61