New 2014 Medical Plan Changes

Transcription

1 New 2014 Medical Plan Changes Mary Johnson Health Care Facilitator Veronica Luna Sr. Program Analyst

2 Why the change? Better Value Health care reform and a changing medical-insurance marketplace provided a good opportunity to rethink our benefits while still maintaining choice and quality Leverage UC s outstanding medical centers and doctors Avoid annual double-digit increases UC will continue to cover an average of over 85 percent of the cost of premiums New plans will generally have lower monthly premiums than Anthem Blue Cross PPO, Anthem Blue Cross PLUS, and Health Net HMO A network of high-quality providers 97% of Blue Cross providers are also included in the Blue Shield network 1

3 Summary of UCR Employees Directly Impacted* Total Eligible # Impacted % Impacted Campus Total % Total Academics % Total Staff % *Impacted employees include those currently enrolled in any Blue Cross plan or the Health Net Full Network plan. 2

4 2014 Options A revamped menu of six plans for 2014 Four plans will be discontinued Anthem Blue Cross: PPO, PLUS, and Lumenos w/hra Health Net Full Network HMO Two NEW plans will be offered Blue Shield Health Savings Plan features a UC-funded health savings account (HSA) and a self-funded option (handout available) UC Care UC s own PPO plan that offers members access to UC medical centers/doctors and hospitals and additional providers (handout available) Kaiser, Health Net Blue and Gold (HMO), Core & the FSA will continue to be offered 3

5 Which of the NEW plans is most like the one I have now? 2014 Plan is most like 2013 Plan UC Care Blue Shield Health Savings Plan w/ HSA Health Net Blue & Gold HMO Anthem Blue Cross PLUS/PPO Anthem Lumenos PPO with HRA Health Net HMO All UC plans should be reviewed to ensure the most informed decision is made (i.e., those with HRA balances may want to choose to elect Blue Shield Health [HSA] to prevent HRA balance forfeiture) 4

6 UC Care In-Network UC Select Includes all UC medical centers, facilities and physicians. Additional Select Blue Shield providers in areas where UC medical centers and physicians may not be accessible. Chosen based on quality, location, cost, and contracts. Member pays set copayments. No deductible. Blue Shield Preferred Includes more than 65,000 providers in the statewide Blue Shield Preferred network. Blue Shield PPO Network 376 hospitals 22,061 primary care physicians 50,197 specialists Member pays a deductible and share of set costs for covered services through coinsurance. 5

7 UC Care Summary of Benefits UC Select IN-NETWORK Blue Shield Preferred OUT-OF-NETWORK Annual deductible None $250 individual/ $750 family $500 individual/ $1,500 family Annual Out-of-pocket maximum $1,500 individual/ $4,500 family $3,000 individual/ $9,000 family $5,000 individual/ $15,000 family MEMBER COPAYMENT/COINSURANCE Physician office visit $20 per visit 20% 50% Specialist office visit $20 per visit 20% 50% Preventative health benefits No charge No charge (not subject to annual deductible) 50% Pregnancy & maternity benefits $20 per visit (initial visit only) 20% 50% Outpatient x-ray, pathology, and laboratory $20 per visit 20% 50% Outpatient surgery (performed at an Ambulatory Surgery Center) n/a covered under Blue Shield Preferred 20% 50% Hospital care (outpatient surgery in hospital) $100 per surgery 20% 50% Hospital care (inpatient nonemergency facility services) $250 per admission 20% 50% Emergency room services (not resulting in admission) $100 per visit $100 per visit $100 per visit 6

8 Blue Shield Health Savings Plan HSA Benefit In-Network Out-of-Network Medical Plan Coverage *In-network preventive care covered at 100% HSA Funding Deductible* Single Family Out-of-Pocket Max Single Family Member Cost Sharing (i.e., coinsurance after deductible is met) $1,250 $2,500 $4,000 $6,400 $2,500 $5,000 $8,000 $16,000 20% 40% Contribution Types Single Family UC Contribution $500 $1,000 Employee Pre-Tax (optional) up to $2,800 up to $5,550 7

9 Health Savings Account (HSA) Details Health Savings Plan Post Deductible Health Reimbursement Account (PDHRA) Stand alone Health Reimbursement Account (SAHRA) A medical plan similar to your prior HRA where the plan is designed with predictable deductibles that apply to the out-of-pocket maximum and is now powered by a Health Saving Account (HSA) An account employees can use to manage their prior HRA dollars. Employees can access PDHRA dollars after they meet their Health Savings Plan medical deductible An account employees can use to manage prior PDHRA dollars after they move into an early retiree or retiree status and when enrolled in a UC sponsored Medicare Supplemental or Exchange medical plan. Please Note: You will not be able to enroll in the Health Care Flexible Spending Account (FSA) if you select the Blue Shield HSA plan 8

10 UC Care Locating Providers To locate in-network providers: Visit and follow the steps to locate in-network providers in both the UC Select and Blue Shield Preferred plans. Or call your dedicated Blue Shield Member Services team toll-free at (855) , from 7 a.m. to 7 p.m. PT, Monday through Friday. 9

11 Step 1. Go to: Read instructions Click on search link provided 10

12 Step 2. Click on Change selection under your plans to select between the UC Select and Blue Shield Preferred network options. 11

13 Step 3. Click on the button next to the desired network UC Select or Blue Shield Preferred Click done 12

14 Step 4. Input search criteria (e.g., search for urgent care centers near a city, state, county, or zip code) Click find now Input criteria 13

15 Step 5. Review results Use results filter if needed Comparison option available Can get results as a PDF for offline review Can view results on a map Can edit location if needed 14

16 Health Net Health Net Full Network will no longer be available. Health Net Blue and Gold will continue and provides the same benefits as the Health Net Full Network, but with a limited choice of providers (handout available) that deliver the best value. Visit the Health Net website for a list of participating physician groups. 15

17 Flexible Spending Accounts Health FSA Enroll or re-enroll during Open Enrollment Annual limit: $2500 Not eligible for FSA if enrolling in the Blue Shield HSA DepCare FSA Enroll or re-enroll during Open Enrollment Annual limit: $5000 ($2500 if married and filing separate) 16

18 2014 Employee Medical Plan Rates $51,000 and under PLAN Self Self + Child(ren) Self + Adult Family $51,001 $101,000 PLAN Self Self +Child(ren) Self + Adult Family Blue Shield Health Savings Plan EE: $9.67 UC: $ EE: $17.41 UC: $ EE: $21.19 UC: $1, EE: $28.92 UC: $1, Blue Shield Health Savings Plan EE: $45.72 UC: $ EE: $82.30 UC: $ EE: $ UC: $ EE: $ UC: $1, Health Net Blue & Gold EE: $29.49 UC: $ EE: $51.17 UC: $1, EE: $ UC: $1, EE: $ UC: $1, Health Net Blue & Gold EE: $65.54 UC: $ EE: $ UC: $ EE: $ UC: $1, EE: $ UC: $1, Kaiser Permanente EE: $11.78 UC: $ EE: $21.20 UC: $ EE: $25.80 UC: $1, EE: $35.21 UC: $1, Kaiser Permanente EE: $47.83 UC: $ EE: $86.09 UC: $ EE: $ UC: $1, EE: $ UC: $1, UC Care EE: $71.96 UC: $ EE: $ UC: $1, EE: $ UC: $1, EE: $ UC: $1, UC Care EE: $ UC: $ EE: $ UC: $ EE: $ UC: $1, EE: $ UC: $1, Western Health Advantage EE: $11.78 UC: $ EE: $21.20 UC: $ EE: $25.80 UC: $1, EE: $35.21 UC: $1, Western Health Advantage EE: $47.83 UC: $ EE: $86.09 UC: $ EE: $ UC: $1, EE: $ UC: $1, Core UC: $ UC: $ UC: $ UC: $ Core UC: $ UC: $ UC: $ UC: $ $101,001 $151,000 PLAN Blue Shield Health Savings Plan Health Net Blue & Gold Kaiser Permanente UC Care Western Health Advantage Core Self EE: $82.72 UC: $ EE: $ UC: $ EE: $84.83 UC: $ EE: $ UC: $ EE: $84.83 UC: $ UC: $ Self + Child(ren) EE: $ UC: $ EE: $ UC: $ EE: $ UC: $ EE: $ UC: $ EE: $ UC: $ UC: $ Self + Adult EE: $ UC: $ EE: $ UC: $1, EE: $ UC: $ EE: $ UC: $1, EE: $ UC: $1, UC: $ Family EE: $ UC: $1, EE: $ UC: $1, EE: $ UC: $1, EE: $ UC: $1, EE: $ UC: $1, UC: $ $151,001 and above PLAN Blue Shield Health Savings Plan Health Net Blue & Gold Kaiser Permanente UC Care Western Health Advantage Core Self EE: $ UC: $ EE: $ UC: $ EE: $ UC: $ EE: $ UC: $ EE: $ UC: $ UC: $ Self + Child(ren) EE: $ UC: $ EE: $ UC: $ EE: $ UC: $ EE: $ UC: $ EE: $ UC: $ UC: $ Self + Adult EE: $ UC: $ EE: $ UC: $ EE: $ UC: $ EE: $ UC: $ EE: $ UC: $ UC: $ Family EE: $ UC: $1, EE: $ UC: $1, EE: $ UC: $1, EE: $ UC: $1, EE: $ UC: $1, UC: $ EE = Employee Contribution UC = UC Contribution Rates for union-represented employees are subject to ongoing collective bargaining as appropriate. 17

19 Key Websites UCnet Medical Plans: UC Care: Blue Shield Health Savings Plan: d=otc-cal-uc