Presentation on theme: "90 Day Maintenance Drug – Retail Option CURRENT2015 Available through Mail order pharmacy UC Owned Outpatient Pharmacies Current plus… UC Care."— Presentation transcript:
90 Day Maintenance Drug – Retail Option CURRENT2015 Available through Mail order pharmacy UC Owned Outpatient Pharmacies Current plus… UC Care & Blue Shield Plans: Safeway/Vons, Walgreens, Costco and others Health Net Blue & Gold: CVS WHA: Walgreens, CVS, Costco, and others Cost sharingMembers pay two copayments (rather than three) Same as current Kaiser members only receive extended supply/2 copay through mail order. Core/HSP subject to deductible and coinsurance – convenient access but no cost savings.
Chiropractic/Acupuncture CURRENT2015 Health Net Blue & Gold; WHA Not covered $20 copay, 24 visits yearly (combined) Kaiser Only acupuncture through Kaiser provider is covered ($20 Copay) $15 copay for acupuncture or chiro, 24 visits yearly for self-referral (combined); or $20 copay through Kaiser provider for acupuncture only UC Care & HSP Chiro/Acupuncture covered (BSC Network) UC Care aligning coinsurance for chiropractic services to match other services Core Both Chiro and Acupuncture subject to $500 maximum Eliminate $500 maximum; 24 visits yearly (combined) Subcontracted Specialty Vendors Health Net Blue & Gold and Kaiser Permanente: American Specialty Health WHA: Landmark
Mandated: Out of Pocket Max Change 2015 Mandate: Member Rx cost must accrue towards meeting Out-of-Pocket (OOP) Maximum. Plans changing to meet mandate: Health Net Blue & Gold and WHA - Combined Medical and Rx OOP: $1,000 single/$3,000 family Kaiser Permanente - Combined Medical and Rx OOP: $1,500 single/$3,000 family UC Care updates described on next slide. Blue Shield HSP and Core currently comply. 3
Other Mandated Changes Nicotine Replacement OTC Products - 2015 will be covered at no cost (currently $5 generic copay) - Kaiser and WHA currently compliant Women’s Preventive Health - Cancer risk reducing medications (e.g., Tamoxifen or Raloxifene) for women at increased risk of breast cancer. - 2015 will be covered at no cost - WHA currently compliant
Mandated: Health Savings Plan Limits Affects Health Savings Plan (Blue Shield). IRS annually increases definition of “high deductible” and Health Savings Account maximum annual contribution amounts. 5 20142015Change Deductible Single Family $1,250 $2,500 $1,300 $2,600 $50 $100 Out-of-pocket max Single Family $4,000 $6,400 No change Max Contribution Single Family $3,300 $6,550 $3,350 $6,650 $50 $100
Teladoc – Blue Shield Telemedicine services available by phone, mobile applications or online video – Board certified physicians 24/7/365 – UC Care: $20 copay (copay does NOT count towards deductible, does count towards OOP) – Core and Health Savings Plan: $40 copay until deductible met and then 20% coinsurance after (copay counts towards deductible and OOP) Top 10 Diagnoses Sinus Problems Urinary Tract Infection Pink Eye Bronchitis Upper Respiratory Infection Nasal Congestion Allergies Flu Cough Ear Infection Top 10 Diagnoses Sinus Problems Urinary Tract Infection Pink Eye Bronchitis Upper Respiratory Infection Nasal Congestion Allergies Flu Cough Ear Infection Prescription Management Electronic prescribing (SureScripts) or by phone, if needed Use of antibiotics limited to short durations No prescribing of DEA-controlled substances, medication for psychiatric illness, or lifestyle drugs Generic drugs are automatically recommended Prescription Management Electronic prescribing (SureScripts) or by phone, if needed Use of antibiotics limited to short durations No prescribing of DEA-controlled substances, medication for psychiatric illness, or lifestyle drugs Generic drugs are automatically recommended
Emergency – UC Care Covered ServiceUC SelectBlue Shield Preferred Non-Preferred (out-of-network) CURRENT Emergency facility (not resulting in an admission) $100 per visit (not subject to the calendar year deductible) $100 per visit (not subject to the calendar year deductible) ER Physician Services20% (not subject to the calendar year deductible) 20% (not subject to the calendar year deductible) NEW FOR 2015: Combining ER facility and Physician services as one fixed copay amount Emergency facility (not resulting in an admission)* $200 per visit (not subject to the calendar year deductible) $200 per visit (not subject to the calendar year deductible) ER Physician ServicesNo Charge * For ER Services resulting in admission – no change; remains $250 copay.
Rehabilitative Services – UC Care Annual visit limitation on rehabilitative services: physical therapy, occupational therapy, and speech therapy CURRENT No limit for any of the three areas of services: physical therapy, occupational therapy, and speech therapy NEW FOR 2015 Combined 48 visits for all three areas of services: physical therapy, occupational therapy, and speech therapy
Vaccinations – UC Care CURRENT Covered at a $0 copay Per medical plan Preventive Health Benefits (based on age and gender requirements) Services received from an in-network physician Coverage for the following vaccinations: tetanus, whooping cough (pertussis) pneumococcal, meningococcal, cervical cancer (HPV) and shingles (herpes zoster). NEW FOR 2015 Covered at a $0 copay Per medical plan Preventive Health Benefits (based on age and gender requirements) Allow adults to receive services from an in-network physician or in-network pharmacy
UC Select Network Status Update LocationProviderStatus UCLA Riverside Community Hospital Los Robles Regional Medical Center West Hills Hospital and Medical Center BSC Contract Manager and Santiago Munoz from UCLA continue to work with the HCA group. Conversations still in progress. UC Berkeley & UCOP John Muir Health (Hospital & JMH Physicians) BSC still in follow up with conversations with John Muir. Santa Barbara Cottage Hospital Sansum Clinic Pueblo Radiology Medical Group Cottage remains in Blue Shield Preferred Sansum will remain in the UC Select Pueblo Radiology is currently being reviewed UC Davis Marshall Medical Center Marshall Physicians Lodi Memorial Hospital Effective January 1, 2015 will move from Blue Shield Preferred to UC Select
2015 Medical Pay Band Adjustments 2014 Pay Band Definition of Range for Medical Contribution Base Using Full-Time Salary As of Jan. 2013 1$51,000 & under 2$51,001 to $101,000 3$101,001 to $151,000 4$151,001 & over 2015 Pay Band Definition of Range for Medical Contribution Base Using Full-Time Salary As of Jan. 2014 1$51,000 & under 2$51,001 to $101,000 3$101,001 to $152,000 4$152,001 & over Pay Bands are adjusted annually, based on the change in California consumer price index from February of prior year to February of current year (determined by the California Department of Finance). The index used is that for urban wage earners and clerical workers (CPI-U). The change from February 2013 to February 2014 was 0.9%.
2015 Monthly Cost by Salary Band PlansCoverage $51,000 or less$51,001-$101,000$101,001 - $152,000 $152,001 or More EE 3, 55, 2, 3, 3, 89, 2, 26 UC Total EE 6, 55, 2, 3, 6, 89, 2, 26 UC Total EEUC Total EEUC Total Kaiser CaliforniaSingle13.78546.91560.6949.83510.86560.6986.83473.86560.69125.14435.55560.69 EDB Code: KS = South Self+child(ren)24.80984.451,009.2589.69919.561,009.25156.29852.961,009.25225.25784.001,009.25 Self+adult30.181,147.281,177.46112.481,064.981,177.46186.24991.221,177.46262.66914.801,177.46 Family41.191,584.821,626.01152.331,473.681,626.01255.691,370.321,626.01362.761,263.251,626.01 Health Net Single35.19626.90662.0971.24590.85662.09108.24553.85662.09146.55515.54662.09 Blue & Gold - HMOSelf+child(ren)63.341,128.421,191.76128.231,063.531,191.76194.83996.931,191.76263.79927.971,191.76 EDB Code: HB Self+adult128.021,262.361,390.38210.321,180.061,390.38284.081,106.301,390.38360.501,029.881,390.38 Family156.181,763.881,920.06267.321,652.741,920.06370.681,549.381,920.06477.751,442.311,920.06 UC Care PPOSingle96.91626.90723.81132.96590.85723.81169.96553.85723.81208.27515.54723.81 EDB Code: SU Self+child(ren)174.441,128.421,302.86239.331,063.531,302.86305.93996.931,302.86374.89927.971,302.86 Self+adult257.641,262.361,520.00339.941,180.061,520.00413.701,106.301,520.00490.121,029.881,520.00 Family335.171,763.882,099.05446.311,652.742,099.05549.671,549.382,099.05656.741,442.312,099.05 Blue ShieldSingle13.78557.66571.4449.83521.61571.4486.83484.61571.44125.14446.30571.44 Health Savings PPOSelf+child(ren)24.801,003.791,028.5989.69938.901,028.59156.29872.301,028.59225.25803.341,028.59 EDB Code: SP Self+adult30.181,169.831,200.01112.481,087.531,200.01186.241,013.771,200.01262.66937.351,200.01 Family41.191,615.961,657.15152.331,504.821,657.15255.691,401.461,657.15362.761,294.391,657.15
Supplemental Disability 13 19% increase in Supplemental Disability Rates – the first rate increase in 5 years. Rates to increase only for 7 and 30 day waiting periods – NOT 90 and 180 day. Rate drivers: Frequency and claim duration for both short and long- term disabilities. Rates are based on age, salary and waiting period elected. Examples: Age 50, $100k salary, 30 day wp Rate increase of $10.45 ($55.00 to $65.45) Age 40, $100k salary, 30 day wp Rate increase of $6.97 ($36.67 to $43. 64)
Group Legal - ARAG The plan will be open for new enrollments this year. Claims experience has been consistent, thus rates are not increasing. Expanded identity theft protection benefit added that includes: - Full service identity restoration - Identity Theft Insurance up to $1million - Lost wallet services - Credit monitoring service, internet surveillance of personal information and child identity monitoring - Powered by CSID, leader of global enterprise level identity protection and fraud detection solutions.
ARAG’s New Expanded ID Theft Protection Many of the new tools are full service/ concierge type, rather than just information based ARAG will work on the member’s behalf to completely resolve the ID theft problem Free insurance covers members’ costs associated with ID theft restoration - For example: child care expenses, unpaid time off work, mileage