UCLA Open Enrollment Slides for Retiree Health, Nov. 14, 2014

t3./3/2OL4

Open Enrollment 20L5 UCLA Retiree Health Benefits Overview J. Bridget Sheehan-Watanabe UCLA Health Care Facilitator Nov.2014

Open rnroliment Agenda

2OfS

) Open Enrollment: when, how, who to call.

) Medical Plans Options, Summary of Changes, Non-Medicare Plans, Medicare Plans.

F Behavioral Health for all plan members. )Other Plans (briefly): Optum Wellness, Dental Vision, Legal

) Retirees outside of CA with Medicare.

l

1.1./3/201.4

Open Enrollment 2015 - When & How > UC Open Enrollment* Begins Oct. 30 at 8 am > UC Open Enrollment Ends Nov. 25 at 5 pm F Changes effective Jan. L,2OLS F Changes made online: http: 'cnet.universitvofcalifornia.edu

,&

r

,.*,.

....,

e b6@

F No Internet Access? Call Retirement Administration Service Center (RASC) 1-800-888-8267

. .,,

:

4Medicore's Open Enrollment runs October 15 to December 7. This is not UC,s openenrollment. You mustcomplywith UC'sOEdateswhenyou are making, changes to your UC plans, even if they are plans that work with Medicare,

What Happens lf You Do Nothing?

j

Flf you make no open enrollment

changes, your

plan enrollments will remain the same.

)You should review information about plan options and changes before deciding to do nothing. Your plan may have some benefit deductible and copay/coinsurance chang"r.

Premiums also change each year.

71./3/20t4

2015 Retiree Plan Options Non-Medicare Plans

.

HMOS

.

Health Net Blue & Gold (limited network plan)

'Kaiser

.

r

Western Health Advantage (Sacramento area only)

PPOs

. . .

UC Care PPO

Health Savings PPO with HSA (restricted) Core (high-deductible plan)

Medicare Plans . Medicare Advantage HMOs . Health Net Senioritv Plus

.

.

Kaiser Senior Advantage

PPOs/Supplement (secondary to Medicare) . Blue Shield Medicare PPO . High Option Supplement to Medicare . Blue Shield Medicare PPO without Rx (restricted)

2015 Split Family Partner Plans*^ (Medicare and non-Medicare enrollees in one family)

Health Net Blue & Gold Kaiser

Health Net Seniority Plus Ka

iser Senior Adva ntage

UC Care PPO

Blue Shield Medicare PPO

Core

Blue Shield Medicare PPO

*High Option and Health Savings PPO are not available to "split" families. High Option requires that all members in family have Medicare, Health Savings PPO requires that no one under the coverage have Medicare. ^lf you are in a non-Medicare plan and become Medicare-eligible during the year, you willtransition to the Medicare partner plan (outside of Open Enrollment).

11,/3/2014

YOUR UC Plan Options

) )

Plan availability determined by zip code and Medicare enrollment status.

Your premium costs determined by UCRP entry date and years of service credit.

F Use Medical Plan Chooser to find costs and plans based on your specific information. ) Medical Plan Chooser found linked from open enrollment website, and under Resources here:

http://ucnet.

un

iversi

ion-a nd-

tml 2015 Chooser

from Open Enrollment website (temporary link) https://u c20 L5_.lhoose r2, p beh. o rsl

Highlight of Changes for 2015 D

Non-Medicare Plans

' . . ' . '

Chiropractic and acupuncture expanded under Health Net Blue & Gold and Kaiser

through American Specialty Health Plan Network; 24 visit limit, Health Net and UC Care:90 day Rx with copay savings (90 days for 2x30 retail copay) at select retail pharmacies for maintenance medications, UC Care

F

and ambulance coverage

Out-of-pocket maximums changing (some amounts and what applies).

Health Savings PPO with HSA: in-network deductibles & HSA contribution limits ncreasi

n

g,

OTC nicotine replacement products

with prescription, 0 copay at network pharmacies.

Women's preventive health benefits adding some breast cancer reducing Rx,0 copay.

Medicare Plans

r

HN Seniority Plus expanding coverage of medically necessary foot orthotics; adding Si

.

D

ER

Health Savings PPO, Core: allowing members to obtain some vaccinations at pharmacies, under pharmacy benefits.

i

' '

adding TeleDoc, changing

UC Care,

lverSnea kers.

High Option adding benefits for gender disorder.

Optum Eehavioral Health: new prior auth requirement on non-standard outpatient visits.

Lrl3/2014

Retiree Non-Medicare Plans Sq xrusrn

FERMANENTE.

H.:,S*.n5

{P

Heatrh Net r

Uf,lvErsriV

of

Caltfoar,ta

blue S of colifornio

Non-Medicare HMO vs. PPO HMO

' . .

Restricted provider access (PCP/medical group or Kaiser).

Care starts with PCP; PCP refers to specialists; medical group authorizes most care outside of PCP's office, Fixed costs - most services have flat copays.

' . .

Must live in service area, Only ER and urgent care covered outside of medical group, May have carve-out benefits (behavioral health,

acupuncture, chiropractor),

PPO

I

Access to larger network of doctors. Not assigned to a doctor

or 8roup.

Self-refer to doctors and specialists; no authorization requirement to see doctors.

Health plan must authorize surgery and some services in advance.

Costs vary depending on whether provider is participating with plan

and other factors. Out-of-network providers cost you more.

May have carve-out benefits through separate specialty plan.

t1./3/2014

Retiree Non-Medicore Plan

Health Net Blue & Gold HMO

:...

Health Net Blue & Gold (with Optum Behavioral Health)

' . . . . . .

Includes UCLA Medical Group, and other groups (limited network).

Requires PCP assignment, referrals, medical group authorizations, Pay set copays for medical services and Rx (copays not cha nging).

No out-of-network medical coverage except ER and urgent care.

OOP Max: 51000 individual/S3000 family (medical and Rx copsys apply) New for 2075! Acupuncture and chiropractic coveroge through American Specialty Heolth Plan Network. 24 visit limit. $20 copoY.

Copoy savings on 90-day maintenonce medications at CVS retail pharmacies (plus mailorder and IJC pharmocies),

Retiree Non-Medicore Plan

Kaiser HMO D Kaiser (includes Optum Behavioral Health) . Must use Kaiser providers and facilities (except behavioral health (Optum or Kaiser) and in emergency) . Pay set copays for medical services and Rx (copays not

. .

cha ngi ng)

OOP Max: $1500 individual/S3000 family (medical ond Rx copays apply)

for 2015! Acupuncture and chiropractic coveroge through Americqn Specialty Health Plan Network, 24 visit limit. $lS copay. (Koiser members con olso use Koiser acupuncture, 520 copoy.)

New

1,1./3/2014

At a Glance

Non-Medicore HMOs

ss/$2sls40*

Health Net Blue

& Gold OOP max:

retail

520 57s

S2s0

(1 nn )r"uu

$3000 fam,

))/)z) -

Kaiser S15oo ind. )5UUU TAM.

50% for infertllity S1O/S5O/SB0 and sexual mail order, dYsfunction Rx or uc pharmac

cVS

S10oo ind.

OOP max:

$20 self-injectables

$zo $zs

s2s0

Sroo

reta

Covered under Rx copays.

iI

510/$50 mail order

50% for infertility

and sexuar dysfunction Rx

*Health Net Rx copays are for generic/brand name formulary/non-formulary.

-Kaiser's Rx copays are for generic/brand name.

Reti ree N on -Me d icdre Plan

UC Care PPO UC Care PPO - no PCP or medical group, no referrals or authorizations to see specialists. Blue Shield processes claims.

Select tier includes UC providers and set co-pays tor many services. $20 copays for office visits; 5200-250 ER; 5250 hospital and skilled nursing unit ln ' hospital admission; 51"00 outpatient surgery in hosirital.

Some services not covered on select tier (including stand-alone skilled nursing '

facility, home health, hospice, DME, prosthetics/orthotics, acupuncture, chiropractic, outpatient surgery at freestanding ambulatory surgery center).

Prefered tier includes Blue shield ppo network and worldwide coverage; deductibles and coinsurance apply, up to annual maximums.

Services outside the US covered at the preferred ppO benelit tevel,

Non-preferred providers covered; higher out-ot'-pocket costs.

Set.co-pays for prescriptions, except specialty drugs.90-day Rx copay savings on

maintenance medications at select pharmacies, uc pharmacies, and mailoider.

2015: Expanding care mqnagement progrqms, I,JCLA patient Centered lntegrated Model, focus on coordinated services and qdherence to cqre plans.

Reod summory.grid for more details ol plan coveroge, ond review lull plon coverqge booklet on lJCNet.

Ltl3l2Ot4

None 54,500

Deductibles Out-of-Pocket Maximums

-

Out-of-Pocket Mdximums

-

Physician Office Visits

Fdciilty & Ambulance ER

ER

/

medical Rx

$1,s00 / 53,600

520A-525A^

Outpatient Surgery in Hospital Hospital (non-emergency)

$zso

Not

Acupuncture*

covered Not covered Not covered Not covered Not covered

Prescrlptlons (subject to Rx nlax)

S5/25la0 30.day;

Durable Medlcal Equlpment S/A Skilled Nursing Facility

Home Health

Chlropractlc'

5750 se,000

Not

No OOP max on AON Rx 50o/o

$2A0-S250 h.d.ductrbt 9200-$2gO hod.du.tbre) $200 fldt $200 fldt fee

fee 20% 20%

s0%1

|

zo%

5oo/o2

I

50%L

20o/o 20%l.L00 day limit) 20% (100 visit llmii) 20% 20% Sf0/50/80 90.day; 30% to

S150/each Speclaltv

Behavioral Health

only)

Ss00 / S1,s00 ss,000 / s1s,000

zo%

N/A covered s100

S/A Ambulatory Surgery Center

/

54,200 (network phatmqcy copay

szo

Urgent Care

Physiclonst

/

S2s0 / 53,000

Rx

I

t---

50% 50%2 (L00 days) 50%3 (100 visits) S0% 20% some Rx not covered out of network; somo 50% of fetall

Carved out to Optum

^ S200 ER only; S250 if admitted to hospital. tPlan limit of 24 visits for chiropractic and acupuncture combined.

3rlf preauthorized, coinsurance will be 20% for non-pref. home health.

Plan Pays maximum of: I 50% on S350/day

':50% on S600/day

Reti ree

N o n -Mt e d i cdre

UC Care PPO -

Plan

Additional Notes

Services with non-preferred providers (providers who are not contracted and do not have a fee agreement with the plan) are paid by plan based on allowed amounts (not billed charges).

Members are responsible for coinsurance and any qmounts in excess of ollowed qmounts, Amounts in excess of allowed amounts do not apply to deductibles or

r .

o

ut- of - poc ket m axi m u m s.

Services with day or visit limit accrue to the limit even if the deductible has not been met.

} Reod summary grid for more details of plan coverdge, and review full plan coverage booklet online,

L1,13/20L4

Understunding Balance Billing

PPO Claim Processing Example Example assumesl

I , ,

Annualdeductible met 80% benefit level for PPO providers (20% coinsurance) 50% benefit level for nonPPO providers (50% co nsu ra n cel I

Note: ln addition to different benefit levels for PPO and non-PPO benefits, most plans nave separate deductibles and separate maximum out-of,pockets on PPO and non-PPO benefits,

Amount Billed

$250

Negotiated Rate

$1 00

N/A

Allowed Amount

$1 00

$1

Plan Pays

$80

QAN

Provider Write-off

$1

50

$250 00

NiA

(lnsurance Adjustmont)

Member Coinsurance

ozu

$50

$20

$200

(applied to max OOP)

Member may be billed

Retiree

N

on- M ed icore plan

Health Savings PPO w/HSA Not open for retiree enrollment. only retirees already enrolled can remain in plan until anyone in family becomes Medicare-eligible.

Low premiums, High-deductibles.

PPO benefits after deductible, up to annual out-of-pocket maximums. Reod plan summory grid dnd full plan booklet for details of the coverdge,

Health Savings Account allows both UC and enrollee contributions.

HSA can be used to meet deductible and pay eligible health care expenses.

After age 65, HSA can be used for non-eligible expenses (taxed but no penalty).

Enrollee owns HSA; no use it or lose it rules, and yours if Vou leave UC coverage.

Former Anthem Lumenos members may have pDHRA from Anthem HRA rollover. once Medicare-eligible and move to Medicare plan, any pDHRA funds move to stand Alone HRA (SAHRA) and can be used for Medicare premiums. plan premiums, and qualified medical and Rx expenses, untilfund is exh a usted.

1,1/3/2014

At a Glance

Health Savings PPO w/HSA HSA

Ssoo

Slooo

Up to $2,8s0 (or $3,8s0 if ss+)

Up to 95,650 (or $6,650 of 55+)

contributions

are annual amounts and subject to IRS rules and limits.

*Services with

n-preferred providers are paid bv plan based on ,i " - -"-'" -' ailoweo amounts.

Members are responsible for no

coinsuranceand any amounts

In

:

Preferred Providers

Non-

Preferred

Preferred*

Providers

5 1,300

(? cnn't

20%

40%*

Deductibles Coinsurance-

52,600 20%

No.n-

Preferred* s5,000 * 40%*

Maximum Out-of_ Pocket

s4,000

S8.00O*

excess of allowed amounts. Amounts in excess of allowed amounts do not apply to deductibles or out-of-pocket maximums,

Retiree

No

n-Med

qA

/vr-vv

4nn

(1A nnn* I Lvtvvw

-Review summary grid for details and coinsurance variations.

i co

re plan

Core High-deductible - 53000 individual (applies to max OOp) Lowest premiums Medical, mental health and Rx all subject to deductible and coinsurance.

20/80 PPo after deductible is met for both preferred and no n-preferred providers D Maximum out-of-pocket: 56,350 individual; SI2,7OO family single deductible and max oop applies to services with preferred and non-preferred providers.

)

Y Reod plan summary grid ond full plan booktetfor details of the coveroge.

10

t1,/3l2Or4

Retiree Non-Medicsre Plans

Prescription Drug Coverage* 30-day supply

(network pharmacy/specialty pharmacy): Health Net B&G Kaiser UC Care PPO** s s.00 $ s.oo Generic ss.o0 s2s,00 52s.00 Brand Formulary S25,00

Non-Formulary $40.00 30% to 5150 Specialty 90-day SUpply

N/A

Szo

s2s

(mait-order andselectnetworkphormqcieslormdintenancemedicotions):

UC Care

Generic Brand Formulary Non-Formulary specialty HSA

s40.o0

PPO

$ro.oo $so,oo 580.00 N/A

Health Net

B&G

s10.00 $50.00 580.00 N/A

Kaiser

s10.00 $50.00 N/A N/A

pp1 * rand g.9!9** members: Rx subject to deductible and colnsuronce, up to

OOP mox'

*Generic drugs mandatory on all UC p.lans unless medically necessary and authorized by plan. *xSome odult vaccines covered under pharmacy benefits vrith no copaY (tetanus, pertussis, pneumococcal, meningocaccol, HPV, shingles), Network pharmacies only'

Retiree Non-Medicorâ‚Ź Plans

Rx Coverage Enhancements F

Health Net Blue & Gold

. .

90 dav supplies, copay savings: UC-owned; CVS retail; cVS mailorder.

Rx included: specific medications listed on HN's maintenance drug list.* hnps://www,healthrlet.com/static/general/unprotected/pdfs/calpharmacv/maint drus list 0dft

F

UC Care 90 day supplies, copay savings: UC-owned; participating retail pharmacies (Safeway/Vons, Walgreens, Costco); PrimeMail.

Rx included: Specific medications listed on Blue Shield of California Selected

. '

Maintenance Medication list'*

https://www.blueshieldca.com/bsca/documents/pharmacv/MaintenanceList.Odf

>

*

UC Care, Health Savings PPO, Core . some adult vaccines (tetanus, whooping cough (pertussis) pneurnococcal, ni.ningoio..rl, cerviial cancer (HPV) and shingles (herpes zoster)).covered under pftrir?iy benefits with no copay. Must use network pharmacies for this benefit

!Dtuglists subjecttochange. Collyourplonilyouhovequestionsdboutwhetheryoutdtug isonthemdintenoncedruglist

LT

tr/3/2014

Questions regarding Non-Medicare Medical Plans

(Medicare plans, and Behavioral Health for all plan members still to come.)

Retiree Medicare FQ xnrsrn

Pla ns

PERMANENTE"

UC CARE Vour raac. Your (horcg,

,ie

:,::"::,1 )

:.:,",,,

"

blue S of colifornio

12

rt/3/2014

UC Rules Review

- Retiree plan Members

MUST Enroll in Medicare tf Eltgible

) ) z

l

Enrollment in Medicare parts A & B - Required by uC if erigibre for premium-free part A. start Medicare enroilment process 3 months before 65 birthday (automatic if collecting sociat seiuritv)'.Look for packet *itlllJglrnat,ion and instructions 2% months before 65rh birthday. Corpf utu torm from UC approx. E and rv return to ru rf_1n

RASC.

I F P

'L'[u"'

t.-q_.1

lf Medicare-elieibre b,ut.fairto enroil -yourisk being permanentry de-enroled frdm uc,s A;;;it;i rvrloitir coverage.

Part,D - your UC medical plan coordinates you with part D (do not need to enroil in part D oLtside otyour-uc pran, wiil cause confrict if you do). p^ay lou. la1} B premiums (amount based on.i.ncome) and may pay Part D Medicare Income Rerated rvontrriy Adjustmerlinn.,"r,it - " - -"': (IRMAA), if higher income.

a

Medicare HMO (w/Medicare assigned) Medicare Advantage prescription Drug plan ) Health Net seniority prus (HNSp) and Kaiser senior Advantage ) Medicare PartsA, p-(!nO D)assigned to-- ptan; Medicare willnot work outside of HMO. '

> )

HNSP requires pCp.and. Medical Group assrgnment.

Networks '-available may not be the same as in iion-Meaicare

HMo.

Care starts with pCp; pCp refers to_specia.lists; medicalgroup authorizes most care outside of pCpls oftrce.

Only ER and urgent care covered outside of medicalgroup/plan.

Fixed costs - most services have flat copays, but some differences between non-Medicar" inl ffn'eAicare HMO. Must live in service area. Service areas may be different than non-Medicare HMO servtce areas. lhqnge to carve-out benefits you used under non_Medicare HMO.

13

Lt/3/2OL4

Retiree Medicare Advantogte HMO Plsn

Health Net Seniority Plus )

UCLA Medical Group /imited ond restricted controct with HNSp . Must be enrolled in Health Net AND assigned to UCLA Medical Group dt time of transitioning into HNSP to remain in UCLA Medical Group under HNSp, . Medicare members from other plans connot select UCLA Medical Group under HNSP, even if using UCLA providers under current plan.

Not all medical groups available under Health Net are available under

) > ) )

Cannot use Medicare outside of Medicare Advantage plan.

Requires PCP assignment, referrals, medical group authorizations.

D

Pay set copays

) 't z )

No out-of-network medical coverage except ER and urgent care.

HNSP

HNSp.

not available in all areas where HN B&G is available (e,g. Ventura

for medical services and most

Rx (coinsurance

Co.).

for specialty

Rx).

New in 2075: Expanded coverage of medically necessary orthotics.

SifverSneakersl Sign up at: silversneal<ers.com or call 1-888-423-4632,

Behavioral health though Managed Health Network (see plan booklet).

Retiree Medicare Advantage HMO Plsn

Kaiser Senior Advantage F Must use Kaiser providers and facilities. ) Cannot use Medicare outside of Kaiser (except for emergency care). ) Pay set copays for medical services and Rx (copays not changing). ) Behavioral health only through Kaiser. > All services (doctors, lab, imaging, pharmacy, hospital) under one roof.

L4

1.L/3/201.4

At a Glance; Retiree Medicare Advantage flMO plans

Health Net SenioritV Plus Med Max OOP s1s00

S5/S2s/$40*

retail

5zo

52s0

5100

510/550/580 mail

or

Rx Max OOP s2000

order

92s0

Med Max OOP s1s00

s100

55/525* retail S10/550 order

Rx Max OOP

mail

54

r:r,

25% for Part B drugs up to S25 max

UC

pharmacy

Kaiser Senior Advantage

25% self-injectibles (up to 52000 annual

50% for infertility and sexual dysfunction Rx Specia lty d rugs covered under Rx

copays.

50% for infertility and sexual dysfunction Rx

^)0

tHealth Net Rx copays are for generic/brand name formulary/non-formulary.

-Kaiser's Rx copavs are for generic/brand name.

Medicare PPO & High Option (Plans

that Process Claims as Secondary to Medicare)

Blue Shield Medicare PPO, PPO w/out Rx, and High Option - Secondary to Medicare Fee for Service (similar to a Medicare Supplement)

F

Medicare pays first; PPO/HO pays second, Secondary plan opplies its benefit to the bolonce remaining after Medicore poys.

F

Must use Medicqre providers for services covered by Medicare. Not assigned to a doctor or group. Not restricted to plan's PPO network.

F

Medicare must authorize surgery and some services in advance.

Secondary plan only makes medical necessity decisions if Medicare coverage is exhausted and plan is paying as primary, or if service is not eligible for coverage by Medicare but is eligible for coverage under secondary plan.

F

For services not eligible for coverage by Medicare, best PPO providers (restricted to contracted rates),

F

UC's retiree group plans that work as secondary to Medicare provide benefits beyond Medicare (e.9. hearing aids, acupuncture, outside US,

to use plan's

and more).

F

UC's plans include Part D Rx coverage, Part D assigned

to

UC Rx plan.

15

L1,/3/2014

Medicare PPO/HO

- Medicare providers

Two Types of Medicare providers ) Providers who occeptMedicsre assignment are limited to billine Medicare allowed amounts, must bill Medicare, and are paid directry by Medicare. ) Providers who do not qccept ossignment may charge L5% more (Medicare limiting charge), must fire craims with Medicare, can coilect payment from you at time of service. Medicare reimburses you, Private contract and opt out providers (for services Medicare would cover) > A "private contract" is a contract between a Medicare beneficiarv and a physician or other practitioner who has "opted out" of Medicare, for arl services the provider furnishes to Medicare beneficraries, In a private contract, the Medicore beneficiory qgrees to: give up Medicare payment for services furnished by the physician or practitioner; ond poy the physician or

proctitioner without regard to any limits thot would otherwise appty to whot the physicion or proctitioner could chorge.

)

Nuit,h"r

M"di."r" norjh"

M"di."ru rnd

"nt"r"d

plun *ill puv *h"n u prouid", hu, opt"d ort of r oriuut" .ont..t *ith th" rvl"JGrru b*"fi.i*[

UC

into

Retiree Medicare Plan

Blue Shield Medicare ppO l Can use any Medicare providers for services covered by Medicare, > S100 annual deductible for services not covered by Medicare, ) Plan covers Medicare part A and part B deductibles. ! Medicare pays first; Blue Shield pavs second. > AIl"j Medicare pays, Blue Shield Medicare ppO pays g0% of remainder )>

or tvteotcare allowed amount.

For services not covered by Medicare, best to use Blue shield providers to contain costs. 20% coinsurance for most services not covered by Medicare but covered under UC plan benefits (e.g. acupuncture, hearing aids, counseling with MFT or MFCC).

i

Annual medical maximum out-of-pocket: S1500.

-

lgqqllt-e.lart

D Rx plan with set copays* SrO753675Ot rerail or 520/560/590 mail order/UC pharmacy, up to g+200 annual max oop on Rx copays (generic, brand name formulary and specialty drugs).

f Rx copays are

for generic/brand name formulary and specialty/non_formularv.

l_o

rL/3/201"4

Retiree Medicare Plan

Blue Shield High OPtion Can use any Medicare providers for services covered by Medicare'

$50 annual deductible for services not covered by Medicare' Plan covers Medicare Part A and Part B deductibles.

Medicare pavs first; Blue Shield pays second.

After Medicare pays, Blue shield High option pays 100% of remainder of

Medicare allowed amount' For services not covered by Medicare (e.g. acupunct_ure), best to use Blue shield providers to contain costs. 20% coinsurance for most servlces noI covered by Medicare but covered under UC plan benefits (e.g. acupuncture, hearing aids, counseling with MFT).

.P

Annual medical maximum out-of-pocket: S1050.

New: Benefits for gender disorder - hormone therapy, psychotherapy, surgical service; plan criterla, co-insurance and prior authorization requirernents. seoarate Part D Rx plan, with set copays* 510/$30/545 retail or S)b/Soo/Sgo mail order/UC pharmacy, up to 51000 annual max ooP on iopiyr (generic, brand name formulary and specialty drugs)'

'

Rx

*Rx copavs are for generic/brand name formulary and specialty/non-formulary

Retiree Medicare Plan

Blue Shield Medicare PPO without Rx Requires that retiree and all covered family members have Medicare and be enrolled in a non-uc Medicare-coordinated plan with Rx benefits (verification required)' CANNOT have a non-UC

Medicare Advantage Plan. can use any Medicare providers for services covered by Medicare.

S100 annual deductible for services not covered by Medicare' Plan covers Medicare Part A and Part B deductibles.

Medicare pays first; Blue Shield pays second.

After Medicare pays, Blue Shield Medicare PPO pays 80% of remainder of Medicare allowed amount.

F For services not covered by Medicare, best to use Blue Shield not oroviders to contain costs. 20% coinsurance for most services lovered by Medicare but covered under UC plan bene-fits.(e g' acupuncture, hearing aids, counseling with MFT or MFCC)' P Annual medical maximum out-of-pocket: 51500'

L7

trl3/2oL4

UC Plans and Medicare Coordination of Benefits (COB)

Doctor visit

Picks up balance

of

Medicare allowed amount after Medicare pays Medicare allowable

Applies benefit (80%) to balance remainlng after Medicare pays

lso

$1so

Medicare pays*

$rzo

s120

Plan pays

$so

524

You pay

0

56 (up to $1,500 annual

S

maximum out-of-pocket *Assuming Medicare deductible met, Both High Option and Blue Shield Medicare PPO plans pick up Medicare deductible, ',1.).

.,:t-l

Deductlble (applles to servlces not covered by Medlcare)

)5U

5100

s10s0

Slsoo

Slooo

$4700

Physician Servlces

No copay

20% of balance after Medlcare

Preventlve Care

No copay

No copay

No copay No copay

20% of balanqe after Medicara

Emergency Care and Ambulance

No copay

20% of balance after Medlcare

Rehabilltation Services (PL OT, ST)

No copay

20% of balance after Medicare

S/A Skllled Nursing Facility (100 day limit/calendar year) Days 1-20 Days 21-100

No copay No copay

20% of balance after Medlcare

Days 100+

Full cost

Full cost

Home Health {must be covered by Medicare)

No copay

20% of balance after

Durable Medical Equipment {covered by Medtcare) Durable Medical Equipment (not covered by Medicare)

No copay

20% of balancE after Medicare

20%

20%

Hearin8 Aids (2 hearing aids every 36 months)

20%

20%

Chiropractlc* (Medicare must cover first)

No copay

20% of balance after lVEdlcare

Out-of-Pocket Maxlmums

-

Out-of-Pocket Maximums

-

medlcar Rx

Hospital Services (first 60 days Hospital (days 61+)

Acupuncture

-

plan ptcks up Medicare deductlble)

I

Behavioral Health (with Medicare providers,

N4Ds,

phDs,

LCSWS)

Behavioral Health (providers types Medlcare dogsn,t cover, MFTs, tvlFCCS) Balance After Medicare=Remaining

No copay

No copay

Medicare

20%

20./"

No copay

20% of balance after Medlcare

20%

20%

Medicare-eligible expenses after Medicare has paid

18

LLB/2AL4

Questions regarding Medicare PPO/HO plans \

(Behavioral Health for all plan members next.)

Retiree Plans

-

HMOs

BehavioraUMental Health Benefits Member cost for outpatient office

Health Blue &

Net

Gold

visits reflected on charts (slides 38-

S2O

copay/visit

101

(flrst 3 no copay)

Health Net

Behavioral health plan deductibles,

$10 group/

Seniority

)zu

Plus*

In0tv.

copays and

copay/visit

Kaiser Kaiser

Senlor Advantage +

(?n

coinsurance track

to medical plan

copay/visit

510 group/ $20 indiv.

{ftrst 3 no copay)

copay/visit

copays an0

$10 group/ S2o indiv.

plan deductibles, coinsurance for

inpatient and outpatient services.

copay/visit

Review Evidence of Coveragei medtcat group may cover mental health through medlcal group, not MHN. :l

ll

19

L1,/3/2014

Retinee Plans

-

PPOs

Behavioral/Mental Health Benefits 20% after deductible (Blue Shield)

-

deductible

Health

PPO

-

deductible

zu% oT oarance afier tvteotcare

2Q%r afte.

0e0ucUole (BIue Shietd)4'

Savlngs

deductible

20%r afler

RX

deductible

(Medicare)

High Optlon (Medlcare)

--

(Optum-) 40% afte(

20% after

Blue Shield PPO &

without

50% after

)zu copay/vrsrI (first 3 no copay)

UC Care

PPO

*

20% after deductible

Core

20%* aft.el deductible

(Optum")

zQa/o*

No

copay

afte(

deductlble (Blue Shield)**

iSome provider types not covefed by Medicare (e.g. MFTs) may be covered bV Blue shield, with 20% coinsurance after deductible, Call plan to verifv coverage of your provider who is not covered by Med icare and is not a Psychologist, Psychiatrist or LCSW. ra The plans will cover non-preferred providers based on allowed amount, not billed charges; mâ&#x201A;Źmber pays balance.

Actions To Take After Flan Change ,

Very lmportant: Complete Blue Shield Medicare Part D form if you are Medicare member moving to Blue Shield PPO or High Option. Complete Medicare Advantage enrollment form if you are new to Health Net Seniority Plus or Kaiser Senior Advantage. UCOP must receive form by December 5,

-

Read all plan materials to understand how plan works, and call your plan with any questions.

-

Check new plan lD card to verify enrollment, and your pCp and medical group if enrolling in Health Net Blue & Gold. Call your plan immediately with any issues. All plan members except Kaiser current members will receive new lD cards.

20

tLl3/201.4

with Optum

UC Living Well

F Wellness program with online and campus activities to help you improve and maintain your health.

F Retirees with and without Medicare, enrolled in any UC medical pla,n, are eligible. Only subscriber is eligible.

Flncentive for participation: SzS Cift Card F Point System to earn Gift Card F Organized campus and online activities available to earn points

FHealth Assessment available but not required for gift ca

rd, http ://ucl ivi ngwe

I

l.

ucop. ed u/

Dental and Vision )

Dental - no plan changes for 2015:

http://ucnet.

r .

un

iversitvofca lifornia.ed u/com pensation-a

n

d-benefits/hea lth-pla ns/d enta l/

Delta Dental PPO

t-800-777-5854 DeltaCare USA

I-800-422-4234

>

VSP Open

http://ucn

. ' . '

et.

un

for 2015

-

no plan or rate changes

iversitvofca iforn ia,ed u/com pensation-a n d- ben efits/hea lth-pla ns/vision/index, htm I

I

Look for mailer from VSP or call t-855-240-8344 Retirees pay premium in full directly to VSP.

Enroll directly with VSP http://vsp.com/golucretirees

2L

LL/3/20L4

ARAG Legal

F Open for enrollment F Legal plan that helps cover http://u cnet. u n iversitvofca lifornia.

F The retiree

costs of legal needs,

ed u/co m pen sation-a nd-be

nefits/oth er-ben efits/lesa l-pla

n.

htm

I

full premium (deducted from annuity), New in 2075, an expanded identity theft protection benefit that includes:

'r

. . . .

pays the

Full service identity restoration ldentity Theft Insurance up to S1-million Lost wallet services

Credit monitoring service, internet surveillance of persona, information and child identity monitoring ARAG: 1-800-828-1395

>

Medicare Members Living Outside of California OneExchange: Medicare Exchange in fieu

, >

"t

ri *",'r"" *"Ot.t,

Allfamily members are enrolled in Medicare* Living in the United States and outside of CA UC makes annual contribution to a Health Reimbursement Account (HRA) that helps cover premiums and medical costs

. .

53000 (in 2015) each for retiree and family member Contribution subject to graduated eligibility

.

Retiree uses HRA to purchase Medicare plan (Advantage Plan or Supplement + Part D) in retiree's area from OneExchange

.

Retiree can use any extra HRA funds to pay medical expenses and Medicare oremiums.

*

Retirees outside of CA with "split t'amilies" remoin under IJC retiree plons through the end of the year in which oll non-Medicare family members hove become eligible Jor Medicore.

22

1,t/3/201.4

!==:\

Questions?

.(r** {t }-

,['J4 -

Contqct RASC; 1-800-888-8267

or UCLA Retiree Hotline: 3LO-794-8598 reti rees@ ch r. u cl a.ed u

Resources

for

Retirees

Health Net Blue & Gold Health Net Seniority Plus

1-800-539-4072

Kaiser

1-800-464-4000

Kaiser Senior Advantage

1-800-443-0815

alue Shield

1-855-201-837s

UC Care Concierge

1-855-201-2087

- Health Equity

1-866-346-5800

Optum Behavioral Health

t-888-440-8225

HSA

r I

Online plon links:

http://ucnet. u niversitvofca liforn ia.edu/co ntacts/pla n-co ntacts.html

23

Lr/3/2014

Resources

for

Retirees

UC Retlrement Administration Service Center

1-800-888-8267

Emeriti Retiree Relations Center

310-825-7456

Medlcare

l.SOO.MEDICARE

(1-800-633-4227) Social Security Administration

L-800-772-12t3

UCLA Health Care Facilitator (retiree dedicated

1-310-794-8598

phone and email)

reti rees@chr,ucla.edu

Open Enrollment Website: http://u cn gt. u n iversitvofcalifo rn ia. ed u/oe UC

Health Plan Booklets available Vear-round:

://u cn et. u n iversitvofca ifo r n i a. ed u/fo (expand link for plan booklets) h

tt

p

I

rm

s/catego

rv. ht m

I

24