UCSB Health Care Facilitator Program
Laura Morgan
893-4201
UC Retirement Administration Service Center
(RASC)
800-888-8267 http://ucnet.universityofcalifornia.edu
4/30/14

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This presentation is intended for communication purposes only, it is not a guarantee of benefits.
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Details about the UC policies and health plans are available on UCnet.
http://ucnet.universityofcalifornia.edu/compensation-and-benefits/index.html
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Future of retiree health benefits
Eligibility for retiree health benefits
Transition to retiree health plans
Health plan premiums
Overview of Medicare (Bill Batty, HICAP)
Enrolling in Medicare
Coordination with Medicare
How UC Medicare plans work
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Committed to ongoing health benefit
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Retiree plan designs are likely to change
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Retiree share of premium will increase
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UC may reduce the overall level of contribution to retiree health programs by
3% per year, to a floor of 70%.
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UC's contribution toward the monthly cost of medical and dental coverage is determined by UC and may change
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Not a guaranteed benefit
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Subject to California's annual budget appropriation
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Medical and dental benefits continue if:
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You were enrolled when you left UC
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You elect to continue coverage when you retire
Your coverage is continuous until the date your retirement benefit begins
Your monthly retirement income begins within
120 days of your separation from UC
You meet UC service credit requirements
Benefits end if you select “lump sum cashout”
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1. UCRP entry prior to 1/1/1990
2. UCRP entry/reentry on or after 1/1/1990
3. NEW 2013 eligibility rules
 Hired on or after 7/1/2013
 Hired before 7/1/2013 and not “grandfathered”
Each group has specific service credit and/or age requirements.
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Retire before 55 w/ 10 years service credit*
Retire at 55 or later w/ 5 years service credit
* Five years for Safety members
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2. UCRP entry/reentry on or after 1/1/1990
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Retire at age 50 or later w/ 10 years service credit
OR
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“Age + service credit = 75”
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Also current employees not “grandfathered”
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Retire at 56 or later w/ 10 years service credit
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Remain under current retiree health eligibility rules if by June 30, 2013 :
 five years of UCRP service credit and
 age plus years of service credit is 50 or greater
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Example:
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Age 45 with 5 years = 50 (grandfathered)
Age 40 with 5 years = 45 ( new eligibility rules )
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At retirement, you and your enrolled family members transfer from the “employee” to the “retiree” insurance program
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Employee insurance ends the month following your separation date – example:
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Separate on June 27
Employee insurance ends July 31
Retiree insurance starts August 1
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Must enroll in Medicare, if eligible, and transfer to Medicare coordinated plan
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May change plans during Open Enrollment or if you move out of your plan’s service area
RASC counselor will help you with the transition and paperwork
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Delta PPO or DeltaCare USA
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Coverage remains the same
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Premium paid in full by UC
OR subject to “graduated eligibility”
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Retiree Vision Services Plan (VSP)
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Enroll in Retiree VSP to continue coverage
Pay full premium to VSP – see rate chart
Same coverage as employee plan
Routine eye exam and eye wear
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Health Net Seniority Plus
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Medicare version of Health Net
Vision benefit similar to VSP
No additional monthly premium
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Non-Medicare Plans
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Retirees and family members who are not
65 or are not eligible for Medicare
Same plans as employees
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Medicare Coordinated Plans
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Retirees or family members who are 65 or older, or disabled
Must enroll in Medicare A & B, if eligible
UC Medicare plans
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Non-Medicare
Health Net Blue & Gold HMO
Kaiser HMO
UC Care (PPO)
Blue Shield Health Savings
Core (Catastrophic)
Medicare
Health Net Seniority Plus HMO
Kaiser Senior Advantage HMO
Blue Shield Medicare PPO
Blue Shield Medicare PPO without Rx
High Option Supplement
Same as employee plans Coordinated with Medicare
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When a family has both non-Medicare & Medicare members
Non-Medicare Members Medicare Members
Health Net Blue & Gold HMO Health Net Seniority Plus HMO
Kaiser HMO
UC Care (PPO)
Kaiser Senior Advantage HMO
Blue Shield Medicare PPO
Core (Catastrophic) Blue Shield Medicare PPO
Blue Shield Health Savings is not available to split family
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All plans cover mental health care and substance abuse treatment
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Provider networks may change when enrolled in Medicare
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Medical Plan
Health Net/
Seniority Plus
Kaiser/
Senior Advantage
UC Care (PPO)
Blue Shield HSP
Core
Blue Shield PPO
High Option
Non-Medicare
Optum
Medicare
MHN with Medicare
Optum & Kaiser Kaiser
Optum & non-Optum
Blue Shield
N/A
N/A
N/A Medicare & Blue Shield
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Must live in California
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Health Net, Kaiser
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Available in US
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UC Care
Blue Shield Health Savings Plan
Core
Blue Shield Medicare PPO (see Exchange One)
High Option (see Exchange One)
Available when LIVING out of US
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UC Care, Core (without Medicare)
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Retiree living out of California
ALL family members are enrolled in Medicare
UC makes annual contribution to a Health
Reimbursement Account (HRA) for retiree and each family member
Retiree uses HRA funds to purchase individual
Medicare supplement plan through Exchange One
UC contribution is subject to graduated eligibility
Can use extra HRA funds to pay medical expenses and Part B premium
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Each year UC determines the maximum amount that UC will pay toward a retiree’s medical and dental insurance
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Some retirees receive the “maximum UC contribution”
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Some retirees have “graduated eligibility” and receive a
% of the maximum amount
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The amount of the UC contribution depends on:
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Retiree health eligibility rules
Years of UCRP service credit
Age – factor added in 7/1/2013 rules
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Hired prior to 1/1/90 (UCRP entry date)
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Hired on/after 1/1/90 with 20 years of
UCRP service credit
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See rate chart http://ucnet.universityofcalifornia.edu/compensation-andbenefits/health-plans/medical/retiree-plan-costs.html
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All family members in Medicare
One or more are not in Medicare
Non-Medicare Plans
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All family members under 65
Non-Medicare Age 65 and Over
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UC Retiree did not coordinate with Social
Security when employed
No one in family eligible for Medicare
Rates are same as employees in category 2
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If your UC medical plan premium is zero, you may receive a full or partial
"reimbursement" of your Medicare Part B premium – example:
$0.00
$44.49 > added to UC pension
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The amount of the reimbursement depends on the premium UC is charged by the insurance carrier for your plan
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Hired on/after 1/1/90 (UCRP entry/reentry date) with less than 20 years of UCRP service credit
UC contributes 50% of the maximum contribution at 10 years of service credit
UC contribution increases 5% per year of service credit
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“Age + service credit = 75” -- 50% of max
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Find rate on UCnet using “Medical Plan Chooser”
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Years
Service
Credit
5-9
10
11
12
13
14
Graduated Eligibility
% of
Maximum
Contribution
Age+years = 75
Years
Service
Credit
15
50% 16
55%
60%
65%
70%
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18
19
20
% of
Maximum
Contribution
75%
80%
85%
90%
95%
100%
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Service credit = 15 years
UC pays 75% of “Maximum UC Contribution”
$436 Maximum UC Contribution (single/non-MC)
$327 75% of Maximum UC Contribution
$611 Gross premium (single/HN Blue & Gold)
- $327 75% of Maximum UC Contribution
$284 = Monthly premium paid by retiree
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https://uc2014.chooser2.pbgh.org
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Hired on/after 7/1/2013
Also current employees not grandfathered
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UC Contribution calculated using age and service credit ;
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100% at age 65 w/ 20 years of service credit
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Graduated eligibility chart is posted on Future of UCRP website – see Fast Facts
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Medicare Part B
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$104.90 – standard rate in 2014
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Deducted from Social Security check or you pay directly
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UC Medical and Dental
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Deducted from UC pension check
Part B Reimbursement added to check
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UC Retiree Vision – paid to VSP
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Medicare Part B and D premiums may be higher for retirees with incomes over:
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$85,000 – single
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$170,000 – married
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Federal program that provides health insurance to:
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People 65 or older
People with disabilities
Covers most medical services
Does not pay total cost of care
Foundation for all UC Medicare plans
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Your own work history
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Work history of spouse or ex-spouse
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Contact Social Security to clarify your eligibility
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Part A - Hospital
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In-patient hospital
Home health care
Skilled nursing facility
Hospice care
Part B - Medical
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Office visits
Lab tests
Physical therapy
Medical equipment
Some preventive care
Part D – Prescription Drugs
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Medicare Part A – No monthly premium
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Medicare Part B - $104.90 per month
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May cost more for retirees with higher incomes
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Deducted from Social Security check or you pay directly
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Medicare Part D – No monthly premium
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May cost more for retirees with higher incomes
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Employees
Eligible at retirement
Eligible after retirement
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Do not enroll in Medicare Part B or D
Spouse enrolled in your UC employee medical plan does not need to enroll *
“Special enrollment period” when UC employee retires
You may enroll in Part A when first eligible at age 65 – not required *
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See special considerations
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Same-sex spouses have the right to delay enrollment in Medicare if enrolled in a UC medical plan
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Domestic partners should consult Social
Security about when to apply
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Blue Shield Health Savings Plan members may NOT be enrolled in Medicare A, B or D per
IRS rules
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You and your family members who are eligible for Medicare must enroll in Parts A
& B
Go to Social Security office one month before UC employee retires
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Complete UC forms to enroll in UC plan
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You may also receive a follow-up
“Coordination of Benefits” form from
Medicare
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You and your family members who are eligible for Medicare must enroll for Parts A & B
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Go to Social Security office or www.ssa.gov
about three months before turning 65
OR
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If receiving a Social Security pension, you will get a Medicare card in the mail
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UCOP will mail UC enrollment forms to you and family member
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HMO Advantage
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Health Net Seniority Plus
Kaiser Senior Advantage
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You assign your Medicare to the insurance plan
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Cannot use Medicare outside the plan
Blue Shield PPO
High Option Supplement
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Medicare is primary payer
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Blue Shield is secondary
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HMO Advantage
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Health Net Seniority Plus
Kaiser Senior Advantage
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You select PCP
PCP coordinates care
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Change to Sansum PCP physicians in medical group
Blue Shield PPO
High Option Supplement 
Any Medicare physician
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Health Net Seniority Plus
Kaiser Senior Advantage
Service Copay
Deductible $0
Office Visit $20
Urgent Care
Emergency Room
Outpatient Surgical Center
Inpatient Hospital
$20
$65
$100
$250
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Deductibles paid by Blue Shield
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Medicare Part A (Hospital) = $1216
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Medicare Part B (Medical) = $147
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Deductible paid by you
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Plan deductible for services not covered by
Medicare
Blue Shield PPO = $100 per individual
High Option = $50 per individual
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Medicare Allowable = $150
Who pays?
Medicare pays 80%
Blue Shield pays
You pay for services
PPO
$120
$24
$6
High
Option
$120
$30
$0
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Stay of 1-60 days
Medicare Part A Deductible = $1,216
Who pays?
PPO High
Option
Blue Shield pays $1,216 $1,216
You pay for services
Medicare pays balance of bill
$0 $0
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1 st to 21 st day Paid in full by Medicare
21 st to 100 th day Daily rate = $152
Who pays?
PPO
Blue Shield pays
You pay for services
80%
$122
$30/day
High
Option
100%
$152
$0
Medicare pays all but $152 per day
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HMO Emergency & Urgent Care only
Blue Shield PPO Plan pays 80%
High Option Plan pays 80%
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All plans have Medicare Part D
NO additional premium for Part D, for most
Copays – NO “donut hole”
Some formulary (drug list) changes
ID cards with Part D logo
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HMO members receive 1 card
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Blue Shield members receive 2 cards
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1 medical card and 1 drug card
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Health Net
Kaiser
Blue Shield
Retail (30 day)
• Generic
• Brand
• Non-formulary
Mail Order (90 day)
• Generic
• Brand
• Non-formulary
$5
$25
$40
$10
$50
$80
$10
$30
$45
$20
$60
$90
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Review the Rehired Retiree policy
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Returning to work can impact how your medical plan coordinates with Medicare
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Contact Benefits Office at 893-2489
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http://ucnet.universityofcalifornia.edu
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Health plan information and rates
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Medical Plan Chooser
Complete Guide to Retirement Benefits
Retirement Handbook http://www.ssa.gov
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Apply for Medicare Benefits http://www.medicare.gov
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“Original” Medicare coverage and publications
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RASC – Retirement Administration Services Center
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Process retirements for UC employees
UC retiree health plans
1-800-888-8267
HICAP - Health Insurance Counseling and Advocacy
Program
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Medicare information and assistance
1-800-434-0222
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