Did you know that fraud costs companies and institutions worldwide an estimated 5 percent of their annual revenues, and management may not even be aware of it?

Considered a “white collar” crime, fraud is defined as illegal or dishonest activity undertaken to give an advantage to the perpetrator. Fraud can include anything from false claims designed to gain insurance or benefit payouts to embezzlement of funds.

In recognition of International Fraud Awareness Week, Nov. 6 through 12, UC’s Office of Ethics, Compliance and Audit Services (ECAS) is sponsoring several events to promote fraud education and awareness of potential fraud risks.

At this week’s First Friday breakfast in the Franklin Lobby, Nov. 4, beginning at 8 a.m., the campaign will kick off with an information table hosted by ECAS staff. Please plan to stop by and meet members of the team.

The Association of Certified Fraud Examiners recommends that organizations set up hotlines so that employees can anonymously report suspected fraud without fear of reprisal.

UC has done just that: employees may report their concerns by calling 1-800-403-4744 to speak with a hotline representative or online at universityofcalifornia.edu/hotline. (Simply click on “Office of the President” in the right-hand column list of UC campus locations.)

Given that employee education is the key to preventing and detecting fraud, ECAS is sponsoring a series of fraud awareness webinars over the next several weeks as part of its Compliance and Audit Education series:

• Monday, Nov. 7, 10 to 11 am: Know Thy Enemy: Fraud, presented by Toffee Jeturian, assistant director of the Office of Audit and Advisory Services, UC Riverside
• Wednesday, Dec. 7, 10 to 11 am: presentation by Timothy Hedley, forensic partner at audit, tax and advisory firm KPMG
• Wednesday, Dec. 14, 10 to 11 am: Developing an Integrated Approach to Prevent, Detect, and Respond to Fraud and Misconduct Risks at UC, presented by Wanda Lynn Riley, director, and Jaime Jue, associate director of Audit and Advisory Services, UC Berkeley

For more information, please contact Tim Mulshine at tim.mulshine@ucop.edu.

UC employees will see modest increases in medical plan costs for 2012, and most will continue to contribute a smaller portion of the full cost than the national average.

Medical plan rates for 2012 are posted on At Your Service.

“Seventy percent of employees will see increases of less than $10 per month,” said Dwaine Duckett, vice president of human resources. This includes virtually all employees earning $48,000 or less.

Those who are enrolled in the Anthem Blue Cross PPO will have lower premiums. The decrease is the result of several factors including recent plan experience — how many and which type of services members used during the year — which was more favorable than expected.

And again this year, UC is offering several value plans that provide the same comprehensive health care coverage as its Choice plans but at lower rates. The only difference between Health Net Blue & Gold, for example, and Health Net HMO plan is that the Blue & Gold plan has only the most reasonably priced health care providers.

“We created the Health Net Blue and Gold plan for UC employees who are flexible and willing to more actively manage their health care costs. We’re pleased to see that it is helping to lower rate increases while still offering employees high quality care,” Duckett said.

The total UC spend on medical plans is projected to go up by $90 million this year, he said.

Both UC and employees will share the cost of that increase, with UC contributing, on average, 87 percent of the cost of premiums.

UC’s contribution to medical premiums is significantly higher than the national average for employer contributions. In its annual survey of employer-sponsored health benefits, the Kaiser Family Foundation found that employers pay roughly 82 percent of premiums for employees with no dependents and 72 percent for family coverage.

Faculty and staff also generally pay less than the national average for office visits and prescriptions.

In addition, UC mitigates the cost impact for lower paid workers by having those with higher salaries offset premiums for those with lower salaries through its pay-banding methodology.

“In these difficult economic times, employees who are not already enrolled in our lower-cost value plans may want to consider doing so during Open Enrollment,” Duckett said.

Open Enrollment begins Monday, Oct. 31, at 8 am and runs through Tuesday, Nov. 22, at 5 pm.

Aside from changes in medical premiums, there are also changes in 2012 to the Vision Service Plan, including an enhanced contact lens benefit. UC will move from VSP’s Signature Network to the Choice Network. About 98 percent of California providers are in the Choice Network.

The University will see significant savings as a result of the change in networks, and is passing part of that savings on to employees in the form of an improved contact lens benefit.

VSP has also added Costco as an affiliated provider, which means Costco will now be able to submit members’ claims for eye exams and eyewear directly to VSP.

UC will continue to offer the Staywell wellness benefit to eligible employees enrolled in all medical plans except Kaiser, which has its own wellness benefit. Participation for the Staywell benefit is governed by collective bargaining agreements in some cases.

Complete information about 2012 health and welfare benefits is available on the At Your Service website.

Everyone is tightening their budget belt and looking for ways to save, and for some faculty and staff, enrolling in one of UC’s lower-cost medical plans might help.

To meet the needs of its diverse workforce, UC offers eight medical plans. All of the plans offer comprehensive coverage, including behavioral health benefits. But the costs of the plans — both premiums and out-of-pocket costs — as well as provider choice and flexibility to use out-of-network doctors and hospitals vary significantly.

Kris Lange, UC’s director of vendor relations management, works closely with medical plan carriers and is an expert on the similarities and differences among the plans. We asked her for tips on choosing the right medical plan.

What are the first steps for choosing the right plan?

When choosing a medical plan, it’s important to know what’s important to you: Do you want your costs to be predictable or can you take on more risk? Do you want to choose your own specialists or do you feel comfortable having a primary care physician make these choices for you? Do you need specific services covered? Do you regularly use prescription drugs? Do you or your family members travel frequently and need coverage away from home?

Once you’ve thought about what’s important, use the Medical Plan Chooser on the At Your Service website to understand the cost of each plan and what it covers. Also, information on the plans’ websites can help you identify each plan’s participating doctors and its prescription formulary.

Last, look beyond the monthly premium. While the premium is predictable, the full cost of the plan will depend on what you pay for services and prescriptions after the plan pays.

We’ve developed two examples that illustrate those additional costs: One scenario shows a person with no dependents and relatively low use of her medical plan; the second example is a family with high medical needs. You can see from these charts that premiums are only part of the cost equation. Staff should compare the total cost of medical care for all of our plans.

Health Net Blue & Gold, Health Net HMO, Kaiser and Western Health Advantage are all health maintenance organizations (HMO), but they have different costs. What are the differences among them?

In some ways they are all similar. All HMOs require you to choose a primary care physician (PCP) from the plan’s network of providers. The PCP coordinates all of your care. If you want to see a specialist, you must have a referral from your PCP. The HMO covers your expenses only if your PCP has authorized the services, unless it’s an emergency — that means it may not be the best choice for you if you travel a lot or spend periods of time away from your PCP’s immediate service area.

With all of UC’s HMO plans, there is a small copay for office visits, hospital stays and prescription drugs, but most other services have no charge. That means your out-of-pocket costs are limited. All of these plans are good choices for those who are comfortable with the HMO model.

Our HMO plans differ in their networks. Health Net Blue & Gold and Health Net HMO are exactly the same plan except for their network of providers. The Health Net Blue & Gold network includes only the most reasonably priced providers — including all of UC’s medical centers — while the Health Net HMO has a wider network of doctors and hospitals.

Kaiser is different from the Health Net plans in that it has an integrated network. Your primary care physician, pharmacist and specialists are all Kaiser employees, and they coordinate your care through your electronic health record.

Western Health Advantage (WHA) is a regional HMO network of medical groups, doctors and hospitals in the Davis/Sacramento area. Its network of providers works much like those of the Health Net plans, and includes the UC Davis Medical Center and doctors. WHA has a unique Advantage Referral Program that allows for specialty care from any WHA specialist — not just those from your primary medical group.

The other difference among these plans is the premium cost. Health Net Blue & Gold, Kaiser and WHA are three of our lower-cost plans, while the Health Net HMO costs more because it offers a wider choice of doctors, hospitals and specialists.

Anthem Blue Cross PPO and Anthem Lumenos PPO with HRA are both PPOs. And isn’t UC’s Core plan also a PPO? First, what is a PPO? What’s the difference between these plans?

PPO stands for preferred provider network, which is a group of doctors and hospitals that have contracted with the insurance plan to offer services at a discounted rate.

PPO plans are similar in that you can choose any doctor or hospital, but you pay less if you choose a doctor in Anthem’s nationwide PPO network. With a PPO, you don’t need a referral from your primary care doctor to see a specialist. And if you live outside of the U.S., all three of these plans provide enhanced in-network coverage for foreign providers.

The coverage provided by the plans is generally the same, except for prescription drugs. That’s because with the PPO, prescriptions are provided for a flat-dollar copay, whereas with the Lumenos plan and Core plan, you pay 20 percent of the total cost of prescriptions.

All the PPO plans have deductibles, but the Anthem Lumenos plan has a higher deductible and the Core plan has a MUCH higher deductible. We sometimes refer to Core as catastrophic coverage since the plan won’t pay until you meet a $3,000 deductible, making it unattractive to most UC  staff, even though UC pays the full cost of Core. Still . . . if you’re healthy or want to “self insure” your costs in exchange for a very inexpensive plan, it is an option. Just make sure you can pay the deductible if something catastrophic does happen.

The nice thing about the Lumenos plan is that it comes with a UC-funded Health Reimbursement Account (HRA), which you use to pay part of your deductible. That means you pay nothing for services and expenses until you use up the HRA; then you pay the full cost of services until you meet the deductible.

Lumenos sounds interesting – but is it complicated?

The Lumenos Plan is really no more complicated than a regular PPO, but you should be willing to actively manage your costs, and Anthem provides online tools to help you do that. And you have to be prepared to pay higher out-of-pocket costs if you use up your HRA. On the other hand, if you don’t use up the HRA, your out-of-pocket costs are zero. Plus, any unused balance rolls over to next year.

We’ve done a head-to-head comparison of Anthem Lumenos and Anthem Blue Cross PPO, looking at the combined cost of monthly premiums and out-of-pocket costs. Our comparison shows that most faculty and staff would pay less overall under the Anthem Lumenos plan than the Anthem Blue Cross PPO. In general, only single employees with very high claim costs and employees with high prescription costs fare better under Anthem Blue Cross PPO.

That leaves the Anthem Blue Cross PLUS. How does that plan compare to the other plans?

If you like the concept of an HMO, but also want the flexibility of PPO, Anthem Blue Cross PLUS may be the one for you. It has features of both HMOs and PPOs. Like an HMO, you have a primary care physician who manages your care and makes referrals to specialists — your costs are limited to copays when you use providers referred through your PCP. But you also have access to PPO network providers, as well as out-of-network providers, as you would in a PPO. You pay a higher monthly premium to get that access, and your cost for out-of-network services is higher.

Do you have any final words of advice about choosing a plan?
All of UC’s medical plans are very good; there are no bad choices. They all offer preventive care at no cost, comprehensive benefits — including medical, hospital, behavioral health, and prescription drug coverage — and access to excellent doctors and hospitals. The copayments or percentage of coinsurance are lower than many plans offered by other employers. But the bottom line is that if the plan fits your needs, then you’ve made the right choice.

Dwaine Duckett, UC vice president for Human Resources, held a systemwide online web chat Monday, Oct. 24, to answer employee questions about the revised staff layoff policy, merit increases, health care and other benefits, UCRP contributions and UC’s new family-friendly programs.

The event was sponsored by the UC Staff Advisors to the Regents and the Council of UC Staff Assemblies (CUCSA) and was moderated by Staff Advisor Penny Herbert and CUCSA chair Ravinder Singh.

If you missed the event, go to http://www.ustream.tv/ucevents to see the archived webcast.

If your question was not addressed, you can submit it online via the UC Staff Advisors website. Please also let the advisors know if you would like to see more events of this type to address questions about HR and other matters of interest to UCOP employees.