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UCSB Human Resources, Benefits

This presentation is intended for communication purposes only. Please see the At Your Service website (http://atyourservice.ucop.edu) and plan documents for complete information.

Blue Shield Health Savings Plan

11/2013

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Blue Shield Health Savings Plan

Combines high deductible PPO with account to pay out-of-pocket expenses

Medical CoverageBlue Shield PPO

Health Savings AccountHealthEquity

+

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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

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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

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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

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Blue Shield PPO - Plan Design

In Network Out of Network

Deductible Single Family

$1,250$2,500

$2,500 $5,000

Member Cost Sharing(Coinsurance for medical services & drugs)

20%

• Plan pays 60% of allowed rate

• You pay balance

Out-of-Pocket Max(includes deductible) Single Family

$4,000 $6,400

$8,000 $16,000

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Deductible, Coinsurance, OOPM

You pay You share cost with plan

Plan pays100%

$1250Deductibl

e20% Coinsurance $4000

OOPM

Individual (Single)Preferred Providers

You can use the UC Contribution to the Health Savings Account to pay part of the deductible.

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Deductible, Coinsurance, OOPM

You pay You share cost with plan

Plan pays100%

$2500Deductibl

e20% Coinsurance $6400

OOPM

Family (2 or more)Preferred Providers

The full family deductible must be met before plan shares costs

You can use the UC Contribution to the Health Savings Account to pay part of the deductible.

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Allowed Amount – In Network

In-Network ExampleDiscounted rate that plan negotiates for each service with “preferred” or participating providers• You pay the in-network

coinsurance on the discounted rate.

• Provider can’t “balance bill”

20% Coinsurance

Provider charge: $200Allowed amount: $100Plan pays 80%: $80You pay 20% $20

Provider write-off:$100

PPO plans negotiate “allowed” rates to process claims.

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Allowed Amount – Out of Network

Out-of-Network ExampleValue that plan assigns to a service when provider is NOT a “preferred provider” (not participating)• Plan pays out-of-network

coinsurance on the allowed amount.

• Provider can “balance bill”

40% Coinsurance

Provider charge: $200Allowed amount: $100Plan pays 60%: $60(60% of $100)You pay 40%: $40You pay balance: $100

PPO plans assign “allowed” rates to process claims.

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Medical Claims, EOBs & Bills

You receive servicesYou pay nothing at the time of service for in-network care

Provider sends claim for services to Blue Shield

Blue Shield sends EOBExplanation of Benefits (EOB) outlines allowed charges, deductible and co-insurance. “This is not a bill”.

Provider sends billThe bill should match the EOB. It should reflect the in-network discount and any payments received from health plan.

You pay provider• Pay with HSA fundsor• Pay with other funds

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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

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Pharmacy ClaimsYou go to the pharmacy

Pay with your HSA debit cardorPay with personal funds and later go to your HealthEquity account online and reimburse yourself (if you have money in the account)

Give pharmacist your Blue Shield ID card so they can apply the Blue Shield Rx discount

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Learn more about PPO CostsFair Health Consumerhttp://www.fairhealthconsumer.org/

Health Care Blue Bookhttps://www.healthcarebluebook.com/

Good Rx• http://www.goodrx.com• Estimate cost of drugs

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Find costs on Blue Shield Website

After your enrollment is complete and you are in the Blue Shield membership system, you will have access to additional tools.

http://www.blueshieldca.com/uc

• Treatment Cost Estimator Tool• Drug costs, information and claim

summary

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Health Saving Account

Blue Shield PPO +

High deductible medical plan paired with a Health Savings Account

Health Savings Account

• The Health Savings Account is a separate account that can be used to pay medical and other health expenses.

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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

Annual Contributions by UC & Employee

• 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+:

$1,000Tip: Contribute the money you would

have put in your Health FSA.

UC Contribution is prorated for plans that start after January 1

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

• Not be claimed as a dependent on someone else’s tax return

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Whose expenses can be paid with HSA?

• The money in your HSA can be used to pay for qualified medical expenses of any family member who qualifies as a dependent on your tax return.

• The family member does not have to be enrolled in this plan

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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

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Your Responsibility• Follow HSA eligibility rules• Contribute only the amount allowed

by IRS• Use HSA funds for eligible expenses• Keep itemized receipts as tax

documents

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

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HSA vs FSA• The HSA is NOT like 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

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www.healthequity.com/ed/uc

Register as new member on this site.

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www.blueshieldca.com/uc Register as new member on this site.

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Health Equity Member Portal

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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

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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• Use smart phone browser to access

mobile website

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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

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Behavioral/Mental Health• Medical and behavioral health deductibles and

OOPM cross accumulate.• See the Optum Evidence of Coverage for complete

details. Covered Service

Optum Clinicians

Out-of-Network

Deductible $1,250 individual$2,500 family

$2,500 individual$5,000 family

Outpatient Office Visits

You pay 20% Plan pays 60% of allowed rateYou pay balance of bill

Emergency Room

You pay 20% Plan pays 80% of allowed rateYou pay balance of bill

Inpatient Stays You pay 20% Plan pays 60% of allowed rateYou pay balance of bill

For more informationHealthEquity Member Services is available

every hour of every dayCall the Blue Shield/UC dedicated line

1.855.201.8375 say

“Health Savings Account”

www.healthequity.com/ed/uc

www.blueshieldca.com/uc