1. 1 1 Blue Shield Health Savings Plan Laura Morgan UCSB Human Resources, Benefits This presentation is intended for communication purposes only. Please see plan document and http://atyourservice.ucop.edu for complete information.http://atyourservice.ucop.edu Big changes New choices 11/2013

2. Open Enrollment OverviewOpen Enrollment Overview Blue Shield PPOBlue Shield PPO Health Savings AccountHealth Savings Account 2

3. 3 Ends Tuesday, November 26, 5:00 pmEnds Tuesday, November 26, 5:00 pm Make changes onlineMake changes online http://atyourservice.ucop.edu All changes are effective January 1, 2014All changes are effective January 1, 2014

4. 4 Change medical and/or dental planChange medical and/or dental plan Enroll in medical, dental, visionEnroll in medical, dental, vision Add eligible family membersAdd eligible family members Enroll or re-enroll in Health Flexible Spending Account (FSA)Enroll or re-enroll in Health Flexible Spending Account (FSA) ◊ unless you select the Blue Shield Health Saving Plan) Enroll or re-enroll in Dependent Care FSAEnroll or re-enroll in Dependent Care FSA

5. 5 20132014 Anthem PPO UC Care PPO (administered by Blue Shield) Anthem PLUS Anthem HRA-PPO Blue Shield Health Savings Plan (PPO) Health Net Blue & Gold HMO Health Net HMO Kaiser HMO Core

6. 6 2013 Medical Plan2014 Medical Plan Health Net Blue & Gold HMO Health Net HMO (full)Health Net Blue & Gold HMO Kaiser HMO Anthem PLUSUC Care Anthem PPOUC Care Anthem Lumenos HRABlue Shield Health Savings Plan Anthem CoreBlue Shield Core

7. 7 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

8. Combines high deductible PPO with account to pay out-of-pocket expenses 8 Medical Coverage Blue Shield PPO Health Savings Account HealthEquity +

9. 9 Deductible  Health Reimbursement Account (HRA)  Member pays PPO Coinsurance Lumenos Blue Shield PPO Deductible  Member pays PPO Coinsurance UC Contributions Member Contributions Lumenos HRA Rollover Health Savings Account

10. 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 http://www.blueshieldca.com/ucSee list of preventive services on http://www.blueshieldca.com/uc http://www.blueshieldca.com/uc 10

11. 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 11

12. 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 12

13. 13 In NetworkOut of Network Deductible Single Family $1,250 $2,500 $5,000 Member Cost Sharing (Coinsurance for medical and drugs) 20%40% Out-of-Pocket Max (includes deductible) Single Family $4,000 $6,400 $8,000 $16,000

14. Same design as Lumenos: Single = one person enrolled in planSingle = one person enrolled in plan Family = more than one person in planFamily = more than one person in plan ◊ Families share one deductible ◊ Families share one out-of-pocket maximum (UC Care has a different plan design) 14

15. 15 You pay You share cost with plan Plan pays 100% $1250 Deductible 20% Coinsurance $4000 OOPM Blue Shield Health Savings Plan Individual (Single) Preferred Providers

16. 16 You pay You share cost with plan Plan pays 100% $2500 Deductible 20% Coinsurance $6400 OOPM Blue Shield Health Savings Plan Family Preferred Providers The full family deductible must be met before plan shares costs

17. 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. 17

18. 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” 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. 18

19. 19 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

20. 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 20

21. 21 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

22. Fair Health Consumer http://www.fairhealthconsumer.org/ Estimate cost of medical proceduresEstimate cost of medical procedures “LEARN” tab – print and video resources“LEARN” tab – print and video resources ◊ How plans work ◊ Cost Sharing, know what you may owe Good Rx http://www.goodrx.comhttp://www.goodrx.comhttp://www.goodrx.com Estimate cost of drugs (for Blue Shield HSP)Estimate cost of drugs (for Blue Shield HSP) 22

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24. 24 Blue Shield PPO + High deductible medical plan paired with a Health Savings Account Health Savings Account The Health Savings Account is not a component of the medical plan as HRA is with Lumenos. It is a separate account that can be used to pay medical and other health expenses.

25. 25 You keep the money even if you change jobs or insurance plans You can make contributions at any time It 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

26. UC Contribution (1/1/14) ◊ ◊ $500 individual ◊ ◊ $1000 family You can contribute up to (optional): ◊ ◊ Single-coverage: $2,800 ◊ ◊ Family-coverage: $5,550 ◊ ◊ Catch-up contribution, age 55+: $1,000 Tip: Contribute the money you would have put in your Health FSA.

27. To own an HSA you need to: Be covered ONLY by an HSA-qualified health plan ◊ ◊ Other health coverage may disqualify you, including Health FSA, Medicare or traditional health plan ◊ ◊ Health FSA must have a $0 balance on Dec. 31, 2013 (complete any claims reimbursement by Dec. 31, 2013) Not be claimed as a dependent on someone else’s tax return

28. 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 Follow HSA eligibility rulesFollow HSA eligibility rules 28

29. Remaining Lumenos HRA money will roll-over into the Health Savings Account (4/1/14) Lumenos HRA $ are treated differently than HSA $ by IRS Lumenos HRA $ becomes a “Post Deductible Health Reimbursement Account” = PDHRA You must pay the Blue Shield HSP deductible with other funds BEFORE you can use the PDHRA to pay eligible expenses.

30. 30 Single Deductible$1,250Single Deductible$1,250 UC Contribution to HSA$500UC Contribution to HSA$500 Remaining balance$750Remaining balance$750 ◊ Pay with personal funds or Pay with your contributions to HSA Lumenos PDHRA can be used to pay 20% coinsurance after deductible is satisfiedLumenos PDHRA can be used to pay 20% coinsurance after deductible is satisfied

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

32. UC makes annual contribution for plans that start on January 1. 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 Invest HSA dollarsInvest HSA dollars when account balance reaches $2000 – no fees to invest

33. 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 make monthly contributions through payroll deduction, you can change the contribution amount during the year ◊ You can make one time contributions through Health Equity 33

34. 34 Register as new member on this site after 1/1/14

35. 35 Register as new member on this site after 1/1/14

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37. 37 View claim detail Choose action to be taken − Pay provider − Reimburse themselves − Close expense Pay from HSA account or external checking/saving s account Schedule payment

38. 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 Smart phone browserSmart phone browser 38

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40. 40 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

41. 41 Medical and behavioral health deductibles and OOPM cross accumulate.Medical and behavioral health deductibles and OOPM cross accumulate. See the Evidence of Coverage for complete details.See the Evidence of Coverage for complete details. Covered ServiceOptum CliniciansOut-of-Network Deductible$1,250 individual $2,500 family $2,500 individual $5,000 family Outpatient Office Visits You pay 20%Plan pays 60% of allowed rate Emergency RoomYou pay 20%Plan pays 80% of allowed rate Inpatient StaysYou pay 20%Plan pays 60% of allowed rate

42. HealthEquity Member Services is available every hour of every day Call the Blue Shield/UC dedicated line 1.855.201.8375 say “Health Savings Account” www.healthequity.com/ed/uc www.blueshieldca.com/uc www.healthequity.com/ed/uc www.blueshieldca.com/uc

43. ResourcesResources ◊ Plan contacts ◊ Plan rates Medical PlansMedical Plans ◊ Benefit summaries ◊ Links to plan websites ◊ Links to provider directories Other plansOther plans ◊ Dental, vision, FSA 43

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45. UC Care281/mo HSP103/mo Difference178 x 12 = 2,136 Family Deductible 2,500 Premium Saving2,136 UC HSA Contribution1,000 Maximum HSA Contribution 5,550 45