11/3/11

1. Big changes New choices Updated 11/22/13 Open Enrollment Highlights Laura MorganUCSB Human Resources, Benefits This presentation is intended for communication purposes only. Please see plan document and http://atyourservice.ucop.edu for complete information. 1 1 11/1/2013 11/3/11

2. Open Enrollment • Ends Tuesday, November 26, 5:00 pm • Make changes online http://atyourservice.ucop.edu • All changes are effective January 1, 2014

3. Actions • Change medical and/or dental plan • Enroll in medical, dental, vision • Add eligible family members • Enroll or re-enroll in Health Flexible Spending Account (FSA) • unless you select the Blue Shield Health Saving Plan) • Enroll or re-enroll in Dependent Care FSA

4. Collective Bargaining For unions in “status quo” or “reopeners” the following may not change: Monthly contribution rates for plans Payband levels An individual’s MCB can go up or down Monthly employee contributions for the new 2014 medical plans will be the same for all participants

5. Review Options for 2014 Booklet atyourservice.ucop.edu/oe

6. Medical Plan Chooser Link from Open Enrollment website: http://atyourservice.ucop.edu/oe/medical

7. Big Changes, New Choices • Comprehensive review of UC's medical plan portfolio • Ensure good benefits while limiting cost increases for employees and the university • Maintain choices to address individual needs • Opportunity to leverage UC's medical centers • Respond to health care reform and a changing medical-insurance marketplace

8. 2014 Medical Plans

9. Default Medical Plans

10. What is your priority? • Cost to enroll – monthly premium • Cost of care • Predictable, low cost copays • Pay a % of each service • Choice of providers • HMO medical group physicians • PPO preferred network or any provider • Effort to manage – coordinating care & bills

11. Medical Plan Design 101 HMO PPO POS

12. HMO – Health Maintenance Organization • Care is delivered by physicians in a “medical group” (e.g. Sansum, SB Select IPA) • Care is coordinated by Primary Care Physician and medical group • Member selects PCP, PCP refers to specialists • Set copay for most services, no deductibles • Emergency and urgently needed care when away Health Net Blue & Gold HMOKaiser HMO

13. PPO – Preferred Provider Organization • You direct your own care, you decide where to receive services • You pay annual deductibles before plan pays • After deductible, you share the cost of each service with the plan - coinsurance • Your costs are lower if you select preferred providers • “Out-of-pocket Maximum” limits your financial liability UC Care Blue Shield Health Savings Plan

14. Deductible, Coinsurance, OOPM

15. Allowed Amount – In Network PPO plans negotiate “allowed” rates to process claims.

16. Allowed Amount – Out of Network PPO plans assign “allowed” rates to process claims.

17. Claims, EOBs & Bills Provider sends billThe bill should match the EOB. It should reflect the in-network discount and any payments received from health plan. You receive services You pay nothing at the time of service for in-network care Provider sends claim for services to health plan You pay provider Health plan sends EOB Explanation of Benefits (EOB) outlines allowed charges, deductible and co-insurance. This is not a bill.

18. Learn more about PPOs Fair Health Consumer http://www.fairhealthconsumer.org/ • Estimate cost of medical procedures • “LEARN” tab – print and video resources • How plans work • Cost Sharing, know what you may owe Good Rx • http://www.goodrx.com • Estimate cost of drugs (for Blue Shield HSP)

19. POS - Point of Service • Combines HMO and PPO plan designs • Limit costs by using HMO providers • Can use providers outside HMO group, but cost for service will be higher Anthem PLUS in 2013 - discontinued

20. Anthem PLUS Dilemma – PPO or HMO Physician • Specific physician • More choice of physicians and facilities What is your priority? Cost • Monthly cost • Predictable copays

21. 2014 Medical Plans Health Net Blue & Gold HMO Kaiser HMO UC CareBlue Shield Health Savings Plan Core

22. Employee may live anywhere • Worldwide services • Employee may live anywhere • Worldwide services Residence Limitations UC Care HMO (Health Net, Kaiser) • Employee must live in California • PCP must be within 30 miles of where you live or work (in most cases) • Employee may live anywhere • Worldwide services CORE Blue Shield Health Savings • Employee must live in US

23. When traveling out of US UC Care HMO (Health Net, Kaiser) • Limited to emergency and urgent care only • No routine care • Comprehensive coverage • Plan pays Preferredbenefit. CORE Blue Shield Health Savings • Limited to emergency and urgent care only • No routine care • Comprehensive coverage • Plan pays out-of-network benefit.

24. Health Net • Full Network HMO is being discontinued • In Ventura County, some medical groups will no longer be available to Health Net members • Employees should consider UC Care or Kaiser HMO • Health Net Blue & Gold HMO will continue with few benefit changes • In Santa Barbara County, all HMO medical groups participate in Blue & Gold • In Ventura County, not all HMO groups participate

25. Health Net Blue & Gold HMO • You select a Primary Care Physician (PCP) to coordinate your care • PCP refers you to specialists • Predictable copays for services: • $20 office visit • $20 urgent care • $75 emergency room (if not admitted) • $100 outpatient surgical center • $250 hospital (in-patient)

26. Kaiser HMO • Kaiser will continue in Ventura County • You select Kaiser PCP • PCP refers you to Kaiser specialists • Predictable copays for services: • 20 office visit • $20 urgent care • $75 emergency room (if not admitted) • $100 outpatient surgical center • $250 hospital (in-patient)

27. UC Care – New PPO • New self-funded PPO plan • Created for UC employees and non-Medicare retirees • UC Medical Centers are part of the “UC Select” network of providers • No PCP, no referral required for specialist

28. UC Care PPO Blue Shield of California – claims administrator & network

29. UC Care: In-Network Providers • UC Select • All UC medical centers, facilities and physicians • Additional select Blue Shield PPO providers in areas where UC medical centers and physicians are not accessible • Blue Shield Preferred PPO in California • 97% of Anthem PPO are also Blue Shield Preferred • Blue Shield outside of CA and US • Blue Cross Blue Shield Network out of CA • BlueCard Network or any physician out of US

30. UC Select Network near UCSB • UC Select providers in • Santa Barbara – Sansum Clinic • Santa Maria • Lompoc • Ventura • Currently, SansumClinic is the only UC Select providers in Santa Barbara area • High cost hospital and medical groups • Still negotiating

31. Blue Shield Preferred at UCSB • Most Anthem Plus and PPO providers are also in the UC Care BlueShield Preferred network • Cottage Hospital and Sansum Clinic are Blue Shield Preferred providers Provider directory: blueshieldca.com/uccareppo or link from http://uc-care.org/

32. UC Care – Cost of Care • Your costs depend on the service and the network status of the provider • UC Select – no deductible, copays for most servicesbut not all • Blue Shield Preferred – deductible and you pay 20% coinsurance for most services • Non-Preferred – deductible and plan pays 50% of allowed rate

33. Deductible, Coinsurance, OOPM UC CareIndividual Coverage Blue Shield Preferred (Tier 2)

34. Deductible: Individual vs Family UC Care ExampleFamily Deductible Blue Shield Preferred (Tier 2) 20% 20%

35. UC Care – Emergency Room Example • There are two charges for emergency care with a PPO plan design: • “Facility” – billed by the hospital • “Professional” – billed by the ER physicians • Emergency Room Visit (not admitted) • Emergency room: $100 per visit • Emergency physician services: 20% • Same coverage across all provider networks

36. More information about UC Care Shield Concierge Blue Shield/UC dedicated line 1-855-201-2087 M-F, 7 to 7 http://uc-care.org/

38. Blue Shield Health Savings Plan • High deductible medical plan paired with a Health Savings Account + Blue Shield PPO Health Savings Account • The Health Savings Account is not a component of the medical plan as HRA is with Lumenos. • It is a separate account that can be used to pay medical and other health expenses.

39. Blue Shield PPO • You direct your own care, you decide where to receive services • Medical and drug expenses apply to deductible and Out-of-Pocket Maximums (OOPM) • No separate drug plan with copays • Family members share same deductibles and OOPMs • Networks: • Blue Shield Preferred • Non-Preferred Providers

40. Deductible, Coinsurance, OOPM Blue Shield Health Savings Plan Individual (Single) Preferred Providers

41. Deductible, Coinsurance, OOPM Blue Shield Health Savings Plan FamilyPreferred Providers The full family deductible must be met before plan shares costs

42. Blue Shield Health Savings Plan • High deductible medical plan paired with a Health Savings Account + Blue Shield PPO Health Savings Account • HSA deposits are not taxes • HSA funds roll over from year to year • Tax-free interest earned • You keep the money even if you change jobs or insurance plans

43. Health Savings Account • Health Equity manages the HSA • UC makes annual contribution for plans that start on January 1. • UC contribution is pro-rated for mid-year enrollments • You may contribute through payroll deductions • Use account to pay for eligible health expenses (medical, dental, vision, etc)

44. Employees can maximize savings • UC Contribution (1/1/14) • $500 individual • $1000 family • 2014 Maximum Contributions allowed by IRS • Single-coverage: $3,300 • Family-coverage: $6,550 • Catch-up contribution, age 55+: $1,000 Tip: Contribute the money you would have put in your Health FSA.

45. Lumenos and Blue Shield HSP • Remaining Lumenos HRA money will roll-over into the Health Savings Account (4/1/14) • Lumenos HRA $ are treated differently than HSA $ by IRS • Lumenos HRA $ becomes a “Post Deductible Health Reimbursement Account” = PDHRA • You must pay the Blue Shield HSP deductible with other funds BEFORE you can use the PDHRA to pay eligible expenses.

46. Who is eligible for HSA? To own an HSA you need to: • Be covered ONLY by an HSA-qualified health plan • Other health coverage may disqualify you, including Health FSA, Medicare or traditional health plan • Health FSA must have a $0 balance on Dec. 31, 2013 (complete any claims reimbursement by Dec. 31, 2013) • Not be claimed as a dependent on someone else’s tax return

47. “Seamless Consumer Experience” • Blue Shield and Health Equity share information • Employee receives welcome kit and live debit card • Use the “smart card” to pay for eligible health expenses • Can track and pay claims on Blue Shield website • Invest HSA dollars when account balance reaches $2000 – no fees to invest

48. For more information Health Equity Member Services is available every hour of every day: Call the Blue Shield/UC dedicated line 1.855.201.8375 say “Health Savings Account” http://www.healthequity.com/ed/uc http:// www.blueshieldca.com/uc (select "go" in the health savings plan section)

50. CORE • High deductible PPO • Administered by Blue Shield • $3000 deductible per individual • Out-of-pocket Maximum is decreasing 2013: $7,600 per individual 2014: $6,350 individual / $12,700 family • Blue Shield PPO and non-PPO providers • Behavioral Health by Blue Shield PPO