2014 Open Enrollment Benefits
2014 Medical Plans
2013 (7 plans)
2014 (5 plans)
• Anthem PPO
• Anthem PLUS
• Anthem HRA-PPO
• UC Care
• Blue Shield Health Savings Plan
• Health Net Blue & Gold HMO
• Health Net Full Network HMO
• Kaiser HMO
• Health Net Blue & Gold HMO
• Kaiser HMO
• Core
• Core
2014 Medical Plans
UC Care plan design comparison
Anthem PLUS
Anthem PPO
UC Care
Blue Shield In/Out
Deductible
In
Out
UC Select
None
$500/$1,500
$250/$750
$500/$1,500
$250/$750
$500/$1,500
None
$5,000/$15,000
$3,000/$9,000
$3,000/$9,000
$5,000/$15,000
$1,500/$4,500
MD Visits (member share)
In
Out
$25
30%
20%
40%
20%
50%
$20
Outpatient (member share)
In
Out
$0
30%
20%
40%
20%
50%
Hospitalization (member share)
In
Out
$250
30%
20%
40%
20%
50%
$10/30/45
$10/30/45
Out-Of-Pocket Max
Rx (member share)
$20/20%
(depending on service)
$250
$5/25/40
UC Care plan design
UC Care network
Differences across locations
• A customized network of UC facilities and other high quality,
low cost providers because every campus does not have a
UC facility nearby
In-network
• UC Select
• Blue Shield Preferred
• BlueCard network coverage outside of CA and the U.S.
Out-of-network
• PPO providers not contracted within UC Select and Blue
Shield Preferred
UC Care network
UC Select
• All UC medical centers, facilities and physicians
• Additional select Blue Shield providers in areas where UC medical
centers and physicians may not be accessible
• Chosen based on quality, location, cost and contracts (with
Blue Shield)
• See appendix for facilities in UC Select
Blue Shield Preferred Network
• 376 hospitals
• 22,061 primary care physicians
• 50,197 specialists
• 97% of Anthem contract providers are in
the Blue Shield Preferred network
• 88% of providers in California are in the
Blue Shield Preferred network
BlueCard Network coverage outside of CA and the U.S.
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
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
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
The Blue Shield Health
Savings Plan
Mark Esteban, Director
Health & Welfare Planning and Financials
Blue Shield Health Savings Plan
Combines high deductible PPO with
account to pay out-of-pocket expenses
+
Medical Coverage
(Blue Shield PPO)
Health Savings Account
(HealthEquity)
Why is it better than an HRA?
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.
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
Medical PPO Plan Design
Medical Plan
Coverage
Deductible*
Single
Family
Out-of-Pocket Max
In Network
Out of Network
$1,250
$2,500
$2,500
$5,000
$4,000
$6,400
$8,000
$16,000
20%
40%
(includes deductible)
*Network
preventive care
covered at 100%
Single
Family
Member Cost
Sharing
(coinsurance after
deductible is met)
HSA Funding
Contribution Types
HSA Funding
UC Contribution
Employee Pre-Tax
(optional)
Individual
Family
$500
$1,000
up to $2,800
up to $5,550
Using Your Health Savings Plan
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
1. Go to your pharmacy.
2a. Pay for your Rx immediately
if you want to use your HSA
Debit Card,
Give Pharmacist your
Blue Shield Card so
they can apply the
Blue Shield Rx
discounts.
OR
2b. Pay with personal funds (e.g., AMEX to get
your points) and later go to your
HealthEquity account online and reimburse
yourself.
Transition of Care Policy – Overview
• All plans provide temporary transition of care services so
members may complete a course of treatment and arrange
for a safe transfer from a non-plan provider.
• Bridges gap between old and new plans. Important for those
currently under care from providers who will no longer be innetwork under member’s new plan.
• However, eligibility is limited; not every member will qualify
• Employees who change plans voluntarily do not qualify
Updated Pay Bands
2013 Pay
Band
Definition of Range Using
Full-Time Salary As of Jan 2012
2014 Pay
Band
Definition of Range Using
Full-Time Salary As of Jan 2013
1
$50,000 & Under
1
$51,000 & Under
2
$50,001 to $98,000
2
$51,001 to $101,000
3
$98,001 to $147,000
3
$101,001 to $151,000
4
$147,001 & Over
4
$151,001 & Over
 Pay bands adjusted annually, based on change in California consumer price index
from February of prior year to February of current year (determined by the
California Department of Finance).
 Use index for urban wage earners and clerical workers (CPI-U).
 Change from Feb 2012 to Feb 2013 was 2.4%.
2013 & 2014 Contribution Rates
California Plans
2013-2014
Pay Band 1
($50,000 and Under)
2013 Contributions
UA
Pay Band 2
($50,001 to $98,000)
U
UC
Health Net B&G HMO
$25.26
$45.47
UAC
Health Net HMO
$108.28 $194.91 $275.59 $362.21
$101.25 $121.45
U
UC
$61.31
Pay Band 3
($98,001 to $147,000)
UA
UAC
$110.36 $183.55 $232.59
U
UC
$98.31
UA
Pay Band 4
($147,001 and Over)
UAC
U
UC
UA
UAC
$176.96 $257.31 $335.95
$136.62 $245.92 $333.73 $443.02
$144.33 $259.80 $357.89 $473.35
$181.33 $326.40 $431.65 $576.71
$219.64 $395.36 $508.07 $683.78
Kaiser
$9.67
$17.41
$20.31
$28.04
$45.72
$82.30
$102.61 $139.18
$82.72
$148.90 $176.37 $242.54
$121.03 $217.86 $252.79 $349.61
WHA
$9.67
$17.41
$20.31
$28.04
$45.72
$82.30
$102.61 $139.18
$82.72
$148.90 $176.37 $242.54
$121.03 $217.86 $252.79 $349.61
Anthem PLUS
$75.43
$135.77 $206.61 $266.94
$111.48 $200.66 $288.91 $378.08
$148.48 $267.26 $362.67 $481.44
$186.79 $336.22 $439.09 $588.51
Anthem PPO
$106.76 $192.17 $272.40 $357.80
$142.81 $257.06 $354.70 $468.94
$179.81 $323.66 $428.46 $572.30
$218.12 $392.62 $504.88 $679.37
$45.72
$82.72
$121.03 $217.86 $252.79 $349.61
Anthem CDH
$9.67
$20.31
$28.04
Pay Band 1
($51,000 and Under)
2014 Contributions
Health Net B&G HMO
Kaiser
WHA
BSC–HSP
UC Care
$17.41
$82.30
$102.61 $139.18
Pay Band 2
($51,001 to $101,000)
$148.90 $176.37 $242.54
Pay Band 3
($101,001 to $151,000)
Pay Band 4
($151,001 and Over)
U
UC
UA
UAC
U
UC
UA
UAC
U
UC
UA
UAC
U
UC
UA
UAC
$29.49
$11.78
$11.78
$9.67
$71.96
$51.17
$21.20
$21.20
$17.41
$127.83
$109.50
$25.80
$25.80
$21.19
$198.99
$131.18
$35.21
$35.21
$28.92
$254.87
$65.54
$47.83
$47.83
$45.72
$108.01
$116.06
$86.09
$86.09
$82.30
$192.72
$191.80
$108.10
$108.10
$103.49
$281.29
$242.32
$146.35
$146.35
$140.06
$366.01
$102.54
$84.83
$84.83
$82.72
$145.01
$182.66
$152.69
$152.69
$148.90
$259.32
$265.56
$181.86
$181.86
$177.25
$355.05
$345.68
$249.71
$249.71
$243.42
$469.37
$140.85
$123.14
$123.14
$121.03
$183.32
$251.62
$221.65
$221.65
$217.86
$328.28
$341.98
$258.28
$258.28
$253.67
$431.47
$452.75
$356.78
$356.78
$350.49
$576.44
$ Difference
Pay Band 1
Pay Band 2
Pay Band 3
Pay Band 4
U
UC
UA
UAC
U
UC
UA
UAC
U
UC
UA
UAC
U
UC
UA
UAC
Health Net B&G HMO
$4.23
$5.70
$8.25
$9.73
$4.23
$5.70
$8.25
$9.73
$4.23
$5.70
$8.25
$9.73
$4.23
$5.70
$8.25
$9.73
Kaiser
$2.11
$3.79
$5.49
$7.17
$2.11
$3.79
$5.49
$7.17
$2.11
$3.79
$5.49
$7.17
$2.11
$3.79
$5.49
$7.17
WHA
$2.11
$3.79
$5.49
$7.17
$2.11
$3.79
$5.49
$7.17
$2.11
$3.79
$5.49
$7.17
$2.11
$3.79
$5.49
$7.17
BSC–HSP*
$0.00
$0.00
$0.88
$0.88
$0.00
$0.00
$0.88
$0.88
$0.00
$0.00
$0.88
$0.88
$0.00
$0.00
$0.88
$0.88
UC Care vs. PPO
($34.80) ($64.34) ($73.41) ($102.93)
($34.80) ($64.34) ($73.41) ($102.93)
($34.80) ($64.34) ($73.41) ($102.93)
($34.80) ($64.34) ($73.41) ($102.93)
UC Care vs. POS
($3.47)
($3.47)
($3.47)
($3.47)
UC Care vs. HNHMO
($36.32) ($67.08) ($76.60) ($107.34)
($7.94)
* BSC-HSP was compared to Anthem Lumenos
($7.62) ($12.07)
($7.94)
($7.62) ($12.07)
($36.32) ($67.08) ($76.60) ($107.34)
($7.94)
($7.62) ($12.07)
($36.32) ($67.08) ($76.60) ($107.34)
($7.94)
($7.62) ($12.07)
($36.32) ($67.08) ($76.60) ($107.34)
New plan provisions for medical
plans
21
Smoking Cessation Programs
Blue Shield: Quit For Life
– 1-866-QUIT-4-LIFE (1-866-784-8454)
– www.quitnow.net/blueshieldca
Health Net: Decision Power (for smoking cessation)
– www.healthnet.com/uc
Kaiser: Quitsmoking
– www.kp.org/quitsmoking
Optum (Wellness): Quit Power
– coming in 2014
Rx – Mandatory Generic
• Generic will automatically be dispensed
• Brand-name drug when generic is available costs member:
– $5 generic copay* + (brand price – generic price)
• Brand available if medically necessary (e.g., allergic to inactive ingredient)
– Preauthorization required to determine if medically necessary
– DAW, DNS or similar wording does NOT = medically necessary
– Member pays brand copay*
* For BSC Health Savings Plan & Core - When a generic drug is available and you choose the brand-name drug,
you must pay coinsurance on the cost of the generic drug plus the difference between the cost of the brandname drug and the generic equivalent. With prior authorization, exceptions for medical necessity can be made
and you pay coinsurance on the cost of the brand-name drug.
Kaiser
These additional preventive care benefits will be
available at no charge:
– Genetic testing for breast cancer susceptibility
– Women’s contraceptive items that by law do not require a
prescription
– Aspirin to reduce heart attack risk
– Folic acid supplements for pregnant women to reduce the
risk of birth defects
– Fluoride supplements for children to reduce the risk of
tooth decay
– Iron supplements for children
New plan provisions for non-medical
plans
25
UC Living Well – Relaunch
UC will relaunch UC Living Well wellness program in 2014
with Optum
Continue to earn points toward an incentive award by participating in activities
and wellness coaching
– Available to all actives and retirees and their spouses / DP’s
enrolled in UC medical plans – including Kaiser!
– Focus on campus-based activities
– Health Assessment
– $75 gift cards incentive for actives and retirees only
– Spouses and domestic partners no longer eligible for
incentive award; they may use wellness website and online
tools
Dental/Vision Plan Changes
DeltaCare USA
• Added Benefits
– Procedures to assess the level of risk associated with dental
decay
– Gingival irrigation, a procedure to treat gums with medical
solutions for health purposes
Vision Service Plan
• Diabetic Eye Care Plus Program
– Now extended to cover both Type I & II Diabetic members.
– Provides diabetic eye exam in addition to the routine vision
examination ($20 copay)
• Retiree Vision open for Enrollment
Group Legal Plan – Benefit Enhancements
Beginning 1/1/2014: Covered in full if using ARAG Attorney – Limits apply otherwise
1. Real Estate Disputes
•
•
Legal disputes about contracts or obligations for purchase, sale or financing of the named
insured’s primary residence.
Example: Member purchases primary residence and the seller is not making needed
repairs per the sales agreement.
2. Personal Property Protection
•
•
Legal disputes about contracts or obligations for the transfer of personal property or legal
disputes about personal property rights.
Example: Plan member sold their car and only received half of the purchase price.
3. Minor Traffic
•
Legal defense for an insured in the defense of a traffic offense, as long as conviction
would not result in suspension or revocation of license.
4. Estate Administration and Closing – up to 9 hours
•
Legal services for an insured in administering an estate when named as the executor.
5. Small Claims Court
•
Legal services for an insured to obtain advice and counseling to bring a claim or defend an
action in Small Claims Court.
Flexible Spending Accounts
Health FSA
• Enroll or re-enroll
• $2,500 annual limit
• Blue Shield Health Savings Plan members not eligible to participate in
UC’s Health FSA
• If employee enrolls in the Blue Shield Health Savings Plan during this
Open Enrollment, Health FSA must have a $0 balance on Dec. 31,
2013 (complete any claims reimbursement by Dec. 31, 2013)
DepCare FSA
• Enroll or re-enroll
• $5,000 ($2,500 if married and filing a separate tax return) annual limit
Important Dates
Open Enrollment Period
• October 28th at 8:00 am to November 26th at 5:00 pm
Benefits Fair -- October 29
•
•
Westwood – RRUCLA & RNPH B-Level Café 7:30 am – 1:00 pm
Santa Monica Conference Center 2:30pm – 4pm
Management Forum – October 22
•
Open Enrollment presentation
Open Enrollment Education Schedule
Presentations with Q & A








Oct 15 & Oct 18: HR Department Contact Meeting
Oct 24: FPG presentation with Q & A 10:30am – 2pm
Nov 4: FPG presentation with Q & A 10:30am – 2pm
Nov 8: RRUCLA 3-3102 2pm – 5pm
Nov 12: SMUCLA Room 1 G350 1:30pm – 2:30pm
Nov 14: 200 Med Plaza 547 11am – 2pm
Nov 18: SMUCLA Room G360 3pm – 4pm
Nov 20: RRUCLA B-Level Café 11:30a – 1:30p