In our CUCSA Town Hall on Tuesday, October 15, 2024, we invited Maynard Jenkins, Executive Director of Benefits Programs & Strategy, and his team to update us on changes to healthcare benefits for 2025 Open Enrollment and to answer staff questions.

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Q&A

We received a number of great questions during the session, and while we did our best to address as many as possible, we unfortunately ran out of time before we could respond to them all.

To ensure you have the information you need, the Systemwide Benefits Team compiled the unanswered questions along with their responses below.

Please describe the benefits of adding volunteer short term or long term disability. The information is a bit confusing.

Short-term and long-term disability insurance provides income replacement if you are disabled and not able to work due to injury, illness or recovery from childbirth. UC provides eligible employees Basic Short-Term Disability coverage which provides a monthly payment of up to $800 when you are out on disability. For most employees, $800 per month is insufficient to cover expenses. Purchasing voluntary short-term and/or long-term disability coverage will provide coverage of 60% of your weekly earnings up to a maximum of $15,000 per month. Need more help? Check out ALEX, virtual Benefits Coach, at https://start.myalex.com/uc/ or contact your local Benefits Team.

Will the UC consider providing money back to employees that choose not to elect benefits , essentially saving the University money in benefits?

This is not under consideration at this time.

1)  What factors are driving the large increase in CORE costs? 2) Are CORE premium increases already going to happen for represented employees, or is this still subject to negotiations?

Due to the increased costs of medical care, UC will begin requiring an employee premium contribution for the CORE plan in 2025 to ensure that employees share the costs of medical coverage fairly. Contributions for CORE will be the lowest of the UC medical plan options.  UC  honors the commitments made in union contracts pertaining to employee contributions to health benefits. Members of unions in “status quo” as of January 1, 2025 will not have premium rate changes until a new contract is ratified.

Senate Bill 729 that will require large group health plans to provide coverage for infertility including IVF. The law will go into effect in July 2025 for most beneficiaries. Can you describe what UCOP is doing to our plan options to reflect?

UC currently covers IVF with an infertility diagnosis with a 2-cycle lifetime limit per member, which was implemented in January 2023. We will be working with our health plans to assess the implications of SB 729 in 2025, which we believe at this time will increase our coverage to a 3 cycle lifetime limit per member.  Additional details will be available once we’ve fully analyzed the bill. Please note UC’s self-funded PPO plans are not required to comply with CA state mandates.

“Two questions on the same topic: 1) Can you speak about how the Health Insurance Premium Rebate is or is not factored into premium increases? Just wondering since I receive this letter every year stating that a premium rebate is given to employers. Just need clarification.

2) A letter was recently sent out advising that UC members did not utilize the behavioral health care benefits to about 80% of what UC paid the provider, and thus the provider is having to refund millions of dollars back to UC. This is not the first time that the services were not utilized as expected. How does that refund and the over-anticipation of benefit usage factor into the UC contributions towards premiums?”

UC calculates the employee portion of the Health Insurance Premium Rebate that Optum issues for the prior year’s benefit coverage.  UC then uses it to buy-down, or reduce, the Optum Behavioral Health rate that is embedded into the overall Kaiser rate for a future plan year.  For example, the 2022 rebate that was issued to UC in September 2023, was used to reduce the Optum rate for Kaiser members for the 2025 plan year.   

Why can’t you share the exact costs and pay bands yet? The way it’s being presented is very DUN DUN DUN and is causing unnecessary anxiety.

When releasing benefit plan information, we want to ensure that all of our educational materials are updated and verified prior to sharing with the employee and retiree populations.  We appreciate your patience as we work to prepare for Open Enrollment.

How are the paybands and UC contribution to paybands determined?

The Consumer Price Index (CPI) from the California Department of Finance is used as the basis for adjusting the salary bands each year. Increases to the salary band tiers will range from $3,000 to $6,000 per band in 2025. As a reminder, an employee’s 2025 pay band level for medical plan premiums is their full-time salary as of January 2024.

Will UC still have their virtual benefits fair?

UC is not hosting a virtual systemwide benefits fair this year.  Please visit ucal.us/oe (starting October 24) or your  UC location’s benefits office website for information on local open enrollment events.

How do we know dates/times of locations’ benefits fairs?

Please visit ucal.us/oe starting October 24 for a list of local events.

Are there any plans for increasing available appointments for UC Health? When you call for an appointment nothing is available, patients have to wait 3 months or more. 

UC Health providers are in high demand for many patients, and appointments can be difficult to schedule. For UC PPO members, an Accolade Health Care Advocate can assist with securing an appointment or finding a recent cancellation that might fit into your scheduling needs. More information regarding Accolade Health Care Advocates can be found here: https://www.uchealthplans.com/commercial/accolade-health-care-advocate 

It’s nice to know how UC is doing compared to national employer averages, but I’m wondering if there is any data on how UC compares to other California employers specifically?

UC’s premium changes are consistent with other public employers in California. For example, CalPERS has announced an overall premium increase of 10.79% for 2025.

Can you explain the 12 covered appointments available with the CORE and Blue/Gold?

The 12 covered visits apply to Accolade Care virtual visits with a PCP or behavioral health  provider through the Accolade App for CORE and UC Care plan members only. A CORE and UC Care member get 12 covered PCP visits and 12 covered Behavioral Health visits every plan year.  Accolade Care is not offered to Blue and Gold HMO Members. 

If benefits end after two months after retirement, is that considered an open enrollment time to choose retiree health benefits? Do we just contact HR?

Active employee benefits will continue until the end of the month following the month in which you separate due to retirement. Retirement does not trigger a Period of Initial Enrollment to change benefit plans. Please choose your benefits carefully during the upcoming Open Enrollment period if you are planning to retire in 2025. Refer to the Notices booklet included in the postal-mailed Open Enrollment packet, which will arrive around the time Open Enrollment begins.

On the Identity Theft protection, after my dependent child turned 18, got a letter that the Experian plan no longer covers him; is there a way to continue that coverage?

The option to extend coverage for a child over age 18 is not available as the child is no longer eligible under UC’s identity theft protection plan. The child may look at a standard product offered on Experian’s website.

Can the pharmacy benefit manager change prescription drug costs mid-year? Or should costs be fixed for the plan year?

Prescription drug price changes can occur mid year based on price agreements a pharmacy benefit manager has with a particular pharmacy. Prices will vary from pharmacy to pharmacy so it’s important, especially for HSP and CORE members, to shop around. Pharmacy drug prices can be searched and compared by using the Navitus app or Navitus member portal. For more information, please visit www.uchealthplans.com  

How is UC working with Health Net to ensure timely access to primary care providers? Wait times for an initial appointment are 9-12 months.

If UC receives feedback from members about difficulties with lengthy wait times to an appointment, we will inquire about trends with Health Net to understand systemic or local provider access issues.  Health Net is required to adhere to the Department of Managed Care’s Timely Access to Care standards.  Standards for PCP appointments for both new and existing members are 48 hours for urgent appointments and 10 business days for non-urgent appointments.  Members may contact a Health Benefit Navigator at Health Net and share their access issues, or file an access to care grievance if they are experiencing excessive wait times. 

Is Scripps covered by UC Blue & Gold plans?

No, Scripps is not in the UC Blue & Gold HMO network.

Where can we provide feedback to UC Health as a whole – areas the health system can and should be a leader in?

Please provide feedback through your local benefits office or health care facilitator.