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

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1 2014 Medical Plans Health Net Blue & Gold HMO Kaiser HMO UC Care Blue Shield Health Savings Plan Core

2 UC Care PPO Blue Shield of California claims administrator & network UC Select Providers Customized for UC Care UC Health System + Select Blue Shield providers Blue Shield Preferred Providers Similar to the standard in network cost-share of the previous Anthem PPO plan Non-Preferred Providers Flexibility to use services from any provider outside the UC Select or Blue Shield Preferred network 2

3 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. 3

4 Preventive Care All medical plans cover preventive care at 100% with in-network providers Preventive care includes: Annual well visit and labs Well woman visits and labs Preventive screening tests Immunizations See list of preventive services on the plan websites 4

5 Residence Limitations HMO (Health Net, Kaiser) Employee must live in California PCP must be within 30 miles of where you live or work (in most cases) Blue Shield Health Savings Employee must live in US UC Care Employee may live anywhere Worldwide services CORE Employee may live anywhere Worldwide services 5

6 When traveling out of US HMO (Health Net, Kaiser) Limited to emergency and urgent care only No routine care when away from medical group UC Care Comprehensive coverage Plan pays Preferred benefit. Blue Shield Health Savings Limited to emergency and urgent care only No routine care CORE Comprehensive coverage Plan pays out-of-network benefit. 6

7 Choice of Physician HMO (Health Net, Kaiser) You select PCP PCP coordinates care PCP refers to specialists Specialists limited to physicians in medical group Blue Shield Health Saving In-Network You select Blue Shield PPO Out-of-Network You select non-blue Shield UC Care In-Network You select UC Select Blue Shield Preferred PPO Out-of-Network You select non-blue Shield CORE In-Network You select Blue Shield PPO Out-of-Network You select non-blue Shield 7

8 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 out of US 8

9 Office Visit Cost Medical Plan Copay Deductible Coinsurance HMO $20 None None UC Care PPO UC Select $20 None Preferred Out-of-Network $250 indiv $750 family $500 indiv $1,500 family You pay 20% Plan pays 50% of allowed rate You pay balance 9

10 Deductible, Coinsurance, OOPM UC Care Individual Coverage Blue Shield Preferred (Tier 2) You pay You share cost with plan Plan pays 100% $250 Deductible 20% Coinsurance $3000 OOPM 10

11 Deductible: Individual vs Family UC Care Example Family Deductible Blue Shield Preferred (Tier 2) $250 Individual / $750 Family Coinsurance Adult 1 Paid $250 20% Adult 2 Paid $100 $175 20% Child 1 Paid $ 75 20% Child 2 Paid $250 20% 11

12 Office Visit Costs Medical Plan Copay Deductible Coinsurance CORE Preferred $3000 You pay 20% Out-of-Network per individual Plan pays 80% of allowed rate Blue Shield HSP Preferred Out-of-Network 12 $1,250 single $2,500 family $2,500 single $5,000 family You pay 20% Plan pays 60% of allowed rate Full family deductible must be met before plan shares cost

13 Deductible, Coinsurance, OOPM Blue Shield Health Savings Plan Individual (Single) Preferred Providers You pay You share cost with plan Plan pays 100% $1250 Deductible 20% Coinsurance $4000 OOPM 13

14 Deductible, Coinsurance, OOPM Blue Shield Health Savings Plan Family Preferred Providers The full family deductible must be met before plan shares costs You pay You share cost with plan Plan pays 100% $2500 Deductible 20% Coinsurance $6400 OOPM 14

15 Hospitalization Costs Medical Plan Copay Deductible Coinsurance HMO $250 None None UC Care PPO UC Select $250 None None Preferred Out-of-Network $250 indiv $750 family $500 indiv $1,500 family You pay 20% Plan pays 50% of allowed rate You pay balance 15

16 Hospitalization Costs Medical Plan Copay Deductible Coinsurance CORE Preferred $3000 You pay 20% Out-of-Network per individual Plan pays 80% of allowed rate Blue Shield HSP Preferred Out-of-Network $1,250 single $2,500 family $2,500 single $5,000 family You pay 20% Plan pays 60% of allowed rate Full family deductible must be met before plan shares cost 16

17 Emergency Room Costs Medical Plan Copay Deductible Coinsurance HMO $75 None None UC Care PPO UC Select $100 None You pay 20% of ER physician Preferred $100 Waived You pay 20% of ER physician Out-of-Network $100 Waived You pay 20% of ER physician 17

18 Emergency Room Costs Medical Plan Copay Deductible Coinsurance CORE Preferred Waived for You pay 20% Out-of-Network facility fee You pay 20% Blue Shield HSP Preferred Out-of-Network $1,250 single $2,500 family $2,500 single $5,000 family You pay 20% You pay 20% Full family deductible must be met before plan shares cost 18

19 Out-of-Pocket Maximum Medical Plan OOPM Notes Health Net HMO Kaiser HMO $1,000 indiv $3,000 family $1,500 indiv $3,000 family Family = 3 or more Family = 2 or more 19

20 Out-of-Pocket Maximum Medical Plan OOPM Notes UC Care PPO UC Select Preferred Out of Network $1,500 indiv $4,500 family $3,000 indiv $9,000 family $5,000 indiv $15,000 family Family = 3 or more In-Network providers cross accumulate Family = 3 or more Out-of-network accumulates separately 20

21 Out-of-Pocket Maximum Medical Plan OOPM Notes CORE Blue Shield HSP Preferred Non-Preferred (Out-of-Network) $6,350 indiv $12,700 family $4,000 indiv (single) $6,400 family $8,000 indiv (single) $16,000 family Family = 2 or more Medical & Drug expenses apply Full family OOPM must be met before plan pays 100% for any enrollee In & Out-of-network accumulate separately Medical & Drug expenses apply 21

22 Prescription Drugs Preferred Drug List (Formulary) is different for each carrier Retail (30 day) Generic Brand Non-formulary Mail Order (90 day) Generic Brand Non-formulary HMO UC Care $5 $25 $40 $10 $50 $80 Blue Shield HSP CORE You pay full cost of medication until you satisfy the deductible After deductible, you pay 20% at preferred pharmacies 22

23 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. 23

24 Lumenos vs Blue Shield HSP Lumenos Deductible Health Reimbursement Account (HRA) Member pays PPO Coinsurance Blue Shield PPO Deductible Member pays PPO Coinsurance Health Savings Account UC Contributions Member Contributions Lumenos HRA Rollover 24

25 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.

26 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

27 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.

28 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

29 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

30 Use the HSA to pay for Deductible Coinsurance Any IRS Publication 502 Expenses, including: Medical Dental Vision Prescription drug Long Term Care insurance premiums 30

31 For more information HealthEquity Member Services is available every hour of every day: Call the Blue Shield/UC dedicated line say Health Savings Account

32 Optum (formerly United Behavioral Health) Optum coordinates 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 33

33 Behavioral/Mental Health Medical Plan OPTUM Network Out of Network Health Net Blue & Gold Kaiser (Optum & Kaiser Providers) Visits 1 3 no copay Visits 4+ $20 $250 inpatient hospitalization Emergency only Emergency only 34

34 Behavioral/Mental Health Medical Plan OPTUM Network Out-of-Network UC Care Visits 1-3 no copay Visits 4+ $20 Inpatient $250 $500 deductible Plan pays 50% allowed You pay balance Blue Shield HSP Deductible: $1,250 indiv $2,500 family Deductible: $2,500 indiv $5,000 family You pay 20% Plan pays 60% allowed You pay balance 35

35 Behavioral/Mental Health Medical Plan Core Blue Shield Network $3000 deductible Out of Network You pay 20% Plan pays 80% allowed You pay balance Note for all plans: The medical and behavioral health deductibles crossaccumulate. The medical and behavioral health coinsurance crossaccumulate toward a common out-of-pocket maximum. In-network and out-of-network deductibles and out-ofpocket maximums do NOT cross accumulate. 36

36 Chiropractic & Acupuncture Medical Plan Providers Costs HMO UC Care Preferred American Specialty Health Blue Shield Out-of-Network Non-Blue Shield 25% discount After deductible, You pay 20% After deductible, Acupuncture: Plan pays 80% allowed Chiropractic: Plan pays 60% allowed Note: Benefit is limited to 24 visits per calendar year combined for Acupuncture and Chiropractic visits 37

37 Chiropractic & Acupuncture Medical Plan Providers Costs Blue Shield HSP Preferred Blue Shield After deductible, You pay 20% Out-of-Network Non-Blue Shield After deductible, Acupuncture: Plan pays 80% of allowed Chiropractic: Plan pays 60% of allowed Note: Benefit is limited to 24 visits per calendar year combined for Acupuncture and Chiropractic visits 38

38 Chiropractic & Acupuncture Medical Plan Provider Out of Network Core Preferred Blue Shield After deductible, You pay 20% Out-of-network Non-Blue Shield After deductible, Acupuncture: Plan pays 80% allowed Chiropractic: Plan pays 80% allowed Note: Plan payment maximum up to $500 per calendar year 39

39 Resources Plan contacts Plan rates Medical Plans Benefit summaries Links to plan websites Links to provider directories Other plans Dental, vision, FSA 40

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