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.

Related Links and Resources

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.

Below are the questions asked in the Q&A Zoom function during the webinar that were answered by the Systemwide Benefits Team.

I’m getting married 11/23/24 this year and if open enrollment is 10/31-11/22 should I update my benefit when open enrollment is open or should I file a life changing for family coverage?

Within 31 days of your marriage, sign in to UCPath to submit a marriage Life Event to add your spouse or make other benefit changes.

What is the link for Alex?

ALEX link: https://start.myalex.com/uc/

How do I ensure that I have enrolled in the FSA account? Two years in a row I was sure I clicked all the right buttons only to find out the following year that I had NOT actually  enrolled and that I missed out on tax savings.  It’s not clear to me what step I missed. Is there a way to verify that I have in fact enrolled after submitting my changes but BEFORE open enrollment ends?

After successfully submitting your elections, you will receive a submission confirmation statement via email.  If you do not receive that email, you know you have not completed the process properly.  If that happens, please submit a case to UCPath using the “Ask UCPath” button on your UCPath dashboard.

How does UC plan to support disabled, low income employees with these increased health costs? This change hits disabled, chronically ill, low income staff members particularly hard. I already struggle to pay my healthcare bills. This increase in premiums and co-pays will wipe out the raise I got this year.

As you’re aware, UC uses pay bands to help moderate costs for lower income employees. For those in pay bands 1 and 2, they contribute lower amounts than those in pay bands 3 and 4. Additionally, we continually assess our plans to explore alternatives that will help make healthcare accessible and affordable for all.

Is it accurate that employees who live out of state can only get the base program for medical coverage?

Employees living out of state, or who have family members living out of state, may choose UC Care,  UC Health Savings Plan or CORE medical.  The HMO plans, UC Blue & Gold HMO and Kaiser, are not available outside of California.

Why did you combine paybands 1 and 2 in the increase?  That seems unfair to our lowest paid employees.

As healthcare continues to rise and rates increase, UC is impacted like most other employers. While UC contributes the majority of costs, cost-sharing for all employees is necessary. For pay bands 1 and 2, their contributions are lower than those in pay bands 3 and 4.

Please explain the PPO plans cost per employee and spouse including the deductible that needs to be met.  Also how much percentage for office visits after deductible is met.

There are 3 different PPO plans that are offered to employees. Information about how much your employee contribution for 2024 and 2025 is posted on UC Net. You can also read an overview of each plan and how the deductibles and out-of-pocket maximums work for each plan.

My due date is Jan 2025, should I add my baby when this enrollment is open or can I update it after my baby is born?

Upon the birth of your child you will have 31 days to add your baby to your coverages. Log in to UCPath to submit a Birth Life Event.

With the UC Health Savings plan this year, even after paying the high deductible and the much higher premiums in 2024 (compared to 2023), my coinsurance is $100+ for every primary care visit, even if virtual, at University of California clinics. This is a cost that I did not anticipate and it is difficult to afford. How can we more accurately predict costs for visits?

Accolade can assist with estimating costs. Prior to your office visit, contact Accolade at 

(866) 406-1182 (Monday–Friday, 5 a.m.–8 p.m. PT).

UCCare has always charged a $20 copay. It’s supposed to be free?

Visits are free for the first 12 visits for virtual primary care and behavioral health through the Accolade Care app. Copays apply for in-person office visits and virtual visits outside of the Accolade Care app.

Will I be able to enroll in Short term and long term disability if I waived it in past years?

You may apply for Voluntary Short- and Long-Term Disability coverage at any time.  You will need to complete an Evidence of Insurability process and approval is not guaranteed.  The only time an employee can elect Voluntary Disability with guaranteed enrollment is during the new hire period of enrollment.

For the dental PPO, how many dental cleanings will be covered per year?

Typically two, although certain medical conditions or pregnancy may allow for additional covered cleanings.

When will the new IVF benefits be in effect at UC? Or how does that process work?

Are you speaking of the new legislation regarding fertility benefits? If yes, these benefits will become effective the first of the next plan year. For UC, this will be 1/1/26.  The 2025 plan year renewal is completed.

Will we have an option to speak to medical plan vendors in person at each campus to hear the benefits of their services (sort of like a fair)?

Yes, there will be representatives from the plan vendors at the benefits fairs with whom you can speak about the plans.

Can I enroll for FSA and PPO? If so, how?

You can enroll in the Health FSA while being covered under any UC medical plan except the Health Savings Plan, which has a Health Savings Account.  You cannot be enrolled in an FSA and HSA during the same tax year. You can elect these plans during Open Enrollment, through UCPath.

I use the UC Health Savings plan, my daughter will move to Oregon in January and she is 23, can she use that there?

Yes, your daughter absolutely would have access to in-network physicians in Oregon through the Anthem Blue Cross Blue Shield National network of providers.

Will UCLA health be covered by the HMO plan in Santa Barbara?  Last year they were dropped in March and it affected so many employees who could no longer see their primary care.

Unfortunately, UCLA Health providers do not have admitting privileges to Cottage Hospital therefore not in-network for the HMO in the Santa Barbara area.

Can we use UCLA Health in Santa Barbara if we have the HMO UC Blue & Gold?

Unfortunately, no, UCLA Health physicians in Santa Barbara do not have admitting agreements into Cottage Hospital. As a result of this, UCLA Health physicians in the Santa Barbara area cannot be in-network for UC Blue & Gold due to CA Department of Managed Healthcare (DMHC) requirements.

If we switch plans, for example PPO but switch to UC Blue & Gold HMO, can we use all the same UC doctors we used in the PPO? Does it reset anything, like do we need to get new referrals to specialists since it is an HMO?

This is a great question! In general, yes, you can continue to see your UC doctors under the UC Blue & Gold HMO (the one exception would be UCLA providers in the Santa Barbara area… see answer to the previous question). Yes, you will have to obtain referrals for your specialists under the Blue & Gold plan.

We have just seen several slides of take aways – increase in premiums, increase in copays, etc.. Are there any “gives” to employees this year? Is there anything that the UC is doing to add benefits to employees?

The slides provide highlights of changes for 2025, but doesn’t include all. Some of the “gives” were highlighted for the supplemental health plans. More details, including other enhancements, will be available in open enrollment materials and UCnet as we approach OE.

Will the AFLAC wellness plan be available again, or another similar plan?

The supplemental health plans, including Critical Illness, Accident and Hospital Indemnity, are now administered by Prudential (no longer Aflac).  Several of those plans have wellness benefits.  Check out your options on UCnet or in ALEX.

Is there an option to NOT receive the mailer? I use the website.

There is currently no method to opt out of the Open Enrollment mailer. It’s a good suggestion, I will pass it on!

Is there any chance that we can do a better job doing outreach to ensure that employees across pay bands participate in dependent care tax savings programs? For the second year in a row, a disproportionate number of higher wage earners at UC participated, and not enough lower wage earners. This causes UC to run afoul of IRS rules, and some employees lost out on maximizing these tax savings programs because the University does not do enough to encourage earners under ~$150k to sign up for these programs. Can we please do something different so that this doesn’t keep happening?

Yes, this continues to be an issue.  We are trying to get the word out in new ways about the great tax advantages of the Dependent Care Flexible Spending Account.

For FSA, I am currently enrolled with FSA, if I don’t use up all the money and I do not enroll for next year, do I get any amount back?

For FSA plans under the IRS Rules, the amount you don’t use within your allotted time period is forfeited. In short, any monies remaining in your plan is not returned to you.

Can we get a rebate/money back if we DON’T take UC’s benefits (for instance if we go on a spouse’s benefits plan)?

UC currently doesn’t offer any incentives for employees who don’t enroll in our medical plans.

I’m expecting my first child December 8, 2024 and am on UC Blue and Gold, HMO plan. Will I be able to use the mentioned doula services for the birth and in 2025, given I am not changing my insurance?

The coverage of doula services begins January 1, 2025.

What is Delta Dental doing to retain the dentists it does/did have?

Delta Dental increased its reimbursement schedule for network dentists 1/1/24. While the reimbursement amount may not be the ideal amount desired, Delta continues to monitor competitive rates. Additionally, for dentists who wish to terminate from the network, Delta Dental makes outreach to persuade them to stay. If they leave, Delta Dental continues to make periodic outreach to them and re-recruit them.

Is Kaiser being included in the new 4th Drug Tier of drugs costing up to $150 co-pay?  I’m concerned about the ability to pay for expensive drugs if I were to suddenly develop a new health condition.

Yes, under Kaiser specialty drugs will have coinsurance, up to $150 per prescription. The coinsurance amounts accrue toward your annual maximum.

I see that with Delta Dental PPO, orthodontic benefits are covered (50%) for adults as well as dependent children. Is that new?

Changes to the Delta Dental PPO plan, including orthodontic benefits, have not changed within the last few years.

Could you please post a link to the paybands info? I might have missed it and I’d like to check how much more I’ll have to pay in premiums.

Medical plan rates will be available on UCnet starting October 24th. Go to ucal.us/OE.

How long is Identity Theft Protection available to us?

The UC Identity Theft Protection plan is available to employees as long as they continue to be employed by UC and are eligible for benefits.

My adult partner will live overseas for a few years with his own health insurance coverage. Can I remove him for a few years and add him back when he returns to the U.S.?

Yes, you can remove your partner during Open Enrollment.

If I switch to a PPO plan, I will no longer be able to use my Sansum doctors, correct?

Sansum providers with a PPO contract are in-network with the PPO plans. Most HMO providers have a PPO contract but not all. Please refer to the Anthem provider search tool to confirm your specific provider is in network.

Is there any info on the Lincoln Financial Disability Insurance which if we did not opt to add coverage says 55% but in small print is max $800 a month with a long waiting period.  This does not compare to the state disability program.  Is there a way to pay into the state program due to the uncomparable benefit or qualify for a health assessment?

Lincoln FInancial is the Disability provider for UC. The Basic Disability plan is provided at no cost to employees (unlike CA SDI).  The Voluntary Disability program has richer benefits than CA SDI. UC is prohibited by law from participating in CA SSI.

For dependent care, for a spouse not a part of UC, is it that my spouse’s maximum is $2500 and mine is $2500 for a total of $5000?

The combined total contribution to DepCare is $5000 per family, unless you or your spouse are considered “highly compensated” by the IRS.  See the DepCare page on UCnet for more info!