Marie Johnson, Benefits Manager Sharon Johnson, Health Care Facilitator October 23 and 24, 2012 Open Enrollment and Benefits Plans Overview for 2013 for

Marie Johnson, Benefits ManagerSharon Johnson, Health Care Facilitator

October 23 and 24, 2012

Open Enrollment and Benefits Open Enrollment and Benefits Plans Overview for 2013Plans Overview for 2013

for Departmental Benefits Administratorsfor Departmental Benefits Administrators

Open Enrollment and Benefits Open Enrollment and Benefits Plans Overview for 2013Plans Overview for 2013

for Departmental Benefits Administratorsfor Departmental Benefits Administrators

2

Today’s TopicsToday’s TopicsToday’s TopicsToday’s Topics

IntroductionOpen Enrollment AdministrationMaking Open Enrollment Changes OnlineMedical Plans for 2013Other Health and Welfare PlansFlexible Spending Accounts - Health and

Dependent CareResources

IntroductionIntroductionIntroductionIntroduction

Benefits in 2013

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Open Enrollment for 2013Open Enrollment for 2013Open Enrollment for 2013Open Enrollment for 2013

Maintain Health and Welfare portfolio stability with modest plan changes • plans remain the same

Balance affordability from both the University and member perspectives• Modest copay increases – last increased on 2006• Using a combination of methods rate increases were

kept to only 3.9% for 2013

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Open Enrollment for 2013Open Enrollment for 2013Open Enrollment for 2013Open Enrollment for 2013

Encourage faculty and staff to read Open Enrollment booklet and look at 2013 rates• Review changes to co-pays

» First time in 7 years copays were raised

Faculty and staff must make sure they are enrolled in the medical plan that best meets their needs

Events:• Employee and Retiree Information Sessions• “Short Appointments”

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UC Health Care CostsUC Health Care CostsUC Health Care CostsUC Health Care Costs

UC Health Care costs continue to rise• UC Costs – in excess of $1.9 Billion• 2013 – 3.9% increase • 2012 – 8% increase • 2011 – 10% increase

UC held Employee monthly dollar increases to a minimum• UC pays about 87% of medical plan cost• 80% EEs – lower than $ 8/month increase

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Salary Bands for 2013Salary Bands for 2013Salary Bands for 2013Salary Bands for 2013

Employee contributions toward medical plan premiums continue to be based on salary• UC wants health coverage to be affordable for all employees;

Lower-paid employees pay less for their health coverage than higher-paid employees

Medical Contribution Base (MCB)• Employee’s premium for 2013 based on January 1, 2012 full-time

salary rate or hire date, if later• For those with two appointments, MCB is based on 100% of the

higher salary• Full-time salary is defined as monthly salary payable through the

University, which is then annualized• Includes stipends, does not include overtime, shift differentials and

other “non-salary” pay Premiums remain the same all year even if salary changes

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Salary Bands for 2013Salary Bands for 2013Salary Bands for 2013Salary Bands for 2013

2013 Salary or Pay Bands• $50,000 and below• $50,001 – $98,000• $98,001 – $147,000• $147,001 and Over

Pay Bands and Premium Rates are subject to collective bargaining• Some units still covered under prior years’ pay bands

and/or premium rates (2012)

Rate Chart handout

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Tax Savings on Insurance Tax Savings on Insurance Premiums (TIP)Premiums (TIP)

Tax Savings on Insurance Tax Savings on Insurance Premiums (TIP)Premiums (TIP)

Employee portion of medical plan premium is paid on a pretax basis

Reduces out-of-pocket medical plan premium costs to employee

Automatically enrolled unless you cancel• May opt out or opt in during Open Enrollment

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SittercitySittercitySittercitySittercity

Name Change to Select Plus Includes

• Sittercity and• Years Ahead

» Eldercare with Needs Assessment, Care Recommendation and Information Gathering

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Pre-Retirement PlanningPre-Retirement PlanningPre-Retirement PlanningPre-Retirement Planning

HR Benefits» 10 Steps to Planning your UC Retirement» Read the Retirement Handbook (answers most questions

people have about retirement)» Review retirement estimates on At Your Service

Retirement Center » Pre-Retirement Planning Program

Fidelity Retirement ServicesRetirement Administration Service Center (RASC) at

510-987-0900 » Monday to Friday, 8:30am - 4:30pm PT» https://secure.ucop.edu/secureapps/ays/csform.html

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Handling RetirementsHandling RetirementsHandling RetirementsHandling Retirements

The Retirement Administration Service Center RASC is processing almost all of Berkeley’s retirements• Survey results - high level of satisfaction with service

When employees are ready to retire• 4 months before retirement, submit request for a

Retirement Initiation Kit

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Retirement Savings ProgramRetirement Savings ProgramRetirement Savings ProgramRetirement Savings Program

Retirement Savings is very important• It’s never too late, but - the earlier you start, the more money

you will accumulate

UC provides a wonderful FREE benefit in the educational workshops and online tools available to faculty and staff• Department Flyer

MAC limits for 2012• Under 50 will be $17,000

• Over 50, will be $22,500

• Catch-up amount remains at $5,500

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Fidelity Retirement ServicesFidelity Retirement ServicesFidelity Retirement ServicesFidelity Retirement Services

Manages and record keeps the DCP, 403(b) and 457(b) plans• Department Workshops • Laura Crymble, [email protected], 510-368-5436• 1-866-682-7787 and www.netbenefits.com: New

accounts, exchanges, distributions, fund options, service inquiries

• Internal Planning & Guidance (IPGC), 800-558-9182: CAP elections, rollovers, retirement income planning, planning and savings goals outside of retirement, stay in plan options for terminated employees

• PGC – 1:1 appointments scheduled through IPGC

Open Enrollment AdministrationOpen Enrollment AdministrationOpen Enrollment AdministrationOpen Enrollment Administration

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Eligible Family MembersEligible Family MembersEligible Family MembersEligible Family Members

DBCs, please remind faculty and staff:• To check that all enrolled family members meet eligibility

criteria

Audit for proof of dependents’ eligibility• Severe penalties apply if UC finds ineligible family

members on employees’ plans

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Review of Open Enrollment Review of Open Enrollment Actions and TimingActions and Timing

Review of Open Enrollment Review of Open Enrollment Actions and TimingActions and Timing

October 29th, 8:00 a.m. – November 20th, 5:00 p.m. Faculty, Staff and Retirees make Open Enrollment

changes online• Use the At Your Service website to make changes• Faculty and Staff who are BELIs 1, 2, 3 & 4

Faculty and Staff must re-enroll in Flexible Spending Accounts for participation in 2013• Health Flexible Spending Account (Health FSA)• Dependent Care Flexible Spending Account (DepCare FSA)

Confirm your choices online!!! • Keep your confirmation statement

Employees are responsible for reporting any mistakes in a timely manner• Check your January 1st pay statement!

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Open Enrollment ActionsOpen Enrollment ActionsOpen Enrollment ActionsOpen Enrollment Actions

Enroll in or change medical or dental plan Enroll eligible family members in

medical/dental/vision Re-enroll or enroll in the DepCare FSA and/or the

Health FSA Opt into or out of medical, dental, vision plans

and/or TIP “Make Quick Changes”

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If you do nothing…If you do nothing…If you do nothing…If you do nothing…

If you take no action during Open Enrollment, current plans will continue in 2013 except:

• Participation in the DepCare FSA and/or the Health FSA plans ends 12/31/12.

• To continue participation in 2013, you must re-enroll during Open Enrollment.

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Open Enrollment CommunicationsOpen Enrollment CommunicationsOpen Enrollment CommunicationsOpen Enrollment Communications

Open Enrollment information • Faculty and Staff hired and entered into HCM before 8/29/12: Open

Enrollment information booklet to home address» Faculty and Staff hired and/or entered into HCM after 8/29/12: Help them

find the Open Enrollment information; give employee copy of booklet and guide them to website information

• Core employees get a separate mailing Open Enrollment posters

• Please post in your department• Remind employees that Open Enrollment ends November 20 th at

5:00 p.m. Open Enrollment DBC email announcements

• Forward to those who have email• Please print messages and distribute to employees who do not use

computers or email at work

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Open Enrollment InformationOpen Enrollment InformationOpen Enrollment InformationOpen Enrollment Information

Cal Message will go out next week HR web (campus specific information)

• http://hrweb.berkeley.edu» Choose “Open Enrollment for 2013” under “Important News”» Link to At Your Service

At Your Service website • http://atyourservice.ucop.edu

• Choose the Open Enrollment icon on home page

• Direct employees here for full Open Enrollment information and to take action

» highlights in Spanish

All changes effective January 1, 2013

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Information SessionsInformation SessionsInformation SessionsInformation Sessions

Faculty/Staff/Non-Medicare Retiree Information Sessions• October 31st, 10:00 a.m. – 11:30 a.m.• November 6th, 1:00 p.m. – 2:30 p.m.

Medicare Retiree Information Sessions• October 26th, 10:00 a.m. – 11:30 a.m.• November 6th, 10:30 a.m. – 12:00 noon

All presentations will be held in 150 University Hall

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Individual AppointmentsIndividual AppointmentsIndividual AppointmentsIndividual Appointments

For all Faculty, Staff and Retirees Will be held at 2199 Addison Street, Room 192, Berkeley

November 2nd, 8:00 a.m. – 5:00 p.m. November 9th, 8:00 a.m. – 5:00 p.m. November 16th, 8:00 a.m. – 5:00 p.m.

Please call 510-642-7053 to schedule your personal

15 minute appointment

Computer assistance is available for help with Open

Enrollment actions

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What if an employee needs help?What if an employee needs help?What if an employee needs help?What if an employee needs help?

We ask DBCs to assist employees by …• Finding a computer to use• Finding Open Enrollment information

» Open Enrollment information booklet» Online at At Your Service» Contact information for medical and dental plans

• Notifying them about Open Enrollment events• Finding their current enrollments• Setting their UC Password

» Can be done on-line; members usually do not need to call HR Benefits

• Finding PCP ID#

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What if an employee needs help?What if an employee needs help?What if an employee needs help?What if an employee needs help?

If an employee has trouble using the Open Enrollment web application, we ask DBCs to:• Verify that all personal and appointment data is correct

in HCM and PPS systems• Try to assist employees in making Open Enrollment

changes online• If still having problems…

Call 510-664-9831

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Open Enrollment Problem ReportingOpen Enrollment Problem Reporting

Provide the following information when reporting an Open Enrollment systems problem:• Employee name• Employee’s work phone number and email address• Employee’s ID #• Date/Time problem occurred• What page was the user on (Quick Changes, Family

Member, Medical, Dental, etc.)• What was the user trying to do

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Special Situations: New HiresSpecial Situations: New HiresSpecial Situations: New HiresSpecial Situations: New Hires

New employee should use online New Hire application in most cases • For initial enrollment in plans during PIE

• Enroll eligible family members in medical/dental/vision plans

• Effective date: date of hire

New employee might also use online Open Enrollment application in some cases • To enroll in the DepCare FSA and/or the Health FSA for 2013

• To change medical and/or dental plans for 2013

• Effective date: January 1, 2013

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Special Situations: Special Situations: Employees on LeaveEmployees on LeaveSpecial Situations: Special Situations:

Employees on LeaveEmployees on Leave

Make Open Enrollment changes online

Employees continuing to pay their benefits while on a leave of absence must contact Payroll: Benefits Accounting Unit regarding new premium amounts for January 2013.• Angela Dizon, [email protected] or 642-0684 • Payroll

» 2195 Hearst Avenue, Room 130 Warren Hall, MC #1108

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Special Situations: Employee Can’t Special Situations: Employee Can’t Use Open Enrollment Web ApplicationUse Open Enrollment Web Application

Special Situations: Employee Can’t Special Situations: Employee Can’t Use Open Enrollment Web ApplicationUse Open Enrollment Web Application

Employee may use form for if:• Newly hired employee and information not in

HCM by 11/13/12• Updated employee information not in HCM by

11/13/12• Employee is out of the country• Employee on Leave of Absence and has no

computer access

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Special SituationsSpecial SituationsSpecial SituationsSpecial Situations

If a form is used:• Employee must fill out UPAY 850 form

» Available only online at At Your Service• Link on hrweb.berkeley.edu

• Must use correct version or form will be returned » Tip: At Your Service website always has the most current version

• Check box that says “Open Enrollment”» First box under #3 and under Change

• Enrollment process will be delayed, ID cards will be mailed late January 2013

» Coverage is still effective January 1, 2013• Include note that provides explanation of the reason the

employee could not use the web• Send, email, or fax (510-643-6856) form(s) and explanation to

Sharon Johnson, HR Benefits, [email protected]

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Special Handling NeededSpecial Handling NeededSpecial Handling NeededSpecial Handling Needed

There can be system challenges with some Open Enrollment actions if:

Employee has a newly eligible dependent(s) in December – need to add ASAP (must use form)

Employees making Open Enrollment changes are separating in December• Department must contact HR Benefits Unit before separating

employee to coordinate benefits continuation…

A – LRuby Thomas [email protected] 643-5835

M – Z Shelia Taliaferro [email protected] 643-7986

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Special Handling Needed for those Retiring in November or DecemberSpecial Handling Needed for those Retiring in November or December

If Open Enrollment changes are desired and employee is retiring during Open Enrollment:• Send UBEN 100 to HR Benefits, Attn: Sharon Johnson. Do not

use the Employee or Retiree Open Enrollment online application. • On the UBEN 100, check “Open Enrollment” and “Retirement”

boxes and include Retirement Date.• Changes will be effective January 1, 2013

If Open Enrollment changes are desired and employee is retiring after Open Enrollment:• Use Employee Open Enrollment online application to make any

changes wanted for January 1, 2013.• Send Open Enrollment confirmation statement with UBEN 100 to

Retiree Insurance» University of CA, RASC, P.O. Box 24570, Oakland, CA 94623, attn:

Retiree Insurance Program

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Canceling CoverageCanceling CoverageCanceling CoverageCanceling Coverage

Reminder: Employees can cancel or opt out of coverage at anytime except:• DepCare FSA • Health FSA

» IRS regulations govern these plans

» Check Summary Plan Descriptions for details

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Postdoc Open EnrollmentPostdoc Open EnrollmentPostdoc Open EnrollmentPostdoc Open Enrollment

October 29th, 8:00 a.m. – November 20th, 5:00 p.m. Changes are effective January 1, 2013 Full information sent to all Postdocs via email from

Sam Castaneda in VSPA Make changes on Garnett-Powers (GPA) website

• Go to www.garnett-powers.com• From the GPA website there will be a link to At Your Service for online

enrollment changes• If online enrollment is not an option Postdocs can use the Enrollment,

Change, Cancellation or Waiver form located on the GPA website• Refer to handout

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RetireesRetireeswho are receiving monthly benefits from the UC Retirement Systemwho are receiving monthly benefits from the UC Retirement System

RetireesRetireeswho are receiving monthly benefits from the UC Retirement Systemwho are receiving monthly benefits from the UC Retirement System

October 29th, 8:00 a.m. - November 20th, 5:00 p.m. Retirees: Open Enrollment information booklet mailed to

home address Retirees make changes using the At Your Service website• Must use their UC password

» Forgot password?? Can request new one online or » Contact RASC

• 1-800-888-8267, option 4

Rehired Retirees• If receiving benefits as a retiree, must make changes as a retiree

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Resources for RetireesResources for Retireeswho are receiving monthly benefits from the UC Retirement Systemwho are receiving monthly benefits from the UC Retirement System


If a form is needed• UBEN 100 Retiree Continuation, Enrollment or

Change-Medical, Dental and/or Legal Plan» (rev 10/12)

• Form is available at: » At Your Service website, http://atyourservice.ucop.edu/

» Call RASC at 1-800-888-8267, option 4

» Email: https://secure.ucop.edu/secureapps/ays/csform.html

» Contact Berkeley HR Benefits Unit, 510-664-9831 or [email protected]

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Health Care Facilitator Program at UCB• Sharon Johnson, HCF, 510-664-9831or

[email protected]

• RASC»1-800-888-8267, option 4 or

https://secure.ucop.edu/secureapps/ays/csform.html

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COBRA Participants are COBRA Participants are Eligible for Open EnrollmentEligible for Open Enrollment

COBRA Participants are COBRA Participants are Eligible for Open EnrollmentEligible for Open Enrollment

COBRA Open Enrollment will be handled by CONEXIS• CONEXIS will mail information, 2013 rates, and paper

forms to all COBRA participants• COBRA participants may view detailed plan changes

online on http://atyourservice.ucop.edu/• All questions should be referred to CONEXIS

COBRA participants must submit Open Enrollment changes directly to CONEXIS• Via website at www.conexis.com, or• Via paper form included in mailing• 1-877-722-2667

Medical Plans for 2013Medical Plans for 2013 Medical Plans for 2013Medical Plans for 2013

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2013 Medical Plans2013 Medical Plans2013 Medical Plans2013 Medical Plans

Overview of Medical Plans• HMOs

» Standard Health Net» Health Net Blue & Gold» Kaiser

• Anthem Lumenos PPO/HRA• Anthem Blue Cross PLUS• Anthem Blue Cross PPO• CORE

Behavioral Health Program• UBH now Optum– No changes

Wellness Program• Staywell• Kaiser Healthworks and My Health Manager

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Plan Changes for 2013Plan Changes for 2013Plan Changes for 2013Plan Changes for 2013

Office Visit Copay

OP Surgery/ASCIn-Network Copay Rx Copay

Emergency Room Copay

Plan Impacted 2012 2013 2012 2013 2012 2013 2012 2013

HealthNet B&GHealthNet HMO

$15 $20 $0 $100Retail: $5/$20/$35

Mail: $10/$40/$70

Retail: $5/$25/$40

Mail: $10/$50/$80$50 $75

Kaiser WHA

$15 $20 $15$100

Retail: $5/$20/$35

Mail: $10/$40/$70

Retail: $5/$25/$40

Mail: $10/$50/$80$50 $75

Anthem PLUS $20 $25 $0 $100Retail: $10/$25/$40

Mail: $20/$50/$80

Retail: $10/$30/$45

Mail: $20/$60/$90$75 $100

Anthem PPO N/A N/A N/A N/ARetail: $10/$25/$40

Mail: $20/$50/$80

Retail: $10/$30/$45

Mail: $20/$60/$90N/A N/A

Office visit co-pay also applies to Optum (Behavioral Health)

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2013 Plan Changes: Benefit Limit on Outpatient 2013 Plan Changes: Benefit Limit on Outpatient Surgery – Out-of-Network Ambulatory Surgical CenterSurgery – Out-of-Network Ambulatory Surgical Center

2013 Plan Changes: Benefit Limit on Outpatient 2013 Plan Changes: Benefit Limit on Outpatient Surgery – Out-of-Network Ambulatory Surgical CenterSurgery – Out-of-Network Ambulatory Surgical Center

Anthem Blue Cross Plans

2012 2013

PLUS (non-Medicare and Medicare)

PPO (non-Medicare and Medicare)

Lumenos PPO with HRA

Core (non-Medicare and Medicare)

High Option

No benefit limitLimit benefit to $350 with prior authorization requirement

•A consumer protection measure.•Helps manage out-of-network outpatient surgery utilization in the Anthem plans•Prevents fraud and abuse by out-of-network providers•Prior authorization requirement protects members & allows Anthem to steer member to participating provider.

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Plan Changes: Women’s Preventive Plan Changes: Women’s Preventive Services at $0 Co-payServices at $0 Co-pay

Plan Changes: Women’s Preventive Plan Changes: Women’s Preventive Services at $0 Co-payServices at $0 Co-pay

Type of Preventive Service Frequency

1. Well-woman visits. Annual

2. Screening for gestational diabetes. In pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes.

3. Human papillomavirus testing. Screening should begin at 30 years of age and should occur no more frequently than every 3 years.

4. Counseling for sexually transmitted infections. Annual.

5. Counseling and screening for human immune-deficiency virus.

Annual.

6. Contraceptive methods and counseling. As prescribed.

7. Breastfeeding support, supplies, and counseling. In conjunction with each birth.

8. Screening and counseling for interpersonal and domestic violence.

Annual.

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Health Net Blue and GoldNetwork Changes for 2013Health Net Blue and Gold

Network Changes for 2013

Removing: Monarch (Orange County)

Brown and Toland (San Francisco County)

Adding: ARTA Health Network (Orange County)

Memorial Care Medical Group (Orange County)

Premier Physicians Network (Los Angeles County)

Physicians Medical Group of San Jose (Santa Clara County)

Affinity Medical Group – Eden/San Leandro (Alameda County)

Vantage Medical Group (San Diego County)

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Health Net Blue & Gold Network ChangesHealth Net Blue & Gold Network ChangesHealth Net Blue & Gold Network ChangesHealth Net Blue & Gold Network Changes

Health Net Blue & Gold members who are losing their medical group/PCP will want to consider their options

Health Net will send letters to affected members» Contact HN to change medical group or PCP

or

» Visit http://atyourservice.ucop.edu to change plans

» Letter will address transition of care Reminder: Changes to PCP or medical group are not an

OE “event”• Plan members should call Health Net to change PCP

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What is an HMO?What is an HMO?What is an HMO?What is an HMO?

You must live or work in plan’s service areaYou must receive services from network

providers • You select a Primary Care Physician (PCP) who coordinates

your care • Preauthorization required for services and specialists

Out-of-area: emergency services onlySmall copayment for most servicesNo claim forms; no annual deductibleStandardized benefits

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Standard Health Net HMOStandard Health Net HMOStandard Health Net HMOStandard Health Net HMO

Premium planFull network of providers includes:

• Brown & Toland• Sutter East Bay Medical Foundation

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Health Net Blue & Gold HMOHealth Net Blue & Gold HMOHealth Net Blue & Gold HMOHealth Net Blue & Gold HMO

Custom network Subset of Standard Health Net HMO network

Alta Bates Medical Group participating• Alta Bates-Summit Hospital, Berkeley

• Summit Medical Center, Oakland

• Tang Center

• All PCPs and Specialists

Sutter East Bay Medical Foundation not participating

• UC and Sutter unable to reach an agreement

All UC Medical Groups/Medical Centers included.

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Health Net Blue & Gold HMOHealth Net Blue & Gold HMOHealth Net Blue & Gold HMOHealth Net Blue & Gold HMO

Health Net Blue & Gold HMO was created exclusively for University of California employees and non-Medicare retirees, and their families

• Same great benefits as the standard Health Net HMO

The difference is the network• Blue & Gold HMO features a select network of

participating providers• Blue & Gold HMO includes more cost efficient providers• Blue & Gold HMO costs less for the University and the

individuals who choose it

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Kaiser PermanenteKaiser PermanenteKaiser PermanenteKaiser Permanente

Value planOne-stop serviceSeamless technologyPreventive careHealthy Lifestyle programs

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Anthem Lumenos PPO Anthem Lumenos PPO Anthem Lumenos PPO Anthem Lumenos PPO

While it has lower cost premiums, you will need to be aware of:• Must be prepared to pay as much as out of pocket

maximum» Calendar year deductible:

• $700, single to $1400, family

» Out-of-Pocket Maximum• $5,000 to $20,000 (depends on level of coverage and in

vs. out of network)

» Plan pays 80% of “usual and customary”

» Member pays 20% and any amount above “usual and customary”

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• Stay healthy with Preventive Care coverage

• Your employer makes an annual allocation to your account

• Use your account dollars to pay for medical care and prescription drugs

• Once you spend all of the funds from your HRA, you pay an out-of-pocket amount to satisfy your annual deductible

• Unused funds rollover year to year to help offset future out-of-pocket costs

• Traditional Health Coverage then covers additional expenses (similar to a PPO when you are accountable for a coinsurance amount)

• An annual out-of-pocket maximum limits the amount you have to pay

Preventive Care100% <In-Network>

+

HRA Funded by annual employer allocation

+

Annual Deductible

Out of Pocket

=

Traditional Health Coverage <80%> In-Network Providers<60%> Non-Network Providers

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Anthem Lumenos PrescriptionsAnthem Lumenos PrescriptionsAnthem Lumenos PrescriptionsAnthem Lumenos Prescriptions

Payments are made directly from your HRA account to the pharmacy

• Prescriptions are full price until deductible is met• If no funds are available, member pays the discounted rate at

the pharmacy until annual deductible has been met• Once annual deductible is met and the Traditional Health

Coverage portion of the plan begins – member pays the appropriate coinsurance amount

• Payments are made directly from your HRA account to the pharmacy

• Prescriptions by mail:Order a 90-day prescription drug supply

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Anthem Lumenos Stand Alone HRAAnthem Lumenos Stand Alone HRAAnthem Lumenos Stand Alone HRAAnthem Lumenos Stand Alone HRA

Lumenos members eligible for SAHRA• Retiree/family member becomes eligible for Medicare• Transfers to another UC medical plan

• More than $100 in HRA

SAHRA created after claims run-out period• Eligible expenses

» Covered expenses for medical, dental, vision, pharmacy, behavioral health

» Deductibles, copayments / coinsurance» Medical plan premiums, Medicare Part B premiums not

reimbursed by UC• No additional UC funds added• SAHRA available until funds exhausted

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What you might expect, and then some• Health care dollars to spend your way – and save for

the future

• Preventive care coverage – for nationally recommended preventive services

• Provider choice – and discounts from thousands of doctors and hospitals nationwide to help your health care dollars go further

• Personalized services and tools – online and by phone to help you maintain and improve your health

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How does Anthem Blue Cross Plus work?How does Anthem Blue Cross Plus work?(Point of Service)(Point of Service)


Two level plan design

• In-network care is coordinated by PCP, authorization required for specialty services

• Out-of-network, self-referral• Combines HMO managed care model with self-

referral

You must reside in California service area• Dependents who live out of state and receive out-of-

network benefits

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Network benefits through chosen PCP• PCP/medical group must preauthorize your

care (works like an HMO) • You pay a copayment for most services

» $25 co-pay for most doctor’s office visits» Authorization required for specialists» No deductibles or claims forms

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Out-of-network benefits through any physician• You may choose any provider

» Use Blue Cross PPO physicians for lower out of pocket costs

• Annual deductible: $500 individual; $1,500 family

• Cost (after deductible):» Blue Cross PPO provider: Plan pays 70%, you pay 30%

» Non-PPO provider: Plan pays 70% of usual and customary, you pay remaining balance

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Anthem Blue Cross PPOAnthem Blue Cross PPO(Preferred Provider Organization)(Preferred Provider Organization)

Anthem Blue Cross PPOAnthem Blue Cross PPO(Preferred Provider Organization)(Preferred Provider Organization)

No PCP referral necessary – you choose any doctor Network: You choose a Blue Cross PPO physician

• Annual deductible: $250 individual; $750 family• Cost (after deductible): Plan pays 80%, you pay 20% • Providers accept contracted rate• No claim forms

Out-of-Network: You choose a non-Blue Cross provider• Annual deductible: $500 individual; $1,500 family• Cost (after deductible): Plan pays 60% of usual and customary

charges, you pay remaining balance• You may need to pay out-of-pocket, and file claim forms for

reimbursement

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If you move outside CaliforniaIf you move outside CaliforniaIf you move outside CaliforniaIf you move outside California

Nationwide and Worldwide plans• Anthem Blue Cross PPO• Anthem Lumenos• Core

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Wellness Benefit: StaywellWellness Benefit: StaywellWellness Benefit: StaywellWellness Benefit: Staywell

• 100 points to earn incentive Step 1: Health Assessment = 50 points Step 2: Follow-up Activity = 50 points

• $100 incentive for employees and retirees, $50 for spouse/DP

• NEW: Campus programs are now eligible for the Step 2 activities

• Can complete Step 2 in any order -- before or after completing a Health Assessment.

• Health Assessment is required and must be completed by June 15, 2013 to earn the incentive.

• All follow-up programs and NextSteps programs (if eligible) must be completed by December 15, 2013.

Eligible for StayWell

NextSteps

UC Location Specific Events Education Session Health Screening Healthy Lifestyle Program Location Fitness Activity One-to-One Consultation Wellness Challenge UC Walks

(25 pts each)

Complete two activities from either of the two boxes below to earn a total of 50 points (25 points per activity).

StayWell Online Classrooms Nutrition 101 Nutrition 201 Back Care Stress Management Weight Management Physical Activity Tobacco Cessation

(25 pts each) UC Location Specific Events Education Session Health Screening Healthy Lifestyle Program Location Fitness Activity One-to-One Consultation Wellness Challenge UC Walks

(25 pts each)

StayWell Online Classrooms Nutrition 101 Nutrition 201 Back Care Stress Management Weight Management Physical Activity Tobacco Cessation

(25 pts each)

Not eligible for StayWell NextSteps

Step 2

Complete two activities from either of the two boxes below to earn a total of 50 points (25 points per activity).

Step 2

Complete one Follow-up Program.

Select from: NextSteps Phone-based NextSteps Mail-based Healthy Living Program - Online

(50 pts)

Step 1 (Required)Complete Health AssessmentOnline or Paper

(50 points)

https://uclivingwell.online.staywell.com

OR

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Wellness Program: StaywellWellness Program: StaywellWellness Program: StaywellWellness Program: Staywell

Staywell Eligibility • Staywell is available to employees and retirees who are enrolled in a UC-

sponsored health plan» Kaiser members are not eligible for StayWell and have access to wellness programs

through Healthworks and My Health Manager

• While new hires are eligible to take the HA and participate in any coaching programs, they are not eligible to receive the incentive

• Staywell is not available to members living outside of the US

• Several unions at UC have chosen not to participate at this time» AFSCME 3299» CNA » UAW 2863» UPTE-CWA» Please see complete list of unions opting out of StayWell Health Assessment:

http://www.uhs.berkeley.edu/facstaff/healthmatters/healthassessment.shtml

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Wellness BenefitWellness Benefit::Kaiser HealthworksKaiser HealthworksWellness BenefitWellness Benefit::Kaiser HealthworksKaiser Healthworks

Available to active and retired Kaiser members

Health Assessment (HA) Questionnaire – Online (only)• Immediate personalized, confidential results• Proof of completion of HA and purchase a Rec Sports

membership, get two months free

Health Improvement Programs online and at Kaiser locations

My Health Manager • Online tools and resources to schedule appointments, order

refill prescriptions, check lab results, email your doctor and more

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Campus Wellness ProgramsCampus Wellness Programs

Health*Matters - UCB’s wellness program for Faculty & Staff

uhs.berkeley.edu/facstaff/healthmatters

• Know Your Numbers Health Screening

• Healthy Lifestyle Programs and Challenges

• Cal Walks: Walking Group MWF, Step Up to Fitness pedometer program

• Workshops and webinars, Nutrition to Kitchen classes

• Breastfeeding Support Program

• Smoking cessation individual consultations, department workshops, resources.

• For Supervisors: Supporting Wellness at Work

Recreational Sports – calbears.berkeley.edu

• RSF membership bonus for completion of Health Assessment (see details at RSF website after January)

• 30-day free trial for faculty and staff

• WorkFit – onsite fitness program

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Wellness Services for DepartmentsWellness Services for DepartmentsWellness Services for DepartmentsWellness Services for Departments

UC Living Well Communications to DBC’s• Health*Matters Newsletter: email sent once a month to

DBC’s for distribution to all department faculty/staff • Occasional flyers for posting

Wellness Ambassadors – new program transitioning from Dept Wellness Network

• Wellness Ambassadors – communication role to spread the word to colleagues about campus wellness programs

• Contact Health*Matters at 643-4646

Healthy Meetings and Events • Healthy Meeting Guidelines; Instant Recess video for activity breaks

uhs.berkeley.edu/facstaff/healthmatters/healthymeetings.shtml

WorkFit (sponsored by Recreational Sports)

• Onsite fitness program with personal trainers from Rec Sports

Other Health & Welfare PlansOther Health & Welfare PlansOther Health & Welfare PlansOther Health & Welfare Plans

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Other Health & Welfare Benefits Other Health & Welfare Benefits Other Health & Welfare Benefits Other Health & Welfare Benefits

Delta Dental PPO• No plan or rate changes

DeltaCare USA• Federally mandated screenings, such as for children

entering kindergarten, are offered at no cost • Preventive resin restoration for permanent teeth of children

to age 15 offered at no cost.

VSP – Vision• No plan or rate changes

ARAG Legal• Open for 2013• No plan or rate changes

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Other Health & Welfare BenefitsOther Health & Welfare BenefitsSupplemental Life, Supplemental Disability and AD&DSupplemental Life, Supplemental Disability and AD&D

Other Health & Welfare BenefitsOther Health & Welfare BenefitsSupplemental Life, Supplemental Disability and AD&DSupplemental Life, Supplemental Disability and AD&D

Supplemental Life – Employee and Dependent (Prudential)• No plan or rate changes • Not open during Open Enrollment

» May enroll through Statement of Health at anytime, subject to carrier approval

Supplemental Disability (Liberty Mutual)• Maximum monthly benefit increasing from $10,000 to $15,000 per month

» New maximum covered salary: $21,429 per month» Affected UC employees will receive notification

• Not open during Open Enrollment» May enroll through Statement of Health at anytime, subject to carrier

approval

• No rate changes AD&D (AIG Benefits Solutions)

• No plan or rate changes• Can enroll at anytime

» UPAY 850

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Health Care Facilitator ProgramHealth Care Facilitator ProgramHealth Care Facilitator ProgramHealth Care Facilitator Program

The Health Care Facilitator (HCF) program is here to help faculty and staff, retirees, survivors and their eligible family members better understand and obtain the full benefits and services available from the UC-sponsored health plans. • Understand your UC health plan coverage and patient rights

• Define your health care issues

• Navigate the health care system

• Resolve issues or problems with your doctor, medical group, medical plan carrier, dental or vision plans

• Understand how Medicare benefits coordinate with UC-sponsored medical plans

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Health Care Facilitator ProgramHealth Care Facilitator ProgramHealth Care Facilitator ProgramHealth Care Facilitator Program

Things to do before contacting the Health Care Facilitator program:

• Contact your doctor’s office• Contact your medical group• Contact your health plan

If you still need help,

Call 510-664-9831or

Send an email to: [email protected]

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Please fill out Evaluation FormPlease fill out Evaluation FormPlease fill out Evaluation FormPlease fill out Evaluation Form

Questions???

Resources for DBCsResources for DBCsResources for DBCsResources for DBCs

University of California University of California Flexible Spending Accounts Flexible Spending Accounts

ProgramProgram

University of California University of California Flexible Spending Accounts Flexible Spending Accounts

ProgramProgram

Health FSAHealth FSADepCare FSADepCare FSA

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Important points about theImportant points about theFlexible Spending PlansFlexible Spending Plans

Important points about theImportant points about theFlexible Spending PlansFlexible Spending Plans

Health FSA maximum changed to $2,500 per yearDepCare FSA maximum remains at $5,000 per

yearResearch plan(s) carefully before enrollingUse it or Lose it plansChange or cancel only with qualifying life or job

eventReview information on microsite

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What is a Flexible Spending What is a Flexible Spending Account and How Does It Work?Account and How Does It Work?

What is a Flexible Spending What is a Flexible Spending Account and How Does It Work?Account and How Does It Work?

Administrator: CONEXIS Save taxes on eligible planned out-of-pocket health

and/or dependent care expenses• Use to help offset the rising cost of health and dependent care

expenses Contribute to the plan each month with pre-tax earnings

through payroll deduction Submit claims for reimbursement of eligible out-of-pocket

expenses from the DepCare or Health FSA, or use the Health FSA Benefit Card to access the funds in your Health FSA account• Save ALL receipts as documentation for the IRS

Estimate annual contributions carefully – if you don’t use all of your contributions, you lose it

Re-enroll annually to continue participation

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Your FSA Money – “Use It or Lose Your FSA Money – “Use It or Lose It” by end of Grace PeriodIt” by end of Grace Period

Your FSA Money – “Use It or Lose Your FSA Money – “Use It or Lose It” by end of Grace PeriodIt” by end of Grace Period

Participants in 2013 have from January 1, 2013 to March 15, 2014 to incur eligible health care and dependent care expenses

• Grace period for 2012 participants ends March 15, 2013 Employees forfeit any money not spent by the end of the

grace period• IRS Rule (Section 125 of IRS Code)• Funds cannot be rolled over to the next plan year and cannot be paid

out without eligible expenses• All contributions not spent on eligible expenses by March 15th will be

forfeitedPlan carefully when making electionsClaims must be submitted by:

• 2012 claims – April 15, 2013• 2013 claims – April 15, 2014

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FSA Savings comparison – example FSA No FSA

Annual Taxable Income $35,000 $35,000

Out-of-Pocket Expenses:

•Healthcare $1,000 $0•Dependent Care $2,500 $0Total Pre-tax Contributions ($3,500) $0

Taxable Income after FSA Contributions $31,500 $35,000

Federal & State Income & Social Security Taxes (40%) ($12,600) ($14,000)

After-Tax Income $18,900 $21,000After-Tax Dollars Spent on Health and Dependent Care Expenses $0 $3,500

Take-home Pay $18,900 $17,500Increased Take-home Pay $1,400 $0

Tax Savings ExampleTax Savings ExampleTax Savings ExampleTax Savings Example

78

Dependent Care Flexible Spending Dependent Care Flexible Spending Account (DepCare FSA)Account (DepCare FSA)

Dependent Care Flexible Spending Dependent Care Flexible Spending Account (DepCare FSA)Account (DepCare FSA)

DepCare FSA allows participants to pay for employment-related dependent care services for qualifying individuals on a pre-tax basis

• For example, children under 13 DepCare maximum: $5,000 per household/family,

$180 minimumFunds are available as contributions are madeIf a participant ends participation in the plan, they

are eligible to claim expenses up to the contribution amount for any dates of services incurred prior to plan’s termination date

Compare to Federal Tax Credit

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Health Flexible Spending Account Health Flexible Spending Account (Health FSA)(Health FSA)

Health Flexible Spending Account Health Flexible Spending Account (Health FSA)(Health FSA)

Use the Health FSA account to reimburse qualified out-of-pocket medical, dental, and vision expenses

• For yourself• Your spouse (at this time, IRS only recognizes opposite sex spouses)

• For anyone claimed as a tax dependent on your Federal income tax return

Account maximum: $2,500 per UC employee, $180 minimum• Formerly $5,000 per UC employee per year

Must take action if going on leave of absence without pay or FMLA (paid or unpaid)

Employees who leave employment can only file for expenses incurred prior to plan’s termination date

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Health FSA Benefit CardHealth FSA Benefit CardHealth FSA Benefit CardHealth FSA Benefit Card

The card functions like any other credit card anywhere VISA is accepted to pay for qualified purchases

You spend only the money in your Flexible Spending Account

Your annual amount is available January 1st Key Benefits: Easy to use, No waiting for reimbursement,

Eliminates some claim forms, Reduces paperwork

Common Purchases and Uses for the card: Prescriptions, Eligible over-the-counter healthcare products, Office visits to a physician or dentist, vision service providers, hospital charges

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Health FSA Benefit Card ProcessHealth FSA Benefit Card ProcessHealth FSA Benefit Card ProcessHealth FSA Benefit Card Process

Participants will be mailed a benefit card from CONEXIS

Need additional cards for dependents?• Login to the participant account on CONEXIS website

and order (after January 1)Some transactions can be auto-approved

• Co-pay Matching• IIAS approval (point of sale)• Recurring Expense• Electronic Feeds from Insurance Carriers

If transaction cannot be auto-approved, CONEXIS notifies employee that action is required for approval

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Health FSA Benefit Card ProcessHealth FSA Benefit Card ProcessHealth FSA Benefit Card ProcessHealth FSA Benefit Card Process

CONEXIS will email employee a monthly statement indicating

• Substantiate a purchase• Status of benefit card• Account balance

If employee does not access their electronic statement, CONEXIS will mail a statement to the employee’s home address

For IRS purposes, third-party receipts must be obtained and retained when using the benefit card, even if not needed by CONEXIS

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Procedures for Paper Claims Procedures for Paper Claims and contacting CONEXISand contacting CONEXIS

Procedures for Paper Claims Procedures for Paper Claims and contacting CONEXISand contacting CONEXIS

Participants can mail, fax, or upload paper claims to CONEXIS

Participants can mail, fax, or upload the monthly card activity statement with required documentation to substantiate purchases to CONEXIS

Microsite: www.conexisfsa.com• Information regarding plan

Website: www.conexis.com• Email

Telephone• Call 1-800-482-4120

Create a web case inquiry on the participant web account

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DepCare FSA, Health FSA, TIPDepCare FSA, Health FSA, TIPand UCRS plansand UCRS plans

DepCare FSA, Health FSA, TIPDepCare FSA, Health FSA, TIPand UCRS plansand UCRS plans

DepCare FSA, Health FSA and TIP contributions do not reduce the wages used to calculate UCRP retirement benefits, 403(b) plan or 457(b) plan maximum annual contribution limits.

If your earnings are below the 2013 Social Security wage base of $113,700, future Social Security benefits may be reduced. Ask your tax advisor for details.

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Eyes of HopeEyes of HopeEyes of HopeEyes of Hope

Eyes of Hope , VSP’s eyewear donation program• Donate used eye wear

» Prescription glasses, readers, sunglasses

• Donation locations» Human Resources, Open Enrollment Events

Making Open Enrollment Making Open Enrollment Changes OnlineChanges Online

Making Open Enrollment Making Open Enrollment Changes OnlineChanges Online

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Making Open Enrollment Changes OnlineMaking Open Enrollment Changes OnlineMaking Open Enrollment Changes OnlineMaking Open Enrollment Changes Online

Establishing a passwordMaking Open Enrollment ChangesPlanning toolsTips

88

Passwords for Passwords for At Your Service At Your Service OnlineOnline

Passwords for Passwords for At Your Service At Your Service OnlineOnline

Everyone needs a password to access personal accounts and make Open Enrollment changes on At Your Service Online

For new hires, default password is your birthday» mmddyyyy

Forgot password??• Click “Sign in to my accounts”, then select “Forgot Password” from the login

page

» You will be emailed a temporary password immediately If you are unable to reset your password online,

» Call 642-7053 and ask for a password reset» Leave name, Social Security # and phone # or email address» If request received by 3 p.m., password will be reset to default

(birthday: mmddyyyy) by end of day

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Making Open Enrollment ChangesMaking Open Enrollment ChangesMaking Open Enrollment ChangesMaking Open Enrollment Changes

Encourage faculty and staff to visit the Open Enrollment website on At Your Service even if they do not plan to make any changes.• http://atyourservice.ucop.edu, • click on the “Open Enrollment 2013” icon

Log in and review your current enrollmentsReview plan costs and coverage for 2013Special tools to compare plansFull instructions available

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Planning ToolsPlanning ToolsPlanning ToolsPlanning Tools

At Your Service website• http://atyourservice.ucop.edu then choose “Open

Enrollment”• Medical Plan Chooser

» Build a spreadsheet comparing plans• Dental Plan Chooser

» Helps you select which plan is best for you• DepCare FSA and Health FSA Tax Savings Calculator• Find a Doctor• For formularies, check medical plan websites or call

plans directly• Links to UC Health plans and links to plan websites• Details of coverage

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TipsTipsTipsTips

Gather personal data for new family members• Birthdates, Social Security numbers

Changing PCP only?• Can change at any time – call medical plan directly

Address needs updating?• Login to At Your Service Online, choose “My Contact

Information”• Tell your department so they can update your

records

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TipsTipsTipsTips

Don’t wait until the last minute to make changes• Open Enrollment ends at 5:00 p.m. on Tuesday,

November 20th!!Confirm your choices!

• Open Enrollment changes are only recorded when you confirm them

• Keep your confirmation statementReview January 1st pay statement

• Shows Open Enrollment changes It is the employee’s responsibility to report any

mistakes in a timely manner!

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BeneficiariesBeneficiariesBeneficiariesBeneficiaries

While not part of Open Enrollment, good idea to confirm beneficiaries

UCRP, Life and AD&D• Review, name, and/or change beneficiaries online at

http://atyourservice.ucop.edu DCP, 403(b) and 457(b) plans

• Review, name and change beneficiaries online with Fidelity Retirement Services or call for form

• www.netbenefits.com• 1-866-682-7787, press 0

If no beneficiary is established, benefits will be paid according to Order of Succession

Paper forms available for UC beneficiaries: UBEN 116• Available at KP or online at http://atyourservice.ucop.edu

Documents

Marie Johnson, Benefits Manager Sharon Johnson, Health Care Facilitator October 23 and 24, 2012 Open Enrollment and Benefits Plans Overview for 2013 for