Plan - UCSB Human Resources

Blue Shield Health Savings Plan
UCSB Human Resources, Benefits
This presentation is intended for communication purposes only.
Please see the At Your Service website ( 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
What’s special about the HSP?
• High deductible PPO medical plan
◊ Administered by Blue Shield
◊ Deductible and OOPM shared by all family
◊ Medical and drug expenses apply to deductible
and OOPM
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
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
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
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
Blue Shield PPO - Plan Design
Medical & Drug Expenses
In Network
Out of Network
• Plan pays 60%
of allowed rate
• You pay balance
Member Cost Sharing
Out-of-Pocket Max
(includes deductible)
Deductible, Coinsurance, OOPM
Individual (Single)
Preferred Providers
You pay
You share cost with plan
Plan pays
20% Coinsurance
$4000 OOPM
You can use the UC Contribution to the Health Savings Account
to pay part of the deductible.
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
20% Coinsurance
$6400 OOPM
You can use the UC Contribution to the Health Savings Account
to pay part of the deductible.
Allowed Amount – In Network
PPO plans negotiate “allowed” rates to process claims.
Discounted rate
that plan negotiates for each
service with “preferred” or
participating providers
20% Coinsurance
Provider charge:
Allowed amount:
• You pay the in-network
Plan pays 80%:
coinsurance on the discounted You pay 20%
• Provider can’t “balance bill”
Provider write-off: $100
Allowed Amount – Out of Network
PPO plans assign “allowed” rates to process claims.
Value that plan assigns
to a service when provider is
NOT a “preferred provider”
(not participating)
40% Coinsurance
Provider charge:
Allowed amount:
• Plan pays out-of-network
coinsurance on the allowed
Plan pays 60%:
(60% of $100)
• Provider can “balance bill”
You pay 40%:
You pay balance:
• Balance over allowed amount
does not apply to OOPM
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
Blue Shield sends EOB
Explanation of Benefits (EOB)
outlines allowed charges,
deductible and co-insurance.
“This is not a bill”.
Provider sends bill
The 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 funds
• Pay with other funds
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
Pharmacy Claims
You go to the pharmacy
Pay with your HSA debit card
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
Learn more about PPO Costs
Fair Health Consumer
Health Care Blue Book
Good Rx
• Estimate cost of drugs
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.
• Treatment Cost Estimator Tool
• Drug costs, information and claim summary
Register as new member
on this site.
Health Saving Account
The Health Savings Account is a separate account
that can be used to pay medical and other health
Medical Coverage
Blue Shield PPO
Health Savings Account
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
UC Contribution is prorated for
plans that start after January 1
◊ $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.
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.
• 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.
Use the HSA to pay for…
• Deductible
• Coinsurance
• Any IRS Publication 502 Expenses, including:
Prescription drug
◊ Long Term Care insurance premiums
• See HealthEquity website for more information
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)
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
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
• Single Deductible
• UC Contribution to HSA
• Remaining balance
◊ Pay with personal funds
Pay with your personal contributions to HSA
Register as new member
on this site.
Health Equity Member Portal
Claim Summary Screen
• View claim detail
• Choose action to
be taken
− Pay provider
− Reimburse
− Close
• Pay from HSA
account or
s account
• Schedule
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
(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
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 Service
Optum Clinicians
$1,300 individual
$2,600 family
$2,500 individual
$5,000 family
Outpatient Office
You pay 20%
Plan pays 60% of allowed rate
You pay balance of bill
Emergency Room
You pay 20%
Plan pays 80% of allowed rate
You pay balance of bill
Inpatient Stays
You pay 20%
Plan pays 60% of allowed rate
You pay balance of bill
For more information
HealthEquity Member Services
available every hour of every day
(866) 212-4729
Blue Shield Concierge
(855) 201-8375

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