11/3/11 11 Open Enrollment Highlights Laura Morgan UCSB Human Resources, Benefits This presentation is intended for communication purposes only. Please see plan document and for complete information. Big changes New choices 11/1/2013 Updated 11/22/13

This presentation is intended for communication purposes only, it is not a guarantee of benefits. Please see insurance plan documents and for complete information. 2

Ends Tuesday, November 26, 5:00 pmEnds Tuesday, November 26, 5:00 pm Make changes onlineMake changes online All changes are effective January 1, 2014All changes are effective January 1,

Change medical and/or dental planChange medical and/or dental plan Enroll in medical, dental, visionEnroll in medical, dental, vision Add eligible family membersAdd eligible family members Enroll or re-enroll in Health Flexible Spending Account (FSA)Enroll or re-enroll in Health Flexible Spending Account (FSA) ◊ unless you select the Blue Shield Health Saving Plan) Enroll or re-enroll in Dependent Care FSAEnroll or re-enroll in Dependent Care FSA 4

For unions in “status quo” or “reopeners” the following may not change:For unions in “status quo” or “reopeners” the following may not change: ◊ Monthly contribution rates for plans ◊ Payband levels  An individual’s MCB can go up or down Monthly employee contributions for the new 2014 medical plans will be the same for all participantsMonthly employee contributions for the new 2014 medical plans will be the same for all participants 5

atyourservice.ucop.edu/oe Booklet 6

Link from Open Enrollment website: 7

Comprehensive review of UC's medical plan portfolioComprehensive review of UC's medical plan portfolio Ensure good benefits while limiting cost increases for employees and the universityEnsure good benefits while limiting cost increases for employees and the university Maintain choices to address individual needsMaintain choices to address individual needs Opportunity to leverage UC's medical centersOpportunity to leverage UC's medical centers Respond to health care reform and a changing medical-insurance marketplaceRespond to health care reform and a changing medical-insurance marketplace 8

Anthem PPO UC Care PPO (administered by Blue Shield) Anthem PLUS Anthem Lumenos HRA-PPO Blue Shield Health Savings Plan (PPO) Health Net Blue & Gold HMO Health Net HMO Kaiser HMO Core 9

Medical Plan2014 Medical Plan Health Net Blue & Gold HMO Health Net HMO (full)Health Net Blue & Gold HMO Kaiser HMO Anthem PLUSUC Care Anthem PPOUC Care Anthem Lumenos HRABlue Shield Health Savings Plan Anthem CoreBlue Shield Core

Cost to enroll – monthly premiumCost to enroll – monthly premium Cost of careCost of care ◊ Predictable, low cost copays ◊ Pay a % of each service Choice of providersChoice of providers ◊ HMO medical group physicians ◊ PPO preferred network or any provider Effort to manage – coordinating care & billsEffort to manage – coordinating care & bills 11

Medical Plan Design 101 HMOPPOPOS

Care is delivered by physicians in a “medical group” (e.g. Sansum, SB Select IPA)Care is delivered by physicians in a “medical group” (e.g. Sansum, SB Select IPA) Care is coordinated by Primary Care Physician and medical groupCare is coordinated by Primary Care Physician and medical group Member selects PCP, PCP refers to specialistsMember selects PCP, PCP refers to specialists Set copay for most services, no deductiblesSet copay for most services, no deductibles Emergency and urgently needed care when awayEmergency and urgently needed care when away Health Net Blue & Gold HMO Kaiser HMO 13

You direct your own care, you decide where to receive servicesYou direct your own care, you decide where to receive services You pay annual deductibles before plan paysYou pay annual deductibles before plan pays After deductible, you share the cost of each service with the plan - coinsuranceAfter deductible, you share the cost of each service with the plan - coinsurance Your costs are lower if you select preferred providersYour costs are lower if you select preferred providers “Out-of-pocket Maximum” limits your financial liability“Out-of-pocket Maximum” limits your financial liability UC Care Blue Shield Health Savings Plan 14

January Calendar Year December Deductible You pay CoinsuranceCopay You share cost with plan Out-of-Pocket Maximum Plan pays 100% 15

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” Coinsurance20% 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. 16

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” Coinsurance50% 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. 17

18 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 Estimate cost of medical proceduresEstimate cost of medical procedures “LEARN” tab – print and video resources“LEARN” tab – print and video resources ◊ How plans work ◊ Cost Sharing, know what you may owe Good Rx Estimate cost of drugs (for Blue Shield HSP)Estimate cost of drugs (for Blue Shield HSP) 19

Combines HMO and PPO plan designsCombines HMO and PPO plan designs Limit costs by using HMO providersLimit costs by using HMO providers Can use providers outside HMO group, but cost for service will be higherCan use providers outside HMO group, but cost for service will be higher Anthem PLUS in discontinued 20

Physician Specific physicianSpecific physician More choice of physicians and facilitiesMore choice of physicians and facilities Cost Monthly cost Predictable copays What is your priority? 21

2014 Medical Plans Health Net Blue & Gold HMO Kaiser HMO UC Care Blue Shield Health Savings Plan Core

23 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

24 HMO (Health Net, Kaiser) Limited to emergency and urgent care onlyLimited to emergency and urgent care only No routine careNo routine care 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 benefit.Plan pays Preferred benefit. CORE UC Care Comprehensive coverageComprehensive coverage Plan pays out-of-network benefit.Plan pays out-of-network benefit.

Full Network HMO is being discontinuedFull Network HMO is being discontinued ◊ In Ventura County, some medical groups will no longer be available to Health Net members ◊ Employees should consider UC Care or Kaiser HMO Health Net Blue & Gold HMO will continue with few benefit changesHealth Net Blue & Gold HMO will continue with few benefit changes ◊ In Santa Barbara County, all HMO medical groups participate in Blue & Gold ◊ In Ventura County, not all HMO groups participate 25

You select a Primary Care Physician (PCP) to coordinate your careYou select a Primary Care Physician (PCP) to coordinate your care PCP refers you to specialistsPCP refers you to specialists Predictable copays for services:Predictable copays for services: ◊ $20 office visit ◊ $20 urgent care ◊ $75 emergency room (if not admitted) ◊ $100 outpatient surgical center ◊ $250 hospital (in-patient) 26

Kaiser will continue in Ventura CountyKaiser will continue in Ventura County You select Kaiser PCPYou select Kaiser PCP PCP refers you to Kaiser specialistsPCP refers you to Kaiser specialists Predictable copays for services:Predictable copays for services: ◊ 20 office visit ◊ $20 urgent care ◊ $75 emergency room (if not admitted) ◊ $100 outpatient surgical center ◊ $250 hospital (in-patient) 27

New self-funded PPO planNew self-funded PPO plan Created for UC employees and non- Medicare retireesCreated for UC employees and non- Medicare retirees UC Medical Centers are part of the “UC Select” network of providersUC Medical Centers are part of the “UC Select” network of providers No PCP, no referral required for specialistNo PCP, no referral required for specialist 28

Customized for UC Care UC Health System + Select Blue Shield providers UC Select Providers Similar to the standard in network cost-share of the previous Anthem PPO plan Blue Shield Preferred Providers Flexibility to use services from any provider outside the UC Select or Blue Shield Preferred network Non-Preferred Providers Blue Shield of California – claims administrator & network 29

UC SelectUC Select ◊ All UC medical centers, facilities and physicians ◊ Additional select Blue Shield PPO providers in areas where UC medical centers and physicians are not accessible Blue Shield Preferred PPO in CaliforniaBlue Shield Preferred PPO in California ◊ 97% of Anthem PPO are also Blue Shield Preferred Blue Shield outside of CA and USBlue Shield outside of CA and US ◊ Blue Cross Blue Shield Network out of CA ◊ BlueCard Network or any physician out of US 30

UC Select providers inUC Select providers in ◊ Santa Barbara – Sansum Clinic ◊ Santa Maria ◊ Lompoc ◊ Ventura Currently, Sansum Clinic is the only UC Select providers in Santa Barbara areaCurrently, Sansum Clinic is the only UC Select providers in Santa Barbara area ◊ High cost hospital and medical groups ◊ Still negotiating 31

Most Anthem Plus and PPO providers are also in the UC Care Blue Shield Preferred networkMost Anthem Plus and PPO providers are also in the UC Care Blue Shield Preferred network Cottage Hospital and Sansum Clinic are Blue Shield Preferred providersCottage Hospital and Sansum Clinic are Blue Shield Preferred providers Provider directory: blueshieldca.com/uccareppo or link from 32

Your costs depend on the service and the network status of the providerYour costs depend on the service and the network status of the provider UC Select – no deductible, copays for most services but not allUC Select – no deductible, copays for most services but not all Blue Shield Preferred – deductible and you pay 20% coinsurance for most servicesBlue Shield Preferred – deductible and you pay 20% coinsurance for most services Non-Preferred – deductible and plan pays 50% of allowed rateNon-Preferred – deductible and plan pays 50% of allowed rate 33

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) 34

$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) 35

There are two charges for emergency care with a PPO plan design:There are two charges for emergency care with a PPO plan design: ◊ “Facility” – billed by the hospital ◊ “Professional” – billed by the ER physicians Emergency Room Visit (not admitted)Emergency Room Visit (not admitted) ◊ Emergency room: $100 per visit ◊ Emergency physician services: 20% ◊ Same coverage across all provider networks 36

Shield Concierge Blue Shield/UC dedicated line M-F, 7 to

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Blue Shield PPO + High deductible medical plan paired with a Health Savings Account Health Savings Account The Health Savings Account is not a component of the medical plan as HRA is with Lumenos. The Health Savings Account is not a component of the medical plan as HRA is with Lumenos. It is a separate account that can be used to pay medical and other health expenses. It is a separate account that can be used to pay medical and other health expenses. 39

You direct your own care, you decide where to receive servicesYou direct your own care, you decide where to receive services Medical and drug expenses apply to deductible and Out-of-Pocket Maximums (OOPM)Medical and drug expenses apply to deductible and Out-of-Pocket Maximums (OOPM) ◊ No separate drug plan with copays Family members share same deductibles and OOPMsFamily members share same deductibles and OOPMs Networks:Networks: ◊ Blue Shield Preferred ◊ Non-Preferred Providers 40

You pay You share cost with plan Plan pays 100% $1250 Deductible 20% Coinsurance $4000 OOPM Blue Shield Health Savings Plan Individual (Single) Preferred Providers 41

You pay You share cost with plan Plan pays 100% $2500 Deductible 20% Coinsurance $6400 OOPM Blue Shield Health Savings Plan Family Preferred Providers The full family deductible must be met before plan shares costs 42

Blue Shield PPO + High deductible medical plan paired with a Health Savings Account Health Savings Account HSA deposits are not taxes HSA deposits are not taxes HSA funds roll over from year to year HSA funds roll over from year to year Tax-free interest earned Tax-free interest earned You keep the money even if you change jobs or insurance plans You keep the money even if you change jobs or insurance plans 43

Health Equity manages the HSAHealth Equity manages the HSA UC makes annual contribution for plans that start on January 1.UC makes annual contribution for plans that start on January 1. ◊ UC contribution is pro-rated for mid-year enrollments You may contribute through payroll deductionsYou may contribute through payroll deductions Use account to pay for eligible health expenses (medical, dental, vision, etc)Use account to pay for eligible health expenses (medical, dental, vision, etc) 44

UC Contribution (1/1/14)UC Contribution (1/1/14) ◊ $500 individual ◊ $1000 family 2014 Maximum Contributions allowed by IRS2014 Maximum Contributions allowed by IRS ◊ Single-coverage: $3,300 ◊ Family-coverage: $6,550 ◊ Catch-up contribution, age 55+: $1,000 Tip: Contribute the money you would have put in your Health FSA. 45

Remaining Lumenos HRA money will roll-over into the Health Savings Account (4/1/14)Remaining Lumenos HRA money will roll-over into the Health Savings Account (4/1/14) Lumenos HRA $ are treated differently than HSA $ by IRSLumenos HRA $ are treated differently than HSA $ by IRS Lumenos HRA $ becomes a “Post Deductible Health Reimbursement Account” = PDHRALumenos HRA $ becomes a “Post Deductible Health Reimbursement Account” = PDHRA You must pay the Blue Shield HSP deductible with other funds BEFORE you can use the PDHRA to pay eligible expenses.You must pay the Blue Shield HSP deductible with other funds BEFORE you can use the PDHRA to pay eligible expenses. 46

To own an HSA you need to: Be covered ONLY by an HSA-qualified health planBe covered ONLY by an HSA-qualified health plan ◊ Other health coverage may disqualify you, including Health FSA, Medicare or traditional health plan ◊ Health FSA must have a $0 balance on Dec. 31, 2013 (complete any claims reimbursement by Dec. 31, 2013) Not be claimed as a dependent on someone else’s tax returnNot be claimed as a dependent on someone else’s tax return 47

Blue Shield and Health Equity share informationBlue Shield and Health Equity share information Employee receives welcome kit and live debit cardEmployee receives welcome kit and live debit card Use the “smart card” to pay for eligible health expensesUse the “smart card” to pay for eligible health expenses Can track and pay claims on Blue Shield websiteCan track and pay claims on Blue Shield website Invest HSA dollars when account balance reaches $2000 – no fees to investInvest HSA dollars when account balance reaches $2000 – no fees to invest 48

Health Equity Member Services is available every hour of every day: Call the Blue Shield/UC dedicated line say “Health Savings Account” (select "go" in the health savings plan section) 49

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High deductible PPOHigh deductible PPO Administered by Blue ShieldAdministered by Blue Shield $3000 deductible per individual$3000 deductible per individual Out-of-pocket Maximum is decreasingOut-of-pocket Maximum is decreasing 2013: $7,600 per individual 2013: $7,600 per individual 2014: $6,350 individual / $12,700 family Blue Shield PPO and non-PPO providersBlue Shield PPO and non-PPO providers Behavioral Health by Blue Shield PPOBehavioral Health by Blue Shield PPO 51

HMO UC Care Blue Shield HSP CORE Retail (30 day) Generic Generic Brand Brand Non-formulary Non-formulary$5$25$40 After you satisfy the deductible, you pay 20% at preferred pharmacies Mail Order (90 day) Generic Generic Brand Brand Non-formulary Non-formulary$10$50$80 Preferred Drug List (Formulary) is different for each carrier 52

Health Net & UC Care Generic drugs will automatically be dispensedGeneric drugs will automatically be dispensed Brand name drugs when generic is available will cost the member moreBrand name drugs when generic is available will cost the member more ◊ $5 generic copay + (brand price – generic price) Brand name is available if “medically necessary”Brand name is available if “medically necessary” ◊ e.g. Allergic to inactive ingredient ◊ Requires prior authorization from plan ◊ DAW, DNS does not = medical necessity 53

Core & Blue Shield Health Savings Plan Generic drugs will automatically be dispensedGeneric drugs will automatically be dispensed Brand name drugs when generic is available will cost the member moreBrand name drugs when generic is available will cost the member more ◊ Generic coinsurance + (brand price – generic price) Brand name is available if “medically necessary”Brand name is available if “medically necessary” ◊ e.g. Allergic to inactive ingredient ◊ Requires prior authorization from plan ◊ DAW, DNS does not = medical necessity 54

All UC Medical Plans continue to provide RX for smoking cessation at $0 cost (e.g., Chantix, Zyban)All UC Medical Plans continue to provide RX for smoking cessation at $0 cost (e.g., Chantix, Zyban) Over the Counter NRT covered at $5 (generic copay)Over the Counter NRT covered at $5 (generic copay)  OTC = Gum – Patch – Lozenge  Doctor’s Prescription Required  Kaiser Only - $0 Copay for both RX and OTC products 55

All medical plans, except CORE, use Optum therapists, psychologists and psychiatrists for in-network care. Health Net Blue & Gold and KaiserHealth Net Blue & Gold and Kaiser ◊ In-network benefit UC Care, Blue Shield Health Savings PlanUC Care, Blue Shield Health Savings Plan ◊ In-network and out-of-network benefit CoreCore ◊ In-network with Blue Shield clinicians and out-of-network benefit 56

All plans provide temporary transition or continuity of care service so members may complete a course of treatment and arrange for a safe transfer from a non-plan provider.All plans provide temporary transition or continuity of care service so members may complete a course of treatment and arrange for a safe transfer from a non-plan provider. Members who lost their current coverage due to plan disruption and were required to enroll in another health plan, AND are currently receiving services may be eligible for transition of care assistance.Members who lost their current coverage due to plan disruption and were required to enroll in another health plan, AND are currently receiving services may be eligible for transition of care assistance. Please call member services to discuss your situation.Please call member services to discuss your situation. 57

Other Plans & Programs

DeltaCare USA  Added Benefits ◊ Procedures to assess the level of risk associated with dental decay ◊ Gingival irrigation, a procedure to treat gums with medical solutions for health purposes Vision Service Plan  Diabetic Eye Care Plus Program ◊ Now extended to cover both Type I & II Diabetic members. ◊ Now extended to cover both Type I & II Diabetic members. ◊ Provides diabetic eye exam in addition to the routine vision examination ($20 copay)  Retiree Vision open for Enrollment 59

Closed to new enrollmentClosed to new enrollment Current members will continueCurrent members will continue 60

Health Flexible Spending Account Enroll or re-enroll in Health FSAEnroll or re-enroll in Health FSA Annual limit is $2,500Annual limit is $2,500 Blue Shield HSP members CANNOT enroll in a Health FSABlue Shield HSP members CANNOT enroll in a Health FSA Dependent Care Account Enroll or re-enroll in DepCare FSAEnroll or re-enroll in DepCare FSA Annual limit remains at $5,000 ($2,500 if married and filing a separate tax return)Annual limit remains at $5,000 ($2,500 if married and filing a separate tax return) YOU MUST RE-ENROLL EACH YEAR 61

New program – branded as UC Living WellNew program – branded as UC Living Well New provider – OptumNew provider – Optum Increased employee eligibilityIncreased employee eligibility More information in

Employees adding family members during Open Enrollment will be required to verify the eligibility of those family members with SECOVAEmployees adding family members during Open Enrollment will be required to verify the eligibility of those family members with SECOVA Employees who have previously verified their family members should NOT need to re-verifyeligibilityEmployees who have previously verified their family members should NOT need to re-verifyeligibility ◊ If an employee receives a request from SECOVA for a previously verified family member, please ask him/her to call SECOVA at

Employees covered by or eligible for UC Benefits, don’t need to take action in the new health Affordable Care Act insurance marketplace.Employees covered by or eligible for UC Benefits, don’t need to take action in the new health Affordable Care Act insurance marketplace. Covered California is the ACA marketplace in CACovered California is the ACA marketplace in CA Employees can explore options with Covered California if:Employees can explore options with Covered California if: ◊ They are not eligible for UC-sponsored benefits ◊ They have family members who age out or are no longer eligible for UC plans 64

Presentations and Fair - November 4Presentations and Fair - November 4 Town Hall - November 7Town Hall - November 7 PresentationsPresentations ◊ Medical Plan Comparison – Nov 13 & 21 ◊ Blue Shield Health Savings Plan – Nov 15 Help Desks w/ Computer Lab – Nov 8 and 22Help Desks w/ Computer Lab – Nov 8 and 22 65

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