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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

893-4201

UC Retirement Administration Service Center (RASC)

800-888-8267

http://ucnet.universityofcalifornia.edu

4/30/14

slide2

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

agenda
Agenda
  • 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

OR

  • “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

dental
Dental
  • Delta PPO or DeltaCare USA
    • Coverage remains the same
    • Premium paid in full by UC

OR subject to “graduated eligibility”

vision
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
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

http://ucnet.universityofcalifornia.edu/compensation-and-benefits/health-plans/medical/retiree-plan-costs.html

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:

$0.00

$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
employees
Employees
  • 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

OR

    • 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

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
resources
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
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