Jerome Perez Open Enrollment October 29 - November 24, uc-care.org

Transcription

1 Jerome Perez Open Enrollment October 29 - November 24, 2015

2 How UC Care Works

3 UC Care Plan Design Rich PPO plan with 3 levels of network choice Blue Shield Preferred Broad access UC Select Customized for UC Care UC Network + Select Blue Shield providers Predictable out-of-pocket costs Out of Network Providers Flexibility to use services from any provider outside the Blue Shield Preferred network

4 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 BlueCard providers outside of California-in the U.S and throughout the world. Low deductible

5 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

6 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

7 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-ofpocket maximum

8 Coverage and Costs

9 Medical Plan Highlights

10 Medical Plan Highlights

11 Pharmacy Plan Highlights

12 Pharmacy Plan Highlights

13 What s New for 2016

14 Travel Immunizations/Vaccines Covered Service CURRENT Travel Immunizations and Vaccines UC Select and Participating Pharmacies Blue Shield Preferred and Participating Pharmacies Non- Preferred (out-of-network) Not covered Not covered Not covered NEW FOR 2016: Adding coverage to the UC Care medical and pharmacy benefit Travel Immunizations and Vaccines No charge No charge 50%

15 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) NEW FOR 2016: Adding coverage at the UC Select level 20% 50% Outpatient Surgery performed at an Ambulatory Surgical Center $100 per surgery 20% 50%

16 Know Before You Go: Lab and Diagnostic Services

17 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.

18 Lab Testing- Potential Fees 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.

19 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).

20 Your Providers

21 Find a Provider

22 Find a Provider

23 Find a Provider-UC Select

24 New UC Select Providers for 2016 Click on Find a Provider tab Under UC Select, click on the link New UC Select Providers Location Northern California/Bay Area Provider 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

25 Blue Card Program Emergency and non-emergency care provided through the BlueCard Program Outside of California - in the U.S. Covered services received through the BlueCard Program 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

26 Resources

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28 UC Care University

29 Treatment Tool Cost Estimator Features Features include: include: Search Search for for over over treatments treatments or or services services Categories Categories are are based based on on most most common common conditions conditions that that claims claims are are filed filed for for Estimate Estimate for for individual individual or or family family member member

30 Teladoc Telemedicine services available by phone, mobile applications or online video Board certified physicians 24/7/365 $20 copay Top 10 Diagnoses Sinus Problems Urinary Tract Infection Pink Eye Bronchitis Upper Respiratory Infection Nasal Congestion Allergies Flu Cough Ear Infection 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

31 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

32 Monday through Friday 7 a.m. to 7 p.m.

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