1. 1 11/4/2015 UCSB Human Resources, Benefits This presentation is intended for communication purposes only. Please see the UCnet website (http://ucnet.universityofcalifornia.edu) and plan documents for complete information.http://ucnet.universityofcalifornia.edu Medical Plan Comparison

2. Open Enrollment Website http://ucnet.universityofcalifornia.edu/oe http://ucnet.universityofcalifornia.edu/oe Insurance Plan Websites ◊ ◊ Plan booklets ◊ ◊ Provider directories Benefits Education Videos https://uc.a.guidespark.com/ https://uc.a.guidespark.com/ ◊ ◊ Medical Terms and Concepts ◊ ◊ Medical Plan Comparisons 2

3. What is your priority? Preventive care Residence requirements Choice of physician Cost of care & prescription drugs Out of Pocket Maximum Health Savings Account Behavioral Health Chiropractic and Acupuncture 3

4. 2016 Medical Plans HMO Health Net Blue & Gold Kaiser PPO UC Care Blue Shield Health Savings Plan Core

5. 5 Cost to enroll – monthly premium Cost of care ◊ ◊ Predictable, low cost copays ◊ ◊ Pay a % of each service Choice of providers ◊ ◊ HMO medical group physicians ◊ ◊ PPO preferred network or any provider Effort to manage – coordinating care & bills

6. All medical plans cover preventive care at 100% with in-network providersAll medical plans cover preventive care at 100% with in-network providers Preventive care includes: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 websitesSee list of preventive services on the plan websites 6

7. 7 HMO (Health Net, Kaiser) Employee must live in CaliforniaEmployee must live in California PCP must be within 30 miles of where you live or work (in most cases)PCP must be within 30 miles of where you live or work (in most cases) Blue Shield Health Savings Employee must live in USEmployee must live in US Employee may live anywhereEmployee may live anywhere Worldwide servicesWorldwide services CORE UC Care Employee may live anywhereEmployee may live anywhere Worldwide servicesWorldwide services Employee may live anywhereEmployee may live anywhere Worldwide servicesWorldwide services

8. 8 HMO (Health Net, Kaiser) Limited to emergency and urgent care onlyLimited to emergency and urgent care only No routine care when away from medical groupNo routine care when away from medical group Blue Shield Health Savings Limited to emergency and urgent care onlyLimited to emergency and urgent care only No routine careNo routine care Comprehensive coverageComprehensive coverage Plan pays Preferred/Tier 2 benefit.Plan pays Preferred/Tier 2 benefit. CORE UC Care Comprehensive coverageComprehensive coverage Plan pays out-of-network benefit.Plan pays out-of-network benefit.

9. 9 HMO (Health Net, Kaiser) You choose PCPYou choose PCP PCP coordinates carePCP coordinates care PCP refers to specialistsPCP refers to specialists Specialists limited to physicians in medical groupSpecialists limited to physicians in medical group Blue Shield Health Saving Out-of-Network Non-Blue ShieldNon-Blue Shield CORE UC Care In-Network Blue Shield PPO Blue Shield PPO Out-of-Network Non-Blue ShieldNon-Blue Shield You choose In-Network UC SelectUC Select Blue Shield Preferred PPOBlue Shield Preferred PPO You choose In-Network Blue Shield PPOBlue Shield PPO Out-of-Network Non-Blue ShieldNon-Blue Shield You choose

10. 10 UC Select (Tier 1) UC Medical Centers & Select Blue Shield PPO Blue Shield Preferred (Tier 2) In CA Blue Shield PPO Out of CA Blue Cross Blue Shield Out of US Any provider Non-Preferred Out-of-Network (Tier 3) Out of the UC Select or Blue Shield Preferred In Network Providers

11. 11 ProvidersStatus Sansum Clinic  UC Select/Tier 1 Quest Diagnostic Lab Unilab  UC Select/Tier 1 Cottage Hospitals  UC Select/Tier 1 Pacific Diagnostic Lab  UC Select/Tier 1 Pueblo Radiology  UC Select/Tier 1 Santa Barbara Preferred Health Partners  Some physicians are in Blue Shield Preferred/Tier 2 NEW in 2016

12. UC Select/Tier 1 providers in ◊ ◊ Santa Barbara ◊ ◊ Santa Maria ◊ ◊ Lompoc ◊ ◊ Ventura UC Care Provider Directory blueshieldca.com/uccareppo Blue Shield Concierge 1-855-702-0477 12

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14. HMOs have predictable copays for servicesHMOs have predictable copays for services PPOs have deductibles and % coinsurancePPOs have deductibles and % coinsurance ◊ Deductible is the amount you pay each year before the plan starts sharing the cost with you ◊ Coinsurance is your share of the cost after you pay the deductible ◊ Your costs are based on the network that the provider is in and the service you receive ◊ You pay discounted rates for “in-network” providers ◊ You pay more for “out-of-network” providers 14

15. In-NetworkExample that plan negotiates for each service with “preferred” or participating providers Discounted rate that plan negotiates for each service with “preferred” or participating providers You pay the in-network coinsurance on the discounted rate. You pay the in-network coinsurance on the discounted rate. Provider can’t “balance bill” Provider can’t “balance bill” 20% Coinsurance Provider charge:$200 Allowed amount:$100 Plan pays 80%:$80 You pay 20%$20 Provider write-off:$100 PPO plans negotiate “allowed” rates to process claims. 15

16. Out-of-NetworkExample to a service when provider is NOT a “preferred provider” (not participating) Value 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. Plan pays out-of-network coinsurance on the allowed amount. Provider can “balance bill” Provider can “balance bill” 50% Coinsurance Provider charge:$200 Allowed amount:$100 Plan pays 50%:$50 (50% of $100) You pay 50%:$50 You pay balance:$100 PPO plans assign “allowed” rates to process claims. 16

17. Medical PlanCopayDeductibleCoinsurance 17 HMO$20None UC Care PPO UC Select/Tier 1$20None Preferred/Tier 2 $250 indiv $750 family You pay 20% Out-of-Network $500 indiv $1,500 family Plan pays 50% of allowed rate You pay balance

18. 18 $250 Individual / $750 FamilyCoinsurance Adult 1Paid $250 20% Adult 2Paid $100 Child 1Paid $ 75 Child 2Paid $250 20% Adult 2Paid $175 20%20% UC Care Example Family Deductible Blue Shield Preferred (Tier 2)

19. 19 Blue Shield HSP In-network $2,600 family $1,300 single $2,600 family You pay 20% Out-of-Network $5,000 family $2,500 single $5,000 family Plan pays 60% of allowed rate Full family deductible must be met before plan shares cost CORE In-network $3000 per individual You pay 20% Out-of-NetworkPlan pays 80% of allowed rate Medical PlanCopayDeductibleCoinsurance

20. Scenario Office visit to a general practitioner who recommends you see a dermatologistOffice visit to a general practitioner who recommends you see a dermatologist Office visit to dermatologist who conducts a biopsy in the office to remove a lesion.Office visit to dermatologist who conducts a biopsy in the office to remove a lesion. 1.How do you access these providers? 2.What will you pay for these services? 20

21. Medical PlanCopayDeductibleCoinsurance 21 HMO$250None UC Care PPO UC Select/Tier 1$250None Preferred/Tier 2 $250 indiv $750 family You pay 20% Out-of-Network $500 indiv $1,500 family Plan pays 50% of allowed rate You pay balance

22. 22 Blue Shield HSP In-network$1,300 single $2,600 family* You pay 20% Out-of-Network$2,500 single $5,000 family* Plan pays 60% of allowed rate *Full family deductible must be met before plan shares cost CORE In-network $3000 per individual You pay 20% Out-of-NetworkPlan pays 80% of allowed rate Medical PlanCopayDeductibleCoinsurance

23. Medical PlanCopayDeductibleCoinsurance 23 HMO$100None UC Care PPO UC Select/Tier 1$100None Preferred/Tier 2 $250 indiv $750 family You pay 20% Out-of-Network $500 indiv $1,500 family Plan pays 50% of allowed rate You pay balance

24. 24 Blue Shield HSP In-network$1,300 single $2,600 family* You pay 20% Out-of-Network$2,500 single $5,000 family* Plan pays 60% of allowed rate *Full family deductible must be met before plan shares cost CORE In-network $3000 per individual You pay 20% Out-of-NetworkPlan pays 80% of allowed rate Medical PlanCopayDeductibleCoinsurance

25. 25 Scenario Surgery for orthopedic problem (medical facility, surgeon, anesthesiologist)Surgery for orthopedic problem (medical facility, surgeon, anesthesiologist) Follow-up physical therapyFollow-up physical therapy 1.How do you access these providers? 2.What will you pay for these services?

26. Medical PlanCopayDeductibleCoinsurance 26 HMO$75None UC Care PPO UC Select/Tier 1$200None Preferred/Tier 2$200WaivedNone Out-of-Network$200WaivedNone

27. 27 Blue Shield HSP In-network$1,300 single $2,600 family* You pay 20% Out-of-Network$2,500 single $5,000 family* You pay 20% *Full family deductible must be met before plan shares cost CORE In-network Waived for facility fee You pay 20% Out-of-NetworkYou pay 20% Medical PlanCopayDeductibleCoinsurance

28. The most the insurance plan requires you to pay in a calendar yearThe most the insurance plan requires you to pay in a calendar year Once you have paid this amount, the insurance plan pays 100% of future expenses.Once you have paid this amount, the insurance plan pays 100% of future expenses. Includes deductible, copay, coinsurance for medical services, behavioral health and prescription drugsIncludes deductible, copay, coinsurance for medical services, behavioral health and prescription drugs Does not include amounts “not allowed” by insurance plan when using out-of-network providers.Does not include amounts “not allowed” by insurance plan when using out-of-network providers. 28

29. Medical PlanOOPM Medical & Rx Notes 29 Health Net HMO$1,000 indiv $3,000 family Family = 3 or more Kaiser HMO$1,500 indiv $3,000 family Family = 2 or more

30. Medical PlanOOPM MedicalNotes 30 UC Care PPO UC Select/Tier 1$1,500 indiv $4,500 family Family = 3 or more Expenses for In-Network providers cross accumulate Preferred/Tier 2$3,000 indiv $9,000 family Out of Network $5,000 indiv $15,000 family Family = 3 or more Out-of-network accumulates separately

31. 31 UC Select /Tier 1 Copays Blue Shield Preferred/Tier 2 Deductible & Coinsurance $$$$ $$$$$$ $1500 Stop Paying UC Select Copays (individual) $3000 Stop paying Blue Shield Preferred Coinsurance (individual)

32. 32 You pay You share cost with plan After you pay OOPM, Plan pays 100% $250 Deductible 20% Coinsurance $3000 OOPM UC Care Individual Coverage Blue Shield Preferred (Tier 2)

33. Medical PlanOOPM RxNotes 33 UC Care PPO In-network pharmacy $3,600 indiv $4,200 family Family = 3 or more Medical and Rx do not cross accumulate Out-of-network PharmacyNone

34. Medical PlanOOPM Medical & Rx Notes 34 CORE $6,350 indiv $12,700 family Family = 2 or more Blue Shield HSP In-network $4,000 indiv (single) $6,400 family Full family OOPM must be met before plan pays 100% for any enrollee Out-of-Network OOPM includes In-network providers Out-of-Network $8,000 indiv (single) $16,000 family

35. 35 You pay You share cost with plan After you pay OOPM, Plan pays 100% $1300 Deductible 20% Coinsurance $4000 OOPM Blue Shield Health Savings Plan Individual (Single) In-Network Providers

36. 36 You pay You share cost with plan After you pay OOPM, Plan pays 100% $2600 Deductible 20% Coinsurance $6500 OOPM Blue Shield Health Savings Plan Family In-Network Providers The full family deductible must be met before plan shares costs

37. HMO UC Care Blue Shield HSP CORE Retail (30 day) Generic Generic Brand Brand Non-formulary Non-formulary$5$25$40 You pay full cost of medication until you satisfy the deductible After deductible, you pay 20% at preferred pharmacies Mail Order (90 day) Selected Retail Generic Generic Brand Brand Non-formulary Non-formulary$10$50$80 37 Preferred Drug List (Formulary) is different for each carrier

38. Fair Health Consumer http://www.fairhealthconsumer.org/ Health Care Blue Book https://www.healthcarebluebook.com/ Good Rx Good Rx – drug costs http://www.goodrx.com Blue Shield Member website After you enroll, see estimator toolsAfter you enroll, see estimator tools 38

39. 39 High deductible medical plan paired with a Health Savings Account Medical Coverage Blue Shield PPO 855-702-0477 blueshieldca.com/uc Health Savings Account HealthEquity 866-212-4729 healthequity.com/ed/uc/ +

40. To own/contribute to Health Savings Account: May not be enrolled in Medicare A or B ◊ ◊ Did you enroll in Medicare at age 65? ◊ ◊ Were you automatically enrolled when you signed up for Social Security pension? May not be enrolled in other medical plan Must have a $0 balance in Health FSA on December 31, 2015 (complete any claims reimbursement by Dec. 31, 2015) May not be claimed as a dependent on someone else’s tax return

41. 41 You keep the money even if you change jobs or insurance plans You can make contributions at any time HSA 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 You can invest funds to earn more

42. UC Contribution (plan starting on 1/1/16) ◊ ◊ $500 individual ◊ ◊ $1000 family You can contribute up to (optional): ◊ ◊ Single-coverage: $3,350 – $500 = $2,850 ◊ ◊ Family-coverage: $6,750 – $1,000 = $5,750 ◊ ◊ Catch-up contribution, age 55+: $1,000

43. Deductible Coinsurance Any IRS Publication 502 Expenses, including: ◊ ◊ Medical ◊ ◊ Dental ◊ ◊ Vision ◊ ◊ Prescription drug ◊ ◊ Long Term Care insurance premiums May pay expenses for tax dependents; don’t have to be enrolled in medical plan 43

44. 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

45. 45 Optum coordinates behavioral health care for all medical plans (except CORE)Optum coordinates behavioral health care for all medical plans (except CORE) ◊ ◊ psychiatrist ◊ ◊ psychologist ◊ ◊ therapist ◊ ◊ substance abuse treatment No referral required from physicianNo referral required from physician Call Optum to notify prior to first visitCall Optum to notify prior to first visit

46. 46 Medical Plan OPTUM Network Out of Network Health Net Blue & Gold Visits 1–3 no copay Visits 4+ $20 $250 inpatient hospitalization Emergency only Kaiser (Optum & Kaiser Providers) Emergency only

47. Medical PlanOPTUM NetworkOut-of-Network UC CareVisits 1-3 no copay Visits 4+ $20 Inpatient $250 $500 deductible Plan pays 50% allowed You pay balance Blue Shield HSP After deductible: $1,300 indiv $2,600 family You pay 20% Deductible: $2,500 indiv $5,000 family Plan pays 60% allowed You pay balance 47

48. 48 Medical Plan Blue Shield Network Out of Network Core $3000 deductible You pay 20% Plan pays 80% allowed You pay balance Note for all plans: The medical and behavioral health deductibles cross- accumulate. The medical and behavioral health coinsurance cross- accumulate toward a common out-of-pocket maximum. In-network and out-of-network deductibles and out-of- pocket maximums do NOT cross accumulate.

49. Medical PlanProvidersCosts Health NetAmerican Specialty Health $20 copay Self-referral 24 visits/year combined KaiserAmerican Specialty Health $15 copay Self-referral 24 visits/year combined Kaiser$20 copay acupuncture only 49

50. Medical PlanProvidersCosts UC Care UC SelectN/A PreferredBlue ShieldAfter deductible, You pay 20% Out-of-NetworkNon-Blue ShieldAfter deductible, Acupuncture: Plan pays 80% allowed Chiropractic: Plan pays 50% allowed Note: Benefit is limited to 24 visits per calendar year combined for Acupuncture and Chiropractic visits 50

51. Medical PlanProvidersCosts Blue Shield HSP In-NetworkBlue Shield After deductible, You pay 20% Out-of-NetworkNon-Blue ShieldAfter 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 51

52. 52 Medical Plan Provider Out of Network Core In-NetworkBlue Shield After deductible, You pay 20% Out-of-networkNon-Blue ShieldAfter deductible, Acupuncture: Plan pays 80% allowed Chiropractic: Plan pays 80% allowed Note: Benefit is limited to 24 visits per calendar year combined for Acupuncture and Chiropractic visits

53. Designed to enhance the care you already receive from your personal physician:Designed to enhance the care you already receive from your personal physician: ◊ When you are considering the ER or urgent care for nonemergency medical issues ◊ After normal office hours ◊ When your primary care physician is not available ◊ With pediatric care, if your child’s primary care physician is not available Doctors can also diagnose, recommend and prescribe medication for many of your non-emergent medical issuesDoctors can also diagnose, recommend and prescribe medication for many of your non-emergent medical issues 53

54. 24/7/365 access to consultations anywhere through online video, phone or secure email24/7/365 access to consultations anywhere through online video, phone or secure email Staffed by Board Certified PhysiciansStaffed by Board Certified Physicians Preregistration on plan website is recommendedPreregistration on plan website is recommended ◊ Health Net – MDLive ◊ UC Care – Teledoc ◊ Blue Shield Health Savings Plan – Teledoc ◊ Core – Teledoc See plan benefit summary for copay/coinsuranceSee plan benefit summary for copay/coinsurance 54

55. Fair Health Consumer http://www.fairhealthconsumer.org/ Health Care Blue Book https://www.healthcarebluebook.com/ Good Rx http://www.goodrx.comhttp://www.goodrx.comhttp://www.goodrx.com Estimate cost of drugsEstimate cost of drugs 55

56. ResourcesResources ◊ Plan contacts ◊ Plan rates Medical PlansMedical Plans ◊ Benefit summaries ◊ Links to provider directories ◊ Links to plan websites Other plansOther plans ◊ Dental, vision, FSA 56

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