UC Care

New 2014
Medical Plan Changes
Mary Johnson
Health Care Facilitator
Veronica Luna
Sr. Program Analyst
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
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Summary of
UCR Employees Directly Impacted*
Total
Eligible
#
Impacted
%
Impacted
Campus Total
3517
793
23%
Total Academics
1043
382
37%
Total Staff
2474
411
17%
*Impacted employees include those currently enrolled in any
Blue Cross plan or the Health Net Full Network plan.
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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
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Which of the NEW plans is most like the
one I have now?
2014 Plan
UC Care
Blue Shield Health
Savings Plan w/ HSA
Health Net
Blue & Gold HMO
is most like
2013 Plan
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)
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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.
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UC Care — Summary of Benefits
IN-NETWORK
OUT-OF-NETWORK
UC Select
Blue Shield Preferred
None
$250 individual/
$750 family
$500 individual/
$1,500 family
$1,500 individual/
$4,500 family
$3,000 individual/
$9,000 family
$5,000 individual/
$15,000 family
Physician office visit
$20 per visit
20%
50%
Specialist office visit
$20 per visit
20%
50%
No charge
No charge (not subject
to annual deductible)
50%
$20 per visit
(initial visit only)
20%
50%
$20 per visit
20%
50%
n/a covered under
Blue Shield Preferred
20%
50%
$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
Annual deductible
Annual Out-of-pocket maximum
MEMBER COPAYMENT/COINSURANCE
Preventative health benefits
Pregnancy & maternity benefits
Outpatient x-ray, pathology, and laboratory
Outpatient surgery (performed at an Ambulatory Surgery
Center)
Hospital care (outpatient surgery in hospital)
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Blue Shield Health Savings Plan — HSA
Benefit
Deductible*
Medical Plan Single
Coverage
Family
*In-network
preventive
care covered
at 100%
Out-of-Pocket Max
Single
Family
Member Cost Sharing
(i.e., coinsurance after
deductible is met)
Contribution Types
HSA
Funding
UC Contribution
Employee Pre-Tax (optional)
In-Network
Out-of-Network
$1,250
$2,500
$2,500
$5,000
$4,000
$6,400
$8,000
$16,000
20%
40%
Single
Family
$500
$1,000
up to $2,800
up to $5,550
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Health Savings Account (HSA) Details
Health Savings
Plan
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)
Post Deductible
Health
Reimbursement
Account (PDHRA)
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
Stand alone
Health
Reimbursement
Account (SAHRA)
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
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UC Care — Locating Providers
To locate in-network providers:
Visit http://uc-care.org/your-providers/ 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) 201-8375, from 7 a.m. to
7 p.m. PT, Monday through Friday.
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Step 1.
• Go to: http://uccare.org/yourproviders/
• Read
instructions
• Click on search
link provided
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Step 2.
Click on “Change
selection” under
“your plans” to
select between
the UC Select
and Blue Shield
Preferred network
options.
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Step 3.
• Click on the
button next to the
desired
network — UC
Select or Blue
Shield Preferred
• Click done
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Step 4.
• Input search
criteria
(e.g., search for
urgent care
centers near a
city, state, county,
or zip code)
Input criteria
• Click “find now”
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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
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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.
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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)
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2014 Employee Medical Plan Rates
$51,000 and under
$51,001–$101,000
PLAN
Self
Self +
Child(ren)
Self +
Adult
Family
PLAN
Self
Self
+Child(ren)
Self +
Adult
Family
Blue Shield Health
Savings Plan
EE: $9.67
UC: $505.90
EE: $17.41
UC: $908.27
EE: $21.19
UC: $1,058.28
EE: $28.92
UC: $1,460.66
Blue Shield Health
Savings Plan
EE: $45.72
UC: $469.85
EE: $82.30
UC: $843.38
EE: $103.49
UC: $975.98
EE: $140.06
UC: $1,349.52
Health Net
Blue & Gold
EE: $29.49
UC: $581.51
EE: $51.17
UC: $1,046.72
EE: $109.50
UC: $1,170.97
EE: $131.18
UC: $1,636.18
Health Net
Blue & Gold
EE: $65.54
UC: $545.46
EE: $116.06
UC: $981.83
EE: $191.80
UC: $1,088.67
EE: $242.32
UC: $1,525.04
Kaiser Permanente
EE: $11.78
UC: $533.24
EE: $21.20
UC: $957.71
EE: $25.80
UC: $1,115.81
EE: $35.21
UC: $1,540.29
Kaiser Permanente
EE: $47.83
UC: $497.19
EE: $86.09
UC: $892.82
EE: $108.10
UC: $1,033.51
EE: $146.35
UC: $1,429.15
UC Care
EE: $71.96
UC: $581.51
EE: $127.83
UC: $1,046.72
EE: $198.99
UC: $1,170.97
EE: $254.87
UC: $1,636.18
UC Care
EE: $108.01
UC: $545.46
EE: $192.72
UC: $981.83
EE: $281.29
UC: $1,088.67
EE: $366.01
UC: $1,525.04
Western Health
Advantage
EE: $11.78
UC: $552.43
EE: $21.20
UC: $992.58
EE: $25.80
UC: $1,156.57
EE: $35.21
UC: $1,596.73
Western Health
Advantage
EE: $47.83
UC: $516.38
EE: $86.09
UC: $927.69
EE: $108.10
UC: $1,074.27
EE: $146.35
UC: $1,485.59
Core
EE: $0.00
UC: $113.19
EE: $0.00
UC: $203.74
EE: $0.00
UC: $237.70
EE: $0.00
UC: $328.25
Core
EE: $0.00
UC: $113.19
EE: $0.00
UC: $203.74
EE: $0.00
UC: $237.70
EE: $0.00
UC: $328.25
PLAN
Self
Self +
Child(ren)
Self +
Adult
Family
PLAN
Self
Self +
Child(ren)
Self +
Adult
Family
Blue Shield Health
Savings Plan
EE: $82.72
UC: $432.85
EE: $148.90
UC: $776.78
EE: $177.25
UC: $902.22
EE: $243.42
UC: $1,246.16
Blue Shield Health
Savings Plan
EE: $121.03
UC: $394.54
EE: $217.86
UC: $707.82
EE: $253.67
UC: $825.80
EE: $350.49
UC: $1,139.09
Health Net
Blue & Gold
EE: $102.54
UC: $508.46
EE: $182.66
UC: $915.23
EE: $265.56
UC: $1,014.91
EE: $345.68
UC: $1,421.68
Health Net
Blue & Gold
EE: $140.85
UC: $470.15
EE: $251.62
UC: $846.27
EE: $341.98
UC: $938.49
EE: $452.75
UC: $1,314.61
Kaiser Permanente
EE: $84.83
UC: $460.19
EE: $152.69
UC: $826.22
EE: $181.86
UC: $959.75
EE: $249.71
UC: $1,325.79
Kaiser Permanente
EE: $123.14
UC: $421.88
EE: $221.65
UC: $757.26
EE: $258.28
UC: $883.33
EE: $356.78
UC: $1,218.72
UC Care
EE: $145.01
UC: $508.46
EE: $259.32
UC: $915.23
EE: $355.05
UC: $1,014.91
EE: $469.37
UC: $1,421.68
UC Care
EE: $183.32
UC: $470.15
EE: $328.28
UC: $846.27
EE: $431.47
UC: $938.49
EE: $576.44
UC: $1,314.61
Western Health
Advantage
EE: $84.83
UC: $479.38
EE: $152.69
UC: $861.09
EE: $181.86
UC: $1,000.51
EE: $249.71
UC: $1,382.23
Western Health
Advantage
EE: $123.14
UC: $441.07
EE: $221.65
UC: $792.13
EE: $258.28
UC: $924.09
EE: $356.78
UC: $1,275.16
Core
EE: $0.00
UC: $113.19
EE: $0.00
UC: $203.74
EE: $0.00
UC: $237.70
EE: $0.00
UC: $328.25
Core
EE: $0.00
UC: $113.19
EE: $0.00
UC: $203.74
EE: $0.00
UC: $237.70
EE: $0.00
UC: $328.25
$101,001–$151,000
$151,001 and above
EE = Employee Contribution UC = UC Contribution
Rates for union-represented employees are subject to ongoing collective bargaining as appropriate.
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Key Websites
UCnet Medical Plans:
http://ucnet.universityofcalifornia.edu/compensation-andbenefits/health-plans/medical/index.html
UC Care: http://uc-care.org/
Blue Shield Health Savings Plan:
https://www.blueshieldca.com/sites/uc/home.sp?WT.mc_i
d=otc-cal-uc-1705
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