Open Enrollment http://ucnet.universityofcalifornia.edu/ Open - - PowerPoint PPT Presentation

Open Enrollment

http://ucnet.universityofcalifornia.edu/

Open Enrollment for 2018

8:00am on October 26 – November 21 at 5:00pm

 Add/Change/Drop plans  Add/Change/Drop coverage level  Add/Change/Drop covered family members  Enroll or re-enroll in FSA and start/change FSA contribution  Start or change personal HSA contribution  Review all coverage options, being aware of any plan changes, costs and benefits for the coming year

Health and Welfare Plan Offerings

 Medical Pay Band Adjustment  Medical plans

‒ Anthem replaces the UC Care website & the current Anthem microsite ‒ Anthem Rx replaces Optum Rx for PPO plans ‒ Mandated changes for statin drug coverage

 Dental Plans  Vision Plan  ARAG Legal Plan  Flexible Spending Accounts require positive re-enrollment

• You must re-enroll if you want to participate in the FSA in 2018

Open Enrollment for 2018

Plans NOT open for Open Enrollment Changes

 Supplemental Life Insurance*  Dependent Life Insurance*  Supplemental Voluntary Disability*

‒ Short – term ‒ Long – term

 Accidental Death and Dismemberment (AD&D)

‒ Enroll/increase coverage amounts anytime of the year; effective date corresponds to capture with first pay compute of AD&D deductions ‒ No health statement required

*Enroll/increase coverage amounts with approval from the carrier using the Statement of Health process

Open Enrollment for 2018

2017 1 $53,000 and under 2 $53,001 - $104,000 3 $104,001 - $156,000 4 $156,001 and above

2018 Pay Bands for Medical Plans

2018 1 $54,000 and under 2 $54,001-$107,000 3 $107,001-$161,000 4 $161,001 and above

Pay band thresholds adjusted each year based on the Consumer Price Index (CPI) from the California Department of Finance based on the urban wage earners and clerical workers (CPI-U) Definition of Range for the 2018 Medical Contribution Base Using Full-time Salary as of January 2017

Employee Premium Cost Share for Certain Unions

 Premium cost share and pay band levels may be held at 2017 levels for some unions due to unsettled contract negotiations  Impacted systemwide unions are NX - Registered Nurses, HX - Residual Health Care Professionals, RX - Research Support Professionals, TX - Technical, EX - Patient Care Technical, SX - Service (premium cost share for EX and SX for Health Net and Kaiser Pay Bands 1 & 2 remain frozen at 2014 level)  Individuals in unions with frozen 2017 pay band levels can still change between different pay bands (using frozen thresholds) based on the employee’s Medical Contribution Base  Announcements will be made if conclusion to contract negotiations for these unions result in any changes to the employee premium cost share

Change in Employee Nets

2017 vs 2018 Contributions

$ Difference All Pay Bands EE EE+C EE+Sp EE+Fam Health Net B&G HMO $2.49 $4.48 $7.49 $9.49 Kaiser $1.19 $2.15 $2.61 $3.57 CORE $0 $0 $0 $0 HSP $2.90 $5.23 $6.36 $8.69 UC Care $17.52 $31.54 $39.05 $53.06 Most faculty and staff will see medical plan premium increases of less than $10 a month across all salary and coverage levels. Premium increases for UC Care will be a bit higher, ranging from $17-$53 a month.

HMO Plans

 Health Net Blue and Gold HMO  Kaiser South HMO

PPO Medical Plans – Anthem

 UC Care PPO  Health Savings Account PPO  CORE

Open Enrollment for 2018, Medical Plans

 If no plan change is made, members will remain in same plan in which they are currently enrolled

– Health Net Blue & Gold HMO – Kaiser South HMO – Anthem PPO plans

 Anthem PPO plan members Rx approval information will transfer to Anthem Rx for this Open Enrollment period

‒ Future verification may be required ‒ Prior authorizations will transfer ‒ DAW’s will transfer where possible ‒ Mail order info will transfer where possible ‒ CVS added to 90-day Rx

Open Enrollment for 2018, Medical Plans

HMO vs. PPO overview

HMO

Restricts medical 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. Only ER and urgent care covered

• utside of medical group.

Fixed costs – most services have flat co-pays. Must live or work in the plan’s service area.

PPO

Access to larger network of

• doctors. Not assigned to a doctor
• r group.

Self-refer to doctors and specialists; no authorization requirement to see doctors. Health plan must authorize surgery and some services and medications in advance. Costs vary depending on whether provider is participating with plan and other factors. Out-of-network providers cost you more.

 Anthem PPO plans

– Mandated coverage will now be added for a 12-month supply (from a 90-day supply) of FDA approved, self-administered hormonal contraceptives when dispensed at one time for the enrollee.  Anthem PPO and Health Net Blue & Gold HMO plans ‒ Low-to-moderate dose statin medication for the prevention of (CVD) cardiovascular disease will be covered at no co-pay/co-insurance.

• Ages 40-75 years
• Have one or more CVD risk factor, and
• Have a calculated 10-year risk of CVD event ≥10%

‒ Athena WISDOM study clinical trial (participation is voluntary) Health Savings Plan with HSA – cost sharing applies

• Risk assessment, stratification and communication
• Genomic profiling and Germline testing
• Breast Health Specialist Consultation

2018 Medical Plans, Changes

 Must use Blue & Gold providers (limited network) and facilities (except for behavior health benefits or in emergencies)

‒ Behavioral Health Benefits through Optum ($20 co-pay)

 No deductible; $20 co-pay office visits for most services  OOP Max: $1,500 Single/$3,000 Family (Family = 3 or more members; medical and drug co-pays apply)  $250 co-pay inpatient hospitalization  $100 co-pay outpatient Ambulatory Surgery Center  $75 co-pay for Emergency Room  Prescription Drug Coverage (see slide 21)  Chiropractic/Acupuncture – 24 aggregate visits covered per year

‒ $20 co-pay when using American Specialty Health Plan Network

Health Net Blue & Gold HMO

 Must use Kaiser providers and facilities (except for behavior health benefits or in emergencies)

‒ Behavioral Health Benefits through Optum or Kaiser ($20 co-pay)

 No deductible; $20 co-pay office visits for most services  OOP Max: $1,500 Single/$3,000 Family (Family = 3 or more members; medical and drug co-pays apply)  $250 co-pay inpatient hospitalization  $100 co-pay outpatient Ambulatory Surgery Center  $75 co-pay for Emergency Room  Prescription Drug Coverage (see slide 21)  Chiropractic/Acupuncture – 24 aggregate visits covered per year

‒ $15 co-pay when using American Specialty Health Plan Network ‒ $20 co-pay for Kaiser provider for acupuncture only

 Behavioral health treatment for pervasive developmental disorder or autism (group or individual) with cost share of $20 per day

‒ Individual = $20/ office visit ‒ Group = $10/office visit

Kaiser South HMO

 UC Care PPO – no PCP or medical group, no referrals or authorizations to see specialists. Anthem processes claims.  Select tier includes UC providers and set co-pays for many services.

• $20 co-pays for office visits; $200-250 ER; $250 hospital and skilled

nursing unit in hospital admission; $100 outpatient surgery in hospital.

• Some services not covered on Select tier (including stand-alone skilled

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

 Preferred tier includes Anthem PPO network and worldwide coverage; deductibles and coinsurance apply, up to annual maximums.  Services outside the US covered at the Preferred PPO benefit level.  For more details of plan coverage, and review full plan coverage booklet on UCNet

UC Care PPO

UC Care PPO at a glance UC Select Preferred Non-preferred Deductibles None $250 / $750 $500 / $1,500 OOP Maximums: Med, B/H, Rx $5,100 / $8,700 $5,100 / $8,700 $8,600 / $19,200

Physician Office Visits/Urgent Care

$20 20% / $30 50% ER Facility & ER Physicians^ Ambulance $200 -$250^ $200 - $250^ (no deductible) $200 -$250^ (no deductible) Ambulatory Surgery Center $100 20% 50%1 Outpatient Surgery/Hospital $100 20% 50%1 Hospital (non-emergency) $250 20% 50%2 Durable Medical Equipment Not covered 20% 50% S/A Skilled Nursing Facility Home Health Not covered Not covered 20% (100 day limit) 20% (100 visit limit) 50%2 (100 days) 50%3 (100 visits) Chiropractic* Not covered 20% 50% Acupuncture* Not covered 20% 20% Prescriptions Drugs Anthem Rx (see slide 21) Travel Immunization/Vaccines if ACA No Charge No Charge 50% Behavioral Health Benefits $20 20% 50%

UC Care PPO

Plan Pays maximum of:

1 50% on $350/day 2 50% on $600/day

^$200 ER co-pay otherwise $250 ER co-pay if admitted to hospital. *Plan limit of 24 visits for chiropractic and acupuncture combined.

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

 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).  Non-preferred providers covered; higher out-of-pocket costs.  Set co-pays for prescriptions, except specialty drugs.  Members are responsible for coinsurance and any amounts in excess of allowed amounts.  Amounts in excess of allowed amounts do not apply to deductibles or out-of-pocket maximums.  Services with day or visit limit accrue to the limit even if the deductible has not been met.  For more details of plan coverage, and review full plan coverage booklet online, go to UC Net.

UC Care – Be Aware of Limitations

• High Deductible PPO plan with Health Savings Account (HSA, Health Equity)
• Employee Contributions to HSA incur tax savings:
• No FICA and Federal taxes on contributions; no taxes on growth
• No taxes on reimbursements if used for IRS eligible expenses
• Can use money for any reason, taxes will apply if not used for

qualified medical expenses, if after age 65, penalties no longer apply.

• Only contributed/deposited funds are accessible to you.
• Once the deductible is met, coinsurance begins; both apply to OOP max.
• Contributions FDIC insured; > $1,000 can be invested in mutual fund no FDIC
• Contribution election amount will rollover to 2018 unless changed
• No use it or lose it rules. Funds are yours if you separate.
• Cannot participate in FSA while HSA member.
• Cannot enroll if you have other coverage that is not a qualified high deductible PPO plan including

Medicare.

• Cannot be claimed as someone else’s tax dependent. Must have valid street address, not PO Box.

Health Savings Plan with HSA

Network Non-network^ Annual Deductible $1,350 / $2,700 $2,550 / $5,100 Out-of-pocket max. $4,000 / $6,400 $8,000 / $16,000 Physicians/Specialists 20% 40% TeleDoc (phone, mobile, online) $40 (before deduct.), 20% after deduct N/A Outpatient Surgery ASC 20% 40%1 Hospitalization 20% 40%2 Preventative No Charge 40% Pregnancy/Maternity 20% 40% ER Services 20% 20% Acupuncture* 20% 20% Chiropractic* 20% 40% Prescriptions 20% 40% Hearing Aids, $2000 max,36mo 50% 50% Behavioral Health Benefits 20% 40% Travel Immunizations/Vaccines

If ACA Preventive, covered in full If not ACA Preventive, 20% If ACA Preventive, 20%; If not ACA Preventive, 40% after deductible If ≥ 2 members, family deductible and OOP apply Plan Pays a maximum: *Up to 24 visits aggregate/year

1 60% on $350/day facilities plan max 2 60% on $600/day facilities plan max

Health Savings Plan with HSA

PPO Plan Individual Coverage Family Coverage (2 +) Preferred Providers Non- Preferred* Preferred Providers Non- Preferred* Deductibles $1,350 $2,550* $2,700 $5,100 * Coinsurance~ 20% 40%* 20% 40%* Max OOP $4,000 $8,000* $6,400 $16,000* HSA Individual Family (2+) UC Contribution $500 $1000 Participant Contribution Up to $2,950 ($3,950 if 55+) Up to $5,900 ($6,900 if 55+)

HSA contributions are annual amounts and subject to IRS rules and limits.

*Services with non-preferred providers are paid by plan based on allowed amounts. Members are responsible for coinsurance and any amounts in excess of allowed

• amounts. Amounts in excess of allowed amounts do not apply to

deductibles or out-of-pocket maximums.

~Review summary grid for details

and coinsurance variations.

Health Savings Plan with HSA

 Annual Deductible $3,000 / individual  Out-of-pocket max. $6,350 / $12,700^  Preventative Health Benefits N/C  Physicians 20%  Outpatient facilities 20%1  Hospitalization facilities 20%2  ER Services 20%  Chiropractic 20%*  Acupuncture 20%*  Mental Health Benefits 20%  Prescriptions 20%  Applied Behavioral Analysis (ABA) 20% in/out-of-network Autism Support after deductible

• Travel Immunizations/Vaccines If ACA Preventive, in-network covered in full and not

subject to deductible; out-of-network covered 20% after deductible. If not ACA Preventive, 20% in/out-of-network after deductible*

CORE PPO

*24 visits maximum aggregate. Home health, hospice, bariatric surgery, durable medical equipment and mail order Rx not covered out of network. ^Balance billing not applied to OOP Plan Pays maximum of:

1 80% on $350/day non‐network 2 80% on $600/day non‐network

UC PPO Website

• Replaces the UC Care website & the current Anthem microsite for

members

• Anthem Admin site remains
• Contains medical, pharmacy, and behavioral health information for

all PPO plans – CORE, UC Care, UC HSP, PPO Medicare plans

• Links to external sites (e.g., Anthem) to connect with plan features

(LiveHealth Online, Castlight, etc.)

• Controlled and powered by UC including content, structure, and
• rganization

PPO Website – Open Enrollment

ucppoplans.com

PPO Website – Open Enrollment

PPO Website – Jan 2018

Open Enrollment Message removed 1/1

30-day supply (network pharmacy/specialty pharmacy):

UC Care PPO HN Blue & Gold Kaiser Generic $ 5.00 $ 5.00 $ 5.00 Brand $25.00 $25.00 $25.00 Non Formulary $40.00 $40.00 N/A Specialty 30% up to $150/fill $20.00 $25.00

90-day supply (mail-order and select network pharmacies for maintenance medications):

UC Care PPO HN Blue & Gold Kaiser Generic $10.00 $10.00 $10.00 Brand $50.00 $50.00 $50.00 Non Formulary $80.00 $80.00 N/A Specialty N/A N/A N/A

Prescription Drug Coverage*

HSA PPO and Core members: Rx subject to deductible and coinsurance, up to OOP max.

*Generic drugs mandatory on all UC plans unless medically necessary and authorized by plan.

Dental Plans

Delta continues as the carrier for both plans

 Delta Dental PPO

‒ Annual maximum benefit of $1,500 ‒ Benefit Enhancement: Fluoride treatment to be extended to members over age 13, twice per calendar year

 DeltaCare

‒ No annual maximum benefit ‒ Must use contracted provider

 Both plans’ premiums continue to be fully paid by UC

Vision Plan

 No benefit changes  Plan premium continues to be fully paid by UC  VSP continues as the carrier

Legal Plan

 Premium paid employee ‒ Increases by 4.47%  New packages to be added ‒ Real Estate ‒ Family Law  Open for enrollment

Legal Plan – Real Estate

Purchase / Sale of Real Estate – Primary & Secondary Residence Home Equity Loan – Primary & Secondary Residence Construction Loan – Primary & Secondary Residence Refinance - Primary and Secondary Residence Land Purchase – Primary Residence Real Estate Disputes – Secondary Residence Residential Contractor Disputes

Legal Plan – Family Law

Protection of Inheritance Rights Child Custody/Child Support Agreement Pre and Postnuptial Agreements Executor Appointment Parental Responsibilities Caregiving Services Elder Care

Legal Plan Enhancements

Document Preparation and Review Insurance Disputes State and Local Tax Collection Defense Expungement

Cannot use ARAG to sue the UC or any

• f the UC

insurance plans.

Health FSA: Real-time Alerts

NEW for 2018: Participants with an email address on file with WageWorks will automatically receive Real-time Alerts and instant messages about their FSA card activity Type of Alerts ‒ Documentation Approved ‒ Action Required ‒ Card Transaction Denied ‒ Card Reactivated ‒ Documentation Ineligible ‒ Card Deactivated Participants can change or de-enroll from any or all alerts via the WageWorks website

Flexible Spending Account (FSA)

• Health

 Administered by WageWorks  NEW Maximum contribution of $2,600 per year  General Health FSA  Compatible with Kaiser, Health Net, WHA, CORE, UC Care. If you enroll in the UC Health Savings Plan, you cannot enroll in the Health FSA due to the Health Savings Account (HSA)  Minimum contribution of $180 per year

 You must re-enroll if you want to participate in 2018!!!

Health FSA - Timeline

December 31, 2017 Last day to incur eligible expenses reimbursed from the 2017 plan year funds January 1, 2018 through April 15, 2018 Claims Run-Out Period. Time to submit claims for eligible expenses incurred in 2017 April 15, 2018 Deadline to file claims for expenses incurred in 2017

Health FSA – Carryover After Re-Enrollment

 Allowed to carry over a minimum of $25 and a maximum of $500 of unused Health FSA funds into the next plan year provided you are enrolled through December 31, 2017.  Funds in excess of the $500 allowed carryover balance is forfeited.  Carryover balance is determined after the April 15, 2018 run-out period (early May of the following plan year).  Unused funds, including carryover funds, disqualifies you for the Health Savings Plan. To enroll in the Health Savings Plan, you must have a $0 balance in your Health FSA as of 12/31/17 or forfeit any unused funds, including carryover funds

Health FSA – Carryover Waiver Form Process

Flexible Spending Account (FSA) – Dependent Care

 Nothing to do with health care. Everything to do with child care or elder care  No change to grace period extension (no carry-over feature)  Must re-enroll if you want to participate in 2018  Minimum contribution of $180 per year  Maximum annual contribution of $5,000 per family or $2,500 if married filing a separate tax return  Last day to submit 2017 claims is April 15, 2018

1

• Comprehensive FMEV
• March to August 2012

2

• Ongoing FMEV for new family members
• Throughout the year

3

• Triennial Recertification
• Launched April of 2017

Family Member Eligibility Verification & Recertification

Comprehensive FMEV

• Verified 175,815

family members from March to August 2012

• 5.26% Non-

verification rate

• $40M in UC savings
• n yearly premiums

Verification Program

• f newly added family

members

• 1,130 Non-

verification rate average since 2012

• $8M Average annual

savings since 2012 Triennial Recertification of spouses, DPs, grandchildren & legal wards

• $20M Estimated

Savings on yearly premiums

FMEV Outcomes

Open Enrollment (OE) Period

 Starts Thursday, October 26 at 8:00 AM PST  Ends Tuesday, November 21 at 5:00 PM PST  OE Elections start January 1, 2018  Employees must confirm their elections

• 3 step confirmation process; will be issued a confirmation #:

ID Cards

Plan Vendor New ID Cards in Jan 2018 Anthem Blue Cross All members in 2018 HealthEquity (HSA debit card) Only for new HSP members; Card is good for 3 years from issue date. Health Net Blue & Gold All members Kaiser Permanente Only new members Delta Dental PPO Cards are not issued Delta Care (PMI) For new DHMO members only WageWorks (Health FSA debit card) Only for new Health FSA members; Card is good through expiration date

• n card.

Stay Connected

Health Net Blue & Gold healthnet.com/uc 1-800-539-4072 Kaiser my.kp.org/ca/universityofcalifornia 1-800-464-4000 UC Care PPO www.ucppoplans.com/content/uc-care 1-844-437-0486 CORE www13.anthem.com/cp/web/ucal 1-844-437-0486 UC Health Savings Plan www13.anthem.com/cp/web/ucal 1-844-437-0486 HSA Health Equity www.healthequity.com 1-866-212-4729 Optum Behavioral Health liveandworkwell.com, enter 11280 1-888-440-8225 OptumRx optumrx.com 1-855-489-0651 Delta Dental PPO deltadentalins.com/uc 1-800-777-5854 DeltaCare USA deltadentalins.com/uc 1-800-422-4234 Vision Service Plan vsp.com 1-866-240-8344 ARAG Legal ARAGLegalCenter.com, enter 11700UC 1-800-828-1395 WageWorks Flexible Spending Accounts uc.conexisfsa.com 1-877-722-2667

Campus Employees Resources, Monday - Friday, 10am - 3pm

 Telephone Hot Line 310-794-0421

Health Systems Employees Resources

 Telephone Hot Line 310-794-8606 email Address: MCHRBenefitsTeam@mednet.ucla.edu

UC retirees – UC Office of the President

 Telephone Hot Line 800-888-8267

Quick question?