2014 overview
DESCRIPTION
2014 Overview. Overview. Michael Baptista, Executive Director Benefits Programs & Strategy. Why Change? Projected Increases. What is the new line-up?. Sustainable Cost (For Members and UC) Comprehensive Care Distinct Value . What are the new plans?. UC Care Health Savings Plan. - PowerPoint PPT PresentationTRANSCRIPT
2014 Overview
Overview
Michael Baptista, Executive DirectorBenefits Programs & Strategy
Why Change?Projected Increases
Anthem PLUS (Single/Family)
Anthem PPO(Single/Family)
Health Net Full Network HMO(Single/Family)
Salary Band 2 (Neutral Band)
2013: $111 / 378 2013: $143 / 469 2013: $144 / 473
2014: $175 / 561 2014: $189 / 602 2014: $208 / 655
2014 Increase
Monthly
Annual
$64 / 183
$768 / 2,196
$46 / 133
$552 / 1,596
$64 / 182
$768 / 2,184
What is the new line-up? Sustainable Cost (For Members and UC) Comprehensive Care Distinct Value
2013 (8 plans)
2014 (6 plans)
Anthem PPOUC Care (Blue Shield)
Anthem PLUS
Core Core
Anthem HRA-PPO Health Savings Plan (Blue Shield)
Health Net Blue & Gold HMOHealth Net Blue & Gold HMO
Health Net Full Network HMO
Kaiser HMO Kaiser HMO
WHA HMO (Davis area) WHA HMO (Davis area)
What are the new plans?
UC Care
Health Savings Plan
UC Care: Network & Plan Design
• Customized for UC Care• UC Network + Select Blue Shield providers
UC Select Providers
• Similar to the standard in network cost-share of the previous Anthem PPO plan
Blue Shield Preferred Providers
• Flexibility to use services from any provider outside the Blue Shield Preferred network
Out of Network Providers
PPO plan that offers wide choices Blue Shield of California – claims administrator and network provider
Blue Shield Health Savings Plan
New high deductible medical plan paired with a Health Savings Account (HSA)
Blue Shield PPO Health Savings Account
* High deductible medical plan* Wide provider network access* Out-of-network coverage* Network preventive care
covered at 100%
* Special account to pay medical expenses
* UC funds $500/$1,000* You can contribute pre-tax* Portable
+
Health Net Full Network
Health Net Full Network
Blue & Gold UC Care Health Savings Plan Kaiser
Anthem PLUS
Blue & Gold UC Care Health Savings Plan Kaiser
Anthem PLUS
Anthem PPO
Anthem PPO
Blue & Gold UC Care Health Savings Plan Kaiser
Anthem Lumenos HRA
Anthem Lumenos HRA
Blue & Gold UC Care Health Savings Plan Kaiser
What do I need to think about?
Member Priority
Doctor Specific physician, hospital,
or least restricted choice
Find preferred doctor in best available benefit/value option
Dollars & Delivery Monthly cost, fixed copay vs.
cost exposure, savings option, administrative ease
Find preferred plan type, select best available physician choice
A look at the new plans
Presented by: Kathy Hajopoulos
• New self-funded PPO plan for 2014• Created for UC employees and non-Medicare retirees to
provide them with greater choice and flexibility• Can get care from UC physicians and medical centers,
the Blue Shield Preferred network of providers, or out-of network providers
• We are able to leverage UC Health to benefit employees and the University:o Offer a preferred discount for UC Care participants o Offer a plan that promotes care at UC medical centers
UC Care. Your care. Your choice.
UC Care plan overview
UC Care cost comparisonMonthly Contributions
* 2014 Pay Band 2 range is $51,001-$101,000.
Anthem PLUS(Single/ Family)
Anthem PPO(Single/ Family)
UC Care(Single/ Family)
$50,001 – $98,000* 2013: $111 / $378 2013: $143 / $469
2014Monthly: $108 / $366 Annual: $1,296/ $4,392
2014 Projected IncreaseMonthly Annual
$64 / 183$768 / 2,196
$46 / 133$552 / 1,596
UC Care rates lower than current Anthem PLUS and PPO rates
UC Care plan design comparison
Anthem PLUS Anthem PPODeductibleIn-networkOut-of-network
None$500 / $1,500
$250 / $750$500 / $1,500
Out-of-Pocket Max $5,000 / $15,000 $3,000 / $9,000
Member Share
Office visits In-networkOut-of-network
$2530%
20%40%
Outpatient In-networkOut-of-network
$030%
20%40%
HospitalizationIn-networkOut-of-network
$25030%
20%40%
Rx $10 / $30 / $45 $10 / $30 /$45
UC Care
Blue Shield Preferred (In/Out) UC Select
$250/$750$500/$1,500
No Deductible
$3,000 / $9,000 $5,000 / $15,000 $1,500 / $4,500
Member Share
20%50%
$20
20%50%
$20 / 20%(depends on service)
20%50%
$250
$5 / $25 / $40
UC Care plan design
UC Care network – in network
• UC Select• All UC medical centers, facilities and physicians• Additional preferred Blue Shield providers in areas where UC
medical centers and physicians may not be accessible• Chosen based on quality, location and cost
• Blue Shield Preferred Network• 376 hospitals• 22,061 primary care physicians• 50,197 specialists
• BlueCard Network coverage outside of CA and the U.S.
• 97% of Anthem contract providers are in the Blue Shield Preferred network
• 88% of providers in California are in the Blue Shield Preferred network
UC Care tool – UC Select providers
1. When you type this url, you are automatically. defaulted to UC Select.
2. To change the to Blue Shield Preferred, click on the “Change selection” link.
blueshieldca.com/uccareppo
UC Care tool – Preferred providers
1. Once you click on the link for “Change selection,” you will see a pop up window.
2. Click on the radio button “Blue Shield Preferred”.
3. Click on the “done” button.
blueshieldca.com/uccareppo
UCLA (1 of 3)UC Select Providers
Citrus Valley Medical Center - Queen of the ValleyDowney Regional Medical CenterGarfield Medical Center (San Gabriel Valley)Glendale Adventist Medical Center Good Samaritan Hospital (Los Angeles)Henry Mayo Newhall Hospital (Santa Clarita Valley)Huntington Memorial Hospital (Pasadena)Northridge Medical Center (Northridge)Providence Little Company of Mary (Torrance)Providence Little Company of Mary Medical Center San PedroProvidence Tarzana Medical Center
UCLA (2 of 3)UC Select Providers
Simi Valley Adventist Hospital(Dignity) St. Mary Medical Center (Long Beach)Torrance Memorial Medical CenterUCLA/Mattel Children's HospitalUCLA/Resnick Neuropsychiatric HospitalUCLA/Ronald Reagan UCLA Medical CenterUCLA/Santa Monica UCLA Medical CenterWhite Memorial Medical CenterWhittier Hospital Medical CenterSan Antonio Community Hospital
UCLA (3 of 3)Some providers were excluded from UC Select, but are in Blue Shield Preferred:• Los Robles Medical Center – excluded due to high cost. Lower cost alternative
providers available in the area• West Hills Medical Center – excluded due to high cost. Lower cost alternative
providers available in the area
UC Care information
• Looking for more details? Visit uc-care.org• To find a provider, visit blueshieldca.com/uccareppo • Have questions? Shield Concierge can help:
• 1-855-201-2087 • Monday through Friday
7:00 a.m. to 7:00 p.m. (Pacific)• Questions?
Thank you
The Blue Shield Health Savings Plan
Mark Esteban, DirectorHealth & Welfare Planning and Financials
Blue Shield Health Savings Plan
Health Savings Account(HealthEquity)
Medical Coverage(Blue Shield PPO)
+
Combines high deductible PPO with account to pay out-of-pocket expenses
Medical PPO Plan Design
Medical Plan Coverage
*Network preventive care
covered at 100%
In Network Out of NetworkDeductible*SingleFamily
$1,250$2,500
$2,500 $5,000
Out-of-Pocket Max(includes deductible)SingleFamily
$4,000 $6,400
$8,000 $16,000
Member Cost Sharing(coinsurance after deductible is met)
20% 40%
HSA Funding
HSA Funding
Contribution Types Individual Family
UC Contribution $500 $1,000
Employee Pre-Tax (optional) up to $2,800 up to $5,550
2014 IRS Maximums for HSA: $3,300 $6,550
How does the HSA work? UC funds your HSA account with $500 for
individual and $1,000 for family You can contribute up to $2,800/individual
$5,550 family If you’re 55 or older, you can contribute more Use HSA $ to pay for your
Deductible Coinsurance (e.g., your 20%) Any IRS Publication 502 Expenses
Things to consider….. You can’t participate in the Blue Shield Health
Savings Plan and UC’s Flexible Spending Account (Conexis) at the same time
You can’t be anyone’s tax dependent
Health Savings Account only allowed for High Deductible Health Plans
Your Health Savings Account: You own the account You can contribute to it It has triple tax advantages It comes with a HSA Debit Card
Currently enrolled in Anthem Lumenos and have an HRA balance? You’ll keep it as long as you enroll in the Health Savings Plan.
Why is it better than an HRA?
1. Go to your doctor.
2. Later – check your HealthEquity account online to see required payment to the doctor.
3. Pay with your HSA funds through your HealthEquity online account.
Give doctor’s office your Blue Shield card so BSC can… process the claim and
get you their special provider discounts and
send info about your amount of claim responsibility to Health Equity
Using Your Health Savings Plan
1. Go to your pharmacy.
2a. Pay for your Rx immediately if you want to use your HSA Debit Card,
OR
Using Your Health Savings Plan
Give Pharmacist your Blue Shield Card so they can apply the Blue Shield Rx discounts.
2b. Pay with personal funds (e.g., AMEX to get your points) and later go to your HealthEquity account online and reimburse yourself.
Questions?
atyourservice.ucop.edu/oe/medical