Blue Shield Health Savings Plan
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.
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11/2013
Blue Shield Health Savings Plan
Combines high deductible PPO with
account to pay out-of-pocket expenses
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Medical Coverage
Blue Shield PPO
Health Savings Account
HealthEquity
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Preventive Care
• Preventive care is covered at 100% with
Blue Shield PPO providers
• Preventive care includes:
◊ Annual well visit and labs
◊ Well woman visits and labs
◊ Preventive screening tests
◊ Immunizations
• See list of preventive services on
http://www.blueshieldca.com/uc
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Blue Shield PPO
• 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 a Blue
Shield PPO provider
• “Out-of-pocket Maximum” limits your financial
liability
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Residence, Networks & Travel
• The employee must live in US
• When in US
◊ Comprehensive coverage
◊ Blue Shield PPO network in CA
◊ Blue Cross Blue Shield network outside CA
• When traveling out of US
◊ Emergency and urgent care only
◊ NO routine care
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Blue Shield PPO - Plan Design
In Network
Out of Network
$1,250
$2,500
$2,500
$5,000
20%
• Plan pays 60%
of allowed rate
• You pay balance
$4,000
$6,400
$8,000
$16,000
Deductible
Single
Family
Member Cost Sharing
(Coinsurance for
medical services & drugs)
Out-of-Pocket Max
(includes deductible)
Single
Family
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Deductible, Coinsurance, OOPM
Individual (Single)
Preferred Providers
You pay
You share cost with plan
Plan pays
100%
$1250
Deductible
20% Coinsurance
$4000 OOPM
You can use the UC Contribution to the Health Savings Account
to pay part of the deductible.
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Deductible, Coinsurance, OOPM
Family (2 or more)
Preferred Providers
The full family deductible must be met before plan shares costs
You pay
You share cost with plan
Plan pays
100%
$2500
Deductible
20% Coinsurance
$6400 OOPM
You can use the UC Contribution to the Health Savings Account
to pay part of the deductible.
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Allowed Amount – In Network
PPO plans negotiate “allowed” rates to process claims.
In-Network
Discounted rate
that plan negotiates for each
service with “preferred” or
participating providers
Example
20% Coinsurance
Provider charge:
Allowed amount:
• You pay the in-network
Plan pays 80%:
coinsurance on the discounted You pay 20%
rate.
• Provider can’t “balance bill”
$200
$100
$80
$20
Provider write-off: $100
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Allowed Amount – Out of Network
PPO plans assign “allowed” rates to process claims.
Out-of-Network
Value that plan assigns
to a service when provider is
NOT a “preferred provider”
(not participating)
Example
40% Coinsurance
Provider charge:
Allowed amount:
$200
$100
• Plan pays out-of-network
coinsurance on the allowed
amount.
Plan pays 60%:
(60% of $100)
$60
You pay 40%:
$40
You pay balance:
$100
• Provider can “balance bill”
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Medical Claims, EOBs & Bills
You receive services
You pay nothing at the time of
service for in-network care
Provider sends claim for
services to Blue Shield
Blue Shield 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
• Pay with HSA funds
or
• Pay with other funds
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Prescription Drugs
• There is no separate drug plan with copays
• Drug expenses are applied to the plan in
the same way as medical expenses
◊ You pay full cost of medication until you
satisfy the deductible
◊ After deductible, you pay 20% at preferred
pharmacies
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Pharmacy Claims
You go to the pharmacy
Pay with your HSA debit card
or
Pay with personal funds and
later go to your HealthEquity
account online and reimburse
yourself (if you have money
in the account)
Give pharmacist
your Blue Shield
ID card so they
can apply the
Blue Shield Rx
discount
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Learn more about PPO Costs
Fair Health Consumer
http://www.fairhealthconsumer.org/
Health Care Blue Book
https://www.healthcarebluebook.com/
Good Rx
• http://www.goodrx.com
• Estimate cost of drugs
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Find costs on Blue Shield Website
After your enrollment is complete and you are in
the Blue Shield membership system, you will have
access to additional tools.
http://www.blueshieldca.com/uc
• Treatment Cost Estimator Tool
• Drug costs, information and claim summary
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Health Saving Account
High deductible medical plan paired
with a Health Savings Account
Blue Shield
PPO
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Health Savings
Account
• The Health Savings Account is a separate account
that can be used to pay medical and other health
expenses.
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Why is HSA better?
• 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
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Annual Contributions by UC & Employee
• UC Contribution (1/1/14)
◊ $500 individual
◊ $1000 family
UC Contribution is prorated for
plans that start after January 1
• 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.
Who is eligible for HSA?
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
• Not be claimed as a dependent on
someone else’s tax return
Whose expenses can be paid with HSA?
• The money in your HSA can be used to
pay for qualified medical expenses of any
family member who qualifies as a
dependent on your tax return.
• The family member does not have to be
enrolled in this plan
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Use the HSA to pay for…
• Deductible
• Coinsurance
• Any IRS Publication 502 Expenses, including:
◊
◊
◊
◊
Medical
Dental
Vision
Prescription drug
◊ Long Term Care insurance premiums
• See Health Equity website for more information
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Your Responsibility
•
•
•
•
Follow HSA eligibility rules
Contribute only the amount allowed by IRS
Use HSA funds for eligible expenses
Keep itemized receipts as tax documents
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How does HSA work?
• UC makes annual contribution for plans that
start on January 1.
• You may contribute through payroll deduction or
make post-tax contributions to HealthEquity
• Use a HSA debit card to pay for health expenses
• Use HealthEquity website to pay medical and
other health claims
• Invest HSA dollars when account balance
reaches $2000 – no fees to invest
HSA vs FSA
• The 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 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
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www.healthequity.com/ed/uc
Register as new member
on this site.
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www.blueshieldca.com/uc
Register as new member
on this site.
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Health Equity Member Portal
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Claim Summary Screen
• View claim detail
• Choose action to
be taken
− Pay provider
− Reimburse
themselves
− Close
expense
• Pay from HSA
account or
external
checking/saving
s account
• Schedule
payment
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Member Resources
• Welcome Kit - to get you started
• Debit card loaded with UC Contribution
• Online resources
◊ Treatment cost estimator tool
◊ Drug costs, information and claim summary
• Use smart phone browser to access mobile
website
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Optum
(formerly United Behavioral Health)
• Optum coordinates behavioral health care
for all medical plans (except CORE)
◊ psychiatrist
◊ psychologist
◊ therapist
◊ substance abuse treatment
• No referral required from physician
• Call Optum to notify prior to first visit
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Behavioral/Mental Health
• Medical and behavioral health deductibles and OOPM cross
accumulate.
• See the Optum Evidence of Coverage for complete details.
Covered Service
Optum Clinicians
Out-of-Network
Deductible
$1,250 individual
$2,500 family
$2,500 individual
$5,000 family
Outpatient Office
Visits
You pay 20%
Plan pays 60% of allowed rate
You pay balance of bill
Emergency Room
You pay 20%
Plan pays 80% of allowed rate
You pay balance of bill
Inpatient Stays
You pay 20%
Plan pays 60% of allowed rate
You pay balance of bill
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For more information
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