UC Health Savings Plan UCSB Human Resources, Benefits 1 This presentation is intended for communication purposes only. Please see the UCnet website (http://ucnet.universityofcalifornia.edu/) and plan documents for complete information. 1 11/2016

What’s new, what’s the same? PPOs have new administrators PPO plan designs and benefits are much the same Coverage 2016 2017 Medical Blue Shield Anthem Blue Cross Behavioral Health Optum Behavioral Health (Core – Blue Shield) Prescription Drug Optum Rx

Transition - PPO Networks Anthem has been working to reduce disruption Blue Shield and Optum providers have been invited to join the Anthem network Transition of Care Support PPO members may request transition-of-care support if they are a continuing member of a PPO plan and are currently receiving medical or behavioral health care from a provider that is not in Anthem’s network. See details on Open Enrollment booklet and website.

Resources Anthem Health Guides M-F 5:00am – 8:00pm PT 844-437-0486 www.anthem.com/ca/uc HealthEquity Always Open 866-212-4729 www.healthequity.com/uc OptumRx M-F 7:00 a.m. to 8:00 p.m PT www.optumrx.com/UOCALIF 855-489-0651

+ UC Health Savings Plan Combines high deductible PPO with account to pay out-of-pocket expenses + Medical Coverage Anthem PPO Health Savings Account HealthEquity

What’s special about the HSP? High deductible PPO medical plan Deductible and OOPM shared by all family members Medical, drug and behavioral health expenses apply to deductible and OOPM Administered by Anthem Blue Cross

What’s special about the HSP? Health Savings Account (HSA) UC makes an annual contribution to this account You may also make pre-tax contributions You use the HSA funds to pay medical and other health care expenses Money in HSA is yours to keep Funds rollover May invest funds Administered by HealthEquity

You share % Coinsurance How does the plan work? You pay Annual Deductible You share % Coinsurance Use HSA to pay deductible and coinsurance or save for retirement

Who is eligible for HSA? Are you eligible to make contributions to the Health Savings Account ?

May not be in Medicare 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 a Social Security pension?

May not have other coverage May not be in another medical plan May not be enrolled in a Health Flexible Spending Account (FSA) Must have $0 balance in Health FSA on December 31, 2016 Complete all claims reimbursement by December 31, 2016

…and a couple of more rules May not be claimed as a dependent on someone else’s tax return Must live in US Consider whether you are eligible for the Health Savings Plan

Anthem PPO Medical, drug and behavioral health expenses apply to deductible and OOPM All family members share a common deductible and OOPM + Medical Coverage Anthem PPO Health Savings Account HealthEquity

Anthem PPO - Plan Design Medical, Drug and Behavioral Health Expenses In Network Out of Network Deductible Single Family $1,300 $2,600 $2,500 $5,000 Member Cost Sharing (Coinsurance) 20% Plan pays 60% of allowed rate You pay balance Out-of-Pocket Max (includes deductible) $4,000 $6,400 $8,000 $16,000

Deductible, Coinsurance, OOPM Individual (Single) Preferred Providers You pay You share cost with plan Plan pays 100% after you pay $1300 Deductible* 20% Coinsurance $4000 OOPM *You can use the UC Contribution to the Health Savings Account to pay part of the deductible.

Deductible, Coinsurance, OOPM Family (2 or more) Preferred Providers The full family deductible must be met before plan shares costs You pay You share cost with plan Plan pays 100% after you pay $2600 Deductible* 20% Coinsurance $6400 OOPM *You can use the UC Contribution to the Health Savings Account to pay part of the deductible.

Allowed Amount – In Network PPO plans negotiate “allowed” rates to process claims. In-Network Example Discounted 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: $200 Allowed amount: $100 Plan pays 80%: $80 You pay 20% $20 Provider write-off: $100

Allowed Amount – Out of Network PPO plans assign “allowed” rates to process claims. Out-of-Network Example 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. Provider can “balance bill” Balance over allowed amount does not apply to OOPM 40% Coinsurance Provider charge: $200 Allowed amount: $100 Plan pays 60%: $60 (60% of $100) You pay 40%: $40 You pay balance: $100

Claims, EOBs & Bills You receive services You pay nothing at the time of service for in-network care Provider sends you bill The bill should match the EOB. It should reflect the in-network discount and any payments received from health plan. Provider sends claim to Anthem You pay provider Pay with HSA funds or Pay with other funds Anthem sends you EOB Explanation of Benefits (EOB) outlines allowed charges, deductible and co-insurance. “This is not a bill”.

Preventive Care Preventive care is covered at 100% with Anthem 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.anthem.com/ca/uc

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

Worldwide BlueCard or any provider for emergency and urgent care In-Network Providers Anthem Blue Cross Blue Cross Blue Shield Out of US Worldwide BlueCard or any provider for emergency and urgent care

OptumRx www.optumrx.com/UOCALIF 855-489-0651

Pharmacy Claims You go to the pharmacy Show pharmacist your Anthem ID so you get the OptumRx discount Pay with your HSA debit card or Pay with personal funds and later go to your HealthEquity account online and reimburse yourself (if you have money in the account)

Learn more about PPO Costs Fair Health Consumer http://www.fairhealthconsumer.org/ Health Care Blue Book https://www.healthcarebluebook.com/ OptumRx – drug costs http://www.optumrx.com/UOCALIF

Find costs on Anthem Website After your Anthem membership is active, you will have access to additional tools. http://www.anthem.com/ca/uc Castlight -Treatment Cost Estimator Tool Claims and plan details

anthem.com/ca/uc Register in 2017

Health Savings Account Health Saving Account The Health Savings Account is a separate account that can be used to pay medical and other health expenses. + Medical Coverage Anthem PPO Health Savings Account HealthEquity

Advantages of an HSA HSA funds rollover from year to year; no use it or lose it as with Health FSA You keep the money even if you change jobs or insurance plans You may make contributions at any time Contributions have triple tax advantage No Federal taxes on contributions No taxes when funds are used No taxes on earnings from investments

Build Savings by Investing You can invest HSA balances of $1000 or more HealthEquity offers Best-in-Class mutual funds Three investment methods depending on your preference for managing the funds on your own or getting help from advisors http://learn.healthequity.com/uc/ hsa/investment

How the HSA works UC contributes in January You contribute anytime Your 2016 payroll deduction will carryover Pay eligible expenses using: Debit card Health Equity website

Annual Contributions by UC & Employee UC Contribution (1/1/17) $500 individual $1000 family (2 or more) You can contribute up to (optional): Single-coverage: $2,900 ($3,400 – $500) Family-coverage: $5,750 ($6,750 – $1,000) Catch-up contribution, age 55+: $1,000 UC Contribution is prorated for plans that start after January 1

How to make HSA contributions? During Open Enrollment Use AYSO application to elect a pre-tax monthly payroll deduction After Open Enrollment Submit UPAY 850 form to Benefits to start or change monthly pre-tax payroll deduction – timing of deduction based on payroll deadlines Make post-tax contribution to Health Equity – write off contribution on you annual taxes

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 www.healthequity.com/uc for details

Whose expenses can be paid with HSA? Family members who are dependents on your tax return The family member does not have to be enrolled in this plan Older children enrolled in your plan but are not tax dependents can’t use HSA funds to pay the health expenses

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 No claim “substantiation” required You are responsible to IRS for expenses paid using HSA funds

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

www.healthequity.com/uc

Manage your HSA

Claim Summary Screen Details View claim Resolve Pay Provider Reimburse Me Close Pay from HSA account or external checking/savings account Schedule payment