Open enrollment news is coming early this year:
- Employees who belong to Western Health Advantage HMO (health maintenance organization) learned Aug. 26 that the university will drop WHA as a medical plan option next year.
- As a comparable alternative, the university will offer its existing UC Blue & Gold HMO (administered by Health Net) at rates that will come down to be among the lowest of all of UC's medical plan options. UC Blue & Gold's provider network includes UC Davis Health and UC Davis Medical Group, as well as Hill Physicians, Mercy Medical Group, Meritage, Woodland Clinic and St. Joseph Health.
- Existing members of UC Blue & Gold HMO will also benefit from the cost reduction.
- All other employees can switch to UC Blue & Gold HMO during open enrollment so they can also benefit from the cost reduction.
UC Blue & Gold and Western Health Advantage HMOs have nearly matching medical provider networks. So, if you move from WHA to UC Blue & Gold, you should be able to keep your providers with uninterrupted access — only your insurance card will change. See the FAQ for exceptions.
The switch will be automatic, unless you choose one of UC's other health plan options during open enrollment, Oct. 31-Nov. 26. WHA members to whom this applies include employees, retirees and their eligible dependents.
When open enrollment begins, you will see yourself enrolled in UC Blue & Gold HMO by default, in the online system. If you take no action by the open enrollment deadline, your switch to UC Blue & Gold will take effect Jan. 1. Or, you can choose a different plan — so long as you act before the open enrollment deadline.
Reason for the change
“UC Davis wants employees and their families to have access to the best care, the most innovative technology, and the best expert clinicians through the most affordable, cost-effective health plans,” reads an FAQ posted on a website dedicated to the transition from WHA.
“By making this change, we can bring down premiums and health care costs for our employees, while also ensuring more of our employees have access to the high quality of care provided by UC Davis Health or other providers in the UC Blue & Gold HMO network.”
UC Davis will subsidize UC Blue & Gold's reduced premiums for employees for the next five years “to help grow the (plan's) insurance pool and reduce the cost of health care for our employees,” the FAQ states. “Unfortunately, it is not possible to subsidize retiree premiums.”
Open enrollment booklets arrive in October
The annual open enrollment booklet — with complete information, including monthly premiums — will arrive by mail at home addresses toward the end of October. Open enrollment will open Thursday, Oct. 31, and close Tuesday, Nov. 26, two days before Thanksgiving. Information also will be posted to UCnet as open enrollment approaches.
Important notes for this year's open enrollment:
- UCPath — Access to the open enrollment website will be through UCPath, which goes live Sept. 27 at UC Davis, UC Davis Health and UC Agriculture and Natural Resources. For more information about UCPath, visit http://ucpath.ucanr.edu.
- Duo — To use UCPath, you must be signed up for Duo multifactor authentication. See “How to Move to Duo.” Need help with Duo? IT Express consultants are attending all Davis campus UCPath town halls in August and September. The consultants will answer questions about Duo and/or help people enroll on the spot. The town hall schedule continues through Wednesday, Sept. 25, with one town hall held weekly. See the schedule here.
As UC Irvine's coordinator of Faculty & Staff Mental Health Care and Respondent Services, Negar Shekarabi often meets with people who know they need help, but aren't sure where to start.
“Figuring out what kind of help you need and how to get it can feel overwhelming, especially when you're in the middle of a difficult time,” Shekarabi said. “I listen, I answer questions and I help people navigate the many resources that are available to UC faculty and staff.”
To help others this Mental Health Awareness Month, Shekarabi shared answers to a few common questions.
Should I start with my location's Employee Assistance Program or my behavioral health plan?
You'll find support from either resource. Here's how they work.
Your Faculty and Staff Assistance Program (also known as an Employee or Academic and Staff Assistance Program) offers free, confidential assessment, intervention, consultation and referral services to all faculty and staff (and their immediate families) at your location. Many programs even offer convenient onsite consultations.
Regardless of your insurance coverage, you can go to your assistance program for no-cost individual counseling for a wide range of personal and work-related problems, with referrals to behavioral health plan and community resources when needed.
If you prefer, you may choose to go directly to your behavioral health plan for support. All of UC's behavioral health plans other than Core and UC Health Savings Plan cover initial outpatient visits without a copay or deductible.
Behavioral health and substance abuse coverage are provided by Anthem Blue Cross for employees and retirees enrolled in:
Behavioral health and substance abuse coverage are provided by Optum for employees and retirees enrolled in:
Kaiser members may also choose to receive behavioral health care through Kaiser.
How should I choose a provider?
Your assistance program counselor is a great resource if you need a referral to a provider in your health plan's network. He or she is familiar with providers in the area, and can talk with you about your preferences and needs.
Your behavioral health plan offers a choice between an online provider search (with options to narrow your search by gender, specialty and languages spoken) or assistance by phone from specially trained representatives.
Either way, once you've narrowed down your search, online research can help you make a decision. Many providers have websites where they explain their background and philosophy. Psychology Today offers an extensive online database with similar information.
If the first few providers you call aren't available or don't respond within a few days, call your plan for assistance. Optum, Anthem and Kaiser are committed to ensuring you receive timely support.
If I get help from UC, will my privacy be protected?
Your privacy is protected by law – whether you visit your location's assistance program or a provider through your health plan. Unless there's a clear legal need (for example, if someone's life or safety is at risk), information about your participation is never released to anyone without your written consent, and it will never appear in any departmental, central or personnel file.
“I want people to know that help is available – and it can make a big difference,” said Shekarabi. “Visit your assistance program, call your behavioral health plan, talk to your doctor – however you start, the most important thing is that you reach out for the help you need.”
If you are enrolled in UC-sponsored health plans and you cover a spouse, domestic partner, grandchild or legal ward under your benefits, Secova, Inc., will contact you in early April as part of the Family Member Eligibility Recertification project.
Why UC is reverifying benefits eligibility?
The university strives to balance the demands of escalating health care costs while maintaining high-quality benefits for our members and their families. The Family Member Eligibility Recertification project is necessary to ensure that the university covers only those family members who continue to remain eligible for UC-sponsored health insurance.
UC is asking faculty, staff and retirees to verify current eligibility for the following family members enrolled in UC-sponsored coverage:
- Domestic partners
- Legal wards
Only these family members will be verified because eligibility can change over time due to divorce, separation or changes in tax status. Therefore, you will NOT have to provide documentation to verify any other family members at this time.
UC is partnering with Secova Inc., our current administrator of Family Member Eligibility Verifications to assist us with this process. Secova has more than 24 years of experience administering family member eligibility verifications and is staffed with knowledgeable professionals who will offer you confidential support and resources throughout the recertification process.
What happens next
In early April, Secova will send verification packets with instructions on how to submit your documentation. If you are contacted by Secova, you must submit your completed and signed verification form and other required documentation to Secova by May 12, 2017.
“There's a lot of good news this year,” said Dwaine Duckett, vice president of human resources. “We've worked hard to manage costs, and offer the protection of disability insurance to more faculty and staff than ever before. I encourage everyone to take a careful look at their options this year, to make sure they're taking full advantage of their UC benefits.”
- Employees will see small increases, or even decreases, in their contributions toward medical premiums this year. Over 90% of employees will see increases under $10 a month, and no increases are over $12 a month. The news is even better for members of UC Care, whose monthly contributions will decrease. Dental and vision plans are still offered by UC at no cost for employees.
- Don't miss your one-time opportunity to change or add UC's Voluntary Disability Insurance during Open Enrollment, with no statement of health required. UC has expanded eligibility for this coverage, so this may be your best opportunity to enroll. Disability coverage can help protect your income if you miss work because of a pregnancy, illness or injury — see details below.
- UC's preferred provider organization (PPO) medical plans (Core, UC Care and UC Health Savings Plan, as well as UC High Option Supplement to Medicare, UC Medicare PPO and UC Medicare PPO without Prescription Drugs) will have new administrators next year for behavioral health and prescription drug benefits. UC has worked to minimize disruption for members, but there are a few steps you should take to make sure you're prepared for the change. Please look for further details during Open Enrollment.
- Kaiser Permanente is expanding into Santa Cruz County, with three new medical offices.
- Health Net Blue & Gold has added several new provider groups in Southern and Northern California, and members in the San Francisco Bay Area will benefit from the Canopy Health alliance formed between Hill Physicians-SF (UCSF), John Muir Health, Meritage Medical Network and the affiliated hospitals.
Disability insurance — Take this opportunity to protect your finances
Time away from work for an illness, injury or pregnancy could mean months without a paycheck. While UC's basic employer-paid disability insurance offers some protection – a benefit capped at $800 per month for six months — it probably won't be enough to cover your expenses. For a modest monthly premium, UC's Voluntary Disability Insurance replaces much more of your income — 60 percent of your eligible pay up to $15,000 per month — for additional financial security when you need it most.
UC is changing its disability insurance offerings to give all benefits-eligible employees (full, mid-level or core) new options for protecting their finances. During Open Enrollment, you'll have a one-time opportunity to enroll in Voluntary Short-Term Disability (benefits up to six months), Long-Term Disability (benefits after six months, up to your Social Security retirement age) or both.
The flexibility of UC's new disability options allows you to tailor your coverage to your needs and budget. For example, choosing only Voluntary Long-Term Disability Insurance might be a good option for faculty eligible for paid medical leave (see APM 710-11PDF) or employees with a substantial balance of sick leave accrued. Choosing both Short- and Long-Term Disability provides the most comprehensive protection for all types of disability leaves.
If you've never thought about disability insurance, this is the year to take a look. During Open Enrollment, you cannot be denied enrollment in Voluntary Disability Insurance due to an existing medical condition. If you wait to enroll (after Open Enrollment ends), you'll need to submit a statement of health to enroll, and you may not qualify. To ensure continuing protection, those who are currently enrolled in Supplemental Disability and don't take action during Open Enrollment will be automatically enrolled in both Short- and Long-Term Voluntary Disability Insurance. This change will affect your premium costs, though, so take the time to choose the coverage you need. You can reduce or discontinue coverage at any time.
Learn more about your 2017 disability insurance options here.
PPO administrator changes
The administrator of your plan processes claims, creates a network of health care providers or pharmacies and sets clinical policies and guidelines. For 2017, a number of administrators will be changing for UC's PPO plans (Core, UC Care and UC Health Savings Plan, as well as UC High Option Supplement to Medicare, UC Medicare PPO and UC Medicare PPO without Prescription Drugs):
- Medical — Anthem Blue Cross replaces Blue Shield as the administrator of medical benefits for UC's PPO plans. HealthEquity will continue as the health savings account custodian.
- Behavioral health — Anthem Blue Cross replaces Optum as the administrator of behavioral health benefits for UC Care and UC Health Savings Plan. Anthem replaces Blue Shield as the administrator of behavioral health benefits for Core, UC High Option Supplement to Medicare and UC Medicare PPO.
- Prescription drugs — OptumRx replaces Blue Shield as the administrator of prescription drug benefits for UC's PPO plans.
During Open Enrollment, members will learn more about how best to prepare for the change. For example, you'll want to confirm your current doctors and other providers (including behavioral health) are in-network in 2017, and to check the OptumRx formulary to confirm the costs of your prescription medications. If you're currently receiving treatment, you may be eligible for transition assistance, depending on your situation.
Growing HMO options
There will be no significant HMO plan changes in 2017, but some new choices may make an HMO plan a better option for some members:
- Kaiser Permanente is opening new medical offices in Watsonville, downtown Santa Cruz and Scotts Valley. Local hospital services and inpatient care will be provided by Watsonville Community Hospital as well as at nearby Kaiser Permanente medical centers in Santa Clara and San Jose. Kaiser Permanente Santa Cruz County facilities provide services to non-Medicare members only, so this option is not available if one or more family members is enrolled in Medicare.
- The Canopy Health alliance formed between Hill Physicians-SF (UCSF), John Muir Health, Meritage Medical Network and the affiliated hospitals will increase access to providers for Health Net Blue & Gold members in the San Francisco Bay Area. If you choose a PCP within one of these medical groups, you will have access to the entire Canopy Health alliance and your PCP can offer referrals to any clinically appropriate specialist within Canopy Health.
- New Blue & Gold medical group choices in 2017 include Facey Medical Group in Los Angeles and Ventura counties, Monarch HealthCare Medical Group in Orange County, and Primary Care Associates Medical Group in San Diego County. Members of Direct Network — Merced will now have access to physicians located at Dignity Health Medical Group — Merced.
The Open Enrollment website and booklet have all of the details about your options and costs. Take time to review your choices, so you'll have the right benefits for you and your family in 2017.
Time away from work for a pregnancy, illness or unexpected injury could mean months without a paycheck. While UC's basic employer-paid disability insurance offers some protection – a benefit capped at $800 per month for six months – it probably won't be enough to cover your expenses.
For a modest monthly premium, UC's Voluntary Disability Insurance replaces much more of your income – 60 percent of your eligible pay up to $15,000 per month – for increased financial security when you need it most.
UC is changing its voluntary disability insurance options to give all eligible employees — those currently covered and those not enrolled — new options for protecting their finances. For 2017, you can choose Voluntary Short-Term Disability (benefits up to six months), Long-Term Disability (benefits after six months, up to your Social Security retirement age) or both, depending on your needs and budget. Since you pay premiums with after-tax dollars, income from Voluntary Disability Insurance is generally not taxable.
If you are not enrolled in Supplemental Disability Insurance
If you've never thought about disability insurance, this is the year to take a look. During Open Enrollment, you cannot be denied coverage due to an existing medical condition. Later, you'll need a statement of health to qualify.
UC has also expanded eligibility to all employees eligible for full, mid-level or core benefits, so this may be your first opportunity to enroll.
If you are already enrolled in Supplemental Disability Insurance
To ensure continuing protection, those who are currently enrolled in Supplemental Disability and don't take action during Open Enrollment will be automatically enrolled in both Short- and Long-Term Voluntary Disability Insurance. This change will affect your premium costs, though, so take the time to choose the coverage you need. You can reduce or discontinue coverage at any time.
You'll get more information, including a tool to help you estimate your monthly premiums, during Open Enrollment. But you don't have to wait to learn about your new choices for Voluntary Disability Insurance. For details — and for more information about why disability coverage is important — visit UCnet's 2017 Disability Insurance page. At the website, a video explains disability options and an overview of what's changing, why this opportunity is important for employees, and how to enroll./h3>/h3>/h3>