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2014 Overview. Overview Michael Baptista, Executive Director Benefits Programs & Strategy.

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Presentation on theme: "2014 Overview. Overview Michael Baptista, Executive Director Benefits Programs & Strategy."— Presentation transcript:

1 2014 Overview

2 Overview Michael Baptista, Executive Director Benefits Programs & Strategy

3 Why Change? Projected Increases Anthem PLUS (Single/Family) Anthem PPO (Single/Family) Health Net Full Network HMO (Single/Family) Salary Band 2 (Neutral Band) 2013: $111 / 3782013: $143 / 4692013: $144 / 473 2014: $175 / 5612014: $189 / 6022014: $208 / 655 2014 Increase Monthly Annual $64 / 183 $768 / 2,196 $46 / 133 $552 / 1,596 $64 / 182 $768 / 2,184

4 What is the new line-up?  Sustainable Cost (For Members and UC)  Comprehensive Care  Distinct Value 2013 (8 plans) 2014 (6 plans) Anthem PPO UC Care (Blue Shield) Anthem PLUS Core Anthem HRA-PPOHealth Savings Plan (Blue Shield) Health Net Blue & Gold HMO Health Net Full Network HMO Kaiser HMO WHA HMO (Davis area)

5 What are the new plans?  UC Care  Health Savings Plan

6 UC Care: Network & Plan Design Customized for UC Care UC Network + Select Blue Shield providers UC Select Providers Similar to the standard in network cost-share of the previous Anthem PPO plan Blue Shield Preferred Providers Flexibility to use services from any provider outside the Blue Shield Preferred network Out of Network Providers  PPO plan that offers wide choices  Blue Shield of California – claims administrator and network provider

7 Blue Shield Health Savings Plan New high deductible medical plan paired with a Health Savings Account (HSA) Blue Shield PPO Health Savings Account * High deductible medical plan * Wide provider network access * Out-of-network coverage * Network preventive care covered at 100% *Special account to pay medical expenses *UC funds $500/$1,000 *You can contribute pre-tax *Portable +

8 Health Net Full Network Blue & Gold UC Care Health Savings Plan Kaiser

9 Anthem PLUS Blue & Gold UC Care Health Savings Plan Kaiser Anthem PLUS

10 Anthem PPO Blue & Gold UC Care Health Savings Plan Kaiser

11 Anthem Lumenos HRA Blue & Gold UC Care Health Savings Plan Kaiser

12 What do I need to think about? Member Priority Doctor  Specific physician, hospital, or least restricted choice  Find preferred doctor in best available benefit/value option Dollars & Delivery  Monthly cost, fixed copay vs. cost exposure, savings option, administrative ease  Find preferred plan type, select best available physician choice

13 A look at the new plans

14 Presented by: Lori Taylor Executive Director, Self-Funded Plans, Risk Services

15 New self-funded PPO plan for 2014 Created for UC employees and non-Medicare retirees to provide them with greater choice and flexibility Can get care from UC physicians and medical centers, the Blue Shield Preferred network of providers, or out-of network providers We are able to leverage UC Health to benefit employees and the University: o Offer a preferred discount for UC Care participants o Offer a plan that promotes care at UC medical centers UC Care. Your care. Your choice.

16 UC Care plan overview

17 UC Care cost comparison Monthly Contributions * 2014 Pay Band 2 range is $51,001-$101,000. Anthem PLUS (Single/ Family) Anthem PPO (Single/ Family) UC Care (Single/ Family) $50,001 – $98,000* 2013: $111 / $3782013: $143 / $469 2014 Monthly: $108 / $366 Annual: $1,296/ $4,392 2014 Projected Increase Monthly Annual $64 / 183 $768 / 2,196 $46 / 133 $552 / 1,596 UC Care rates lower than current Anthem PLUS and PPO rates

18 UC Care plan design comparison Anthem PLUSAnthem PPO Deductible In-network Out-of-network None $500 / $1,500 $250 / $750 $500 / $1,500 Out-of-Pocket Max$5,000 / $15,000$3,000 / $9,000 Member Share Office visits In-network Out-of-network $25 30% 20% 40% Outpatient In-network Out-of-network $0 30% 20% 40% Hospitalization In-network Out-of-network $250 30% 20% 40% Rx$10 / $30 / $45 UC Care Blue Shield Preferred (In/Out)UC Select $250/$750 $500/$1,500 No Deductible $3,000 / $9,000$5,000 / $15,000$1,500 / $4,500 Member Share 20% 50% $20 20% 50% $20 / 20% (depends on service) 20% 50% $250 $5 / $25 / $40

19 UC Care plan design

20 UC Care network – in network UC Select All UC medical centers, facilities and physicians Additional preferred Blue Shield providers in areas where UC medical centers and physicians may not be accessible Chosen based on quality, location and cost Blue Shield Preferred Network 376 hospitals 22,061 primary care physicians 50,197 specialists BlueCard Network coverage outside of CA and the U.S. 97% of Anthem contract providers are in the Blue Shield Preferred network 88% of providers in California are in the Blue Shield Preferred network

21 UC Care tool – UC Select providers 1.When you type this url, you are automatically. defaulted to UC Select. 2.To change the to Blue Shield Preferred, click on the “Change selection” link. blueshieldca.com/uccareppo

22 UC Care tool – Preferred providers 1.Once you click on the link for “Change selection,” you will see a pop up window. 2.Click on the radio button “Blue Shield Preferred”. 3.Click on the “done” button. blueshieldca.com/uccareppo

23 UCLA (1 of 3) UC Select Providers Citrus Valley Medical Center - Queen of the Valley Downey Regional Medical Center Garfield Medical Center (San Gabriel Valley) Glendale Adventist Medical Center Good Samaritan Hospital (Los Angeles) Henry Mayo Newhall Hospital (Santa Clarita Valley) Huntington Memorial Hospital (Pasadena) Northridge Medical Center (Northridge) Providence Little Company of Mary (Torrance) Providence Little Company of Mary Medical Center San Pedro Providence Tarzana Medical Center

24 UCLA (2 of 3) UC Select Providers Simi Valley Adventist Hospital (Dignity) St. Mary Medical Center (Long Beach) Torrance Memorial Medical Center UCLA/Mattel Children's Hospital UCLA/Resnick Neuropsychiatric Hospital UCLA/Ronald Reagan UCLA Medical Center UCLA/Santa Monica UCLA Medical Center White Memorial Medical Center Whittier Hospital Medical Center San Antonio Community Hospital

25 UCLA (3 of 3) Some providers were excluded from UC Select, but are in Blue Shield Preferred: Los Robles Medical Center – excluded due to high cost. Lower cost alternative providers available in the area West Hills Medical Center – excluded due to high cost. Lower cost alternative providers available in the area

26 UC Care information Looking for more details? Visit uc-care.org To find a provider, visit blueshieldca.com/uccareppo Have questions? Shield Concierge can help: 1-855-201-2087 Monday through Friday 7:00 a.m. to 7:00 p.m. (Pacific) Questions?

27 Thank you

28 The Blue Shield Health Savings Plan Mark Esteban, Director Health & Welfare Planning and Financials

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

30 Your Health Savings Account:  You own the account  You can contribute to it  It has triple tax advantages  It comes with a HSA Debit Card Currently enrolled in Anthem Lumenos and have an HRA balance? You’ll keep it as long as you enroll in the Health Savings Plan. Why is it better than an HRA?

31 How does the HSA work?  UC funds your HSA account with $500 for individual and $1,000 for family  You can contribute up to $2,800/individual $5,550 family  If you’re 55 or older, you can contribute more  You can’t participate in this plan and UC’s Flexible Spending Account at the same time  You can’t be anyone’s tax dependent

32 Medical PPO Plan Design Medical Plan Coverage *Network preventive care covered at 100% In NetworkOut of Network Deductible* Single Family $1,250 $2,500 $5,000 Out-of-Pocket Max (includes deductible) Single Family $4,000 $6,400 $8,000 $16,000 Member Cost Sharing (coinsurance after deductible is met) 20%40%

33 HSA Funding Contribution Types IndividualFamily UC Contribution$500$1,000 Employee Pre- Tax (optional) up to $2,800up to $5,550

34 1.Go to your doctor. 2.Later – check your HealthEquity account online to see required payment to the doctor. 3.Pay with your HSA funds through your HealthEquity online account. 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 Using Your Health Savings Plan

35 1.Go to your pharmacy. 2a. Pay for your Rx immediately if you want to use your HSA Debit Card, OR Using Your Health Savings Plan Give Pharmacist your Blue Shield Card so they can apply the Blue Shield Rx discounts. 2b. Pay with personal funds (e.g., AMEX to get your points) and later go to your HealthEquity account online and reimburse yourself.

36 Questions? atyourservice.ucop.edu/oe/medical


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