1 UCSB Human Resources, Benefits This presentation is intended for communication purposes only. Please see the UCnet website ( and plan documents for complete information. Blue Shield Health Savings Plan 11/2015

Combines high deductible PPO with account to pay out-of-pocket expenses 2 Medical Coverage Blue Shield PPO Health Savings Account HealthEquity +

HealthEquity Member Services available every hour of every day (866) Blue Shield Concierge (855)

High deductible PPO medical planHigh deductible PPO medical plan ◊ Administered by Blue Shield ◊ Deductible and OOPM shared by all family members ◊ Medical, drug and Optum behavioral health expenses apply to deductible and OOPM 4

Health Savings Account (HSA)Health Savings Account (HSA) ◊ Administered by HealthEquity ◊ 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 ◊ Funds rollover; the money in the account is yours to keep and grow as an investment 5

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

The employee must live in USThe employee must live in US When in USWhen in US ◊ Comprehensive coverage ◊ Blue Shield PPO network in CA ◊ Blue Cross Blue Shield network outside CA When traveling out of USWhen traveling out of US ◊ Emergency and urgent care only ◊ NO routine care 7

Medical, drug and behavioral health expenses apply to deductible and OOPM All family members share a common deductible and OOPM 8 Medical Coverage Blue Shield PPO Health Savings Account HealthEquity +

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 9

Preventive care is covered at 100% with Blue Shield PPO providersPreventive care is covered at 100% with Blue Shield PPO 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 list of preventive services on

11 Medical, Drug & Optum Expenses In NetworkOut 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) Single Family $4,000 $6,400 $8,000 $16,000

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

13 You pay You share cost with plan Plan pays 100% after you pay $2600 Deductible* 20% 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.

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. 14

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” Balance over allowed amount does not apply to OOPM 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 PPO plans assign “allowed” rates to process claims. 15

16 You receive services You pay nothing at the time of service for in-network care Provider sends claim for services to Blue Shield Blue Shield sends EOB Explanation of Benefits (EOB) outlines allowed charges, deductible and co-insurance. “This is not a bill”. Provider sends bill The 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 funds or Pay with other funds

There is no separate drug plan with copaysThere is no separate drug plan with copays Drug expenses are applied to the plan in the same way as medical expensesDrug 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 17

18 You go to the pharmacy 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) Give pharmacist your Blue Shield ID card so they can apply the Blue Shield Rx discount

19 Optum coordinates behavioral health careOptum coordinates behavioral health care ◊ ◊ psychiatrist ◊ ◊ psychologist ◊ ◊ therapist ◊ ◊ substance abuse treatment No referral required from physicianNo referral required from physician May choose Optum or non-Optum cliniciansMay choose Optum or non-Optum clinicians Call Optum to notify prior to first visitCall Optum to notify prior to first visit

20 Medical and behavioral health deductibles and OOPM cross accumulate (shared by both plans).Medical and behavioral health deductibles and OOPM cross accumulate (shared by both plans). See the Optum Evidence of Coverage for complete details.See the Optum Evidence of Coverage for complete details. Covered ServiceOptum CliniciansOut-of-Network Deductible$1,300 individual $2,600 family $2,500 individual $5,000 family Outpatient Office Visits You pay 20%Plan pays 60% of allowed rate You pay balance of bill Emergency RoomYou pay 20%Plan pays 80% of allowed rate You pay balance of bill Inpatient StaysYou pay 20%Plan pays 60% of allowed rate You pay balance of bill

Fair Health Consumer Health Care Blue Book Good Rx Estimate cost of drugsEstimate cost of drugs 21

After your enrollment is complete and you are in the Blue Shield membership system, you will have access to additional tools. Treatment Cost Estimator ToolTreatment Cost Estimator Tool Drug costs, information and claim summaryDrug costs, information and claim summary 22

23 Register as new member on this site.

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

26 HSA funds rollover from year to year; no use it or lose it as with Health FSA You can make contributions at any time You keep the money even if you change jobs or insurance plans triple tax It has triple tax advantage No Federal taxes on contributions No taxes when funds are used No taxes on earnings

27 You can invest HSA balances of $2000 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 rces/docs/HSA_invest.pdf rces/docs/HSA_invest.pdf

UC makes annual contribution for plans that start on January 1; prorated for mid-year starts You may contribute through payroll deduction or make post-tax contributions to HealthEquity HSA debit cardUse a HSA debit card to pay for health expenses HealthEquity websiteUse HealthEquity website to pay medical and other health claims or reimburse expenses Invest HSA dollarsInvest HSA dollars when account balance reaches $2000 – no fees to invest

UC Contribution (1/1/16) ◊ ◊ $500 individual ◊ ◊ $1000 family You can contribute up to (optional): ◊ ◊ Single-coverage: $2,850 ($3,350 – $500) ◊ ◊ Family-coverage: $5,750 ($6,750 – $1,000) ◊ ◊ Catch-up contribution, age 55+: $1,000 Tip: Contribute the money you would have put in a Health FSA. UC Contribution is prorated for plans that start after January 1

During Open Enrollment, use AYSO application to elect a pre-tax monthly payroll deductionDuring Open Enrollment, use AYSO application to elect a pre-tax monthly payroll deduction Submit UPAY 850 form to Benefits to start or change monthly pre-tax payroll deduction – timing of deduction based on payroll deadlinesSubmit 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 taxesMake post-tax contribution to Health Equity – write off contribution on you annual taxes 2015 members - HSA contribution elections made through payroll deduction will automatically carry over into 2016 unless a change is made.2015 members - HSA contribution elections made through payroll deduction will automatically carry over into 2016 unless a change is made. 30

Deductible Coinsurance Any IRS Publication 502 Expenses, including:IRS Publication 502 Expenses ◊ ◊ Medical ◊ ◊ Dental ◊ ◊ Vision ◊ ◊ Prescription drug ◊ ◊ Long Term Care insurance premiums See HealthEquity website for more informationHealthEquity website 31

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 You can’t claim expenses for family members enrolled in this plan but who are not your tax dependents (older children who are no longer tax dependents) 32

The HSA is NOT like the Health FSA where you have access to the entire annual contribution starting on January 1The 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 itThe HSA is like a checking account – the money must be in the account before you can spend it ◊ You can pay an expense with a credit card and reimburse your self later when you have sufficient funds in your account. 33

Follow HSA eligibility rulesFollow HSA eligibility rules Contribute only the amount allowed by IRSContribute only the amount allowed by IRS Use HSA funds for eligible expensesUse HSA funds for eligible expenses Keep itemized receipts as tax documentsKeep itemized receipts as tax documents HealthEquity does not review your use of the account funds, but IRS may 34

Lumenos Post-Deductible HRA funds can be used to pay 20% coinsurance or other eligible expenses after Blue Shield PPO deductible is satisfied Example: Single Deductible$1,300Single Deductible$1,300 UC Contribution to HSA$500UC Contribution to HSA$500 Remaining balance before HRA will pay$800Remaining balance before HRA will pay$800 ◊ Pay with personal funds or Pay with your personal contributions to HSA 35

36 Register as new member on this site.

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38 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

Welcome Kit - to get you startedWelcome Kit - to get you started Debit card loaded with UC ContributionDebit card loaded with UC Contribution Online resourcesOnline resources ◊ Treatment cost estimator tool ◊ Drug costs, information and claim summary Use smart phone browser to access mobile websiteUse smart phone browser to access mobile website 39

40 blueshieldca.com/uchealthequity.com/ed/uc

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