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UCSB Human Resources, Benefits

This presentation is intended for communication purposes only. Please see the At Your Service website (http://atyourservice.ucop.edu) and plan documents for complete information.

Blue Shield Health Savings Plan

11/2015

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Blue Shield Health Savings Plan

Combines high deductible PPO with account to pay out-of-pocket expenses

Medical CoverageBlue Shield PPO

Health Savings AccountHealthEquity

+

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What’s special about the HSP?

• High deductible PPO medical plan◊ Administered by Blue Shield◊ Deductible and OOPM shared by all family

members◊ Medical and drug expenses apply to

deductible and OOPM

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What’s special about the HSP?

• Health Savings Account (HSA)◊ Administered by HealthEquity◊ UC makes an annual contribution to this

account◊ You may also make pre-tax contributions◊ You use the HSA funds to pay medical and

other health care expenses◊ Funds rollover; the money in the account is

yours to keep• You are not eligible to have a HSA if

enrolled in Medicare Part A or B

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Residence, Networks & Travel

• The employee must live in US• When in US

◊ Comprehensive coverage

◊ Blue Shield PPO network in CA

◊ Blue Cross Blue Shield network outside CA

• When traveling out of US◊ Emergency and urgent care only

◊ NO routine care

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Blue Shield PPO – Medical Plan

• You direct your own care, you decide where to receive services

• You pay annual deductibles before plan pays

• After deductible, you share the cost of each service with the plan - coinsurance

• Your costs are lower if you select a Blue Shield PPO provider

• “Out-of-pocket Maximum” limits your financial liability

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Preventive Care

• Preventive care is covered at 100% with Blue Shield PPO providers

• Preventive care includes:◊ Annual well visit and labs◊ Well woman visits and labs◊ Preventive screening tests◊ Immunizations

• See list of preventive services on http://www.blueshieldca.com/uc

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Blue Shield PPO - Plan Design

Medical & Drug Expenses

In NetworkOut of

Network

Deductible Single Family

$1,300$2,600

$2,500 $5,000

Member Cost Sharing(Coinsurance)

20%

• Plan pays 60% of allowed rate

• You pay balance

Out-of-Pocket Max(includes deductible) Single Family

$4,000 $6,400

$8,000 $16,000

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Deductible, Coinsurance, OOPM

You pay You share cost with plan

Plan pays100%

$1300Deductibl

e20% Coinsurance $4000

OOPM

Individual (Single)Preferred Providers

You can use the UC Contribution to the Health Savings Account to pay part of the deductible.

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Deductible, Coinsurance, OOPM

You pay You share cost with plan

Plan pays100%

$2600Deductibl

e20% Coinsurance $6400

OOPM

Family (2 or more)Preferred Providers

The full family deductible must be met before plan shares costs

You can use the UC Contribution to the Health Savings Account to pay part of the deductible.

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Allowed Amount – In Network

In-Network Example

Discounted rate that plan negotiates for each service with “preferred” or participating providers

• You pay the in-network coinsurance on the discounted rate.

• Provider can’t “balance bill”

20% Coinsurance

Provider charge: $200Allowed amount: $100

Plan pays 80%: $80

You pay 20% $20

Provider write-off:$100

PPO plans negotiate “allowed” rates to process claims.

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Allowed Amount – Out of Network

Out-of-Network Example

Value that plan assigns to a service when provider is NOT a “preferred provider” (not participating)

• Plan pays out-of-network coinsurance on the allowed amount.

• Provider can “balance bill”

• Balance over allowed amount does not apply to OOPM

40% Coinsurance

Provider charge: $200Allowed amount: $100

Plan pays 60%: $60(60% of $100)

You pay 40%: $40

You pay balance: $100

PPO plans assign “allowed” rates to process claims.

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Medical Claims, EOBs & Bills

You receive servicesYou pay nothing at the time of service for in-network care

Provider sends claim for services to Blue Shield

Blue Shield sends EOBExplanation of Benefits (EOB) outlines allowed charges, deductible and co-insurance. “This is not a bill”.

Provider sends billThe bill should match the EOB. It should reflect the in-network discount and any payments received from health plan.

You pay provider• Pay with HSA fundsor• Pay with other funds

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Prescription Drugs

• There is no separate drug plan with copays

• Drug expenses are applied to the plan in the same way as medical expenses◊ You pay full cost of medication until you

satisfy the deductible◊ After deductible, you pay 20% at

preferred pharmacies

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Pharmacy Claims

You go to the pharmacy

Pay with your HSA debit cardorPay with personal funds and later go to your HealthEquity account online and reimburse yourself (if you have money in the account)

Give pharmacist your Blue Shield ID card so they can apply the Blue Shield Rx discount

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Learn more about PPO Costs

Fair Health Consumerhttp://www.fairhealthconsumer.org/

Health Care Blue Bookhttps://www.healthcarebluebook.com/

Good Rx• http://www.goodrx.com• Estimate cost of drugs

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Find costs on Blue Shield Website

After your enrollment is complete and you are in the Blue Shield membership system, you will have access to additional tools.

http://www.blueshieldca.com/uc

• Treatment Cost Estimator Tool• Drug costs, information and claim

summary

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www.blueshieldca.com/uc Register as new member on this site.

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Health Saving Account

Medical CoverageBlue Shield PPO

+Health Savings Account

HealthEquity

The Health Savings Account is a separate account that can be used to pay medical and other health expenses.

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Advantages of an HSA

• HSA funds rollover from year to year; no use it or lose it as with Health FSA

• You can make contributions at any time

• It has triple tax advantage

• No Federal taxes on contributions

• No taxes when funds are used

• No taxes on earnings

• You keep the money even if you change jobs or insurance plans

Who is eligible to own an HSA?

To own/contribute to Health Savings Account:

• May not be enrolled in Medicare A or B

◊ Did you enroll in Medicare at age 65?

◊ Were you automatically enrolled when you signed up for Social Security pension?

• May not be enrolled in other medical plan

• Must have a $0 balance in Health FSA on December 31, 2014 (complete any claims reimbursement by Dec. 31, 2014)

• May not be claimed as a dependent on someone else’s tax return

How does HSA work?

• UC makes annual contribution for plans that start on January 1.

• You may contribute through payroll deduction or make post-tax contributions to HealthEquity

• Use a HSA debit card to pay for health expenses

• Use HealthEquity website to pay medical and other health claims or reimburse expenses

• Invest HSA dollars when account balance reaches $2000 – no fees to invest

Annual Contributions by UC & Employee

• UC Contribution (1/1/15) ◊ $500 individual ◊ $1000 family

• You can contribute up to (optional):

◊ Single-coverage: $2,850 ($3,350 – $500)◊ Family-coverage: $5,650 ($6,650 –

$1,000)◊ Catch-up contribution, age 55+: $1,000

Tip: Contribute the money you would have put in a Health FSA.

UC Contribution is prorated for plans that start after January 1

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How to make HSA contributions?

• During Open Enrollment, use AYSO application to elect a pre-tax monthly payroll deduction

• Submit UPAY 850 form to Benefits to start or change monthly pre-tax payroll deduction – timing of deduction based on payroll deadlines

• Make post-tax contribution to Health Equity – write off contribution on you annual taxes

• 2014 members - HSA contribution elections made through payroll deduction will automatically carry over into 2015 unless a change is made.

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HSA vs FSA

• The HSA is NOT like the Health FSA where you have access to the entire annual contribution starting on January 1

• The HSA is like a checking account – the money must be in the account before you can spend it

◊ You can pay an expense with a credit card and reimburse your self later when you have sufficient funds in your account.

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Use the HSA to pay for…

• Deductible• Coinsurance• Any IRS Publication 502 Expenses, including:

◊ Medical◊ Dental◊ Vision◊ Prescription drug◊ Long Term Care insurance premiums

• See HealthEquity website for more information

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Whose expenses can be paid with HSA?

The money in your HSA can be used to pay for qualified medical expenses of any family member who qualifies as a dependent on your tax return

• The family member does not have to be enrolled in this plan

• You can’t claim expenses for family members enrolled in this plan but who are not your tax dependents (older children who are no longer tax dependents)

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Your Responsibility

• Follow HSA eligibility rules• Contribute only the amount allowed

by IRS• Use HSA funds for eligible expenses• Keep itemized receipts as tax

documents

HealthEquity does not review your use of the account funds, but IRS may

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Lumenos Rollover from 2013

Lumenos Post-Deductible HRA funds can be used to pay 20% coinsurance or other eligible expenses after Blue Shield PPO deductible is satisfied

Example:• Single Deductible $1,300• UC Contribution to HSA $500• Remaining balance $800

◊ Pay with personal fundsorPay with your personal contributions to HSA

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www.healthequity.com/ed/uc

Register as new member on this site.

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Health Equity Member Portal

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Claim Summary Screen

• View claim detail

• Choose action to be taken

− Pay provider

− Reimburse themselves

− Close expense

• Pay from HSA account or external checking/savings account

• Schedule payment

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Member Resources

• Welcome Kit - to get you started• Debit card loaded with UC

Contribution• Online resources

◊ Treatment cost estimator tool◊ Drug costs, information and claim

summary• Use smart phone browser to access

mobile website

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Optum (formerly United Behavioral Health)

• Optum coordinates behavioral health care for all medical plans (except CORE)◊ psychiatrist◊ psychologist◊ therapist◊ substance abuse treatment

• No referral required from physician• Call Optum to notify prior to first visit

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Behavioral/Mental Health• Medical and behavioral health deductibles and

OOPM cross accumulate (shared by both plans).

• See the Optum Evidence of Coverage for complete details. Covered

ServiceOptum

CliniciansOut-of-Network

Deductible $1,300 individual$2,600 family

$2,500 individual$5,000 family

Outpatient Office Visits

You pay 20% Plan pays 60% of allowed rateYou pay balance of bill

Emergency Room

You pay 20% Plan pays 80% of allowed rateYou pay balance of bill

Inpatient Stays You pay 20% Plan pays 60% of allowed rateYou pay balance of bill

For more information

HealthEquity Member Services available every hour of every day

(866) 212-4729

www.healthequity.com/ed/uc

Blue Shield Concierge(855) 201-8375

www.blueshieldca.com/uc