Blue Shield of California and Sutter Health Termination University of California Impact Frequently Asked Questions January 14, 2015

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1 OVERVIEW Blue Shield of California and Sutter Health Termination University of California Impact Frequently Asked Questions January 14, 2015 Blue Shield of California and Sutter Health have been engaged in discussions on rates and terms for several months. Unfortunately, Blue Shield was unable to negotiate terms that would allow us to continue to offer our customers access to Sutter providers without jeopardizing the long term affordability of healthcare coverage in Northern California. As a result, effective January 1, 2015, Sutter Health is no longer a Preferred Hospital in any Blue Shield PPO network. Blue Shield remains open to further discussions with Sutter Health in order to agree on terms for a new contract. In the meantime, we will ensure that members have continued access to care, including continuity of care for those that qualify to continue current course of treatment with a Sutter Health provider. TRANSITION PERIOD In order to ensure an orderly transition of care to participating providers, Blue Shield and Sutter Health have agreed to a six-month transition period beginning January 1, This transition period has been established to allow members sufficient time to locate an alternative provider. There will be no disruption of care during this transition period. During this transition period, Blue Shield will continue to offer in-network benefits to members who receive care from Sutter Health providers. The six-month transition period will end on June 30, 2015, at which time services received by Blue Shield members from a Sutter Health provider will be paid at the out-of-network benefit level, resulting in higher out of pocket costs. Members are encouraged to transition their care to a Blue Shield Preferred Provider to ensure the continuation of in-network benefits after the transition period ends. WHO DOES THIS CHANGE EFFECT The termination affects all Blue Shield members; however, the impact varies by plan type. This document provides an overview and frequently asked questions, specifically for UC employees who are enrolled in the following plans: Non-Medicare Plans Health Savings Plan Core plan UC Care plan

2 Medicare Plans The Sutter Health termination only affects the non Medicare covered services that Blue Shield covers for the following plans: High Option Supplement to Medicare* Medicare PPO plans (with and without Rx)* Examples of these services include acupuncture; outpatient marriage, family, and child counseling; inpatient residential treatment; and hearing aids. (Please refer to your plan s Benefits Booklet for additional coverage details by going to blueshieldca.com/uc and selecting Medicare Plans.) UNDERSTANDING THE NETWORK CHANGE How is the Blue Shield network changing? As of January 1, 2015, the network relationship between Blue Shield and Sutter Health has terminated. This termination affects all Independent Provider Associations, Medical Groups, Hospitals and Specialty Providers associated with Sutter Health. However, until June 30, 2015, a six-month transition period will allow members to continue seeing Sutter providers at the in-network level. Where are Sutter Health providers located? Sutter Health providers are located in Northern and Central California (see listing of counties below). For listing of Sutter Health facilities visit and select the type of facility you are looking for on the left side of the page. Sutter Health Counties Alameda Marin San Joaquin Santa Cruz Sutter Amador Merced San Luis Obispo Shasta Yolo Contra Costa Placer San Mateo Solano Del Norte Sacramento Santa Barbara Sonoma Lake San Francisco Santa Clara Stanislaus I currently see Sutter Health provider(s). How will this change affect me? In order to ensure an orderly transition of care for members, Blue Shield and Sutter Health have agreed to a six-month transition period through June 30, 2015, while they continue contract negotiations. There will be no disruption of care during this transition period. Starting July 1, 2015, if no agreement has been reached, members are encouraged to transition their care to a Blue Shield Preferred provider. Blue Shield of California will no longer offer in-network benefits without an approved Continuity of Care with a Sutter Health provider. For more information on Continuity of Care, please see below. 2

3 How can I learn about other provider groups available through Blue Shield? To find other Blue Shield network providers, Health Savings Plan, Core plan and UC Medicare plan members can call Shield Concierge at (855) or visit blueshieldca.com/uc and select Find a Provider. UC Care members can call Shield Concierge at (855) or go to blueshieldca.com/uccareppo. How do I verify if my provider is affiliated with Sutter Health? To verify if your provider is affiliated with Sutter Health, click on the provider s name to see the provider s affiliation. UC Non-Medicare plan members also have access to Teladoc to connect 24/7/365 with a board-certified physician by phone or online chat for non emergency medical conditions. The cost varies by plan: Health Savings Plan and Core plan members pay a $40 copayment per consult. After their plan's network deductible is met, the cost is only 20% of the cost per consult, which is $8. UC Care members pay a $20 copayment and the first consult is free. Visit Teladoc.com/uc to learn more or call Teladoc ( ). Members also have access to NurseHelp 24/7 SM for non-emergency medical conditions by calling (877) MEMBER COMMUNICATION How will I be notified about the termination of the network relationship between Blue Shield and Sutter Health? Plan subscribers will receive letters from Blue Shield in January 2015 explaining the Sutter Health network termination and what it means to them, depending on their health plan. In addition, the following websites will be updated with information advising members that Sutter Health is no longer a provider in the Blue Shield network: UCC PPO plan member website: blueshieldca.com/uc UC Care website: uc-care.org Blue Shield s Find a Provider page: blueshieldca.com/fap 3

4 Additionally, you may receive a letter from Sutter Health stating that they are no longer accepting Blue Shield coverage. Please note that during the six-month transition period (January 1 through June 30, 2015) Blue Shield will continue to offer in-network benefits to members who receive care from Sutter Health providers. The six-month transition period will end on June 30, How will new hires know about the Sutter Health termination? Notifications about the termination will be posted on the UC PPO plan member website (blueshieldca.com/uc), UC Care website (uc-care.org), Blue Shield s Find a Provider page (blueshieldca.com/fap), and the UC website (ucnet.universityofcalifornia.edu). Whom do I call if I have additional question? If you have any questions, please contact Shield Concierge toll-free from 7 a.m. to 7 p.m. PT, Monday through Friday. Below are the phone numbers for each plan: Health Savings Plan and Core plan: (855) UC Care plan: (855)

5 MEMBER HEALTH COVERAGE IMPACT BY PLAN TYPE HEATLH SAVINGS PLAN (HSP) AND CORE PLAN MEMBERS Will my out-of-pocket costs be the same when I see a Sutter Health provider during the six-month transition period? No. During the transition period (January 1, 2015 through June 30, 2015), Blue Shield will continue to offer in-network benefits however, Sutter Health provider charges will be higher. Therefore, the member cost-share will also increase. Will this change impact the processes in place for my Post Deductible HRA (PDHRA)? The termination does not impact the PDHRA process. Will my Sutter Health Provider bill me for the services I receive during the transition period? During the six-month transition period, all claim billing procedures should remain the same and your Sutter Health provider should file the claim to Blue Shield of California on your behalf. Starting July 1, 2015, if Sutter becomes an out-of-network provider, Sutter providers may not agree to bill claims to Blue Shield on your behalf. If you use an out-of-network provider, you may need to take on more responsibility for filing claims. If you receive a billing statement which doesn t make sense, please contact Shield Concierge immediately at (855) What happens when the six-month transition period ends? After the six-month transition period which ends on June 30, 2015, services received from a Sutter Health provider will be subject to the out of network deductible and coinsurance plus any charges in excess of the Blue Shield allowable amount. Also, Sutter Health providers may require you to pay for the services up front and you will have to file your own claim to Blue Shield of California. If you have questions on a billing statement you received or need assistance with filing a claim, please contact Shield Concierge immediately at (855) To ensure the continuation of in-network benefits, members are encouraged to transition their care to a Blue Shield network provider. To find a Blue Shield network provider, please visit blueshieldca.com/uc and select Find a Provider or contact Shield Concierge at (855) I was hired during the transition period (from January 1, 2015 June 30, 2015). Can I see a Sutter Health provider at the in-network benefit level? 5

6 Yes. If you are hired between January 1, 2015 and June 30, 2015 and enrolled in the Health Savings Plan or Core plan, you may still access care through a Sutter Health provider at the in-network benefit level through the end of the transition period. To continue receiving the highest level of benefits as well as the added value of Blue of Shield s negotiated discounts after June 30, 2015, you must transition your care to a Blue Shield network provider. To find a Blue Shield network provider, members should go to blueshieldca.com/uc and select Find a Provider or contact Shield Concierge at (855) Please note that it may take several weeks to update the Blue Shield Find a Provider database to reflect this network change. Therefore, Sutter Health providers may continue to be listed as Blue Shield Network provider until the site has been updated. I was hired after the transition period that ended on June 30, Can I see a Sutter Health provider at the in-network benefit level? No. As of July 1, 2015, services received from a Sutter Health provider will be paid at the out-of-network benefit level and you will be responsible for the billed charges for services you have accessed through a Sutter Health provider. Which hospitals should I use? During the six month transition period, members can still access Sutter Health hospitals at the in-network benefit level. However, you may have lower out of pocket cost for services received from a non Sutter health hospital within the Blue Shield network provider. Members can compare the costs of hospital stays, MRIs, office visits, surgeries, vaccines, X-rays and more by using Blue Shield s Treatment Cost Estimator. To access the tool, members will need to log on to blueshieldca.com, select Help and Support and then Treatment Cost Estimator. Members can locate a contracted Blue Shield provider, by going to blueshieldca.com/uc and selecting Find a Provider or contacting Shield Concierge at (855) What if I am in treatment with a Sutter Health provider or have a procedure scheduled? In order to ensure an orderly transition of care for members, Blue Shield and Sutter Health have agreed to a six-month transition period through June 30, 2015, while they continue contract negotiations. There will be no disruption of care during this transition period. Starting July 1, 2015, if no agreement has been reached, members who are receiving care from Sutter Health providers, or who have a procedure scheduled to be performed by a Sutter Health provider may request continuity of care for an ongoing course of treatment. The services approved for continuity of care will be provided at the in-network level of benefits. 6

7 Examples of conditions that may qualify for continuation of care include: An acute condition requiring prompt medical attention and that has a limited duration A serious chronic condition Pregnancy, including the immediate postpartum period Care for a child, from newborn to 36 months of age A surgery or other treatment that was previously recommended and documented by your doctor to take place after June 30 A terminal illness that has a high probability of causing death within one year or less is covered for the duration of the terminal illness. For more information or to apply for continuity of care, members should call Shield Concierge at (855) What should I do if during the transition period (January 1, 2015 through June 30, 2015) my Sutter Health provider tells me that they don t accept Blue Shield? During the six-month transition period (January 1 through June 30, 2015), services from a Sutter Health provider will be paid at the network benefit level. If providers have any questions about this transition period or questions with regards to your plan benefits, please have them contact Shield Concierge at (855) What if I need emergency services before or after the transition period? For each visit to the emergency room you will receive at least two separate bills. One bill is for the use of the hospital's emergency room and the other bill is for the doctor(s) who saw you in the emergency room. Health Savings Plan members will receive in-network benefit based on Blue Shield s allowable amount. Members will be responsible for the applicable in-network deductible and/or coinsurance. Core plan members will also receive in-network benefits however, they may be balance billed by the attending physician(s) for the professional service charges. If you have questions regarding a balance bill for professional charges, please call Shield Concierge at (855)

8 UC CARE PLAN MEMBERS Will my out-of-pocket costs be the same when I see a Sutter Health provider during the six-month transition period? Sutter Health charges may be higher depending on which network level is accessed for that service: UC Select: Member s flat dollar copayment associated with services received at a UC Select Sutter Health provider will remain the same during the six month transition period. Blue Shield Preferred: Member s cost-share will remain at the in-network benefit level; however Sutter Health charges will be higher. Members should be aware that this will result in higher out-of- pocket expense for services received from Sutter Health Preferred providers. Out-of-Network Sutter Providers: If your Sutter Provider was out-of-network in 2014, it will remain out-of-network during the transition period. For a detailed description of coverage benefits and limitations, please see your plan s Benefit Booklet by going to uc-care.org and selecting Use Your Benefits, then Medical Benefits. Will my Sutter Health Provider bill me for the services I receive during the transition period? During the six-month transition period, all claim billing procedures should remain the same and your Sutter Health provider should file the claim to Blue Shield of California on your behalf. Starting July 1, 2015, if Sutter becomes an out-of-network provider, Sutter providers may not agree to bill claims to Blue Shield on your behalf. If you use an out-of-network provider, you may need to take on more responsibility for filing claims. If you receive a billing statement which doesn t make sense, please contact Shield Concierge immediately at (855) What happens when the six-month transition period ends? After the six-month transition period which ends on June 30, 2015, services received from a Sutter Health provider will be subject to the out of network deductible and coinsurance or copayment plus any charges in excess of the Blue Shield allowable amount. Also, Sutter Health providers may require you to pay for the services up front and you will have to file your own claim to Blue Shield of California. If you have questions on a billing statement you received or need assistance with filing a claim, please contact Shield Concierge immediately at (855) To ensure the continuation of in-network benefits, members are encouraged to transition their care to a Blue Shield network provider. To find a UC Select network 8

9 provider, members should go to blueshieldca.com/uccareppo or contact Shield Concierge at (855) What if I am in treatment with a Sutter Health provider or have a procedure scheduled? In order to ensure an orderly transition of care for members, Blue Shield and Sutter Health have agreed to a six-month transition period through June 30, 2015, while they continue contract negotiations. There will be no disruption of care during this transition period. Starting July 1, 2015, if no agreement has been reached, members who are receiving care from Sutter Health providers, or who have a procedure scheduled to be performed by a Sutter Health provider may request continuity of care for an ongoing course of treatment. The services approved for continuity of care will be provided at the in-network level of benefits. Examples of conditions that may qualify for continuation of care include: An acute condition requiring prompt medical attention and that has a limited duration A serious chronic condition Pregnancy, including the immediate postpartum period Care for a child, from newborn to 36 months of age A surgery or other treatment that was previously recommended and documented by your doctor to take place after June 30 A terminal illness that has a high probability of causing death within one year or less is covered for the duration of the terminal illness. For more information or to apply for continuity of care, members should call Shield Concierge at (855) I was hired during the transition period (from January 1, 2015 June 30, 2015). Can I see a Sutter Health provider at the in-network benefit level? Yes. If you are hired between January 1, 2015 and June 30, 2015, you may still access care through a Sutter Health provider at the UC Select benefit level. However, we encourage members to choose a UC Select network provider to receive the highest level of benefits. To find a UC Select network provider, members should go to blueshieldca.com/uccareppo or contact Shield Concierge at (855)

10 I was hired after the transition period that ended on June 30, Can I see a Sutter Health provider at the in-network benefit level? No. As of July 1, 2015, services received from a Sutter Health provider will be paid at the out-of-network benefit level and you will be responsible for the billed charges for services you have accessed through a Sutter Health provider. What should I do if my Sutter Health provider has told me that they don t accept Blue Shield? During the six-month transition period (January 1 through June 30, 2015), services from a Sutter Health provider will be paid at their current participating benefit level as stated above. If providers have any questions about this transition period, please have them contact Shield Concierge at (855) What if I need emergency services before or after the transition period? UC Care members will continue to receive the same emergency room (ER) benefit from a Sutter Health facility. For each visit to the emergency room you will be charged the applicable Emergency Room copay: $200 copay for ER visits not resulting in admission and $250 copay for ER visits resulting in hospital admission. There is no charge for Emergency Room physician services. If you have questions regarding a bill for emergency room visits, please call Shield Concierge at (855)

11 UC MEDICARE PLAN MEMBERS As a UC Medicare plan member, will I be affected by this termination? The Sutter Health termination only affects the non Medicare covered services that Blue Shield covers for the following plans: High Option Supplement to Medicare* Medicare PPO plans (with and without Rx)* Examples of these services include acupuncture; outpatient marriage, family, and child counseling; inpatient residential treatment; and hearing aids. (Please refer to your plan s Benefits Booklet for additional coverage details by going to blueshieldca.com/uc and selecting Medicare Plans.) If you are accessing these services through a Blue Shield PPO network provider, we encouraged you to transition their care to a Blue Shield Preferred Provider as soon as possible to ensure the continuation of in-network benefits after the transition period ends. Blue Shield network providers can be found by visit blueshieldca.com/uc and select Find a Provider. Please note that it may take several weeks to update the Blue Shield Find a Provider database to reflect this network change. Therefore, you may still see Sutter Health Providers listed until the site has been updated. ### 11