1. UC Health Savings Plan UCSB Human Resources, Benefits 1
This presentation is intended for communication purposes only. Please see the UCnet website ( and plan documents for complete information. 1
11/2016

2. What’s new, what’s the same?
PPOs have new administrators
PPO plan designs and benefits are much the same
Coverage
2016
2017
Medical
Blue Shield
Anthem Blue Cross
Behavioral Health
Optum Behavioral Health
(Core – Blue Shield)
Prescription Drug
Optum Rx

3. Transition - PPO Networks
Anthem has been working to reduce disruption
Blue Shield and Optum providers have been invited to join the Anthem network
Transition of Care Support
PPO members may request transition-of-care support if they are a continuing member of a PPO plan and are currently receiving medical or behavioral health care from a provider that is not in Anthem’s network. See details on Open Enrollment booklet and website.

4. Resources Anthem Health Guides M-F 5:00am – 8:00pm PT 844-437-0486
HealthEquity
Always Open
OptumRx
M-F 7:00 a.m. to 8:00 p.m PT

5. + UC Health Savings Plan Combines high deductible PPO with
account to pay out-of-pocket expenses +
Medical Coverage
Anthem PPO
Health Savings Account
HealthEquity

6. What’s special about the HSP?
High deductible PPO medical plan
Deductible and OOPM shared by all family members
Medical, drug and behavioral health expenses apply to deductible and OOPM
Administered by Anthem Blue Cross

7. What’s special about the HSP?
Health Savings Account (HSA)
UC makes an annual contribution to this account
You may also make pre-tax contributions
You use the HSA funds to pay medical and other health care expenses
Money in HSA is yours to keep
Funds rollover
May invest funds
Administered by HealthEquity

8. You share % Coinsurance
How does the plan work?
You pay
Annual
Deductible
You share % Coinsurance
Use HSA to pay deductible and coinsurance
or save for retirement

9. Who is eligible for HSA?
Are you eligible to make contributions to the Health Savings Account ?

10. May not be in Medicare May not be enrolled in Medicare A or B
Did you enroll in Medicare at age 65?
Were you automatically enrolled when you signed up for a Social Security pension?

11. May not have other coverage
May not be in another medical plan
May not be enrolled in a Health Flexible Spending Account (FSA)
Must have $0 balance in Health FSA on December 31, 2016
Complete all claims reimbursement by December 31, 2016

12. …and a couple of more rules
May not be claimed as a dependent on someone else’s tax return
Must live in US
Consider whether you are eligible for the Health Savings Plan

13. Anthem PPO
Medical, drug and behavioral health expenses apply to deductible and OOPM
All family members share a common deductible and OOPM +
Medical Coverage
Anthem PPO
Health Savings Account
HealthEquity

14. Anthem PPO - Plan Design
Medical, Drug and Behavioral Health Expenses
In Network
Out of Network
Deductible
Single
Family
$1,300
$2,600
$2,500
$5,000
Member Cost Sharing (Coinsurance)
20%
Plan pays 60% of allowed rate
You pay balance
Out-of-Pocket Max
(includes deductible)
$4,000
$6,400
$8,000
$16,000

15. Deductible, Coinsurance, OOPM
Individual (Single)
Preferred Providers
You pay
You share cost with plan
Plan pays
100% after you pay
$1300 Deductible*
20% Coinsurance
$4000 OOPM
*You can use the UC Contribution to the Health Savings Account to pay part of the deductible.

16. Deductible, Coinsurance, OOPM
Family (2 or more) Preferred Providers
The full family deductible must be met before plan shares costs
You pay
You share cost with plan
Plan pays
100% after you pay
$2600 Deductible*
20% Coinsurance
$6400 OOPM
*You can use the UC Contribution to the Health Savings Account to pay part of the deductible.

17. Allowed Amount – In Network
PPO plans negotiate “allowed” rates to process claims.
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: $200 Allowed amount: $100
Plan pays 80%: $80
You pay 20% $20
Provider write-off: $100

18. Allowed Amount – Out of Network
PPO plans assign “allowed” rates to process claims.
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”
Balance over allowed amount does not apply to OOPM
40% Coinsurance
Provider charge: $200 Allowed amount: $100
Plan pays 60%: $60 (60% of $100)
You pay 40%: $40
You pay balance: $100

19. Claims, EOBs & Bills You receive services
You pay nothing at the time of service for in-network care
Provider sends you bill The bill should match the EOB. It should reflect the in-network discount and any payments received from health plan.
Provider sends claim to Anthem
You pay provider
Pay with HSA funds or
Pay with other funds
Anthem sends you EOB Explanation of Benefits (EOB) outlines allowed charges, deductible and co-insurance. “This is not a bill”.

20. Preventive Care
Preventive care is covered at 100% with Anthem PPO providers
Preventive care includes:
Annual well visit and labs
Well woman visits and labs
Preventive screening tests
Immunizations
See list of preventive services on

21. Prescription Drugs There is no separate drug plan with copays
Drug expenses are applied to the plan in the same way as medical expenses
You pay full cost of medication until you satisfy the deductible
After deductible, you pay 20% at preferred pharmacies

22. Worldwide BlueCard or any provider for emergency and urgent care
In-Network Providers
Anthem Blue Cross
Blue Cross Blue Shield
Out of US
Worldwide BlueCard or any provider for emergency and urgent care

23. OptumRx

24. Pharmacy Claims You go to the pharmacy
Show pharmacist your Anthem ID so you get the OptumRx discount
Pay with your HSA debit card or
Pay with personal funds and later go to your HealthEquity account online and reimburse yourself (if you have money in the account)

25. Learn more about PPO Costs
Fair Health Consumer Health Care Blue Book OptumRx – drug costs

26. Find costs on Anthem Website
After your Anthem membership is active, you will have access to additional tools.
Castlight -Treatment Cost Estimator Tool
Claims and plan details

27. anthem.com/ca/uc
Register in 2017

29. Health Savings Account
Health Saving Account
The Health Savings Account is a separate account that can be used to pay medical and other health expenses. +
Medical Coverage
Anthem PPO
Health Savings Account
HealthEquity

30. Advantages of an HSA
HSA funds rollover from year to year; no use it or lose it as with Health FSA
You keep the money even if you change jobs or insurance plans
You may make contributions at any time
Contributions have triple tax advantage
No Federal taxes on contributions
No taxes when funds are used
No taxes on earnings from investments

31. Build Savings by Investing
You can invest HSA balances of $1000 or more
HealthEquity offers Best-in-Class mutual funds
Three investment methods depending on your preference for managing the funds on your own or getting help from advisors
hsa/investment

32. How the HSA works UC contributes in January You contribute anytime
Your 2016 payroll deduction will carryover
Pay eligible expenses using:
Debit card
Health Equity website

33. Annual Contributions by UC & Employee
UC Contribution (1/1/17)
$500 individual
$1000 family (2 or more)
You can contribute up to (optional):
Single-coverage: $2,900 ($3,400 – $500)
Family-coverage: $5,750 ($6,750 – $1,000)
Catch-up contribution, age 55+: $1,000
UC Contribution is prorated for plans that start after January 1

34. How to make HSA contributions?
During Open Enrollment
Use AYSO application to elect a pre-tax monthly payroll deduction
After Open Enrollment
Submit UPAY 850 form to Benefits to start or change monthly pre-tax payroll deduction – timing of deduction based on payroll deadlines
Make post-tax contribution to Health Equity – write off contribution on you annual taxes

35. Use the HSA to pay for… Deductible Coinsurance
Any IRS Publication 502 Expenses, including:
Medical
Dental
Vision
Prescription drug
Long Term Care insurance premiums
See for details

36. Whose expenses can be paid with HSA?
Family members who are dependents on your tax return
The family member does not have to be enrolled in this plan
Older children enrolled in your plan but are not tax dependents can’t use HSA funds to pay the health expenses

37. HSA vs FSA
The 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 it
No claim “substantiation” required
You are responsible to IRS for expenses paid using HSA funds

38. Your Responsibility Follow HSA eligibility rules
Contribute only the amount allowed by IRS
Use HSA funds for eligible expenses
Keep itemized receipts as tax documents

40. Manage your HSA

41. Claim Summary Screen Details View claim Resolve Pay Provider
Reimburse Me
Close
Pay from HSA account or external checking/savings account
Schedule payment