1. 1 12/2013 UCSB Human Resources, Benefits This presentation is intended for communication purposes only. Please see the At Your Service website (http://atyourservice.ucop.edu) and plan documents for complete information.http://atyourservice.ucop.edu Medical Plan Comparison

2. Medical Plan Design 101Medical Plan Design 101 Medical Plan ComparisonsMedical Plan Comparisons ◊ Residence requirements ◊ Choice of physician ◊ Cost of care & prescription drugs ◊ Out of Pocket Maximum ◊ Health Savings Account ◊ Behavioral Health 2

3. 3 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

4. Medical Plan Design 101 HMOPPOPLUS

5. Insurance plan delegates your care to a “medical group” (e.g. Sansum, SB Select IPA) Care is coordinated by a Primary Care Physician (PCP) and medical group Member selects PCP, PCP refers to specialists Predictable, low cost, copay for services - no deductibles Emergency and urgently needed care when away Health Net Blue & Gold HMO Kaiser HMO 5

6. 6 Primary Care Physicians Specialists Labs Radiology Durable Medical Equip Urgent Care Hospitals When you need care go to your PCP PCP refers you to specialist, x-ray, lab, hospital HMO Medical Group Medical Group authorizes referrals to some specialists and treatment Access to Care

7. 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 preferred providers “Out-of-pocket Maximum” limits your financial liability UC Care Blue Shield Health Savings Plan 7

8. January Calendar Year December Deductible You pay CoinsuranceCopay You share cost with plan Out-of-Pocket Maximum Plan pays 100% 8

9. 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. 9

10. 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. 10

11. 11 You receive services You pay nothing at the time of service for in-network care Provider sends claim for services to health plan Health plan 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

12. Fair Health Consumer http://www.fairhealthconsumer.org/http://www.fairhealthconsumer.org/http://www.fairhealthconsumer.org/ Health Care Blue Book https://www.healthcarebluebook.com/https://www.healthcarebluebook.com/https://www.healthcarebluebook.com/ Good Rx – drug costs http://www.goodrx.comhttp://www.goodrx.comhttp://www.goodrx.com 12

13. Combines HMO and PPO plan designsCombines HMO and PPO plan designs Limit costs by using HMO providersLimit costs by using HMO providers Can use providers outside HMO group, but cost for service will be higherCan use providers outside HMO group, but cost for service will be higher Anthem PLUS in 2013 - discontinued 13

14. PPO Use physicians out of the HMO medical groupUse physicians out of the HMO medical group Use out-of-network behavioral healthUse out-of-network behavioral health Deductible & CoinsuranceDeductible & Coinsurance HMO Use PCP and specialists in the HMO medical group Use Optum behavioral health Predictable copays How do you use your plan? 14

15. 2014 Medical Plans Health Net Blue & Gold HMO Kaiser HMO UC Care Blue Shield Health Savings Plan Core

16. 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 16

17. 17 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

18. 18 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 benefit.Plan pays Preferred benefit. CORE UC Care Comprehensive coverageComprehensive coverage Plan pays out-of-network benefit.Plan pays out-of-network benefit.

19. 19 HMO (Health Net, Kaiser) You select PCPYou select 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 In-Network You select Blue Shield PPOYou select Blue Shield PPO Out-of-Network You select non-Blue ShieldYou select non-Blue Shield In-Network – You select UC SelectUC Select Blue Shield Preferred PPOBlue Shield Preferred PPO Out-of-Network You select non-Blue ShieldYou select non-Blue Shield CORE UC Care In-Network You select Blue Shield PPOYou select Blue Shield PPO Out-of-Network You select non-Blue ShieldYou select non-Blue Shield

20. 20 UC Medical Centers Select Blue Shield PPO providers UC Select Providers Blue Shield PPO providers Blue Shield Preferred Providers Providers outside the UC Select or Blue Shield Preferred network Non-Preferred Providers Blue Shield of California – PPO network & claims administrator

21. UC Select ◊ ◊ UC medical centers, facilities and physicians ◊ ◊ Additional select Blue Shield PPO providers in areas where UC medical centers and physicians are not accessible Blue Shield Preferred PPO in California ◊ ◊ Blue Shield PPO providers Blue Shield outside of CA and US ◊ ◊ Blue Cross Blue Shield Network out of CA ◊ ◊ BlueCard Network out of US 21

22. UC Select providers in ◊ ◊ Santa Barbara – Sansum Clinic ◊ ◊ Santa Maria ◊ ◊ Lompoc ◊ ◊ Ventura Currently, Sansum Clinic is the only UC Select provider in Santa Barbara area ◊ ◊ High cost hospital and medical groups 22

23. Most Anthem Plus and PPO providers are also in the UC Care “Blue Shield Preferred” network Providers include: Cottage Hospital System, Pacific Diagnostic Labs, Jackson Group, many SB Select IPA physicians and independent physicians Check the provider directory to confirm the status of providers important to you UC Care Provider directory blueshieldca.com/uccareppo Blue Shield Concierge 1-855-201-2087 23

24. Medical PlanCopayDeductibleCoinsurance 24 HMO$20None UC Care PPO UC Select$20None Preferred $250 indiv $750 family You pay 20% Out-of-Network $500 indiv $1,500 family Plan pays 50% of allowed rate You pay balance

25. 25 UC Select (Tier 1) Copay Blue Shield Preferred (Tier 2) Deductible Coinsurance Non-Preferred Out-of-Network (Tier 3) Deductible Coinsurance Your costs are based on the tier/network that the provider is in Not all services are covered at the UC Select benefit tier Some services are covered only at the Blue Shield Preferred and Non-Preferred tiers

26. 26 You pay You share cost with plan Plan pays 100% $250 Deductible 20% Coinsurance $3000 OOPM UC Care Individual Coverage Blue Shield Preferred (Tier 2)

27. 27 $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)

28. 28 Blue Shield HSP Preferred $2,500 family $1,250 single $2,500 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 Preferred $3000 per individual You pay 20% Out-of-NetworkPlan pays 80% of allowed rate Medical PlanCopayDeductibleCoinsurance

29. 29 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

30. 30 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

31. Medical PlanCopayDeductibleCoinsurance 31 HMO$250None UC Care PPO UC Select$250None Preferred $250 indiv $750 family You pay 20% Out-of-Network $500 indiv $1,500 family Plan pays 50% of allowed rate You pay balance

32. 32 Blue Shield HSP Preferred $2,500 family $1,250 single $2,500 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 Preferred $3000 per individual You pay 20% Out-of-NetworkPlan pays 80% of allowed rate Medical PlanCopayDeductibleCoinsurance

33. Medical PlanCopayDeductibleCoinsurance 33 HMO$75None UC Care PPO UC Select$100NoneYou pay 20% of ER physician Preferred$100WaivedYou pay 20% of ER physician Out-of-Network$100WaivedYou pay 20% of ER physician

34. 34 Blue Shield HSP Preferred $2,500 family $1,250 single $2,500 family You pay 20% Out-of-Network $5,000 family $2,500 single $5,000 family You pay 20% Full family deductible must be met before plan shares cost CORE Preferred Waived for facility fee You pay 20% Out-of-NetworkYou pay 20% Medical PlanCopayDeductibleCoinsurance

35. Medical PlanOOPMNotes 35 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

36. Medical PlanOOPMNotes 36 UC Care PPO UC Select$1,500 indiv $4,500 family Family = 3 or more In-Network providers cross accumulate Preferred$3,000 indiv $9,000 family Out of Network $5,000 indiv $15,000 family Family = 3 or more Out-of-network accumulates separately

37. Medical PlanOOPMNotes 37 Blue Shield HSP Preferred $4,000 indiv (single) $6,400 family Full family OOPM must be met before plan pays 100% for any enrollee In & Out-of-network accumulate separately Medical & Drug expenses apply Non-Preferred (Out-of-Network) $8,000 indiv (single) $16,000 family CORE $6,350 indiv $12,700 family Family = 2 or more Medical & Drug expenses apply

38. 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) Generic Generic Brand Brand Non-formulary Non-formulary$10$50$80 38 Preferred Drug List (Formulary) is different for each carrier

39. 39 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.

40. 40 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

41. 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.

42. 42 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

43. 43 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

44. UC Contribution (plan starting on 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.

45. 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

46. 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

47. 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 47

48. Deductible Coinsurance Any IRS Publication 502 Expenses, including: ◊ ◊ Medical ◊ ◊ Dental ◊ ◊ Vision ◊ ◊ Prescription drug ◊ ◊ Long Term Care insurance premiums 48

49. 49 1. 1.Go to your doctor. 2. 2.Later – check your HealthEquity account online to see required payment to the doctor. 3. 3.Pay with your HSA funds through your HealthEquity online account. OR Pay with another source (e.g. check, credit card) Give doctor’s office your Blue Shield card so BSC can…   process the claim and get you their special provider discounts and   send info about your amount of claim responsibility to Health Equity

50. 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

51. 51 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

52. 52 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

53. 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 HSPDeductible: $1,250 indiv $2,500 family You pay 20% Deductible: $2,500 indiv $5,000 family Plan pays 60% allowed You pay balance 53

54. 54 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.

55. Medical PlanProvidersCosts HMO American Specialty Health 25% discount UC Care PreferredBlue Shield After deductible, You pay 20% Out-of-NetworkNon-Blue ShieldAfter deductible, Acupuncture: Plan pays 80% allowed Chiropractic: Plan pays 60% allowed Note: Benefit is limited to 24 visits per calendar year combined for Acupuncture and Chiropractic visits 55

56. Medical PlanProvidersCosts Blue Shield HSP PreferredBlue 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 56

57. 57 Medical Plan Provider Out of Network Core PreferredBlue Shield After deductible, You pay 20% Out-of-networkNon-Blue ShieldAfter deductible, Acupuncture: Plan pays 80% allowed Chiropractic: Plan pays 80% allowed Note: Plan payment maximum up to $500 per calendar year

58. ResourcesResources ◊ Plan contacts ◊ Plan rates Medical PlansMedical Plans ◊ Benefit summaries ◊ Links to plan websites ◊ Links to provider directories Other plansOther plans ◊ Dental, vision, FSA 58

59. 59