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Timing

Timing. Open Enrollment runs from 8:00 a.m. (PST) on Friday, November 1 through midnight on Saturday, November 30 Changes effective January 1, 2003 Including new costs. If you make no changes during OE, most enrollments will continue in 2003 Exceptions:

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Timing

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  1. Timing • Open Enrollment runs from 8:00 a.m. (PST) on Friday, November 1 through midnight on Saturday, November 30 • Changes effective January 1, 2003 • Including new costs • If you make no changes during OE, mostenrollments will continue in 2003 • Exceptions: • UC Care no longer available – default into new Blue Cross plans • DepCare now requires positive reenrollment

  2. Medical Plan Choices for 2003 • Health Maintenance Organizations (HMOs) • Point-of-Service (POS) plan • Preferred Provider Organization (PPO) plan • Fee-for-Service plan

  3. New Rate Structure

  4. Employee Monthly Costs for 2003for those earning $40,000 and less self + child(ren) $17.36 3.60 18.22 101.22 141.81 self + adult $20.25 4.20 21.26 118.09 165.44 self + family $27.95 5.80 29.35 163.06 228.46 Health Net Kaiser--California PacifiCare of California Blue Cross PLUS Blue Cross PPO self $9.64 2.00 10.12 56.23 78.78

  5. Employee Monthly Costs for 2003for those earning over $40,000 self + child(ren) $31.76 18.00 32.62 115.62 156.21 2,037.00 self + adult $37.05 21.00 38.06 134.89 182.24 2,502.00 self + family $51.15 29.00 52.55 186.26 251.66 3,187.00 Health Net Kaiser--California PacifiCare of California Blue Cross PPO High Option self $17.64 10.00 18.12 64.23 86.78 1,352.00

  6. HMOs • Health Net • Kaiser Permanente—California • PacifiCare of California • No significant changes to co-payments or benefits in 2003 • Monthly employee costs rising

  7. HMOs • You must live or work in plan’s service area • You select a Primary Care Physician (PCP) who coordinates your care • preauthorization required for some services • You must receive services from network providers (except for emergencies) • Out-of-area: emergency services only • Small co-payment for most services • No claim forms; no annual deductible

  8. Check your Open Enrollment Statement ** You must name a PCP if going into Blue Cross PLUS, even to keep your UC Care PCP Transition from Aetna to Blue Cross

  9. New Blue Cross Plans • UC Care no longer offered • New plans: • Blue Cross PLUS–point of service (POS) plan • Blue Cross PPO–preferred provider plan • Blue Cross of California will also administer Core

  10. Blue Cross PLUS In-Network • You select a PCP who authorizes your care • You pay copayment for most services • $20 for most doctor’s office visits • No claim forms

  11. Blue Cross PLUS Out-of-Network • You may choose any provider, but you pay more of the costs • Annual plan deductible • $500 individual; $1,500 family • You pay 30% for most services, after deductible • No “balance billing” if you use a Blue Cross PPO Provider • You must file claim forms

  12. Blue Cross Plus *Self-referral benefit to network providers, does not require PCP referral

  13. Preferred Provider Organization (PPO) • Highest monthly employee cost • Greatest choice of providers • No PCP • Plan pays more if you use in-network providers • Members file claims for partial payment after deductible is satisfied

  14. Blue Cross PPO • PPO network • Annual deductible: $250 individual; $750 family • You pay 20% after deductible • Out-of-network • Annual deductible: $500 individual; $1,500 family • You generally pay 40% for services • Plan pays 60% of reasonable and customary charges • You must file claim forms

  15. Blue Cross PPO

  16. Fast Track for Blue Cross PLUS • Special Fast Track worksheet included in OE booklet on Blue Cross PLUS page • Action Line will identify these members, and allow them to select PCP immediately • Don’t have to go through entire IVR application

  17. Fast Track for Blue Cross PLUS • For those currently in UC Care AND in a Blue Cross PLUS service area • Must select a PCP if they’re going into Blue Cross PLUS • Even if they want to keep the same physician

  18. Flexible Spending Accounts

  19. Flexible Spending Accounts • HealthCare Reimbursement Account • Pretax dollars for Medical, Dental & Vision out of pocket expenses • DepCare – Dependent Care Account • Pretax dollars to pay for child care or care of an incapacitated adult • Effective January 1, 2003 Flexible Spending Accounts are administered by SHPS • Positive reenrollment required for DepCare (existing DepCare enrollees will be de-enrolled on December 31, 2002, MUST reenroll)

  20. HCRA Contribution Limits • Maximum annual contribution = $5,000 • If you and your spouse are both UC employees, you may each contribute up to $5,000 • Minimum annual contribution = $180

  21. Dependent Care Reimbursement Account (DepCare) • Maximum annual contribution = $5,000 • If you and your spouse are both UC employees, your total maximum set by IRS is $5,000 • Minimum annual contribution = $180 • Now administered by SHPS, Inc. • New claim forms and procedures • Reimbursement within 11 business days

  22. SHPS is Here to Help • For more information, link to mySHPS website from At Your Service • http://atyourservice.ucop.edu • or go directly to www.shps.net • or call the SHPS Customer Service Center at 1-877-270-3915

  23. Dental, Vision, TIP, and DepCare

  24. Dental Plans – Delta Dental • Worldwide coverage—any dentist • Maximize benefits with Delta dentists • $1,500 annual maximum benefit • Premiums paid by UC/employer

  25. Dental Plans – Delta Dental • No benefit changes for 2003 • Delta Preferred Option (DPO) network • Participants save on out-of-pocket expenses for basic and major services • No special enrollment required • Approx 1/3 of Delta dentists are in PPO • Check Delta website for participating dentists

  26. Dental Plans - PMI • Prepaid dental plan - PMI dentists only • No annual maximum benefit • Premiums paid by UC/employer • No benefit changes for 2003

  27. Vision Plan - VSP • Covers exams, lenses, frames, contacts • Higher benefit with VSP providers • Discount laser surgery • Premiums paid by UC/employer

  28. Vision Plan - VSP • New in 2003: • $130 frame allowance - recharacterized in retail terms so participants better understand the value of the benefit • Members will be able to purchase annual supplies of select contact lenses at a reduced cost

  29. Tax Savings on Insurance Premiums (TIP) • Pretax payments of health plan employee monthly cost for employee and eligible family members • Additional costs for same-sex domestic partner and partner’s children/grandchildren generally not eligible • Automatically enrolled unless canceled

  30. Enrollment Procedures

  31. Before You Make Any Open Enrollment Changes • Review your personal Open Enrollment statement • Read the booklet for information about plans, programs, and rates • Complete the worksheet in the booklet

  32. Things to consider during OE • Self plus child(ren) coverage if your spouse/partner is eligible for medical coverage through another employer • Health care reimbursement account if your 2003 out-of-pocket expenses will exceed $180 • Call the plan to confirm service area, PCP, and prescription drug formulary

  33. Open Enrollment Action Line • Available 24 hrs/day from 8:00 a.m. (PST) on Friday, November 1 through midnight on Saturday, November 30 • Core employees use forms to make changes • Must be received in local Benefits or Payroll office by 5:00 p.m. on November 27 • Changes effective January 1, 2003 • Including new costs

  34. Open Enrollment Action Line 1. Complete Open Enrollment Worksheet 2. Call Open Enrollment Action Line 3. Make your changes by pressing buttons on your touch-tone phone 4. Confirm your changes and wait for confirmation number 5. Review confirmation statement when it arrives

  35. Action Line • Best to call late evenings or weekends • Don’t wait until the last week • Employees can use UC PIN or Open Enrollment code • Code on the OE statement mailed to the home

  36. Action Codes 1 Medical 2 Dental 3 Vision 4 Opt out 5 TIP 6 HCRA 7 DepCare 8 Add/Delete Family Members 9 Confirmation

  37. Add/Delete Family Members • If you transfer to a different medical plan, all enrolled family members transfer automatically—no need to reenroll them • Add new family members • Delete listed family members

  38. Confirmation • Write down 6-digit confirmation number • DO NOT HANG UP UNTIL YOU HEAR CONFIRMATION NUMBER—OR ELSE ALL YOUR CHANGES WILL BE ERASED! • Confirmation statement • Fax or mail • Review carefully—call to make more changes

  39. Life, Disability, AD&D, and Legal Other Insurance Plans

  40. Life Insurance • No benefit changes for Basic Life, Core Life, Supplemental Life or Dependent Life • Rates for Supplemental Life decreasing • No change to Dependent Life rates • Life plans not open during Open Enrollment

  41. Web resources • http://atyourservice.ucop.edu • Medical Plan Chooser • Health Pages • Carrier websites

  42. At Your Service

  43. Health Pages

  44. Health Plan Chooser

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