Open enrollment is under way — giving staff and faculty until Nov. 23 to make any benefits changes for 2011.

Significantly, in the area of health care, UC has added two lower-cost plans. And, pursuant to federal health care reform, UC will begin providing coverage to eligible children up to age 26 (which replaces 23 as the cutoff age).

Also, the ARAG Legal Plan is open for enrollment (this is not available every year).

For many people, the most perplexing option for 2011 likely involves the Health Net health maintenance organization, or, rather, the two Health Net HMOs.

One is basically the same as this year’s, the standard Health Net HMO, but with premiums that are going up from 46 percent to 273 percent, or almost four times higher, depending on your pay band. The other is the new Health Net Blue & Gold HMO, with premiums about 6 percent higher than what people are paying this year for the standard Health Net HMO.

On the basis of cost alone, this decision is a no-brainer. But there is more to the equation: To combat rising costs, the Health Net Blue & Gold provider network excludes Sutter Health. So, if you have a Sutter Health doctor, and you want to go with Health Net Blue & Gold, you may need to switch doctors; you could avoid this only if your Sutter Health doctor also happens to be affiliated with one of the groups in the Blue & Gold network.

The Blue & Gold network includes all of the UC medical centers and medical groups, and many of UC’s largest provider groups — but not Sutter Health. In Yolo County and the surrounding counties, the medical groups with Blue & Gold affiliation are:

• Yolo — Hill Physicians, UC Davis and Woodland Healthcare
• Sacramento — Hill Physicians, Mercy Medical Group and UC Davis
• Placer — Hill Physicians, Mercy Medical Group and UC Davis
• El Dorado — Hill Physicians

For employees who stick with the standard Health Net HMO, here are two examples of what you will pay:

• For a single person in Pay Band 1 ($47,000 or less) — $74.40 a month, compared with $19.97 this year (273 percent increase).
• Family coverage in Pay Band 2 ($47,001 to $93,000) — $360.83 a month, compared with $194.50 this year (86 percent increase).

If you choose the Health Net Blue & Gold plan, here are two examples of what you will pay:

• For a single person in Pay Band 1 ($47,000 or less) — $21.21 a month, compared with $19.97 this year in the standard Health Net HMO.
• Family coverage in Pay Band 2 ($47,001 to $93,000) — $206.58 a month, compared with $194.50 this year in the standard Health Net HMO.

The Blue & Gold premiums are about 6.2 percent higher than what people paid this year for the standard Health Net. Subscribers in UC’s two other HMOs, Kaiser Permanente and Western Health Advantage, will be paying from 6.4 percent to almost 9 percent more next year.

‘Complex choices’

“We’re aware that it may present complex choices for people looking to take advantage of these new lower-cost options,” Dwaine Duckett, vice president of Human Resources at the UC Office of the President, said in a UCOP news story.

He explained that UCOP “developed the best plan we could for the greatest number of UC employees.”

“If we had not developed the Health Net Blue & Gold HMO, all Health Net members would have seen increases comparable to those in the standard Health Net HMO. This would have had a greater negative impact on even more employees.”

For people considering another HMO, the Davis campus benefits manager, Bill Brooks, reminded that the locally-owned Western health Advantage “provides benefits very similar to both Health Net plans at lower premiums than the Blue & Gold.”

However, like the Blue & Gold plan, WHA does not include Sutter Health affiliates as providers. Nor does Kaiser, which uses its own doctors.

Here are two examples of WHA rates (which are the same as Kaiser’s):

• For a single person in Pay Band 1 ($47,000 or less) — $7.45 a month, compared with $6.84 this year (8.9 percent increase).
• Family coverage in Pay Band 2 ($47,001 to $93,000) — $123.81 a month, compared with $116.06 this year (6.7 percent increase).

Voice mail runneth over

Since news of the changes came out, Guerren Solbach’s telephone has been ringing off the hook. “My voice mail is filling multiple times a day,” said Solbach, who runs the Health Care Facilitator Program at UC Davis.

He said he is working overtime to return all his calls — but he hopes people will take the time to attend a presentation or visit a help desk over the next few weeks on the Davis and Sacramento campuses. See more information below.

The clamor for information is understandable, especially in light of the Health Net changes. Statistics from July showed Health Net as having a majority of the health care subscribers among UC’s 144,179 employees and retirees with health coverage: 56,804 subscribers, or around 40 percent.

The data also showed Health Net with about 40 percent of the health care enrollments at UC Davis (including the health system): 6,558 out of 16,566 active employees.

Sticking with Health Net is only one way to keep your affiliation with Sutter Health. Here are your best options:

• Anthem Blue Cross PPO — A preferred provider organization, more expensive than Health Net.
• Anthem Lumenos PPO plus HRA — This is a new plan, replacing the CIGNA Choice Fund. The Anthem Lumenos premiums are significantly lower than CIGNA’s (and Health Net’s), but come with high deductibles and out-of-pocket maximums. The HRA component is a health reimbursement account; i.e., UC puts money in an account for you ($1,000 for a single person, $1,500 for two adults or one adult and children, or $2,000 for a family), to pay a portion of your annual deductible. Any amount that you do not use is rolled over to the next year.

Going above and beyond

Duckett noted that the university, despite its ongoing financial challenges, continues to protect lower-paid workers by linking premiums to salaries (the lower your pay, the lower your premium) and offering all employees the same wide range of plans — all with the same comprehensive benefits coverage, including prescription drugs and behavioral health services.

In addition, UC continues to provide the same coverage for dependents as for employees, which, according to Duckett, is very different from the approach of other large employers who cover around 70 percent of the cost versus UC’s 87 percent.

UC also is doing more for children up to age 26 — in some cases more than what is required under federal health care reform and new state legislation.

Federal law extends health coverage for children up to age 26, while state law extends dental and vision coverage to this group. UC is doing all of that, and adding in legal, life, and accidental death and dismemberment.

If you have children up to age 26 who qualify, take note: You must register them during open enrollment, so that their coverage can begin Jan. 1. Read the eligibility rules.

Federal health care reform also is bringing these changes in 2011:

• No lifetime limits on medical coverage — Many of UC’s plans already have unlimited coverage, but all medical plans will comply effective Jan. 1. If you previously changed medical plans because you reached the lifetime limit, you may re-enroll in your old plan during open enrollment.
• Preventive care at no charge — Note, however, that not all medical plans cover all services, and for some plans you must use an in-network provider to receive coverage at no charge. Read more.

What you need to do

If you are making no changes in benefits coverage for 2011, and you are not renewing a flexible spending account, you need not do anything during open enrollment.

However, you must take action to do any of the following:

• Change health plans.
• Add dependents (including those who are 23, 24 or 25 years old).
• Enroll in the ARAG Legal Plan (if not already enrolled).
• Renew or establish a tax-saving flexible spending account for dependent care or medical expenses — FSA accounts do not renew automatically; if you want an FSA, you must sign up again. And here is something else to keep in mind: Starting Jan. 1, health FSA funds may no longer be used for over-the-counter medicines such as aspirin, cold medicine, cough drops, etc., unless you have a prescription for such items.

Open enrollment began at 8 a.m. Oct. 25 and continues until 5 p.m. Nov. 23.

For medical, dental, vision and legal, the place to take care of open enrollment is online. Employees without computer access should contact their department or unit offices, or the Davis campus or UC Davis Health System benefits office:

• Davis campus — (530) 752-1774
• UC Davis Health System — (916) 734-8099

For changes in life insurance and accidental death and dismemberment coverage (such as adding a child up to age 26), you need to fill out a form and submit it to your campus’s benefits office. Click here for the form, or contact your benefits office.

Where to go for assistance

• Large group presentations, dealing primarily with health plan options (no reservations required) — Nov. 4 and 5 in Davis, and Nov. 8 and 9 in Sacramento.
• Open Enrollment Fair, on the Sacramento campus — Nov. 3.
• Drop-in presentations, offering a very general view of open enrollment (seating is first-come, first-served) — Nov. 3, 8, 18 and 22, all on the Davis campus.
• Help desk hours, for individual counseling (on a first-come, first-served basis) — Nov. 4, 5 and 15 in Davis, and Nov. 5, 8, 9, 10 and 16 in Sacramento. Brooks said representatives of local medical groups plan to attend the Nov. 15 session.

Click here for a detailed schedule.

More information

At Your Service: The open enrollment website includes premiums and summaries for each health plan, and a number of planning tools, including a “medical plan chooser.”

UC Davis Human Resources open enrollment page