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California Employees

California Employees. Open Enrollment Actions. Change medical and/or dental plan Enroll in medical, dental, vision Add eligible family members Opt out of medical, dental, or vision Cancel or enroll in TIP Enroll in new Health Care Reimbursement Account Enroll in or change DepCare. Timing.

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California Employees

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  1. California Employees

  2. Open Enrollment Actions • Change medical and/or dental plan • Enroll in medical, dental, vision • Add eligible family members • Opt out of medical, dental, or vision • Cancel or enroll in TIP • Enroll in new Health Care Reimbursement Account • Enroll in or change DepCare

  3. Timing • Open Enrollment runs 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

  4. Challenges facing Large Purchasers for 2003 • Overall 2003 health plan increases ranging from 25% to 45% • Higher increases for Medicare plans • Increases across all plan types – HMOs, POS and PPO • Slow economy – limited compensation adjustments anticipated for employees • Shrinking marketplace and options (e.g., Medicare+ Choice plans)

  5. Future • State’s budget crisis continuing • Medical inflation continuing; esp. Rx • UC looking at group purchasing for Rx • May pilot a consumer model plan • Contribution strategy task force continuing

  6. UC Health Plans • An employer can control: • Who is covered • Which plans are offered • How the plans are designed • An employer cannot control: • Provider withdrawals from medical plans • Plans merging or going out of business • Plan withdrawals from service areas • Health plan policy • Example: Approved prescription drug lists (formulary)

  7. Employee Monthly Costs

  8. New Rate Structure

  9. New Rate Structure • Better aligns rates with actual cost of care for children and adults • Employee with children now less expensive than two adults or a family

  10. Transitional Allowance • Employee costs are lower for employees who earn $40,000 or less per year • Makes rates more affordable • Medical Contribution Base is determined by FTE salary rate: • As of prior January • Upon hire • No mid-year adjustments

  11. Medical Plan Choices for 2003 • Health Maintenance Organizations (HMOs) • Health Net • Kaiser • PacifiCare • Point-of-Service (POS) plan • Blue Cross Plus • Preferred Provider Organization (PPO) plan • Blue Cross PPO • Fee-for-Service plan • Core

  12. New Blue Cross Plans • UC Care (administered by Aetna) 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 the Core and High Option Plans

  13. 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

  14. Blue Cross PLUS Point-of-Service (POS) Plan • Two level plan design • network and out-of-network • combines managed care and self-referral • Network benefits through 14,000 physicians, PCP selection required, care authorized by PCP • Out-of-network benefits through 40,000 PPO physicians or all other physicians, you self refer • Employee must reside in CA • Dependents can live out-of-state and receive non-network benefits

  15. Blue Cross PLUS In-Network • Must choose PCP, Primary Medical Group (PMG), or Participating Physician Group (PPG) for each family member • Use online plan directories for provider codes • http://atyourservice.ucop.edu/ go to contacts • You pay co-payment for most services • $20 for most doctor’s office visits • No claim forms

  16. 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 • If no action taken Blue Cross will be assign a PCP. • Special worksheet included in OE packet

  17. 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

  18. PPO Provider Non-PPO Provider Cost of Service $100 (contracted rate) $150 UCR $100.00 $100 Plan pays $70 (70% of contracted rate) $70 (70% of UCR) You pay $30 (30% of contracted rate) $30 TOTAL $30 (30% of UCR) $50 (balance billing) $80 TOTAL Blue Cross PLUS: Out-of-network costs

  19. Blue Cross PPO • In-network, PPO providers • 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

  20. PPO Provider (in-network) Non-PPO Provider (out-of-network) Cost of Service $100 (contracted rate) $120 UCR $100 $100 Plan pays $80 (80% of contracted rate) $60 (60% of UCR) You pay $20 (20% of contracted rate) $20 TOTAL $40 (40% of UCR) $20 (balance billing) $60 TOTAL Blue Cross PPO: Cost example

  21. Provider Directories • Link to provider sites and Health Pages through UC benefits website • http://atyourservice.ucop.edu • Call providers directly • Toll-free numbers in Open Enrollment booklet

  22. Web resources • http://atyourservice.ucop.edu • Medical Plan Chooser • TBA • Health Pages • http://www.uc.thehealthpages.com/ • Carrier websites • http://atyourservice.ucop.edu/contact/medical_plan.html

  23. Health Care Reimbursement Account

  24. What is an FSA? • A benefit program allowing you to pay for out-of-pocket health care and/or dependent care expenses with pre-tax money • You contribute to an FSA through payroll deductions • Two types of FSAs: • Health Care Reimbursement Account (Medical, Dental, Vision) • Dependent Care Reimbursement Account • You can participate in one or both accounts

  25. Health Care Reimbursement Account (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 • HCRA contributions do not reduce the wages used to calculate UCRP benefits • HCRA contributions do not affect the calculation of your 403(b) Plan maximum annual contribution amount

  26. What are the advantages? • The tax advantages: • Tax-free money for health care & dependent care expenses • Lower income taxes • Receive reimbursement throughout the year • Health care expenses are tax-free • Immediate availability of Health Care Account funds • Built-in budgeting

  27. The FSA Tax Advantage

  28. What expenses are eligible? • Vision • Eye exams & eyeglasses • Contact lenses & supplies • Prescription sunglasses • Laser eye surgery • Dependent Care • Daycare • Private babysitter • Care for an incapacitated adult • Medical and Dental • Deductibles & co-payments • Birth control pills • Prescription drugs • Routine check-ups • Chiropractic services • Dental cleanings & fillings • Orthodontia not covered by a dental plan • And more Please see your Plan Documents for more details on eligible expenses.

  29. Who is covered? • Health Care Reimbursement Account: • Employee • Spouse and children • Other IRS qualified dependents • Dependent Care Reimbursement Account: • Children under age 13 • Mentally or physically disabled spouse • Other IRS qualified dependents who are physically or mentally unable to care for themselves

  30. How does an FSA work? It’s easy to use an FSA with SHPS’ simple 2-step process. • Step 1 • You submit a claim. • When you incur eligible expenses, you fax or mail a simple claim form to SHPS with an Explanation of Benefits (EOB) and/or receipt when EOB is not available • Claims can be submitted anytime during the current plan year. • Claims for the plan year must be received by April 15 of the following year.

  31. How does an FSA work? Step 2 SHPS sends your money. • You can choose to receive reimbursement via Electronic Funds Transfer (direct deposit) or by check. • SHPS pays claims daily for prompt service • Average turnaround for reimbursement is within 5-7 days of claim receipt. Claim turnaround will not exceed 11 days.

  32. COBRA and the Health Care FSA • How will COBRA work? • COBRA is available for continued participation upon loss of eligibility. • SHPS issues a Qualifying Event Notice to the participant for continuation of this benefit. • Cost will be monthly after-tax contribution plus 2%. • If participant elects COBRA for their Health Care FSA, SHPS will bill monthly • COBRA Billing Questions should be directed to: • (800) 301-7556

  33. Things to remember… • When you enroll, you elect an amount to cover your expected out-of-pocket health care and/or dependent care expenses for the plan year • Careful planning maximizes the benefits of an FSA • The IRS has imposed a “use it or lose it” rule. • Plan your FSA contributions wisely. • Changes to account contributions can be made at OE or upon change in family/employment status. • Expenses are reimbursed after they are incurred.

  34. SHPS is there 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

  35. 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

  36. Future options

  37. ScholarShare • California’s Golden State ScholarShare College Savings Trust • Sponsored by the State of California • Administered by TIAA-CREF • Choice of investment allocation options • Available through UC payroll beginning in Spring 2003

  38. ScholarShare • After-tax payroll deductions • Withdrawals tax free (federal and state) if used for qualified higher education expenses • Including tuition and fees, books, supplies, room and board

  39. ScholarShare • Information available at • www.scholarshare.com • Employees will receive more information in coming months • Keep ScholarShare option in mind when making decisions about DepCare and HCRA

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