More On UC Care (CORRECTED AND UPDATED BELOW)

By Berkeley Anonymous

Previous posts have identified problems with UC Care for employees at non-medical campus and a particular problem with the coverage around UCSB.

But there are broader problems with replacing Anthem’s Blue Cross Plus Program with UC Care. 

Anthem Blue Cross Plus had three tiers including an HMO which I guess most people used most of the time.  But it also allowed flexibility to get out-of-HMO care if needed. 

UC Care purports to be similar with three ostensibly corresponding tiers 1 - UC Select, 2 - PPO network, and 3 - out-of-network.  But as we heard before, the UC Care Select network excludes many doctors in the Anthem Blue Cross Plus HMO network.  Even the broader UC Care PPO omits some that were part of the PLUS HMO (including one of mine).  Going to Tier3 out-of-network means you’ll probably pay a majority of the cost out of pocket.  UC Care also seems to cover fewer prescriptions; specialty drugs cost some fourfold more.

Perhaps the biggest difference is that one could meet all medical needs using the Anthem Blue Cross Plus HMO -- never needing to pay deductible or co-insurance, even for some out-of-network consultations with specialists and while traveling.  Alternative medicine (acupuncture and chiropractic) were also covered at fixed co-pays without deductible.  Vast swaths of HMO medical expenses were free.  These included: laboratory tests & X-rays not at a hospital, outpatient ambulatory surgery, home health care, medical equipment & devices, hospice care, skilled nursing facilities, home infusion and nurses, emergency physician services, and ambulance.  Free!

UC Care is different.  The UC Care Select tier doesn’t cover most of those free services at all.  Instead, most are bumped to the PPO tier (along with alternative medicine), requiring deductable and co-insurance.   If the type of specialist you need isn’t in UC Care Select, you must go to the PPO tier.  Even some physician services at UC Care Select facilities seem to be billed as co-insurance.  It seems some illnesses will require some PPO tier treatment, with its substantially greater costs.

In short, Anthem Blue Cross Plus mixed low HMO co-pays with out-of-network flexibility when needed.  UC Care is just a PPO with deductibles and co-insurance, except for some Select types of coverage with Select doctors.

* * *

In light of this it is worth looking at the other UC PPO option.  At the bottom of the totem pole in the UC insurance world is the Core plan, the only choice for employees who do not work enough hours to qualify for full or mid-level benefits. However, the costs and benefits of the new UC Care plan make the Core plan look comparatively attractive.

The Core plan has a $0 employee premium.  Though it has a $3000 deductable and co-insurance on drugs, its _maximum_ out-of-pocket cost of $6,350 is not vastly higher than -- or even lower than -- the employee family premium alone for the UC Care program ($4,392 in IncomeBandII, $6,917 in IncomeBandIV -- though bear in mind that premiums are pre-tax).  Its out-of-network benefits look better than UC Care.

So, the Core plan could be the most cost-effective plan for many families, considering premium plus out-of-pocket costs.

CORRECTION:  http://atyourservice.ucop.edu/oe/medical/core.html says “Annual out-of-pocket maximums ($6,350 per member) limit what you pay.”   In my original post I assumed “member” meant employee or family.  However, it turns out that “member” means “family member;” i.e., the out of pocket is $6,350 per person, and for a family the maximum is $12,700.  This is listed in the new detailed plan description, at https://www.blueshieldca.com/sites/uc/documents/2014-OE-Brochure-Non-Medicare.pdf (page 12).   Given this, it turns our that Core will not be as appealing as I previously suggested.

UPDATE: Also, there is a confusing statement at http://atyourservice.ucop.edu/oe/tools-resources/discontinued-plans/anthem-plus-plan.html which says:

"If you do nothing
 You will be enrolled in the new UC Care plan, with the same dependent coverage you have now. UC Care has the same in-network and out-of-network coverage you have now, with much more."

This statement on the UCOP website is only true if "with much more" is interpreted to mean "with more out-of-pocket expense, for deductible and co-insurance charges."