Blue Shield Health Savings Plan Laura Morgan UCSB Human Resources, Benefits

1. Big changes New choices Blue Shield Health Savings Plan Laura MorganUCSB Human Resources, Benefits 1 This presentation is intended for communication purposes only. Please see plan document and http://atyourservice.ucop.edu for complete information. 1 11/2013

2. Topics • Open Enrollment Overview • Blue Shield PPO • Health Savings Account

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

4. 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

5. 2014 Medical Plans

6. Default Medical Plans

7. 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

8. Blue Shield Health Savings Plan Combines high deductible PPO with account to pay out-of-pocket expenses + Medical Coverage Blue Shield PPO Health Savings Account HealthEquity

9. Lumenos vs Blue Shield HSP Blue Shield PPO Lumenos Health Savings Account

10. Preventive Care • Preventive care is covered at 100% with Blue Shield PPO providers • Preventive care includes: • Annual well visit and labs • Well woman visits and labs • Preventive screening tests • Immunizations • See list of preventive services on http://www.blueshieldca.com/uc

11. Blue Shield PPO • 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 a Blue Shield PPO provider • “Out-of-pocket Maximum” limits your financial liability

12. Residence, Networks & Travel • The employee must live in US • When in US • Comprehensive coverage • Blue Shield PPO network in CA • Blue Cross Blue Shield network outside CA • When traveling out of US • Emergency and urgent care only • NO routine care

13. Blue Shield PPO - Plan Design

14. Single vs Family Same design as Lumenos: • Single = one person enrolled in plan • Family = more than one person in plan • Families share one deductible • Families share one out-of-pocket maximum (UC Care has a different plan design)

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

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

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

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

19. Medical 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 claimfor services to Blue Shield • You pay provider • Pay with HSA funds • or • Pay with other funds Blue Shield sends EOB Explanation of Benefits (EOB) outlines allowed charges, deductible and co-insurance. “This is not a bill”.

20. Prescription Drugs • There is no separate drug plan with copays • Drug expenses are applied to the plan in the same way as medical expenses • You pay full cost of medication until you satisfy the deductible • After deductible, you pay 20% at preferred pharmacies

21. Pharmacy Claims You go to the pharmacy Give pharmacist your Blue Shield ID card so they can apply the Blue Shield Rx discount Pay with your HSA debit card or Pay with personal funds and later go to your HealthEquity account online and reimburse yourself(if you have money in the account)

22. 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)

24. Health Saving Account • 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.

25. Why is HSA better? • You keep the money even if you change jobs or insurance plans • You can make contributions at any time • It has triple tax advantage • No Federal taxes on contributions • No taxes when funds are used • No taxes on earnings • HSA funds rollover from year to year; no use it or lose it as with Health FSA

26. Employees can maximize savings • UC Contribution (1/1/14) • $500 individual • $1000 family • You can contribute up to (optional): • Single-coverage: $2,800 • Family-coverage: $5,550 • Catch-up contribution, age 55+: $1,000 Tip: Contribute the money you would have put in your Health FSA.

27. 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

28. Your Responsibility • Contribute only the amount allowed by IRS • Use HSA funds for eligible expenses • Keep itemized receipts as tax documents • Follow HSA eligibility rules

29. Lumenos HRA Rollover • 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.

30. Example: Lumenos PDHRA • Single Deductible $1,250 • UC Contribution to HSA $500 • Remaining balance $750 • Pay with personal fundsorPay with your contributions to HSA • Lumenos PDHRA can be used to pay 20% coinsurance after deductible is satisfied

31. Use the HSA to pay for… • Deductible • Coinsurance • Any IRS Publication 502 Expenses, including: • Medical • Dental • Vision • Prescription drug • Long Term Care insurance premiums • See Health Equity website for more information

32. How does HSA work? • UC makes annual contribution for plans that start on January 1. • You may contribute through payroll deduction or make post-tax contributions to HealthEquity • Use a HSA debit card to pay for health expenses • Use HealthEquity website to pay medical and other health claims • Invest HSA dollars when account balance reaches $2000 – no fees to invest

33. HSA vs FSA • The HSA is NOTlike the Health FSA where you have access to the entire annual contribution starting on January 1 • The HSA is like a checking account – the money must be in the account before you can spend it • You make monthly contributions through payroll deduction, you can change the contribution amount during the year • You can make one time contributions through Health Equity

34. www.healthequity.com/ed/uc Register as new member on this site after 1/1/14

35. www.blueshieldca.com/uc Register as new member on this site after 1/1/14

36. Health Equity Member Portal

37. Claim Summary Screen • View claim detail • Choose action to be taken • Pay provider • Reimburse themselves • Close expense • Pay from HSA account or external checking/savings account • Schedule payment

38. Member Resources • Welcome Kit - to get you started • Debit card loaded with UC Contribution • Online resources • Treatment cost estimator tool • Drug costs, information and claim summary • Smart phone browser

40. Optum(formerly United Behavioral Health) • Optumcoordinates behavioral health care for all medical plans (except CORE) • psychiatrist • psychologist • therapist • substance abuse treatment • No referral required from physician • Call Optum to notify prior to first visit

41. Behavioral/Mental Health • Medical and behavioral health deductibles and OOPM cross accumulate. • See the Evidence of Coverage for complete details.

42. For more information HealthEquityMember Services is available every hour of every day Call the Blue Shield/UC dedicated line 1.855.201.8375 say “Health Savings Account” www.healthequity.com/ed/ucwww.blueshieldca.com/uc

43. http://atyourservice.ucop.edu/oe • Resources • Plan contacts • Plan rates • Medical Plans • Benefit summaries • Links to plan websites • Links to provider directories • Other plans • Dental, vision, FSA

45. Two Adults – Payband 51K-101K UC Care 281/mo HSP 103/mo Difference 178 x 12 = 2,136 Family Deductible 2,500 Premium Saving 2,136 UC HSA Contribution 1,000 Maximum HSA Contribution 5,550