2014 Overview
Overview
Michael Baptista, Executive Director
Benefits Programs & Strategy
Why Change?
Projected Increases
Anthem PLUS
Anthem PPO
Health Net Full
Network HMO
(Single/Family)
(Single/Family)
(Single/Family)
2013: $111 / 378
2013: $143 / 469
2013: $144 / 473
2014: $175 / 561
2014: $189 / 602
2014: $208 / 655
Monthly
$64 / 183
$46 / 133
$64 / 182
Annual
$768 / 2,196
$552 / 1,596
$768 / 2,184
Salary Band 2
(Neutral Band)
2014 Increase
What is the new line-up?
 Sustainable Cost (For Members and UC)
 Comprehensive Care
 Distinct Value
2013
2014
(8 plans)
(6 plans)
Anthem PPO
Anthem PLUS
UC Care (Blue Shield)
Core
Core
Anthem HRA-PPO
Health Savings Plan (Blue Shield)
Health Net Blue & Gold HMO
Health Net Full Network HMO
Health Net Blue & Gold HMO
Kaiser HMO
Kaiser HMO
WHA HMO (Davis area)
WHA HMO (Davis area)
What are the new plans?
 UC Care
 Health Savings Plan
UC Care: Network & Plan Design
 PPO plan that offers wide choices
 Blue Shield of California – claims administrator and network provider
UC Select Providers
• Customized for UC Care
• UC Network + Select Blue Shield providers
Blue Shield Preferred Providers
• Similar to the standard in network cost-share of
the previous Anthem PPO plan
Out of Network Providers
• Flexibility to use services from any provider
outside the Blue Shield Preferred network
Blue Shield Health Savings Plan
New high deductible medical plan paired with
a Health Savings Account (HSA)
Health Savings Account
Blue Shield PPO
* 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
Health Net Full Network
Health Net
Full Network
Blue & Gold
UC Care
Health
Savings Plan
Kaiser
Anthem PLUS
Anthem PLUS
Blue & Gold
UC Care
Health
Savings Plan
Kaiser
Anthem PPO
Anthem PPO
Blue & Gold
UC Care
Health
Savings Plan
Kaiser
Anthem Lumenos HRA
Anthem Lumenos HRA
Blue & Gold
UC Care
Health
Savings Plan
Kaiser
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
A look at the
new plans
Presented by: Lori Taylor
Executive Director, Self-Funded Plans, Risk Services
UC Care. Your care. Your choice.
• 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 plan overview
UC Care cost comparison
Monthly Contributions
Anthem PLUS
(Single/ Family)
$50,001 –
$98,000*
2014 Projected
Increase
Monthly
Annual
2013: $111 / $378
$64 / 183
$768 / 2,196
Anthem PPO
(Single/ Family)
2013: $143 / $469
$46 / 133
$552 / 1,596
* 2014 Pay Band 2 range is $51,001-$101,000.
UC Care
(Single/ Family)
2014
Monthly: $108 / $366
Annual: $1,296/ $4,392
UC Care rates lower than
current Anthem PLUS and
PPO rates
UC Care plan design comparison
UC Care
Deductible
In-network
Out-of-network
Out-of-Pocket Max
Anthem PLUS
Anthem PPO
Blue Shield Preferred (In/Out)
UC Select
None
$500 / $1,500
$250 / $750
$500 / $1,500
$250/$750
$500/$1,500
No Deductible
$5,000 / $15,000
$3,000 / $9,000
$3,000 / $9,000
$5,000 / $15,000
Member Share
Member Share
$20
Office visits
In-network
Out-of-network
$25
30%
20%
40%
20%
50%
Outpatient
In-network
Out-of-network
$0
30%
20%
40%
20%
50%
Hospitalization
In-network
Out-of-network
$250
30%
20%
40%
20%
50%
$10 / $30 / $45
$10 / $30 /$45
Rx
$1,500 / $4,500
$20 / 20%
(depends on service)
$250
$5 / $25 / $40
UC Care plan design
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
• 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.
UC Care tool – UC Select providers
blueshieldca.com/uccareppo
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.
UC Care tool – Preferred providers
blueshieldca.com/uccareppo
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.
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
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?
Thank you
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)
Single
*Network
Family
preventive care
covered at 100% Member Cost
Sharing
(coinsurance after
deductible is met)
HSA Funding
Contribution
Types
HSA Funding UC Contribution
Employee PreTax (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.
Questions?
atyourservice.ucop.edu/oe/medical