Blue Shield Health Savings Plan

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

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

Medical Coverage Blue Shield PPO + Health Savings Account HealthEquity 2

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

• 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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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 - Plan Design

In Network Out of Network Deductible

Single Family

Member Cost Sharing

(Coinsurance for medical services & drugs)

Out-of-Pocket Max

(includes deductible) Single Family $1,250 $2,500 20% $4,000 $6,400 • • $2,500 $5,000 Plan pays 60% of allowed rate You pay balance $8,000 $16,000

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Deductible, Coinsurance, OOPM

Individual (Single)

Preferred Providers You pay $1250 Deductible You share cost with plan 20% Coinsurance Plan pays 100% $4000 OOPM You can use the UC Contribution to the Health Savings Account to pay part of the deductible.

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Deductible, Coinsurance, OOPM

Family (2 or more)

Preferred Providers The full family deductible must be met before plan shares costs You pay You share cost with plan Plan pays 100% $2500 Deductible 20% Coinsurance $6400 OOPM 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

PPO plans negotiate “allowed” rates to process claims.

In-Network Example

• •

Discounted rate

that plan negotiates for each service with “preferred” or participating providers 20% Coinsurance Provider charge: Allowed amount:

You

coinsurance on the discounted rate.

pay the in-network Plan pays 80%: You pay 20% Provider

can’t

“balance bill” $200 $100 $80 $20 Provider write-off: $100

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Allowed Amount – Out of Network

PPO plans assign “allowed” rates to process claims.

• •

Out-of-Network 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”

Example

40% Coinsurance Provider charge: Allowed amount: Plan pays 60%: (60% of $100) You pay 40%: You pay balance: $200 $100 $60 $40 $100

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Medical Claims, EOBs & Bills

You receive services

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

Provider sends claim

for services to Blue Shield

Provider sends bill

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

.

Blue Shield sends EOB

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

You pay provider

• Pay with HSA funds or • 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 card or Pay 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 Consumer

http://www.fairhealthconsumer.org/

Health Care Blue Book

https://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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Health Saving Account

High deductible medical plan paired with a Health Savings Account

Blue Shield PPO

+

Health Savings Account

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

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Why is HSA better?

• • • • You keep the money even if you change jobs or insurance plans 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 HSA funds rollover from year to year; no use it or lose it as with Health FSA

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Annual Contributions by UC & Employee

• UC Contribution (1/1/14) ◊ ◊ $500 individual $1000 family UC Contribution is prorated for plans that start after January 1 • You can contribute up to (optional): ◊ ◊ ◊ Single-coverage: $2,800 Family-coverage: $5,550 Catch-up contribution, age 55+: $1,000

Tip:

Contribute the money you would have put in your Health FSA.

Who is eligible for HSA?

To own an HSA you need to: • Be covered ONLY by an HSA-qualified health plan ◊ Other health coverage may disqualify you, including Health FSA, Medicare or traditional health plan • Not be claimed as a dependent on someone else’s tax return

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

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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 Health Equity website for more information

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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

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

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 make monthly contributions through payroll deduction, you can change the contribution amount during the year ◊ You can make one time contributions through Health Equity

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www.healthequity.com/ed/uc

Register as new member on this site.

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www.blueshieldca.com/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/saving s account

•

Schedule payment 29

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.

• See the Optum Evidence of Coverage for complete details.

Covered Service

Deductible Outpatient Office Visits Emergency Room

Optum Clinicians

$1,250 individual $2,500 family You pay 20% You pay 20% Inpatient Stays You pay 20%

Out-of-Network

$2,500 individual $5,000 family Plan pays 60% of allowed rate You pay balance of bill Plan pays 80% of allowed rate You pay balance of bill Plan pays 60% of allowed rate You pay balance of bill

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For more information

HealthEquity Member Services is available every hour of every day Call the Blue Shield/UC dedicated line

1.855.201.8375

say “Health Savings Account” www.healthequity.com/ed/uc www.blueshieldca.com/uc