Big changes
New choices
Blue Shield Health Savings Plan
Laura Morgan
UCSB Human Resources, Benefits
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This presentation is intended for communication purposes only. Please see plan
document and http://atyourservice.ucop.edu for complete information.
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11/2013
Topics
• Open Enrollment Overview
• Blue Shield PPO
• Health Savings Account
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Open Enrollment
• Ends Tuesday, November 26, 5:00 pm
• Make changes online
http://atyourservice.ucop.edu
• All changes are effective January 1, 2014
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Actions
• Change medical and/or dental plan
• Enroll in medical, dental, vision
• Add eligible family members
• Enroll or re-enroll in Health Flexible
Spending Account (FSA)
◊ unless you select the Blue Shield Health
Saving Plan)
• Enroll or re-enroll in Dependent Care FSA
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2014 Medical Plans
2013
2014
Anthem PPO
Anthem PLUS
UC Care PPO
Anthem HRA-PPO
Health Net Blue & Gold HMO
Health Net HMO
(administered by Blue Shield)
Blue Shield
Health Savings Plan (PPO)
Health Net Blue & Gold HMO
Kaiser HMO
Kaiser HMO
Core
Core
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Default Medical Plans
2013 Medical Plan
2014 Medical Plan
Health Net Blue & Gold HMO Health Net Blue & Gold HMO
Health Net HMO (full)
Health Net Blue & Gold HMO
Kaiser HMO
Kaiser HMO
Anthem PLUS
UC Care
Anthem PPO
UC Care
Anthem Lumenos HRA
Blue Shield Health Savings Plan
Anthem Core
Blue Shield Core
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What is your priority?
• Cost to enroll – monthly premium
• Cost of care
◊ Predictable, low cost copays
◊ Pay a % of each service
• Choice of providers
◊ HMO medical group physicians
◊ PPO preferred network or any provider
• Effort to manage – coordinating care & bills
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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
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Lumenos vs Blue Shield HSP
Lumenos
Deductible
 Health
Reimbursement
Account (HRA)
 Member pays
PPO Coinsurance
Blue Shield PPO
Deductible
 Member pays
PPO Coinsurance
Health Savings Account
UC Contributions
Member Contributions
Lumenos HRA Rollover
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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%
40%
$4,000
$6,400
$8,000
$16,000
Deductible
Single
Family
Member Cost Sharing
(Coinsurance for
medical and drugs)
Out-of-Pocket Max
(includes deductible)
Single
Family
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Single vs Family
Same design as Lumenos:
• Single = one person enrolled in plan
• Family = more than one person in plan
◊ Families share one deductible
◊ Families share one out-of-pocket maximum
(UC Care has a different plan design)
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Deductible, Coinsurance, OOPM
Blue Shield Health Savings Plan
Individual (Single)
Preferred Providers
You pay
You share cost with plan
Plan pays
100%
$1250
Deductible
20% Coinsurance
$4000 OOPM
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Deductible, Coinsurance, OOPM
Blue Shield Health Savings Plan
Family
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
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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 PPOs
Fair Health Consumer
http://www.fairhealthconsumer.org/
• Estimate cost of medical procedures
• “LEARN” tab – print and video resources
◊ How plans work
◊ Cost Sharing, know what you may owe
Good Rx
• http://www.goodrx.com
• Estimate cost of drugs (for Blue Shield HSP)
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Health Saving Account
High deductible medical plan paired
with a Health Savings Account
Blue Shield
PPO
+
Health Savings
Account
• The Health Savings Account is not a component
of the medical plan as HRA is with Lumenos.
• It 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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Employees can maximize savings
• UC Contribution (1/1/14)
◊ $500 individual
◊ $1000 family
• 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
◊ Health FSA must have a $0 balance
on Dec. 31, 2013 (complete any claims
reimbursement by Dec. 31, 2013)
• Not be claimed as a dependent on someone
else’s tax return
Your Responsibility
• Contribute only the amount allowed by
IRS
• Use HSA funds for eligible expenses
• Keep itemized receipts as tax documents
• Follow HSA eligibility rules
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Lumenos HRA Rollover
• Remaining Lumenos HRA money will roll-over
into the Health Savings Account (4/1/14)
• Lumenos HRA $ are treated differently than
HSA $ by IRS
• Lumenos HRA $ becomes a “Post Deductible
Health Reimbursement Account” = PDHRA
• You must pay the Blue Shield HSP deductible
with other funds BEFORE you can use the
PDHRA to pay eligible expenses.
Example: Lumenos PDHRA
• Single Deductible
• UC Contribution to HSA
• Remaining balance
$1,250
$500
$750
◊ Pay with personal funds
or
Pay with your contributions to HSA
• Lumenos PDHRA can be used to pay 20%
coinsurance after deductible is satisfied
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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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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 after 1/1/14
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www.blueshieldca.com/uc
Register as new member
on this site after 1/1/14
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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
• Smart phone browser
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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 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
Emergency Room
You pay 20%
Plan pays 80% of allowed rate
Inpatient Stays
You pay 20%
Plan pays 60% of allowed rate
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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
http://atyourservice.ucop.edu/oe
• Resources
◊ Plan contacts
◊ Plan rates
• Medical Plans
◊ Benefit summaries
◊ Links to plan websites
◊ Links to provider directories
• Other plans
◊ Dental, vision, FSA
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Two Adults – Payband 51K-101K
UC Care
HSP
Difference
281/mo
103/mo
178 x 12 = 2,136
Family Deductible
Premium Saving
UC HSA Contribution
2,500
2,136
1,000
Maximum HSA Contribution
5,550
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