90 Day Maintenance Drug –
Retail Option
CURRENT
2015
Available through
 Mail order pharmacy
 UC Owned
Outpatient
Pharmacies
 Current plus…
 UC Care & Blue Shield
Plans: Safeway/Vons,
Walgreens, Costco and others
 Health Net Blue & Gold: CVS
 WHA: Walgreens, CVS,
Costco, and others
Cost sharing
• Members pay two
copayments (rather
than three)
 Same as current
•
•
Kaiser members only receive extended supply/2 copay through mail order.
Core/HSP subject to deductible and coinsurance – convenient access but no cost savings.
Chiropractic/Acupuncture
CURRENT
2015
 Not covered
 $20 copay, 24 visits yearly
(combined)
 Only acupuncture
through Kaiser provider
is covered ($20 Copay)
 $15 copay for acupuncture
or chiro, 24 visits yearly for
self-referral (combined); or
$20 copay through Kaiser
provider for acupuncture only
 Chiro/Acupuncture
covered (BSC Network)
 UC Care aligning
coinsurance for chiropractic
services to match other
services
Core
 Both Chiro and
Acupuncture subject to
$500 maximum
 Eliminate $500 maximum; 24
visits yearly (combined)
Subcontracted
Specialty Vendors
 Health Net Blue & Gold and Kaiser Permanente: American
Specialty Health
 WHA: Landmark
Health Net Blue &
Gold; WHA
Kaiser
UC Care & HSP
Mandated: Out of Pocket Max
Change
2015 Mandate:
 Member Rx cost must accrue towards meeting Out-of-Pocket (OOP)
Maximum.
Plans changing to meet mandate:
 Health Net Blue & Gold and WHA
- Combined Medical and Rx OOP: $1,000 single/$3,000 family

Kaiser Permanente
- Combined Medical and Rx OOP: $1,500 single/$3,000 family

UC Care updates described on next slide.

Blue Shield HSP and Core currently comply.
3
Other Mandated Changes
 Nicotine Replacement OTC Products
- 2015 will be covered at no cost (currently $5 generic copay)
- Kaiser and WHA currently compliant
 Women’s Preventive Health
- Cancer risk reducing medications (e.g., Tamoxifen or
Raloxifene) for women at increased risk of breast cancer.
- 2015 will be covered at no cost
- WHA currently compliant
Mandated: Health Savings Plan
Limits


Affects Health Savings Plan (Blue Shield).
IRS annually increases definition of “high deductible” and Health Savings
Account maximum annual contribution amounts.
Deductible
Single
Family
Out-of-pocket
max
Single
Family
Max Contribution
Single
Family
2014
2015
Change
$1,250
$2,500
$1,300
$2,600
$50
$100
$4,000
$6,400
$3,300
$6,550
$3,350
$6,650
No change
$50
$100
5
Teladoc – Blue Shield
Telemedicine services available by phone, mobile applications or online video
– Board certified physicians 24/7/365
– UC Care: $20 copay (copay does NOT count towards deductible, does count
towards OOP)
– Core and Health Savings Plan: $40 copay until deductible met and then 20%
coinsurance after (copay counts towards deductible and OOP)
Prescription Management
Top 10 Diagnoses
•
•
•
•
•
•
•
•
•
•
Sinus Problems
Urinary Tract Infection
Pink Eye
Bronchitis
Upper Respiratory Infection
Nasal Congestion
Allergies
Flu
Cough
Ear Infection
•
•
•
•
Electronic prescribing
(SureScripts) or by phone,
if needed
Use of antibiotics limited to short
durations
No prescribing of DEA-controlled
substances, medication for psychiatric
illness, or lifestyle drugs
Generic drugs are automatically
recommended
Emergency – UC Care
Covered Service
UC Select
Blue Shield Preferred
Non-Preferred
(out-of-network)
$100 per visit
$100 per visit
$100 per visit
(not subject to the calendar
year deductible)
(not subject to the calendar
year deductible)
20%
20%
(not subject to the calendar
year deductible)
(not subject to the calendar
year deductible)
CURRENT
Emergency facility (not
resulting in an admission)
ER Physician Services
20%
NEW FOR 2015: Combining ER facility and Physician services as one fixed copay amount
Emergency facility (not
resulting in an admission)*
ER Physician Services
$200 per visit
No Charge
$200 per visit
$200 per visit
(not subject to the calendar
year deductible)
(not subject to the calendar
year deductible)
No Charge
No Charge
* For ER Services resulting in admission – no change; remains $250 copay.
Rehabilitative Services – UC Care
Annual visit limitation on rehabilitative services:
physical therapy, occupational therapy, and speech therapy
CURRENT
No limit for any of the three
areas of services:
 physical therapy,
occupational therapy, and
speech therapy
NEW FOR 2015
Combined 48 visits for all three
areas of services:
 physical therapy,
occupational therapy, and
speech therapy
Vaccinations – UC Care
Coverage for the following vaccinations:
tetanus, whooping cough (pertussis) pneumococcal, meningococcal, cervical
cancer (HPV) and shingles (herpes zoster).
CURRENT
Covered at a $0 copay
 Per medical plan Preventive
Health Benefits (based on
age and gender
requirements)
 Services received from an
in-network physician
NEW FOR 2015
Covered at a $0 copay
 Per medical plan Preventive
Health Benefits (based on
age and gender
requirements)
 Allow adults to receive
services from an in-network
physician or in-network
pharmacy
UC Select Network Status Update
Location
Provider
Status
UCLA
 Riverside Community
Hospital
 Los Robles Regional Medical
Center
 West Hills Hospital and
Medical Center
 BSC Contract Manager and Santiago
Munoz from UCLA continue to work with
the HCA group. Conversations still in
progress.
UC Berkeley &
UCOP
 John Muir Health (Hospital &
JMH Physicians)
 BSC still in follow up with conversations
with John Muir.
Santa Barbara
 Cottage Hospital
 Sansum Clinic
 Pueblo Radiology Medical
Group
 Cottage remains in Blue Shield Preferred
 Sansum will remain in the UC Select
 Pueblo Radiology is currently being
reviewed
 Marshall Medical Center
 Marshall Physicians
 Lodi Memorial Hospital
Effective January 1, 2015 will move from
Blue Shield Preferred to UC Select
UC Davis
2015 Medical Pay Band Adjustments
2014
Pay Band
Definition of Range for
Medical Contribution
Base Using Full-Time
Salary As of Jan. 2013
2015
Pay Band
Definition of Range for
Medical Contribution
Base Using Full-Time
Salary As of Jan. 2014
1
$51,000 & under
1
$51,000 & under
2
$51,001 to $101,000
2
$51,001 to $101,000
3
$101,001 to $151,000
3
$101,001 to $152,000
4
$151,001 & over
4
$152,001 & over



Pay Bands are adjusted annually, based on the change in California consumer price index
from February of prior year to February of current year (determined by the California
Department of Finance).
The index used is that for urban wage earners and clerical workers (CPI-U).
The change from February 2013 to February 2014 was 0.9%.
2015 Monthly Cost by Salary Band
$51,000 or less
Plans
Coverage
$51,001-$101,000
3, 55, 2, 3, 3, 89,
EE
6, 55, 2, 3, 6, 89,
EE
2, 26 UC
EE
2, 26 UC
Total
$101,001 - $152,000
UC
Total
$152,001 or More
UC
EE
Total
Total
Kaiser California
Single
13.78
546.91
560.69
49.83
510.86
560.69
86.83
473.86
560.69
125.14
435.55
560.69
EDB Code: KS = South
Self+child(ren)
24.80
984.45
1,009.25
89.69
919.56
1,009.25
156.29
852.96
1,009.25
225.25
784.00
1,009.25
Self+adult
30.18
1,147.28
1,177.46
112.48
1,064.98
1,177.46
186.24
991.22
1,177.46
262.66
914.80
1,177.46
Family
41.19
1,584.82
1,626.01
152.33
1,473.68
1,626.01
255.69
1,370.32
1,626.01
362.76
1,263.25
1,626.01
Health Net
Single
35.19
626.90
662.09
71.24
590.85
662.09
108.24
553.85
662.09
146.55
515.54
662.09
Blue & Gold - HMO
Self+child(ren)
63.34
1,128.42
1,191.76
128.23
1,063.53
1,191.76
194.83
996.93
1,191.76
263.79
927.97
1,191.76
EDB Code: HB
Self+adult
128.02
1,262.36
1,390.38
210.32
1,180.06
1,390.38
284.08
1,106.30
1,390.38
360.50
1,029.88
1,390.38
Family
156.18
1,763.88
1,920.06
267.32
1,652.74
1,920.06
370.68
1,549.38
1,920.06
477.75
1,442.31
1,920.06
UC Care PPO
Single
96.91
626.90
723.81
132.96
590.85
723.81
169.96
553.85
723.81
208.27
515.54
723.81
EDB Code: SU
Self+child(ren)
174.44
1,128.42
1,302.86
239.33
1,063.53
1,302.86
305.93
996.93
1,302.86
374.89
927.97
1,302.86
Self+adult
257.64
1,262.36
1,520.00
339.94
1,180.06
1,520.00
413.70
1,106.30
1,520.00
490.12
1,029.88
1,520.00
Family
335.17
1,763.88
2,099.05
446.31
1,652.74
2,099.05
549.67
1,549.38
2,099.05
656.74
1,442.31
2,099.05
Blue Shield
Single
13.78
557.66
571.44
49.83
521.61
571.44
86.83
484.61
571.44
125.14
446.30
571.44
Health Savings PPO
Self+child(ren)
24.80
1,003.79
1,028.59
89.69
938.90
1,028.59
156.29
872.30
1,028.59
225.25
803.34
1,028.59
EDB Code: SP
Self+adult
30.18
1,169.83
1,200.01
112.48
1,087.53
1,200.01
186.24
1,013.77
1,200.01
262.66
937.35
1,200.01
Family
41.19
1,615.96
1,657.15
152.33
1,504.82
1,657.15
255.69
1,401.46
1,657.15
362.76
1,294.39
1,657.15
Supplemental Disability



19% increase in Supplemental Disability Rates – the first rate
increase in 5 years.
Rates to increase only for 7 and 30 day waiting periods – NOT 90
and 180 day.
Rate drivers: Frequency and claim duration for both short and longterm disabilities.
Rates are based on age, salary and waiting period elected.
Examples:
Age 40, $100k salary, 30 day wp
Rate increase of $6.97
($36.67 to $43. 64)
Age 50, $100k salary, 30 day wp
Rate increase of $10.45
($55.00 to $65.45)
13
Group Legal - ARAG
 The plan will be open for new enrollments this year.
 Claims experience has been consistent, thus rates are not
increasing.
 Expanded identity theft protection benefit added that
includes:
- Full service identity restoration
- Identity Theft Insurance up to $1million
- Lost wallet services
- Credit monitoring service, internet surveillance of personal
information and child identity monitoring
- Powered by CSID, leader of global enterprise level identity
protection and fraud detection solutions.
ARAG’s New Expanded
ID Theft Protection
 Many of the new tools are full service/ concierge type, rather
than just information based
 ARAG will work on the member’s behalf to completely resolve
the ID theft problem
 Free insurance covers members’ costs associated with ID
theft restoration
- For example: child care expenses, unpaid time off work,
mileage
Thank you. Questions?