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OPEN ENROLLMENT 2016 Introduction.  3% overall cost increase o 34% will see a rate reduction o 50% will see increases of < $6 o 16% will see increases.

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Presentation on theme: "OPEN ENROLLMENT 2016 Introduction.  3% overall cost increase o 34% will see a rate reduction o 50% will see increases of < $6 o 16% will see increases."— Presentation transcript:

1 OPEN ENROLLMENT 2016 Introduction

2  3% overall cost increase o 34% will see a rate reduction o 50% will see increases of < $6 o 16% will see increases of $18 to $53  Key to cost containment o Plan designs that promote efficiency and appropriate cost sharing o UC Health System collaboration Medical program – great rates in 2016

3 3 Health Net Blue & Gold Travel Immunizations/Vaccines CURRENTNEW FOR 2016 20% coinsuranceCovered in full

4 4 Health Net Blue & Gold Quit for Life Smoking Cessation Program CURRENT Online program – web based learning and support tools No telephonic coaching NEW FOR 2016 Online program – web based learning and support tools Telephonic coaching – phone based behavioral coaching

5 5 Health Net Blue & Gold Omada Prevent Program CURRENT Health improvement program targeting members at risk for diabetes NEW FOR 2016 Health improvement program expanded to target members at risk for diabetes and/or heart disease

6 6 Kaiser No Changes for 2016

7 7 Health Savings Plan (Blue Shield) Travel Immunizations/Vaccines CURRENTNEW FOR 2016 Not CoveredIf ACA Preventive, in-network covered in full and not subject to deductible/40% out-of- network after deductible* If not ACA Preventive, 20% in-network/40% out-of-network after deductible *According to federal Affordable Care Act (ACA) guidelines for preventive services. For additional details see www.blueshield.com/uc

8 8 Health Savings Plan (Blue Shield) Health Spending Account (HSA) CURRENTNEW FOR 2016HSA Contribution LimitIndividual $3,350 Family $6,650Family $6,750 (IRS mandate)

9 9 Health Savings Plan (Blue Shield) New Programs Welvie Online surgery support tool for members Oncology Practice of the Future Program is an innovative approach predicated upon deep partnerships with providers to ensure best care for members in need

10 10 Core Medical Travel Immunizations/Vaccines CURRENTNEW FOR 2016 Not CoveredIf ACA Preventive, in-network covered in full and not subject to deductible/20% out- of-network after deductible* If not ACA Preventive, 20% in/out-of- network after deductible *According to federal Affordable Care Act (ACA) guidelines for preventive services. For additional detail see www.blueshield.com/uc

11 11 Core Medical Applied Behavioral Analysis (ABA) Autism Support CURRENTNEW FOR 2016 Not Covered20% in/out-of-network after deductible

12 12 Core Medical New Program Oncology Practice of the Future Program is an innovative approach predicated upon deep partnerships with providers to ensure best care for members in need

13 UC Care Covered ServiceUC SelectBlue Shield Preferred Non- Preferred (out-of-network) CURRENT Outpatient Surgery performed at an Ambulatory Surgical Center N/A (Services covered under Blue Shield Preferred) 20%50% NEW FOR 2016: Adding coverage at the UC Select level Outpatient Surgery performed at an Ambulatory Surgical Center $100 per surgery20%50% Ambulatory Surgical

14 UC Care Covered ServiceUC Select and Participating Pharmacies Blue Shield Preferred and Participating Pharmacies Non- Preferred (out-of-network) CURRENT Travel Immunizations/Vaccines Not covered NEW FOR 2016: Adding coverage to the UC Care medical and pharmacy benefit Travel Immunizations/Vaccines No charge 50% Travel Immunizations/Vaccines

15 LocationProvider Santa Barbara Area Cottage Hospital- Santa Barbara and Goleta Pacific Diagnostics Labs Pueblo Radiology Orange County Orange County Foot and Ankle Aurora Breast MRI of Orange County *Professional providers must have a PPO contract with Blue Shield UC Care Select Network Additions – Effective 1/1/2016

16 16 Optum Behavioral Health No Changes for 2016 Continues as carve-out for Health Net, UC Care, Health Savings Plan, and Western Health Advantage. Continues as supplemental overlay for Kaiser.

17 17 2016 UC Living Well Program A healthy, engaged, and productive workforce is essential to support UC’s academic and research mission Highlight local wellness programs Local wellness coordinators serve as SMEs Build on current system-wide policies and partnerships that support healthy workforce and culture Consistent communications strategy Discontinue health assessment, coaching and incentive program (Optum) ! Leverage health plan wellness programs

18 Non-Medical Benefit Plans 2016 Renewal Summary

19 19 Dental  PPO – No changes to dental benefits – The Dental PPO plan will be self-funded by UC beginning in 2016 – Cost decreases, as self-funding will save UC $2.7M per year in fees imposed by the Affordable Care Act on fully-insured health plans – “Automatic” enrollment in PPO for eligible new hires will cease (similar to Core Medical)  DHMO – Rates will decrease by 7.9% – Some slight benefit enhancements due to dental coding changes  Both plans continue to be paid by UC on behalf of employees  Delta Dental continues as the carrier

20 20 Vision  Active Employees – No benefit changes – Plan continues to be fully paid by UC on behalf of employees – “Automatic” enrollment in Vision for eligible new hires will cease (similar to Core Medical)  VSP continues as the carrier

21 21 Disability UC-Paid Short-Term Disability Supplemental Short- and Long-Term Disability  No benefit changes for 2016 to either plan  UC continues to provide limited STD plan at no cost to employees  Supplemental coverage cost to employees remains the same in 2016  Liberty Mutual continues as the disability partner  Plan redesign coming in 2017 – more on that this afternoon

22 22 Life Basic and Core Life Employee Supplemental Life Dependent Basic and Expanded Life  No benefit or premium changes to the plans in 2016  Not open for enrollment  Prudential continues as the carrier

23 23 Legal  Slight changes to benefits which result in fewer limitations and higher benefit maximums for certain services - strengthening benefits overall – Example: Limitation of one claim per benefit year per family unit is being eliminated  Premium remains the same  Open for enrollment  ARAG continues as carrier

24 24 Personal Accident Insurance (AD&D)  No benefit changes  Premium remains the same  AIG continues as carrier  Not open for enrollment

25 25 Flexible Spending Accounts  The Health FSA annual maximum contribution amount will be $2,550 – an increase of $50 in 2016  The Dependent Care FSA annual maximum contribution remains at $5,000

26 AFFORDABLE CARE ACT 2016 Introduction

27 27 Affordable Care Act 1.Per Diems and Limited appointment employees will receive free Core benefits effective 1/1/16 if they worked at least 1566 hours this past year. 2.When managers hire per diems and limited appointment staff, they MUST create the req using the ACTUAL FTE the employee will most likely be working—not an artificial FTE. 3.Penalties for hiring employees in with an artificially low FTE will create a penalty for the organization. 4.More info to follow


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