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University of California Active 2013 Open Enrollment.

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Presentation on theme: "University of California Active 2013 Open Enrollment."— Presentation transcript:

1 University of California Active 2013 Open Enrollment

2 2 University of California Active Plan Benefit Changes Effective January 1, 2013 Anthem Blue Cross Plus Plan: Office visit co-pay­ from $20 to $25 Emergency room co-pay from $75 to $100 In network outpatient surgery and Ambulatory Surgical Center co- pay from $0 to $100 Out of network Ambulatory Surgical Center, 70% up to $350maximum (prior authorization required) Retail prescription drug $10/$30/$45 Mail order prescription drug $20/$60/$90 ered

3 3 University of California Active Plan Benefit Changes Effective January 1, 2013 Anthem Blue Cross Plus Plan: New and newly expanded benefits for womens preventive care have been added. The following services, drugs and supplies will now be paid at 100% in-network. Well woman visits Breastfeeding support, supplies and counseling* Prescription contraceptives (birth control) and counseling for women** Permanent surgical contraception (sterilization) for women Counseling for sexually transmitted infections Counseling and screening for HIV Screening and counseling for interpersonal and domestic violence Screening for gestational diabetes HPV testing * Breast pumps must be purchased from an in-network durable medical equipment (DME) outlet to get 100% coverage

4 4 University of California Active Plan Benefit Changes Effective January 1, 2013 Anthem Blue Cross PPO: Out of network Ambulatory Surgical Center, 60% up to $350 maximum (prior authorization required) Retail prescription drug $10/$30/$45 Mail order prescription drug $20/$60/$90 Newly expanded benefits for womens preventive care have been added. The following services, drugs and supplies will now be paid at 100% in- network. Well woman visits Breastfeeding support, supplies and counseling* Prescription contraceptives (birth control) and counseling for women** Permanent surgical contraception (sterilization) for women Counseling for sexually transmitted infections Counseling and screening for HIV Screening and counseling for interpersonal and domestic violence Screening for gestational diabetes HPV testing * Breast pumps must be purchased from an in-network durable medical equipment (DME) outlet to get 100% coverage

5 5 University of California Active Plan Benefit Changes Effective January 1, 2013 Anthem Blue Cross Core: Out of network Ambulatory Surgical Center, 60% up to $350 maximum (prior authorization required) Newly expanded benefits for womens preventive care have been added. The following services, drugs and supplies will now be paid at 100% in- network. Well woman visits Breastfeeding support, supplies and counseling* Prescription contraceptives (birth control) and counseling for women** Permanent surgical contraception (sterilization) for women Counseling for sexually transmitted infections Counseling and screening for HIV Screening and counseling for interpersonal and domestic violence Screening for gestational diabetes HPV testing * Breast pumps must be purchased from an in-network durable medical equipment (DME) outlet to get 100% coverage

6 6 University of California Active Plan Benefit Changes Effective January 1, 2013 Anthem Blue Cross Lumenos PPO with HRA: Out of network Ambulatory Surgical Center, 60% up to $350 maximum (prior authorization required) Newly expanded benefits for womens preventive care have been added. The following services, drugs and supplies will now be paid at 100% in- network. Well woman visits Breastfeeding support, supplies and counseling* Prescription contraceptives (birth control) and counseling for women** Permanent surgical contraception (sterilization) for women Counseling for sexually transmitted infections Counseling and screening for HIV Screening and counseling for interpersonal and domestic violence Screening for gestational diabetes HPV testing * Breast pumps must be purchased from an in-network durable medical equipment (DME) outlet to get 100% coverage

7 7 Anthem Blue Cross PLUS A Two Level Plan Design: In-network and out-of-network Network benefits through PCPs and Specialists PCP selection required; Specialist care authorized by PCP Out-of-Network benefits through PPO or non-PPO physicians Employees must reside in California Dependents may live out-of-state and receive non- network benefits

8 8 Anthem Blue Cross PLUS In-Network Deductible $0 Out-of-Pocket-Maximum$1,500/$4,500 Out-of-Network Deductible $500/$1,500 Out-of-Pocket-Maximum $5,000/$15,000 Prescription Drug Benefit Retail$10/$30/$45 Mail Order$20/$60/$90

9 9 Anthem Blue Cross PLUS NetworkOut-of-Network Office Visit $25/visit30% Preventive Visit No Copay 30% Hospital $250/admission30% Outpatient Surgery $10030% X-Ray/Lab $030% DME/Prosthetics$030% Chiropractic$25/visit Not Covered Acupuncture$25/visit Not Covered

10 10 Anthem Blue Cross PPO Coinsurance Plan Design 80%/60% Network providers bill Anthem directly and may not balance bill members (for expenses greater than PPO allowance) Out-of-state residents may access PPO & Traditional providers through the local Anthem Blue Cross & Blue Shield plans or, any other licensed provider

11 11 Anthem Blue Cross PPO In-Network Deductible $250/$750 Out-of-Pocket-Maximum $3,000/$9,000 Out-of-Network Deductible $500/$750 Out-of-Pocket-Maximum $6,000/$18,000 Prescription Drug Benefit Retail$10/$30/$45 Mail Order$20/$60/$90

12 12 Anthem Blue Cross PPO Network Out-of-Network Office Visit 20%40% Preventive Visit No Copay 40% Hospital 20%40% Outpatient Surgery 20%40% X-Ray/Lab 20%40% DME/Prosthetics20%40% Chiropractic20%40% Acupuncture*20% 40% * up to $500 calendar year maximum

13 13 CORE Coinsurance Plan Design 80% Network providers bill Anthem directly and may not balance bill members (for expenses greater than PPO allowance) Out-of-state residents may access PPO & Traditional providers through the local Anthem Blue Cross & Blue Shield plans or, any other licensed provider

14 14 CORE Deductible $3,000/member Out-of-Pocket-Maximum $7,600/member NetworkOut-of-Network Office Visit 20%20% Preventive Visit No Copay 20% Hospital 20%20% Outpatient Surgery 20%20% X-Ray/Lab 20%20% DME/Prosthetics20%20% Chiropractic20%20% Acupuncture*20%20% Prescription Drugs20% Not Covered * $500 Calendar Year Maximum

15 15 Anthem Lumenos PPO with HRA Plan Stay healthy with Preventive Care coverage Your employer makes an annual allocation to your account Use your account dollars to pay for medical care and prescription drugs Once you spend all of the funds from your HRA, you pay an out-of-pocket amount to satisfy your annual deductible Unused funds rollover year to year to help offset future out-of-pocket costs Traditional Health Coverage then covers additional expenses (similar to a PPO when you are accountable for a coinsurance amount) An annual out-of-pocket maximum protects you from large medical expenses + HRA Funded by annual employer allocation + Preventive Care 100% Traditional Health Coverage In-Network Providers Non-Network Providers Annual Deductible = Out-of-Pocket

16 16 Your HRA Plan Details At-a-Glance *OOP amount = annual deductible minus employer annual HRA allocation Lumenos PPO HRA Plan Single Coverage Two Party Coverage Family Coverage Preventive Nationally recommended services No cost, no deduction from HRA with in- network providers HRA Employers annual allocation$1,000$1,500$2,000 Traditional Health Coverage Out-of-pocket* amount to satisfy remaining annual deductible Your OOP amount will vary depending on whether you have rollover funds available $700 $1,050$1,400 Then, you pay coinsurance for covered services 20% for In-Network Services 40% for Non-Network Services Plan pays 100% after annual out-of-pocket maximum (consists of annual deductible and co-insurance amounts) In-Network $5,000 Non-Network $10,000 In-Network $7,500 Non-Network $15,000 In-Network $10,000 Non-Network $20,000

17 17 Meet Carol Lewis | Single Coverage Carol Lewis Lumenos HRA Plan $1,000 allocation from employer$1,000 Expenses: Ob/Gyn visit & lab tests - $350 Prescription drugs - $150 $500 Paid by Preventive Care benefit at 100%$350 Paid from HRA$150 HRA Rollover to Year 2$850 Year 1 HRA $1,000 + Preventive Care 100% In-Network Traditional Health Coverage In-Network Providers Non-Network Providers Annual Deductible $1,700 = Out-of-Pocket Towards Ded $700

18 18 Additional Benefits 360 Degree Health Condition Care Program Condition Care Program is designed to help members with chronic conditions such as asthma, diabetes, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD) and heart failure Future Moms Program provides moms-to-be with telephone access to nurses to discuss pregnancy related concerns. This program provides an educational packet, which includes a book about pregnancy, a questionnaire to evaluate risk for preterm delivery and other tools to help track pregnancy week by week and prepare for baby

19 19 Additional Benefits 360 Degree Health Condition Care Program 24/7 NurseLine provides anytime, toll-free access to nurses for answers to general health questions and guidance with critical health concerns. Callers can also access confidential, recorded messages about hundreds of health topics MyHealth Advantage is designed to help find potential health problems early, which can lead to better outcomes. We review your health status daily and check to see what medications your taking. If we spot a potential drug interaction, we alert your doctor. We also track your routine tests, and mail a MyHealth note to remind you to make an appointment.

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