Jerome Perez Open Enrollmenthr.berkeley.edu/sites/default/files/2016_uc_care_presentation.pdf ·...
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uc-care.org Jerome Perez Open Enrollment October 29 - November 24, 2015
Transcript of Jerome Perez Open Enrollmenthr.berkeley.edu/sites/default/files/2016_uc_care_presentation.pdf ·...
uc-care.org
Jerome PerezOpen Enrollment
October 29 - November 24, 2015
uc-care.org
How UC Care Works
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UC Care Plan Design
• Broad access
Blue Shield Preferred
• Customized for UC Care• UC Network + Select Blue Shield providers• Predictable out-of-pocket costs
UC Select
• Flexibility to use services from any provider outside the Blue Shield Preferred network
Out of Network Providers
• Rich PPO plan with 3 levels of network choice
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Blue Shield Preferred
• Provides for a full range of covered benefits
• Choose from more than 70,000 providers in the Blue Shield of California’s Preferred network
• Access to more than 600,000 BlueCardproviders outside of California-in the U.S and throughout the world.
• Low deductible
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Blue Shield Preferred
• No Primary Care Physician (PCP) required
• Self refer to any specialist
• Certain services and prescriptions may require prior authorizations
• Fee for service model
• Deductibles and coinsurance
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UC Select
• Special in-network option in California
• Set copays with no deductible
• Includes UC medical centers and UC doctors
• Select primary care physicians and providers near every campus-even those without medical centers
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Out-of-Network
• Higher deductible
• Pay more until the deductible is met
• Responsible for any differences between the provider’s charge and the allowed amount
• Amounts in excess of the allowed amounts do not count toward your deductible or out-of-pocket maximum
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Coverage and Costs
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Medical Plan Highlights
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Medical Plan Highlights
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Pharmacy Plan Highlights
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Pharmacy Plan Highlights
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What’s New for 2016
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Travel Immunizations/Vaccines
Covered Service UC Select and ParticipatingPharmacies
Blue Shield Preferred and Participating Pharmacies
Non- Preferred(out-of-network)
CURRENT
Travel Immunizationsand Vaccines Not covered Not covered Not covered
NEW FOR 2016: Adding coverage to the UC Care medical and pharmacy benefit
Travel Immunizationsand Vaccines No charge No charge 50%
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Ambulatory Surgical Center
Covered Service UC Select Blue Shield Preferred Non- Preferred(out-of-network)
CURRENT
Outpatient Surgery performed at an Ambulatory Surgical Center
N/A(Services covered under Blue Shield
Preferred)
20% 50%
NEW FOR 2016: Adding coverage at the UC Select level
Outpatient Surgery performed at an Ambulatory Surgical Center
$100 per surgery 20% 50%
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Know Before You Go: Lab and Diagnostic
Services
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Lab Testing- Potential Fees
Scenario One: You go to the doctor—for annual preventive care—and have blood drawn while you’re there. Your doctor’s office sends the sample to a stand-alone lab for testing.
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Scenario Two: You go to the doctor—not for an annual physical—and have diagnostic testing done while you’re there. An outside physician reviews your results.
Lab Testing- Potential Fees
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Lab Testing- Potential Fees
Scenario Three: Your primary doctor or a specialist orders diagnostic tests that are outside of preventive care guidelines. You go to a UC Select or Blue Shield Preferred facility (stand-alone lab or imaging center).
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YourProviders
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Find a Provider
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Find a Provider-UC Select
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New UC Select Providers for 2016
• uc-care.org
• Click on Find a Provider tab
• Under UC Select, click on the link New UC Select Providers
Location Provider
NorthernCalifornia/Bay Area
• John Muir Medical Center-Walnut Creek and Concord
• John Muir Physician Network*
Santa Barbara Area • Cottage Hospital- Santa Barbara and Goleta
• Pacific Diagnostics Labs• Pueblo Radiology
Orange County • Orange County Foot and Ankle
• Aurora Breast MRI of Orange County
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Blue Card ProgramEmergency and non-emergency care provided through the
BlueCard Program• Outside of California - in the U.S.
– Covered services received through the BlueCardProgram are paid at the Blue Shield Preferred level
• Outside of the U.S.– Coverage at the Blue Shield Preferred level of benefits
regardless of the provider level– Note: non-BlueCard Worldwide providers may require
payment up front; submit a claim to Blue Shield
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Resources
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UC Care University
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Features include:• Search for over 300
treatments or services• Categories are based
on most common conditions that claims are filed for
• Estimate for individual or family member
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Treatment Tool Cost Estimator
Features include:• Search for over 300
treatments or services• Categories are based
on most common conditions that claims are filed for
• Estimate for individual or family member
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TeladocTelemedicine services available by phone, mobile applications or online video
• Board certified physicians 24/7/365 • $20 copay
Prescription Management
Electronic prescribing (SureScripts) or by phone,if needed
Use of antibiotics limited to short durations
No prescribing of DEA-controlled substances, medication for psychiatric illness, or lifestyle drugs
Generic drugs are automatically recommended
Top 10 Diagnoses
Sinus Problems Urinary Tract Infection Pink Eye Bronchitis Upper Respiratory Infection Nasal Congestion Allergies Flu Cough Ear Infection
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Shield Concierge
• Shield Concierge is THE place to call for help with:
– Initiating prior authorization requests
– Requesting referrals
– Finding providers
– Understanding out-of-pocket costs of care
– Processing claims
– Any other questions regarding the UC Care plan
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1-855-702-0477Monday through Friday
7 a.m. to 7 p.m.
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