1. UC Retiree Health Benefits UCSB Health Care Facilitator Program Laura Morgan 893-4201 UC Retirement Administration Service Center (RASC) 800-888-8267 http://ucnet.universityofcalifornia.edu 4/30/2015

2. This presentation is intended for communication purposes only, it is not a guarantee of benefits. Details about the UC policies and health plans are available on UCnet. http://ucnet.universityofcalifornia.edu/compensation-and-benefits/index.html 2

3. Join the Emeriti or Retiree Association  Local events & parties, email listserv & quarterly newsletters, advocacy  Within two weeks of your official retirement date you will receive a Welcome Letter, retiree ID card, list of privileges and a retiree or emeriti membership application  Debra Martin, Coordinator 805-893-2168 debra.martin@hr.ucsb.edu http://www.hr.ucsb.edu/retirees/welcomedebra.martin@hr.ucsb.edu

4. 4 Agenda Future of retiree health benefits Eligibility for retiree health benefits Transition to retiree health plans Health plan premiums Overview of Medicare Enrolling in Medicare Coordination with Medicare How UC Medicare plans work

5. 5 Future of Retiree Health Committed to ongoing health benefit Retiree plan designs are likely to change over time Retiree share of premium will increase UC may reduce the overall level of contribution to retiree health programs by 3% per year, to a floor of 70%.

6. 6 Health Benefit – “fine print” UC's contribution toward the monthly cost of medical and dental coverage is determined by UC and may change Not a guaranteed benefit Subject to California's annual budget appropriation

7. Eligibility for Health Benefits Meet the UCRP service credit eligibility requirements for medical and dental coverage Choose to receive a monthly retirement benefit Benefits end if you select “lump sum cashout” Be eligible for UC-sponsored coverage when you leave UC employment Be enrolled in either UC coverage or other qualifying non-UC coverage 7

8. Eligiblity cont’d Elect to continue coverage at the time of retirement or to suspend UC coverage because of other qualifying coverage Have a retirement date that is within 120 calendar days of your separation from employment Have continuous coverage until the date your retirement income begins 8

9. 9 3 Eligibility Groups 1.UCRP entry prior to 1/1/1990 2.UCRP entry or reentry on or after 1/1/1990 to 6/30/2013 3.UCRP entry or reentry on or after 7/1/2013 Each group has specific service credit and/or age requirements

10. 10 1. UCRP entry prior to 1/1/90 Retire before 55 w/ 10 years service credit* Retire at 55 or later w/ 5 years service credit * Five years for Safety members

11. 11 2. UCRP entry/reentry 1/1/1990 to 6/30/2013 Retire at age 50 or later w/ 10 years service credit OR “Age + service credit = 75”

12. 12 3. UCRP entry/reentry on/after 7/1/2013 Retire at 56 or later w/ 10 years service credit

13. 13 Transition to Retiree Health At retirement, you and your enrolled family members transfer from the “employee” to the “retiree” insurance program Employee insurance ends the month following your separation date – example: Separate on June 29 Employee insurance ends July 31 Retiree insurance starts August 1

14. Transition cont’d Medical – continues with UC contribution Non-Medicare retirees remain in same medical plan If eligible for Medicare, retiree and/or family members must enroll in Medicare A & B and transfer to Medicare coordinated plan Dental - continues with UC contribution Retiree VSP - may elect to continue and pay for coverage in full 14

15. Transition cont’d May change plans during Open Enrollment OR if you move out of your plan’s service area RASC counselor will help you with the transition and paperwork 15

16. 16 Dental Delta PPO or DeltaCare USA Coverage remains the same Premium paid in full by UC OR subject to “graduated eligibility”

17. 17 Vision Retiree Vision Services Plan (VSP) Enroll in Retiree VSP to continue coverage Pay full premium to VSP – see rate chart Same coverage as employee plan Routine eye exam and eye wear Health Net Seniority Plus Medicare version of Health Net Vision benefit similar to VSP No additional monthly premium

18. Medical Plans Non-Medicare Plans Retirees and family members who are not 65 or are not eligible for Medicare Same plans as employees Medicare Coordinated Plans Retirees or family members who are 65 or older, or disabled and eligible for Medicare Must enroll in Medicare A & B UC Medicare plans 18

19. Medical Plans 19 Non-Medicare Health Net Blue & Gold HMO Kaiser HMO UC Care (PPO) Blue Shield Health Savings Core (PPO) Medicare Health Net Seniority Plus HMO Kaiser Senior Advantage HMO Blue Shield Medicare PPO with Rx Blue Shield Medicare PPO without Rx High Option Supplement Same as employee plans Coordinated with Medicare

20. Transition to Medicare Plan 20 Employee PlanMedicare Plan Health Net Blue & Gold HMOHealth Net Seniority Plus HMO Kaiser HMOKaiser Senior Advantage HMO UC Care (PPO)Blue Shield Medicare PPO w/Rx Blue Shield Health SavingsBlue Shield Medicare PPO w/Rx Core (PPO)Blue Shield Medicare PPO w/Rx If you or a family member are eligible for Medicare when you retire, you will change plans at that time.

21. Split Families – Partner Plans 21 Non-Medicare MembersMedicare Members Health Net Blue & Gold HMOHealth Net Seniority Plus HMO Kaiser HMOKaiser Senior Advantage HMO UC Care (PPO)Blue Shield Medicare PPO w/Rx Core (PPO)Blue Shield Medicare PPO w/Rx When a family has both non-Medicare & Medicare members Blue Shield Health Savings is not available to split family

22. 22 Behavioral Health All plans cover mental health care and substance abuse treatment Provider networks may change when enrolled in Medicare plan

23. Behavioral Health Providers 23 Medical PlanNon-MedicareMedicare Health Net B&G/ Seniority Plus OptumMHN with Medicare Kaiser/ Senior Advantage Optum & KaiserKaiser UC Care (PPO) Blue Shield HSP Optum & non-Optum N/A CoreBlue ShieldN/A Blue Shield PPO High Option N/AMedicare & Blue Shield

24. 24 Are you moving? Available in US UC Care Blue Shield Health Savings Plan Core Blue Shield Medicare PPO (see Exchange One) High Option (see Exchange One) Must live in California service area Health Net, Kaiser Available when LIVING out of US UC Care, Core (without Medicare)

25. 25 OneExchange – Out of CA Retirees living out of California in USA ALL family members are enrolled in Medicare UC makes annual contribution to a Health Reimbursement Account (HRA) for retiree and each family member Retiree uses HRA funds to purchase individual Medicare supplement plan through OneExchange UC contribution is subject to graduated eligibility Can use extra HRA funds to pay medical expenses and Part B premium

26. 26 OneExchange – Enrollment UC Retiree Insurance Program will notify you in September if you are required to transfer from the UC medical plan to a local Medicare plan You will be directed to call an OneExchange counselor for information about plan options and assistance enrolling You will select from Medicare Supplement plans and Part D (Drug) plans that are available where you are living

27. 27 Retiree Health Premiums Each year UC determines the maximum amount that UC will pay toward a retiree’s medical and dental insurance Some retirees receive the “maximum UC contribution” Some retirees have “graduated eligibility” and receive a % of the maximum amount The amount of the UC contribution depends on: Retiree health eligibility rules Years of UCRP service credit Age – factor added for 7/1/2013 group

28. 28 Maximum UC Contribution Hired prior to 1/1/90 (UCRP entry date) Hired on/after 1/1/90 with 20 years of UCRP service credit See Retiree Medical Plan Costs on UCnet http://ucnet.universityofcalifornia.edu/compensation-and- benefits/health-plans/medical/retiree-plan-costs.html

29. 29 Maximum UC Contribution – Rate Chart All family members in Medicare One or more are not in Medicare Non-Medicare Plans All family members under 65 Non-Medicare Age 65 and Over UC Retiree did not coordinate with Social Security when employed No one in family eligible for Medicare Rates are same as employees in salary band 2

30. 30 Medicare Part B Reimbursement If your UC medical plan premium is zero, you may receive a full or partial "reimbursement" of your Medicare Part B premium – example for Kaiser Senior Adv: $0.00 $91.99 > added to UC pension The amount of the reimbursement depends on the premium UC is charged by the insurance carrier for your plan

31. 31 Graduated Eligibility – Group 2 Hired on/after 1/1/90 (UCRP entry/reentry date) with less than 20 years of UCRP service credit UC contributes 50% of the maximum contribution at 10 years of service credit UC contribution increases 5% per year of service credit “Age + service credit = 75” -- 50% of max Find rate on UCnet using “Medical Plan Chooser”

32. 32 Graduated Eligibility Years Service Credit % of Maximum Contribution Years Service Credit % of Maximum Contribution Age+years = 75 50%1575% 1050%1680% 1155%1785% 1260%1890% 1365%1995% 1470%20100%

33. 33 Graduated Eligibility – Example $454 Maximum UC Contribution (single/non-MC) $340 75% of Maximum UC Contribution $662 Gross premium (single/HN Blue & Gold) - $340 75% of Maximum UC Contribution $322 = Monthly premium paid by retiree Service credit = 15 years UC pays 75% of “Maximum UC Contribution”

34. 34 https://uc2015.chooser2.pbgh.org

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36. 36 Graduated Eligibility – Group 3 Hired on/after 7/1/2013 UC Contribution calculated using age and service credit; 100% at age 65 w/ 20 years of service credit Graduated eligibility chart is posted on Future of UCRP website – see Fast Facts

37. 37 Monthly Premiums Medicare Part B $104.90 – standard rate in 2015 Deducted from Social Security check or you pay directly UC Medical and Dental Deducted from UC pension check Part B Reimbursement added to check UC Retiree Vision – paid to VSP

38. 38 “Income Related Adjustment” Medicare Part B and D premiums may be higher for retirees with incomes over: $85,000 – single $170,000 – married

39. 39 What is Medicare? Federal program that provides health insurance to: People 65 or older People with disabilities Covers most medical services Does not pay total cost of care Foundation for all UC Medicare plans

40. 40 Medicare Eligibility Your own work history Work history of spouse or ex-spouse Contact Social Security to clarify your eligibility

41. 41 Three Parts of Medicare In-patient hospital Home health care Skilled nursing facility Hospice care Office visits Lab tests Physical therapy Medical equipment Some preventive care Part B - Medical Part A - Hospital Part D – Prescription Drugs

42. 42 Medicare Premiums in 2015 Medicare Part A – No monthly premium Medicare Part B - $104.90 per month May cost more for retirees with higher incomes Deducted from Social Security check or you pay directly Medicare Part D – No monthly premium May cost more for retirees with higher incomes

43. 43 When to enroll in Medicare? Employees Eligible at retirement Eligible after retirement

44. 44 Employees Do not enroll in Medicare Part B or D Spouse enrolled in your UC employee medical plan does not need to enroll * “Special enrollment period” when UC employee retires You may enroll in Part A when first eligible at age 65 – not required * * See special considerations

45. Employees – Special Considerations Domestic partners should consult Social Security about when to apply for Medicare Blue Shield Health Savings Plan members may NOT be enrolled in Medicare A, B or D IRS does not allow Medicare recipients to make contributions to a Health Savings Account (HSA) Delay enrollment in Medicare until retirement Please note: If you are drawing a Social Security Pension, you will automatically be enrolled in Part A at age 65 – you can’t contribute to HSA. 45

46. 46 Eligible at Retirement You and your family members who are eligible for Medicare must enroll in Parts A & B Go to Social Security office two month before UC employee retires RASC will mail you forms: “Request for Employment Information” for Social Security Office UC form(s) to enroll in UC Medicare plan – one for each family member on Medicare

47. 47 Eligible after Retirement You and your family members who are eligible for Medicare must enroll for Parts A & B Go to Social Security office or www.ssa.gov about three months before turning 65 OR If receiving a Social Security pension, you will get a Medicare card in the mail UCOP will mail you and family members UC forms to enroll in the UC Medicare plan

48. Initial Enrollment Questionnaires Purpose is to determine if Medicare is your primary insurance Do you have group health plan (GHP) coverage (based on your own or a spouse’s current employment)? Answer NO – if your UC insurance is from RETIREE plan not an employer group plan Answer YES – if you have insurance benefit as active employee or spouse of active employee 48

49. 49 Coordination with Medicare HMO Advantage Health Net Seniority Plus Health Net Seniority Plus Kaiser Senior Advantage Kaiser Senior Advantage You assign your Medicare to the insurance plan Cannot use Medicare outside the plan Blue Shield PPO Blue Shield PPO w/o Rx High Option Supplement Medicare is primary payer Blue Shield is secondary

50. Blue Shield & Medicare Crossover “Medicare Crossover” allows Medicare to electronically transfer claims to Blue Shield for secondary payment Blue Shield initiates the crossover with Medicare You may receive a questionnaire requesting information about enrollment in other insurance plans or Medicare Call the number on the form – easier than trying to answer questions in writing 50

51. 51 Choice of Physician Any Medicare physician Blue Shield PPO Blue Shield PPO w/o Rx High Option Supplement Sansum Clinic is only HNSP provider in Santa Barbara Change to Sansum PCP Change to Blue Shield plan HMO Advantage Health Net Seniority Plus Health Net Seniority Plus Kaiser Senior Advantage Kaiser Senior Advantage You select PCP PCP coordinates care PCP refers to specialists Specialists limited to physicians in medical group

52. HMOs have copays for care 52 ServiceCopay Deductible$0 Office Visit$20 Urgent Care$20 Emergency Room$65 Outpatient Surgical Center$100 Inpatient Hospital$250 Health Net Seniority Plus Kaiser Senior Advantage

53. 53 Blue Shield - Deductibles Deductibles paid by Blue Shield Medicare Part A (Hospital) = $1260 Medicare Part B (Medical) = $147 Deductible paid by you Plan deductible for services not covered by Medicare (e.g. acupuncture, hearing aids) Blue Shield PPO = $100 per individual/year High Option = $50 per individual/year

54. Blue Shield – Office Visit Example Who pays? Medicare pays 80% Blue Shield pays You pay for services 54 Medicare Allowable = $150 PPO $120 $24 $6 High Option $120 $30 $0

55. Blue Shield – Hospital Example 55 Who pays? Blue Shield pays You pay for services PPO $1,260 $0 High Option $1,260 $0 Stay of 1-60 days Medicare Part A Deductible = $1,260 Medicare pays balance of bill

56. Blue Shield – Skilled Nursing 56 Who pays for 21 st – 100 th day? Blue Shield pays You pay for services PPO 80% $126 $31.50/day High Option 100% $157.50 $0 Medicare pays all but $157.50 per day 21 st to 100 th day: Daily rate = $ 157.50 1 st to 21 st day: Paid in full by Medicare

57. 57 Are you traveling out of US? HMOEmergency & Urgent Care only Blue Shield PPO Plan pays 80% High Option Plan pays 80%

58. 58 Prescription Drugs - Part D All Medicare plans have Part D except Blue Shield PPO without Rx NO additional premium for Part D, for most Copays – NO “donut hole” Some formulary (drug list) changes ID cards with Part D logo HMO members receive 1 card Blue Shield members receive 2 cards 1 medical card and 1 drug card

59. Prescription Drug Costs Health Net * Kaiser Blue Shield Retail (30 day) Generic Brand Non-formulary $5 $25 $40 $10 $30 $45 Mail Order (90 day) Generic Generic Brand Brand Non-formulary Non-formulary $10 $50 $80 $20 $60 $90 NOTE: With Health Net Seniority Plus you pay 25% of the cost of some self-injectable and higher cost specialty drugs, up to $2000/year. See Medicare Part D formulary on http://www.healthnet.com/uchttp://www.healthnet.com/uc 59

60. Blue Shield PPO w/o Rx Medicare allows one Part D (Drug) plan Retirees enrolled in a non-UC Part D group or individual plan may enroll in the Blue Shield PPO without Rx Medical coverage will be provided by the UC Blue Shield PPO insurance Drug coverage will be provided by the non-UC insurance 60

61. Out-of-Pocket Maximums 61 After an individual pays the following amount for medical services or prescriptions drugs, the plan pays 100% of the costs for the rest of the year. Medicare PlanMedicalDrug Health Net Seniority Plus$1,500$2,000 Kaiser Senior Advantage$1,500$4,700 Blue Shield Medicare PPO$1,500$4,700 High Option$1,050$1,000

62. Suspend UC Retiree Insurance You may “suspend” UC medical or dental insurance if you have other group or individual insurance You may reenroll in UC retiree insurance When you have an “involuntary loss of coverage” During any Open Enrollment period 62

63. 63 Can’t stay away??? Review the Rehired Retiree policy Returning to work can impact how your medical plan coordinates with Medicare Contact Benefits Office at 893-2489

64. 64 Web Resources http://ucnet.universityofcalifornia.edu Health plan information and rates Medical Plan Chooser Complete Guide to Retirement Benefits Retirement Handbook http://www.ssa.gov Apply for Medicare Benefits http://www.medicare.gov Original Medicare coverage and publications “Your Medicare Benefits” booklet

65. Resources RASC – Retirement Administration Services Center Process retirements for UC employees UC retiree health plans 1-800-888-8267 HICAP - Health Insurance Counseling and Advocacy Program Medicare information and assistance 1-800-434-0222 65

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