Your UC PPO Medical Plans

Transcription

1 Your UC PPO Medical Plans Health Savings Plan UC Care CORE 2018 ucppoplans.com

2 Contents What s New or Changing for Your UC Medical Plan Options... 4 UC Health Savings Plan...6 UC Care...8 CORE...10 What s the Difference Between the Plans? Find Your Fit Do the Math...14 Find a Doctor Contacts Summary of Benefits Definitions...36 Transition Checklist... Back Cover The University of California intends to continue the benefits described here indefinitely; however, the benefits of all employees, retirees and plan beneficiaries are subject to change or termination at the time of contract renewal or at any other time by the University or other governing authorities. If you belong to an exclusively represented bargaining unit, some of your benefits may differ from those described here.

3 What s New or Changing for 2018 The changes described below are effective January 1, The Big Headlines» The medical, pharmacy, and behavioral health programs for the UC PPO plans will all be managed by Anthem Blue Cross. This means you ll be able to get information about all of these benefits from one vendor and website.» Anthem Health Guide will continue to provide support for medical and behavioral health services.» You ll get a new ID card in December 2017.» There s a new online resource for UC medical and pharmacy benefits information: ucppoplans.com. During Open Enrollment, learn about and compare your choices. Then, during the rest of the year, get information about your medical plan and find links to other resources at your convenience and from any device. Your UC PPO Medical Plans 1

4 Medical Plan Benefits ALL PLANS You ll get a new ID card. In late December, you and each covered family member will get one ID card from Anthem that you ll use beginning January 1, 2018, for medical, prescription drug and behavioral health services. LiveHealth Online, which lets you see a licensed doctor from your home via video chat, will expand to include visits with psychiatrists.* For the HSP and CORE plans, your cost for a psychiatrist visit (before you meet the deductible) is $175 for the initial evaluation and $75 per visit for follow-up visits. After the deductible, you pay $35 for the initial visit and $15 per visit thereafter. For UC Care, your cost is. Expanded ACA preventive care coverage. In compliance with the Affordable Care Act (ACA): For those who meet certain criteria, low- to moderate-dose statins will be covered at a $0 copayment for cardiovascular disease prevention. Up to a 12-month supply of oral contraceptives will be covered. The University of California is recognized as a national leader in health research and has numerous clinical trial opportunities. As a UC member, you have may access to volunteer to participate in these trials, such as the trial described below. The Wisdom Study is a UC-wide trial designed to test a new personalized approach to breast cancer screening based on individual risk factors. The Wisdom Study is recruiting 100,000 women across California, with the goal to improve breast cancer screening for all. All female UC PPO members ages with no history of breast cancer or ductal carcinoma in situ (DCIS) are invited to join this voluntary study. To learn more and see if you re eligible, visit wisdomstudy.org. HEALTH SAVINGS PLAN (HSP) Calendar-year deductibles (the amount you pay before the plan pays benefits) are increasing: The in-network calendar year deductible will increase from $1,300 to $1,350 for individual coverage and from $2,600 to $2,700 for family coverage. The out-of-network calendar year deductible will increase from $2,500 to $2,550 for individual coverage and from $5,000 to $5,100 for family coverage. The maximum Health Savings Account (HSA) contribution will increase to $3,450 for individual coverage and $6,900 for family coverage, including UC s contribution of $500 for individual coverage and $1,000 for family coverage. If you will be age 55 or older, you can contribute an additional $1,000 over and above these limits. UC CARE The cost for urgent care visits (through an Anthem Preferred provider) is changing from coinsurance (after deductible) to a copayment of $30 per visit (no deductible). *LiveHealth Online psychiatrists are not able to prescribe controlled substances. 2 Your UC PPO Medical Plans

5 Prescription Drugs Anthem is replacing OptumRx as the administrator of prescription drug benefits. Anthem will process claims, create a network of pharmacies, and set clinical policy and guidelines. Anthem will also run the home delivery service for maintenance medications and a specialty pharmacy Accredo for complex drugs. Prior authorizations or approvals for exceptions to prescription benefit rules and regulations (e.g., quantity limits, step therapy, or using a brand name drug instead of generic) that are still active on December 31, 2017 will be honored by Anthem for as long as you are taking that specific medication. Most open prescriptions will transfer automatically:* If you have an open prescription at a retail pharmacy, simply show your new ID card when you get your first prescription filled in Most open mail order prescriptions will be transferred to the Anthem mail service vendor, Express Scripts. You ll get more information about this, including any steps you need to take, directly from Anthem by early In late December, you and each covered family member will each get one ID card from Anthem that you ll use beginning January 1, Use this ID card for medical, prescription drug and behavioral health services. It s critical that you show your new ID card for prescription drugs beginning January 1; otherwise, your claims may be delayed or processed incorrectly. Your copayment amount/coinsurance for each drug tier will be the same as your current plan. However, drugs may be classified differently (in a different tier or coverage level), which could affect your out-of-pocket costs. For example, the Anthem drug list features four tiers of medications, including generic and brand name drugs, with the lowest out-of-pocket costs in Tier 1. This is different from the way OptumRx classifies and prices drugs, which means that you might pay more, or less, for your prescriptions than you do today. Anthem will mail information to you about any changes to your prescription tier before the end of the year. *By law, certain prescriptions cannot be automatically transferred. If your prescription cannot be transferred, Anthem will notify you. Or call Anthem Health Guide at (844) during Open Enrollment to confirm if your prescription can be transferred, or to get answers to your questions about the transition. HSP and CORE members can get a 90-day supply at CVS, Walgreens, Safeway/Vons, Costco, UC Medical Center Pharmacies and Retail90 pharmacies. This applies to all medications that can be safely filled at that quantity, not just maintenance medications. Go to ucppoplans.com for more information about finding a Retail90 pharmacy. UC Care members can get a 90-day supply for the cost of two copayments at CVS, Walgreens, Safeway/Vons, Costco and UC Medical Center Pharmacies. A 90-day supply for the cost of three copayments is available at designated Retail90 pharmacies. This applies to all medications that can be safely filled at that quantity, not just maintenance medications. Prescription Drug Transition To-Do List ü Check the Anthem drug list and prescription drug costs. Anthem uses a different drug list than OptumRx. View the Anthem drug list at ucppoplans.com. Talk to your doctor about alternatives to lower your cost. Get help: If you re taking a drug that s not on the Anthem drug list or have other questions, call Anthem Health Guide at (844) , Monday through Friday, 5:00 a.m. to 8:00 p.m. (Pacific). BEFORE DECEMBER 31 ü Get refills of any daily medication so that you have enough to last through early ü If your refills will expire on or around January 1, ask your doctor to write a new prescription (with refills) that you can submit to Anthem in January. (Active prescriptions will be automatically transferred.*) ü Register with optumrx.com for access to 2017 prescription information. ON OR AFTER JANUARY 1, 2018 ü Show your new ID card at the pharmacy on your first visit in 2018; otherwise your claims may be delayed or processed incorrectly. ü Register on anthem.com/ca to access cost information and the prescription drug mail order pharmacy. After registering click on Benefits > Pharmacy. On your first visit, register on the Express Scripts website. After that, you ll be able to access medical and pharmacy information just by logging in to anthem.com/ca. Your UC PPO Medical Plans 3

6 Your UC Medical Plan Options UC offers three different PPO plans to meet different health needs and budgets.» UC Health Savings Plan (HSP): A medical plan that s also a savings plan.» UC Care: A custom PPO designed especially for UC employees that offers low out-of-pocket costs when you get care from UC physicians and medical centers.» CORE: A high-deductible plan with premiums paid by UC. ALL OF THE PLANS OFFER: Comprehensive benefits, including 100% coverage for in-network preventive care A wide choice of providers, including UC doctors and hospitals Behavioral health coverage and resources Care that s available whenever and wherever you need it, 24/7 Help with all aspects of your medical care through Anthem Health Guide Cost-comparison tools Provider-rating and review tools Medical care that travels with you around the state and the globe 24/7 access to coverage information and plan resources 4 Your UC PPO Medical Plans

7 Three Things to Know About the Plans UC Health Savings Plan (HSP) 1 The HSP offers a lower premium than UC Care. You could put those premium savings to work for you by contributing to your HSA. Interest and other earnings on your HSA balance are tax-free. And so are distributions used to pay for qualified medical expenses. 2 If you have moderate to low health care costs, UC's contribution ($500 for individuals/$1,000 for family) to the HSA could cover all of your out-of-pocket expenses. 3 If you enroll in family coverage, you must meet the full in-network family deductible of $2,700 before the plan will pay benefits for any covered family member. UC Care 1 When you use UC Select providers, including UC physicians and medical centers, you pay low copayments for most services. This helps to offset the higher premiums of this plan if you need a lot of care particularly hospitalization and/or surgery. 2 UC Select providers including primary care providers are available in all five of UC s nationally ranked medical centers across the state. 3 For services not available through UC providers, you have access to the Anthem Preferred network of over 60,000 doctors and other health care providers. CORE 1 UC pays the entire premium for your coverage. You only pay for the care you receive. Because of this, you ll have higher out-of-pocket costs when you get care. 2 If you have very low health care needs, this might be a good plan for you. However, you might also want to consider the UC Health Savings Plan (HSP). You pay monthly premiums, but UC s contribution to a Health Savings Account (HSA) could mean you come out ahead financially. 3 You re responsible for 100% of the first $3,000 of expenses for each enrolled family member before the plan will pay benefits. Your UC PPO Medical Plans 5

8 UC Health Savings Plan (HSP) The HSP combines the flexibility of a PPO with the tax-saving benefits of a Health Savings Account (HSA). MEDICAL PLAN HIGHLIGHTS You pay a calendar-year deductible before the plan begins to share in the cost of covered services, including prescription drugs. Once the annual deductible is met, the plan pays 80% of the cost of most in-network covered services, including prescription drugs, and you pay. If you re enrolled in family coverage, the full family deductible must be met before the plan pays benefits for any family member. Expenses for each family member count toward meeting the family deductible. An out-of-pocket maximum limits your financial liability for covered expenses. After you meet this amount, you get 100% coverage for most covered services, including prescription drugs, for the remainder of the year. You can choose to see in- or out-of-network providers. However, choosing an out-of-network provider will likely result in greater out-of-pockets for you. SAVINGS PLAN HIGHLIGHTS To help pay your initial expenses, UC funds a Health Savings Account (HSA) with $500 (if you cover just yourself) or $1,000 (if you cover family members). Use the money in your HSA for current health expenses, or let your balance grow and save your funds to use in the future even in retirement. Or spend some and save some. The choice is yours. You can contribute to your HSA, too. Your contributions lower your taxable income and help you build additional savings to use today or in the future including for Medicare or other health care expenses after retirement. Any money used to pay eligible health care expenses comes out of your account tax-free. How It Works WHAT YOU PAY FOR CARE In-Network Deductible The deductible is the amount you pay before the plan starts paying expenses. In-Network Coinsurance Coinsurance is what you pay after the deductible is met. In-Network Out-of-Pocket Maximum The out-of-pocket maximum is the most you'll pay in a year for covered services. Single coverage $1,350 Family coverage $2,700 $500 HSA contribution from UC $1,000 HSA contribution from UC = $850 = $1,700 Once the annual deductible is met, you pay of the cost of services. If your in-network covered expenses reach $4,000, the plan pays 100% of the cost for the rest of the year. If your in-network covered expenses reach $6,400, the plan pays 100% of the cost for the rest of the year. 6 Your UC PPO Medical Plans

9 3 Ways You Can Benefit From a Health Savings Account (HSA) 1. Pay less in taxes* The contributions you make to your HSA come out of your paycheck before taxes are withheld, so you pay taxes on a lower amount. The interest and other earnings on your HSA assets are tax-free. You don t pay taxes on money you withdraw for qualified health care expenses. You can save up to the IRS annual maximum of $3,450 for individual coverage and $6,900 for family coverage (including UC s contribution), plus an additional $1,000 (catch-up contribution) if you are or will be age 55 in For more information, go to ucppoplans.com. 2. The money is yours forever. There s no use-it-orlose-it rule. Unlike with a Flexible Spending Account (FSA), your HSA balance rolls over each year. Plus, your unused balance grows through interest. Your entire HSA balance and any contributions yours and UC s are yours to keep forever, even if you leave UC or retire. 3. Invest for the future. Once your HSA balance reaches $1,000, you can invest it for the opportunity to grow. IS THE HSP RIGHT FOR ME? When you enroll in the HSP, an HSA will be automatically opened for you with HealthEquity. To participate in the HSA, you must meet the following requirements: You or your spouse cannot be enrolled in a general-purpose Health Flexible Spending Account (FSA) and will not enroll in one in You have no other health coverage (including Medicare), except what is permitted under IRS Publication 969. You cannot be claimed as a dependent on someone else s tax return. You have a valid U.S. address (needed to establish your HSA). Why the HSP Works for Me We re all pretty healthy and only see a doctor a few times a year for minor illnesses. I ve been enrolled in UC Care for many years because I liked the predictable copayments when we saw UC Select providers. But this year I m eyeing the HSP with the Health Savings Account because I don t want to pay more for coverage that we don t use. And I like the idea that UC contributes $1,000 to my HSA. That should cover most if not all of our expected health care expenses. I ll put the difference in premiums into my HSA, too. That way I ll build a cushion for any unexpected expenses, while also saving on taxes and building financial resources for retirement. TAKE A CLOSER LOOK: Go to ucppoplans.com *Applies to federal taxes only. Currently, for residents of California, Alabama and New Jersey, HSA contributions and earnings are not excluded from state income tax. For more information, please consult your tax advisor. Your UC PPO Medical Plans 7

10 UC Care UC Care gives you three options for care. You pay higher premiums in exchange for lower costs when you get care. UC Select providers including UC physicians and medical centers offer the lowest costs. You can also use any provider within the extensive Anthem Preferred network. UC Care also gives you the option to see any provider you want (out-of-network) at a higher out-of-pocket cost to you. PLAN HIGHLIGHTS UC Select In-Network Anthem Preferred Out-of-Network Lowest out-of-pocket cost; fewer providers Higher cost; greater number of providers Highest cost; greatest number of providers No-cost preventive care. Pay copayments (a set dollar amount) for covered services, and you don t have a calendar-year deductible. Choose from providers within California, including UC physicians, UC medical centers and a group of other quality providers. Every campus even those without medical centers has access to UC Select providers. Access five nationally ranked UC medical centers (Davis, Irvine, Los Angeles, San Diego and San Francisco) and most affiliated facilities, physicians and other professional providers. Visit select primary care physicians and providers near every campus even those without UC medical centers. No-cost preventive care. Pay a low calendar-year deductible before UC Care begins to share in the cost of covered services. After you meet your deductible, the plan pays a percentage of the cost for covered services, and you pay the rest. The percentage you pay is called coinsurance. Choose from a broad range of providers in the Anthem network. See any provider you wish. An out-of-network calendar-year deductible that s higher than and totally separate from your in-network deductible. What you pay toward one doesn t count toward the other. Coinsurance (the percentage you pay for covered health services after you meet the out-of-network deductible) costs are higher than what you d pay with in-network providers. You pay charges above the plan allowed amount, in addition to any coinsurance. In most cases, you will need to pay in full at the time of service. You not the provider are responsible for submitting out-of-network claims to Anthem. 8 Your UC PPO Medical Plans

11 SAVE MONEY WITH A FLEXIBLE SPENDING ACCOUNT (FSA) Not all health care expenses are covered by your medical, dental and vision plans. With the Health Care FSA, you can save money all year on your out-of-pocket medical expenses because your contributions to your account are tax-free and so are your reimbursements. Just be sure to choose your contribution level carefully. Any money over $500 left in your account at the end of each year is forfeited. Learn more about the FSA at UCnet > Compensation & Benefits > Other Benefits > Flexible Spending Accounts. Note: The Health FSA is not available if you enroll in the HSP. TAKE A CLOSER LOOK: Go to ucppoplans.com Why UC Care Works for Me Last year I switched to UC Care. Both my wife and I have ongoing health conditions and see the doctor pretty frequently. An asthma attack put me in the hospital for a few days, too. I live near a UC medical center and my regular doctor is part of UC Select, so my out-of-pocket costs are relatively low and predictable. That s important to me because I can t afford to meet a high deductible. I d rather pay more out of my paycheck in exchange for paying less when I get care. Your UC PPO Medical Plans 9

12 CORE A high-deductible health plan that lets you see any provider you want in- or out-of-network. Generally, the plan pays the same amount toward services no matter where you receive care. However, you can lower your costs by seeing Anthem doctors. PLAN HIGHLIGHTS The plan covers preventive care at 100%, with no out-of-pocket costs to you. There s no monthly premium for coverage, but out-of-pocket costs are higher when you receive care. Each covered family member has a calendar-year deductible that must be met before the plan begins to share in the cost of covered services, including prescription drugs. Once the annual deductible is met, the plan pays 80% of the cost of most covered services, including prescription drugs, and you pay. An out-of-pocket maximum limits your financial liability for covered expenses. After you meet this amount, you ll get 100% coverage for most covered services, including prescription drugs, for the remainder of the year. You can lower your out-of-pocket costs by seeing Anthem PPO providers. You re not responsible for any costs over the amount allowed by Anthem. CHOOSE TO SAVE WITH A FLEXIBLE SPENDING ACCOUNT (FSA) Even if your health care needs are low, most people have at least some out-of-pocket medical expenses, like when you see a doctor or have to get a prescription filled. Even if you only spend a few hundred bucks a year, you can still save money and come out ahead on your everyday health care expenses by enrolling in an FSA because the money you contribute comes out of your check before taxes are calculated. So you ll generally lower your taxable income. Learn more about the FSA at UCnet > Compensation & Benefits > Other Benefits > Flexible Spending Accounts. Note: The Health FSA is not available if you enroll in the Health Savings Plan. Why CORE Works for Me Right now I ve got other financial priorities, so I m watching every dollar closely including what I pay for health care coverage. Fortunately, I m in good health and rarely go to the doctor, except for annual checkups. I take a prescription allergy medication, but it s generic and doesn t cost much. Right now, the CORE plan works for me and my budget. I know there s the risk that I could get sick or injured and have a lot of medical bills, but I could come up with the $6,350 out-of-pocket maximum if I had to. TAKE A CLOSER LOOK: Go to ucppoplans.com 10 Your UC PPO Medical Plans

13 What s the Difference Between the Plans? While all the plans cover services such as preventive care, doctors office visits, hospitalization and prescription drugs, there are important differences between them both in what you pay for coverage (the premium that comes out of your paycheck) and what you pay when you get care (your out-of-pocket costs). In general, plans that offer low premiums have higher out-of-pocket costs when you get care. That s because these plans typically have higher deductibles and coinsurance. Plans with higher premiums usually have lower out-of-pocket costs. For a more personalized comparison of costs, go to comparemyhsa.com/uc. UC Health Savings Plan UC Care CORE Premiums The amount that comes out of your paycheck for coverage. Higher premium than CORE, but lower than UC Care. Highest premium of the PPO plans. UC pays 100% of the premium. Health Savings Account Contribution Money from UC that you can use to pay health care expenses and save for the future. $500 (individual coverage)/ $1,000 (family coverage) Not available Not available Deductible The amount you pay for medical, behavioral health and prescriptions before the plan begins to share in the cost for covered services. In-network $1,350 (individual coverage)/ $2,700 (family coverage) Out-of-network 3 $2,550 (individual coverage)/ $5,100 (family coverage) For family coverage, the full family deductible must be met before the plan pays benefits for any family member. In-network 1 UC Select 2 None Anthem Preferred $250 (individual coverage)/ $750 (family coverage) 3 Out-of-network 3 $500 (individual coverage)/ $1,500 (family coverage) 3 In-network and out-ofnetwork deductibles are separate what you pay toward one doesn t count toward the other. In- and out-of-network 3 $3,000 per covered person Each covered person must meet the deductible before the plan pays benefits for that person. Out-of-Pocket Maximum The most you ll pay for covered medical or behavioral health services, including prescription drugs, in a calendar year. In-network $4,000 (individual coverage)/ $6,400 (family coverage); includes deductible Out-of-network 3 $8,000 (individual coverage)/ $16,000 (family coverage); includes deductible For family coverage, the family out-of-pocket maximum must be met before the plan pays 100% of covered expenses. In-network UC Select 2 $5,100 (individual coverage)/ $8,700 (family coverage) 4 Anthem Preferred $6,600 (individual coverage)/ $13,200 (family coverage) 4 Out-of-network 3 $8,600 (individual coverage)/ $19,200 (family coverage) 4 In-network and out-ofnetwork maximums are separate what you pay toward one doesn t count toward the other. In- and out-of-network 3 $6,350 (individual coverage/ $12,700 (family coverage) Your UC PPO Medical Plans 11

14 WHAT YOU PAY FOR CARE UC Health Savings Plan UC Care CORE Preventive care 5 In-network $0, no deductible Out-of-network 3 40% after deductible In-network UC Select 2 No copayment Anthem Preferred $0, no deductible Out-of-network 3 after deductible In-network $0, no deductible Out-of-network 3 after deductible Doctor and specialist visits In-network after deductible Out-of-network 3 40% after deductible In-network UC Select 2 $20 copayment Anthem Preferred after deductible Out-of-network 3 after deductible In- and out-of-network 3 after deductible Hospitalization In-network after deductible Out-of-network 3 40% after deductible In-network UC Select 2 $250 per admission Anthem Preferred after deductible Out-of-network 3 after deductible In- and out-of-network 3 after deductible WHAT YOU PAY FOR PRESCRIPTION DRUGS Prescription Drugs In-network Retail: You pay the full cost of prescriptions until you reach the plan deductible. After that, you pay for most covered drugs. The mail service offers convenient refills delivered by mail to your home. Out-of-network You pay the full cost of prescriptions until you reach the plan deductible. After that, you pay 40% for most covered drugs. In-network Retail: You pay $5 for Tier 1 (typically generic) drugs; $25 for Tier 2 (typically preferred/brand name) drugs; $40 for Tier 3 (typically non-preferred and some specialty) drugs, and 30% (up to $150 maximum) for Tier 4 specialty drugs. You can save by using the mail service or an Anthem Retail90 pharmacy. You can get a 90-day supply for three copayments. Out-of-network You pay of the cost. In- and out-of-network Retail: You pay the full cost of prescriptions until you reach the plan deductible. After that, you pay for most covered drugs. 1. In-network and out-of-network calendar-year deductibles are separate what you pay toward one doesn t count toward the other. The Anthem Preferred deductible does apply toward the in-network out-of-pocket copayment maximum. The out-of-network deductible applies toward the out-of-network out-of-pocket copayment maximum. 2. Some services are not available in UC Select, but can be obtained through the Anthem Preferred network. Details can be found in the 2018 UC Care Benefit Booklet available at ucppoplans.com > Resources > Get Help > Plan Documents 3. In addition to any deductible and coinsurance, you are responsible for any billed charge that exceeds Anthem s maximum allowed amount for services provided by an out-of-network provider. For outpatient non-emergency services or surgery in an out-of-network facility, the maximum plan payment amount is $210 per day under HSP, $175 per day under UC Care and $280 per day under CORE. For outpatient surgery in an out-of-network ambulatory surgical center, the maximum plan payment amount is $280 per day under HSP, $175 per day under UC Care and $280 per day under CORE. For inpatient non-emergency services in an out-of-network facility, the maximum plan payment amount is $360 per day under HSP, $300 per day under UC Care and $480 per day under CORE. 4. In-network (Anthem Preferred and UC Select) medical and prescription drug out-of-pocket copayment maximums count toward each other. In-network and out-of-network medical copayment maximums are separate what you pay toward one doesn t count toward the other. Annual out-of-pocket maximums include deductibles, copayments, coinsurance and prescription drug charges. 5. Not all services provided during a preventive care visit are considered preventive health benefits. For more information about what services are covered, go to anthem.com/ca. 12 Your UC PPO Medical Plans

15 Find Your Fit HSP might be a good choice if you: Prefer lower premiums each pay period in exchange for higher out-of-pocket costs when you get care. Have low to moderate health care needs including prescription drugs. Are interested in getting $500 (individual coverage) or $1,000 (family coverage) from UC in a Health Savings Account to help pay your current and future health care costs.* Can afford to pay $850 (individual coverage) or $1,700 (family coverage) out of pocket before the plan begins to pay benefits. UC Care might be a good choice if you: Are willing to pay significantly higher premiums to minimize out-of-pocket costs when you get care. Have considerable health care needs because you (or a covered family member) are managing an ongoing illness and/or take costly prescription medications. Live in California, in an area with enough UC Select providers to take advantage of low copayments when you get care. Live or work outside of the U.S. Want to save money on out-of-pocket expenses by contributing to a Health Care Flexible Spending Account. CORE might be a good choice if you: Want no monthly premiums. Expect to need only minimal health care services beyond preventive care. Don t take any, or take only low-cost ongoing prescription medications. Want to be able to see any provider without penalty or referrals. Are not interested in receiving up to $1,000 from UC in a Health Savings Account to pay current and future health care costs. Want to save money on out-of-pocket expenses by contributing to a Health Care Flexible Spending Account. Can afford to pay $3,000 out-of-pocket before the plan begins to pay benefits. * UC s annual HSA contribution is prorated for new hires based on date of hire. However, the HSP deductible is not prorated. For details, see ucppoplans.com and select UC Health Savings Plan > Health Savings Account. Your UC PPO Medical Plans 13

16 Do the Math Often, the choice of medical plan comes down to the monthly premium. But there s more to what you pay for health care than just what comes out of your paycheck. These simple examples based on premiums for Pay Band 2 ($54,001 $107,000) illustrate that the lowest premium plan might not always result in the lowest cost overall. The right choice for you will depend on a variety of factors, including your health needs. For a more personalized comparison, go to comparemyhsa.com/uc. Example 1 For illustration purposes only. Annual Salary: $54,001 $107,000 Coverage: Self only Health needs: Low to moderate HSP UC Care CORE Annual Premium $671 $1,708 $0 Annual Health Care Expenses: Doctors office visits: Preventive care: 1 $0 $0 $0 Minor illnesses: 2 $80 $160 $20 (UC Select) $40 $80 $160 Urgent care visit: 1 $150 (Anthem Preferred) $30 $150 Prescriptions: 1 ongoing generic medication (mail service, 90-day supply) Total Annual Health Care Expenses 4 $25 $100 4 $10 $40 4 $25 $100 $410 $110 $410 HSA Reimbursement $410 $0 $0 Total Annual Out-of-Pocket Expense (Including premium) HSA Balance to Carryover $500 $410 = $90 $671 $1,818 $ Your UC PPO Medical Plans

17 Example 2 For illustration purposes only. Annual Salary: $54,001-$107,000 Coverage: Family Health needs: High HSP UC Care CORE* Annual Premium $2,045 $5,748 $0 Annual Health Care Expenses: Doctors office visits: Preventive care: 1 $0 $0 $0 Chronic illnesses: 10 (based on $150 allowed amount) ER visit: 1 (based on $1,900 allowed amount) Inpatient hospital stay (based on a 3-day, $25,000 allowed amount) Physical Therapy: 10 (based on $75 allowed amount) Prescriptions: 5 ongoing formulary generic medications (mail service, 90-day supply) Total Annual Health Care Expenses $150 $1,500 $20 (UC Select) $200 $150 $1,500 $1,200+ coinsurance on remaining $700 because annual deductible is met coinsurance $5,000 UC Select copayment $75 each x coinsurance $25 each x 4 fills x 5 prescriptions x coinsurance Total of $8,090 exceeds $6,400 out-of-pocket maximum $1,340 $200 $1,900 $250 $1,500+ coinsurance of remaining $23,500 because annual deductible for only individual has been met $150 $20 (UC Select) $200 $75 each x coinsurance $100 $10 each x 4 annual fills x 5 prescriptions $200 $25 each x 4 fills x 5 prescriptions x coinsurance $6,200 $150 $100 $6,400 $1,050 $9,850 HSA Reimbursement $1,000 $0 $0 Total Annual Out-of-Pocket Expense (Including premium) $7,445 $6,798 $9,850 HSA Balance to Carryover $0 $0 $0 *Example based on costs for two individuals. Each individual covered by CORE must meet a $3,000 deductible before the plan pays benefits. Consider This HSP: When you consider the lower premiums, plus UC s contribution to your Health Savings Account which pays for your initial health care expenses this could be the most cost-effective choice. Plus, if you make your own tax-deductible contributions to your Health Savings Account, you get an added tax break today, and you ll pay no taxes on the money in your account as long as it s used for eligible health care expenses. And the HSA is another tax-advantaged way to save for retirement. UC Care: If you have significant health care needs, the higher premium in exchange for lower out-of-pocket costs might be the most cost-effective choice when you seek care from UC Select providers. Your share of costs may be higher when you seek care from Anthem Preferred providers. CORE: It s hard to say no to zero premiums, but this plan might not be the right choice for you if you have high health care needs because it will take you longer to meet your deductible and out-of-pocket maximum. Consider the HSP. UC contributes to an HSA, which could cover some or even all of your out-of-pocket health care costs. And any HSA funds you don t use for health care are yours to keep, always. Your UC PPO Medical Plans 15

18 Find a Doctor The UC PPO plans give you the flexibility to choose in-network doctors and other providers. You can also see out-of-network doctors and other providers, but you ll always pay less when you get in-network care.» Current UC PPO members: Get help from Castlight. Log in to anthem.com/ca and click Find a Doctor, Hospital or Urgent Care (under Resources & Tools).» Prospective PPO members: Go to anthem.com/ca/uc and click on Find a Doctor, Hospital or Urgent Care (under Resources & Tools). Choose the plan you are interested in and enter the type of provider you re looking for, such as family practice, internal medicine, dermatologist or behavioral health. Enter your location and the distance you re willing to travel and click Search. You can also call Anthem Health Guide toll-free at (844) , Monday through Friday, 5:00 a.m. to 8:00 p.m. (Pacific). 16 Your UC PPO Medical Plans

19 Contacts For information about the UC PPO plans, start at ucppoplans.com. Contact any of the resources below for more details. Anthem Register with Anthem to: Check medical and pharmacy claim status Find a doctor, hospital or pharmacy Get mail-order pharmacy fills and refills, view drug pricing and the drug list Access LiveHealth Online to see a doctor from your computer or mobile device 24/7 Access LiveHealth Online Psychology to schedule an online or telephone therapy appointment Log in to anthem.com/ca Anthem Health Guide Personalized support to: Find providers Initiate prior authorization requests for medical services Request referrals (when needed) Understand out-of-pocket costs, such as copayments and coinsurance Check on the status of a claim and explain how a claim was processed Answer questions about the UC PPO plans ConditionCare: Manage the symptoms of asthma, diabetes, COPD, heart failure and coronary artery disease ComplexCare: Support for major orthopedic, heart, nerve or cancerrelated health issues Future Moms: Nurse coaching for a successful pregnancy and delivery Toll-free (844) , Monday through Friday, 5:00 a.m. to 8:00 p.m. (Pacific) Anthem 24/7 Nurse Line Instant access to registered nurses who can help with medical issues (800) available 24/7 Anthem Behavioral Health Resource Center No-cost help for depression, substance misuse and more. (844) available 24/7 Castlight Find providers Access cost comparison tools Review past expenses See patient ratings and reviews anthem.com/ca > Member Log In > Find a Doctor, Hospital or Urgent Care (under Resources & Tools) HealthEquity Learn about the Health Savings Account and manage your account. learn.healthequity.com/uc/hsa/ (866) LiveHealth Online See a board-certified doctor 24/7 by video chat. anthem.com/ca > Member Log In > LiveHealth Online (855) LiveHealth Online Psychology Private visit with a psychologist or therapist by phone or video. anthem.com/ca/uc > Member Log In > LiveHealth Online > LiveHealth Online Psychology (844) :00 a.m. to 11:00 p.m. (in any time zone) Mobile Health Consumer Access health plan data with programs, resources and personalized content specific to your health. Download from Google Play or the App Store mystrength Online and mobile applications for depression, anxiety and substance misuse. anthem.com/ca > Member Log In > Find a Doctor, Hospital or Urgent Care (under Resources & Tools) > mystrength (under Browse for Care) Solera Sixteen-week diabetes prevention program to help you lose weight, adopt healthy habits and reduce your risk of developing type 2 diabetes. solera4me.com/uc UC Health Care Facilitators Get help with: Understanding your coverage and patient rights Defining your health care issues Navigating the health care system Resolving issues with your doctor, medical group or Anthem Understanding how Medicare benefits coordinate with UC-sponsored medical plans Health Care Facilitators by campus ucnet.universityofcalifornia.edu/ contacts/health-care-facilitators.html Welvie Surgery decision support anthem.com/ca > Member Log In > Welvie Are You Considering Surgery Toll-free (888) (TTY: 711), Monday through Friday, 8:00 a.m. to 7:00 p.m. (Eastern) Anthem s SpecialOffers anthem.com/ca > Member Log In > Health & Wellness > SpecialOffers Your UC PPO Medical Plans 17

20 Effective: January 1, 2018 UC Health Savings Plan (HSP) Your Network: Anthem Prudent Buyer PPO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does not reflect each and every benefit, exclusion and limitation which may apply to the coverage. For more details, important limitations and exclusions, please review the formal UC Health Savings Plan benefit Booklet. If there is a difference between this summary and the UC Health Savings Plan benefit Booklet, the UC Health Savings Plan benefit Booklet, will prevail. Calendar Year Medical Deductible (See notes section to understand how your deductible works. Innetwork deductible accumulates towards Out-of-Network deductible. Out-of-Network deductible does not accumulate towards In network deductible. The family deductible is nonembedded meaning the cost shares of all family members apply to one shared family deductible. The individual deductible only apply to individuals enrolled under single coverage.) Calendar Year Out-of-Pocket-Limit (When you meet your out-of-pocket limit, you will no longer have to pay cost-shares during the remainder of your benefit period. Pharmacy copays apply to your Out-of-Pocket maximum. In network out of pocket accumulates towards Out-of-Network out of pocket. Out-of-Network out of pocket does not accumulate towards In network out of pocket. The family out-of-pocket maximum is nonembedded meaning the cost shares of all family members apply to one shared family out-of-pocket maximum. The individual out-ofpocket maximum only apply to individuals enrolled under single coverage. See notes section for additional information regarding Anthem Prudent Buyer Out-of-Network Provider Provider $1,350 Individual / $2,550 Individual / $5,100 $2,700 Family Family $4,000 Individual $6,400 Family / $8,000 Individual / $16,000 Family your out of pocket maximum.) Benefit Lifetime Maximum Unlimited Unlimited COVERED MEDICAL BENEFITS Doctor Home and Office Services Preventive care/screening/immunization No Charge 40% Primary care visit to treat an injury or illness 40% Specialist care visit 40% 40% Prenatal and Post-natal Care 40% Other practitioner visits: Retail health clinic 40% On-line Visit LiveHealth Online N/A ( Chiropractor services 40% (Coverage for Anthem Prudent Buyer Providers and Out-of- Network-Providers are limited to 24 visits per calendar year. Combined with acupuncture.) Acupuncture 40% (Coverage for Anthem Prudent Buyer Providers and Out-of- Network-Providers are limited to 24 visits per calendar year. Combined with chiropractor services.) Other services in an office: Allergy testing and treatment 40% Allergy serum purchased separately for treatment (billed 40% separately from office visit) Chemo/radiation therapy 40% Hemodialysis 40% Office based injectable 40% (For the drugs itself dispensed in the office thru infusion/injection.) 18 Your UC PPO Medical Plans

21 Diagnostic Services Lab: Office 40% Freestanding Lab 40% Outpatient Hospital 40% (Out-of-Network Providers are subject to a maximum payment of $210 per visit.) X-ray: Office 40% Freestanding Lab Outpatient Hospital 40% (Out-of-Network Providers are subject to a maximum payment of 40% $210 per visit.) Advanced diagnostic imaging (for example, MRI/PET/CAT scans): Office 40% Freestanding Lab 40% Outpatient Hospital 40% (Out-of-Network Providers are subject to a maximum payment of $210 per visit.) Emergency and Urgent Care Emergency room facility services (This is for the hospital/facility charge only. The ER physician charge may be separate.) Emergency room doctor and other services Ambulance (air and ground) Urgent Care (office setting) 40% Outpatient/Inpatient Mental/Behavioral Health and Substance Abuse Doctor office visit 40% Facility visit: Facility fees 40% Outpatient Surgery Facility fees: Hospital 40% (Out-of-Network Providers are subject to a maximum payment of $210 per visit). Freestanding Surgical Center 40% (Out-of-Network Providers are subject to a maximum payment of $210 per visit). Doctor and other services 40% Hospital Stay (all inpatient stays including maternity, mental/ behavioral health, and substance abuse) Facility fees (for example, room & board) 40% (Out-of-Network Providers are subject to a maximum payment of $36 0 per day. If no pre-authorization is obtained for out of network providers, there will be an additional $250 copay). Bariatric surgery Not Covered (Prior authorization required, medically necessary surgery for weight loss, for morbid obesity only) Doctor and other services Recovery & Rehabilitation Home health care (Coverage is limited to 100 visit limit per Calendar Year. (If preauthorized, Out-of-Network may be paid at the Anthem Prudent Buyer PPO coinsurance level.) Not Covered Your UC PPO Medical Plans 19

22 Rehabilitation services (for example, physical/speech/occupational therapy): Office (Costs may vary by site of service.) 40% Outpatient hospital 40% (Out-of-Network Providers are subject to a maximum payment of $210 per visit.) Habitation services 40% Speech therapy Cardiac rehabilitation Office (Costs may vary by site of service.) 40% Outpatient hospital 40% (Out-of-Network Providers are subject to a maximum payment of $210 per visit.) Skilled nursing care (in a facility) (Coverage for Anthem Prudent Buyer PPO Provider and Out-of- Network Provider combined is limited to 100 day limit per Calendar Year. Additional $250 copay for Out-of-Network providers if prior authorization is not obtained.) Hospital 40% Freestanding Skilled Nursing Facility (SNF) 40% Hospice Not covered (If pre-authorized, Out-of-Network may be paid at the Anthem Prudent Buyer PPO coinsurance level.) Durable Medical Equipment 40% Prosthetic Devices 40% Hearing Aids (limited to $2,000 per 36 months) Diabetes Care Benefits: Devices, equipment and supplies Diabetes self-management training office location 40% 40% Family Planning Counseling and consulting No Charge 40% (includes insertion of IUD, as well as injectable and implantable contraceptives for women) Tubal ligation No Charge 40% (An additional facility copayment may apply when services are rendered in a hospital) Vasectomy (An additional facility copayment may apply when services are 40% rendered in a hospital) Travel Immunizations ACA Travel immunizations Non-ACA Travel immunizations: Japanese Encephalitis, Rabies, Typhoid, and Yellow Fever Care Outside of Plan Service Area Within US: Blue Cross Blue Shield Global Global Core Outside of US: Blue Cross Blue Shield Global Core No charge 40% 40% All covered services provided through a BlueCard Program, for out-of-state emergency and nonemergency care, are provided at the Anthem Blue Cross Prudent Buyer level of the local Blue Plan allowable amount when you use an Anthem Blue Cross provider. All covered services for emergency care will be eligible for reimbursement when received outside the US. Please refer to the Anthem Blue Cross Prudent Buyer Tier for covered services and corresponding member liability. 20 Your UC PPO Medical Plans

23 Notes: All medical services subject to a coinsurance are also subject to the annual medical deductible. Annual Out-of-Pocket Maximums includes deductible, coinsurance and prescription drug. In network deductible and out of pocket maximum accumulate towards out of network deductible and out of pocket maximums. However, out of network deductible and out of pocket maximum do not accumulate towards In-network. Preventive Care Services includes physical exam, preventive screenings (including screenings for cancer, HPV, diabetes, cholesterol, blood pressure, hearing and vision, immunization, health education, intervention services, HIV testing) and additional preventive care for women provided for in the guidance supported by Health Resources and Service Administration. If your plan includes out of network benefit and you use an Out-of-Network provider, you are responsible for any difference between the covered expense and the actual Out-of-Network providers charge. Certain services are subject to the utilization review program. Before scheduling services, the member must make sure utilization review is obtained. If utilization review is not obtained, benefits may be reduced or not paid, according to the plan. If your plan includes out of network benefits, all services with calendar/plan year limits are combined both in and out of network. Transplants covered only when performed at Centers of Medical Excellence or Blue Distinction Centers. Bariatric Surgery covered only when performed at Blue Distinction Center for Specialty Care for Bariatric Surgery. Skilled Nursing Facility day limit does not apply to mental health and substance abuse. Freestanding Lab and Radiology Center is defined as services received in a non-hospital based facility. Coordination of Benefits: The benefits of this plan may be reduced if the member has any other group health or dental coverage so that the services received from all group coverage do not exceed 100% of the covered expense. The maximum allowed charges for non-emergency surgery and services performed in an Out-of-Network Ambulatory Surgical Center or outpatient unit of an Out-of-Network hospital is subject to a maximum payment of $210. Members are responsible for the additional charges not covered by the maximum payment of $210 Your UC PPO Medical Plans 21

24 Effective: January 1, 2018 Your Plan: UC Health Savings Plan Prescription Drug Coverage This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does not reflect each and every benefit, exclusion and limitation which may apply to the coverage. For more details, important limitations and exclusions, please review the formal Summary Plan Description (SPD). If there is a difference between this summary and the SPD, the SPD will prevail. COVERED PRESCRIPTION DRUG BENEFITS Calendar Year Drug Deductible (The family deductible is non-embedded meaning the cost shares of all family members apply to one shared family deductible. The individual deductible only applies to individuals enrolled under single coverage.) Calendar Year Out-of-Pocket Maximum (The family out-of-pocket maximum is non-embedded meaning the cost shares of all family members apply to one shared family out-of-pocket maximum. The individual out-of-pocket maximum only applies to individuals enrolled under single coverage. The deductible is included in the out-ofpocket maximum for the plan.) Prescription Drug Coverage This plan uses the National 4-Tier Drug List. Drugs not on the list are not covered. Please refer to the drug list at to determine which Tier(s) apply to your prescription(s). Retail Pharmacy Prescriptions (up to a 30-day supply) Contraceptive Drugs and Devices (Up to a 12 month supply of contraceptive drugs when dispensed or MEMBER COPAYMENT Cost if you use an In-Network Pharmacy $1,350 Individual / $2,700 Family (Combined with medical deductible) $4,000 Individual / $6,400 Family (Combined with medical out of pocket) Cost if you use an In-Network Pharmacy Cost if you use a Non-Network Pharmacy $2,550 Individual / $5,100 Family (Combined with medical deductible) $8,000 Individual / $16,000 Family (Combined with medical out of pocket) Cost if you use a Non-Network Pharmacy $0 copay $0 copay furnished at one time.) Preferred Generic Drugs 40% Preferred Brand Name Drugs 40% Non- Preferred Brand Name Drugs 40% UC Pharmacies, Specified Pharmacies and Home Delivery Program (up to a 90-day supply) Contraceptive Drugs and Devices $0 copay $0 copay (Up to a 12 month supply of contraceptive drugs when dispensed or furnished at one time.) Preferred Generic Drugs N/A Preferred Brand Name Drugs N/A Non- Preferred Brand Name Drugs N/A Specialty Pharmacy and Select UC Pharmacies (up to a 30-day supply) (Classified specialty drugs must be obtained through our Specialty Pharmacy Program or select UC Pharmacies and are subject to the terms of the program. Covers up to a 30 day supply. N/A There is a $200 maximum per prescription for Oral Anti-Cancer medications 22 Your UC PPO Medical Plans