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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

UC Retiree Health Benefits

UCSB Health Care Facilitator Program

Laura Morgan


UC Retirement Administration Service Center (RASC)





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
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

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 day Daily rate = $152

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
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