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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. 4/30/14.

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UC Retiree Health Benefits

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Uc retiree health benefits

UC Retiree Health Benefits

UCSB Health Care Facilitator Program

Laura Morgan


UC Retirement Administration Service Center (RASC)




Uc retiree health benefits

  • 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.




  • Future of retiree health benefits

  • Eligibility for retiree health benefits

  • Transition to retiree health plans

  • Health plan premiums

  • Overview of Medicare (Bill Batty, HICAP)

  • Enrolling in Medicare

  • Coordination with Medicare

  • How UC Medicare plans work

Future of retiree health

Future of Retiree Health

  • Committed to ongoing health benefit

  • Retiree plan designs are likely to change

  • 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%.

Health benefit fine print

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

Eligibility for health benefits

Eligibility for Health Benefits

Medical and dental benefits continue if:

  • You were enrolled when you left UC

  • You elect to continue coverage when you retire

  • Your coverage is continuous until the date your retirement benefit begins

  • Your monthly retirement income begins within 120 days of your separation from UC

  • You meet UC service credit requirements

  • Benefits end if you select “lump sum cashout”

3 eligibility groups

3 Eligibility Groups

  • UCRP entry prior to 1/1/1990

  • UCRP entry/reentry on or after 1/1/1990

  • NEW 2013 eligibility rules

    • Hired on or after 7/1/2013

    • Hired before 7/1/2013 and not “grandfathered”

Each group has specific service credit and/or age requirements.

1 ucrp entry prior to 1 1 90

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

2 ucrp entry reentry on or after 1 1 1990

2. UCRP entry/reentry on or after 1/1/1990

  • Retire at age 50 or later w/ 10 years service credit


  • “Age + service credit = 75”

3 hired on after 7 1 2013

3. Hired on/after 7/1/2013

  • Also current employees not “grandfathered”

  • Retire at 56 or later w/ 10 years service credit

2013 grandfathering provision

2013 “Grandfathering” Provision

  • Remain under current retiree health eligibility rules if by June 30, 2013:

    • five years of UCRP service credit and

    • age plus years of service credit is 50 or greater

  • Example:

    • Age 45 with 5 years = 50 (grandfathered)

    • Age 40 with 5 years = 45 (new eligibility rules)

Transition to retiree health

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 27

    • Employee insurance ends July 31

    • Retiree insurance starts August 1

Transition cont d

Transition cont’d

  • Must enroll in Medicare, if eligible, and transfer to Medicare coordinated plan

  • 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



  • Delta PPO or DeltaCare USA

    • Coverage remains the same

    • Premium paid in full by UC

      OR subject to “graduated eligibility”



  • 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

Medical plans

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

    • Must enroll in Medicare A & B, if eligible

    • UC Medicare plans

Medical plans1

Medical Plans

Same as employee plans

Coordinated with Medicare

Split families partner plans

Split Families – Partner Plans

When a family has both

non-Medicare & Medicare members

Blue Shield Health Savings is not available to split family

Behavioral health

Behavioral Health

  • All plans cover mental health care and substance abuse treatment

  • Provider networks may change when enrolled in Medicare

Behavioral health providers

Behavioral Health Providers

Are you moving in 2014

Are you moving in 2014?

  • Must live in California

    • Health Net, Kaiser

  • Available in US

    • UC Care

    • Blue Shield Health Savings Plan

    • Core

    • Blue Shield Medicare PPO (see Exchange One)

    • High Option (see Exchange One)

  • Available when LIVING out of US

    • UC Care, Core (without Medicare)

Exchange one out of ca

Exchange One – Out of CA

  • Retiree living out of California

  • 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 Exchange One

  • UC contribution is subject to graduated eligibility

  • Can use extra HRA funds to pay medical expenses and Part B premium

Retiree health premiums

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 in 7/1/2013 rules

Maximum uc contribution

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 rate chart


Maximum uc contribution rate chart

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 category 2

Medicare part b reimbursement

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:


    $44.49 > added to UC pension

  • The amount of the reimbursement depends on the premium UC is charged by the insurance carrier for your plan

Graduated eligibility

Graduated Eligibility

  • 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 UCnetusing “Medical Plan Chooser”

Graduated eligibility example

Graduated Eligibility – Example

  • Service credit = 15 years

  • UC pays 75% of “Maximum UC Contribution”

$436 Maximum UC Contribution (single/non-MC)

$327 75% of Maximum UC Contribution

$611 Gross premium (single/HN Blue & Gold)

- $327 75% of Maximum UC Contribution

$284 = Monthly premium paid by retiree

Uc retiree health benefits


New 2013 graduated eligibility

New 2013 Graduated Eligibility

  • Hired on/after 7/1/2013

  • Also current employees not grandfathered

  • 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

Monthly premiums

Monthly Premiums

  • Medicare Part B

    • $104.90 – standard rate in 2014

    • 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

Income related adjustment

“Income Related Adjustment”

  • Medicare Part B and D premiums may be higher for retirees with incomes over:

    • $85,000 – single

    • $170,000 – married

What is medicare

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

Medicare eligibility

Medicare Eligibility

  • Your own work history

  • Work history of spouse or ex-spouse

  • Contact Social Security to clarify your eligibility

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

Three Parts of Medicare

Part B - Medical

Part A - Hospital

Part D – Prescription Drugs

Medicare premiums in 2013

Medicare Premiums in 2013

  • 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

When to enroll in medicare

When to enroll in Medicare?

  • Employees

  • Eligible at retirement

  • Eligible after retirement



  • Do not enroll in Medicare Part B or D

  • Spouse enrolled in your UC employeemedical 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

Employees special considerations

Employees – Special considerations

  • Same-sex spouses have the right to delay enrollment in Medicare if enrolled in a UC medical plan

  • Domestic partners should consult Social Security about when to apply

  • Blue Shield Health Savings Plan members may NOT be enrolled in Medicare A, B or D per IRS rules

Eligible at retirement

Eligible at Retirement

  • You and your family members who are eligible for Medicare must enroll in Parts A & B

  • Go to Social Security office one month before UC employee retires

  • Complete UC forms to enroll in UC plan

  • You may also receive a follow-up “Coordination of Benefits” form from Medicare

Eligible after retirement

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 beforeturning 65


    • If receiving a Social Security pension, you will get a Medicare card in the mail

  • UCOP will mail UC enrollment forms to you and family member

Coordination with medicare

  • You assign your Medicare to the insurance plan

  • Cannot use Medicare outside the plan

HMO Advantage

  • Health Net Seniority Plus

  • Kaiser Senior Advantage

  • Medicare is primary payer

  • Blue Shield is secondary

Blue Shield PPO

High Option Supplement

Coordination with Medicare

Choice of physician

Blue Shield PPO

High Option Supplement

  • Any Medicare physician

Choice of Physician

  • You select PCP

  • PCP coordinates care

  • PCP refers to specialists

  • Specialists limited to physicians in medical group

HMO Advantage

  • Health Net Seniority Plus

  • Kaiser Senior Advantage

  • Sansum Clinic is only HNSP provider in Santa Barbara

  • Change to Sansum PCP

  • Change to Blue Shield plan

Hmos have copays for care

HMOs have copays for care

Health Net Seniority Plus

Kaiser Senior Advantage

Blue shield deductibles

Blue Shield - Deductibles

  • Deductibles paid by Blue Shield

    • Medicare Part A (Hospital) = $1216

    • Medicare Part B (Medical) = $147

  • Deductible paid by you

    • Plan deductible for services not covered by Medicare

    • Blue Shield PPO = $100 per individual

    • High Option = $50 per individual

Blue shield office visit example

Blue Shield – Office Visit Example

Medicare Allowable = $150

Blue shield hospital example

Blue Shield – Hospital Example

Stay of 1-60 daysMedicare Part A Deductible = $1,216

Blue shield skilled nursing

Blue Shield – Skilled Nursing

1st to 21st day Paid in fullby Medicare

21st to 100th dayDaily rate = $152

Are you traveling out of us

Are you traveling out of US?

Prescription drugs part d

Prescription Drugs - Part D

  • All plans have Medicare Part D

  • 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

Prescription drug costs

Prescription Drug Costs

Can t stay away

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

Web resources

Web Resources


  • Health plan information and rates

  • Medical Plan Chooser

  • Complete Guide to Retirement Benefits

  • Retirement Handbook


  • Apply for Medicare Benefits


  • “Original” Medicare coverage and publications



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

  • Login