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

Open Enrollment for 2018 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

2018 Pay Bands for Medical Plans 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) 2017 2018 1 $53,000 and under 1 $54,000 and under 2 $53,001 - $104,000 2 $54,001-$107,000 3 $104,001 - $156,000 3 $107,001-$161,000 4 $156,001 and above 4 $161,001 and above 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 All Pay Bands $ Difference 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.

Open Enrollment for 2018, Medical Plans 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

HMO vs. PPO overview HMO PPO  Restricts medical provider access  Access to larger network of (PCP/medical group or Kaiser). doctors. Not assigned to a doctor or group.  Care starts with PCP; PCP refers to specialists; medical group  Self-refer to doctors and authorizes most care outside of specialists; no authorization PCP’s office. requirement to see doctors.  Only ER and urgent care covered  Health plan must authorize outside of medical group. surgery and some services and medications in advance.  Fixed costs – most services have flat co-pays.  Costs vary depending on whether provider is participating with plan  Must live or work in the plan’s and other factors. Out-of-network service area. providers cost you more.

2018 Medical Plans, Changes  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.  A nthem 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

Health Net Blue & Gold HMO  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

Kaiser South 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

UC Care PPO  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^ $200 -$250^ $200 - $250^ (no $200 -$250^ (no Ambulance deductible) 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% 50% 2 (100 days) S/A Skilled Nursing Facility Not covered 20% (100 day limit) 50% 3 (100 visits) Home Health Not covered 20% (100 visit limit) 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% Plan Pays maximum of: ^$200 ER co-pay otherwise $250 ER co-pay if admitted to hospital. 1 50% on $350/day *Plan limit of 24 visits for chiropractic and acupuncture combined. 2 50% on $600/day 3I If preauthorized, coinsurance will be 20% for non-pref. home health.