Frequently asked questions about Open Enrollment

Premiums for 2025 are increasing because UC’s costs for medical and prescription drug claims are increasing. These increases are due to a combination of increased health care utilization as our population ages and rates of chronic health conditions rise, enhanced benefits, and the rapidly expanding use of costly new drugs and treatments.

Determining the amount that employees contribute to medical plan premiums is a challenging process that weighs budgetary constraints and the critical importance of equity and affordability. UC takes its responsibility to ensure employees access to strong, sustainable benefit plans very seriously, and is working with experts to determine strategies to control cost increases.

The total cost of UC medical plan premiums is increasing by $282 million — from $3.43 billion in 2024 to 3.71 billion in 2025. UC’s contribution is increasing from $2.79 billion in 2024 to 2.99 billion in 2025 — an additional $198 million investment to reduce the impact of rising costs on employees and retirees.

However, because of the size of the overall premium increases, UC employees and retirees will see increases in their premium contributions and in some out-of-pocket costs for care.

Yes. To ensure that the costs of medical coverage are shared fairly, the CORE PPO plan will require an employee premium contribution beginning in 2025. For UC’s other medical plans, employees with annual salaries up to $140,000 a year in 2024 will see 9% increases in their medical plan premiums and employees with annual salaries over $140,000 a year in 2024 will see 11% increases. To maintain as much stability as possible within these salary ranges, percentage increases in employee contributions will be the same for each salary band across UC’s medical plans (other than CORE) and levels of coverage.  

Contributions for CORE will be the lowest of the UC medical plan options, but this will be a significant adjustment for UC employees who have appreciated the option of a plan that did not require a premium contribution. The Open Enrollment website and ALEX, UC’s virtual benefits counselor, will be available starting October 24 to help CORE members understand their choices and consider carefully whether CORE is still the best option for them.

For many years, UC has worked to ensure equitable access to quality health care for all UC employees by requiring lower contributions to monthly premiums from employees with lower annual salaries.  

In 2025, UC will cover an average of:

• 71% of medical plan premiums for those earning $210,000 or more
• 91% of medical plan premiums for employees earning the full-time equivalent of $71,000 or less
• 83% of medical plan premiums for those earning $71,001 to $140,000
• 76% of medical plan premiums for those earning $140,001 to $210,000

On average, UC pays 85% of the cost of medical coverage for a single employee ($21,000 per year in 2025, on average), and over 80% of the cost of coverage for a family. UC contributes 100% of the cost of dental and vision plan premiums for eligible employees and their covered dependents. UC’s contribution is competitive when compared to other employers, who contribute an average (nationally) of 83% of the cost of medical coverage for a single employee and 71% of the cost of coverage for a family. Retirees may also pay a premium for Medicare Part B and D, depending on their income and the plan they choose.

UC is committed to supporting employees and will increase its contribution to medical plan premium costs from $2.79 billion in 2024 to $2.99 billion in 2025. Despite a challenging budget year for California, this is a 50% higher increase than UC’s projected budget, with the additional spending going directly toward reducing premium costs for employees and retirees.

Because of the magnitude of the overall premium increases, UC’s increased contribution will not fully protect UC members from rising premium costs. Given the significant increases to employee contributions in 2024, UC’s goal for 2025 was to mitigate the impact to employees by keeping contribution increases for those earning up to $140,000 to single digits (9%), and for those earning over $140,000 to 11% (for plans other than CORE).

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. Starting October 24, the Open Enrollment website and ALEX, UC’s virtual benefits counselor, will provide information to help CORE members understand their choices and consider carefully whether CORE is still the best option for them.

As health care costs and premiums increase, UC must explore all options to minimize those costs, including modifying the features of UC medical plans to moderate increases to employee premiums.

Copayments for outpatient visits have been set at $20 for members of UC Blue & Gold HMO, Kaiser HMO and UC Care (UC Select/Tier 1) for more than 10 years, even as the costs for care paid by UC have increased dramatically. While UC has managed to provide a high level of stability and predictability in those plans, UC leadership opted to increase these and a few other cost-sharing amounts as part of its overall strategy to minimize premium increases for employees.

Copayments for outpatient visits will increase from $20 to $30 for members of UC Blue & Gold HMO, Kaiser HMO and UC Care (UC Select/Tier 1). Copays for prescription drugs will go up for most of UC’s medical plans, and there will be a new tier for specialty drugs that will have 30% coinsurance, up to $150 per prescription, for UC Blue & Gold HMO and Kaiser HMO.

The out-of-pocket maximums for UC’s plans (which set limits on how much you have to pay for covered services in a plan year) are not increasing.

You can view your plan costs here:

• Employee plan costs
• Retiree plan costs

UC continues to offer multiple medical plans for employees and for retirees, with a range of premium costs. For employees, this includes the CORE plan which has no monthly premium (but does have a higher deductible and greater out-of-pocket costs at the time of care).

UC’s benefits decision support tool, ALEX, is available to help employees determine which plan is the best fit for you and your family. ALEX will ask a few questions, then provide rates specific to each employee, as well as estimates of out-of-pocket costs for care and side-by-side plan comparisons.

Each medical plan carrier contracts with doctors, medical groups, hospitals and other providers. One plan may negotiate a lower rate than another, and so be able to include a doctor or medical group in its lowest cost network while another cannot. That’s one of the reasons UC offers a choice of medical plans: to provide the widest choice of doctors and facilities at the lowest cost possible.

Due to IRS regulations, the HSA must be combined with a qualifying high deductible medical plan, so it’s only available to you if you enroll in the UC Health Savings Plan. If you enroll in any of UC’s other medical plans, you’re eligible to enroll in the Health FSA. You are not allowed to contribute to both an HSA and a Health FSA concurrently.

With an HSA (Health Savings Account), both UC and you can contribute to the account, up to the limits set by the IRS. Your contributions are pretax and lower your taxable income. You can use the money in the account to pay eligible medical expenses for you and your eligible tax dependents, and when you withdraw funds for qualified medical expenses, the funds continue to be tax-free. Funds in the account earn interest and carry over at the end of the year. If you leave UC or retire, the account goes with you and you can continue to use the money in it to pay for eligible medical expenses.

The Health FSA also allows you to make pretax contributions to an account to pay for eligible medical expenses for you and your eligible family members. You can carry over up to $640 from one year to the next, but the account does not go with you if you leave UC or retire. Unreimbursed funds in excess of the carryover amount are forfeited.

CORE, UC Care and the UC Health Savings Plan are three appropriate plan options for those with covered family members who live and/or study out-of-state. All three plans allow members to access the nationwide Anthem provider network at the Preferred level of coverage (in-network). To find a provider, visit the provider directory.

The detailed benefits summary on each plan’s website provides information on specific procedures.

Yes, UC’s medical coverage includes behavioral health benefits for mental health services and substance abuse treatment. Here are a few things you should know:

• If you select Kaiser HMO, you may access care from Kaiser behavioral health providers or from Optum in-network providers.
• If you select UC Blue and Gold HMO, you may access care from Health Net Behavioral Health in-network providers.
• If you select a PPO plan, you may access care from Anthem Blue Cross in-network providers. You may also access care from out-of-network providers, but your costs will be higher and you may need to pay your provider directly for services and submit a claim for reimbursement.
• Even if you are a member of an HMO plan, you do not need a referral from your primary care provider to see a behavioral health provider. Some services require preauthorization.

All of UC’s medical plans except the UC Medicare PPO without Prescription Drugs plan include prescription drug benefits.

Some of UC’s medical plans have a single plan administrator for medical and prescription drug benefits and others have a separate pharmacy benefit manager for prescription drug benefits. Your plan’s administrator or pharmacy benefit manager will be your point of contact for questions about your prescription drug benefits.

UC Medicare PPO without Prescription Drugs is only available to those who have other Medicare-coordinated health insurance that covers prescription drugs through a non-UC plan (such as another employer or former employer) or a government program like Tricare. You must provide proof of your Part D coverage to enroll in the UC Medicare PPO without Prescription Drugs plan. This requirement is to ensure you have the coverage you need, and to help protect you from being assessed a penalty by Medicare.

The prescription drugs covered by each medical plan are included in the plan’s formulary (a list of generic and brand name prescription drugs covered by a plan) which is developed by the plan’s administrator or pharmacy benefit manager.

Each plan’s formulary can be slightly different, so if you’re considering a new medical plan it’s a good idea to check the plan’s formulary. You can call the customer service number on your ID card to find out whether a particular drug is on the formulary, or you can search the formulary on your plan’s or pharmacy benefit manager’s website.

See Plan contacts for information about who manages pharmacy benefits for UC’s plans and how to find the formulary.

The pharmacy benefit manager will list covered alternatives for prescribed drugs that are not on the formulary. Talk to your doctor about whether any of the alternate drugs on the formulary would be a safe and effective substitute for your current prescription.

If your doctor decides that you need a drug that is not on the formulary, your doctor can request an exception to cover that drug. Contact your plan administrator or pharmacy benefit manager or visit the website to learn more about the exception and appeals process.

If you and your doctor decide to request an exception for a drug not on the formulary, make sure your doctor submits the clinical information and documentation needed to support your request. Your plan’s pharmacy benefit manager can explain to your doctor exactly what is needed, including clinical information explaining why the covered drug cannot be used.>Why do I pay more for some prescription drugs that are on my plan’s formulary than others?

Generally, your share of the cost will be lower for generic drugs than for brand-name drugs, but some other factors may affect your share of the cost, too.

Many drug formularies use a prescription drug tier system (developed by the pharmacy benefit manager) to organize covered drugs and help you understand your costs ahead of time. In most cases, the higher the tier a drug is assigned, the higher your share of the costs will be. For example, a drug in Tier 1 will be less expensive to you than a drug in Tier 3. Check your plan’s coverage summary to learn more.

Generally, your share of the cost will be lower for generic drugs than for brand-name drugs, but some other factors may affect your share of the cost, too.

Many drug formularies use a prescription drug tier system (developed by the pharmacy benefit manager) to organize covered drugs and help you understand your costs ahead of time. In most casejs, the higher the tier a drug is assigned, the higher your share of the costs will be. For example, a drug in Tier 1 will be less expensive to you than a drug in Tier 3. Check your plan’s coverage summary to learn more.

No. There will be no plan design changes. UC will continue to cover 100% premium for employees and their eligible dependents.

No. These enhancements have been added to the plans with no increase to 2025 premiums.

Enrollment in voluntary disability, life insurance and/or AD&D are not available as part of Open Enrollment through UCPath. However, you may submit a request to enroll or change your elections at any time during the year. Here’s how:

• Voluntary disability — Submit an Evidence of Insurability application (which includes a Statement of Health) PDF to the insurance company — approval is not guaranteed.
• Supplemental life — Submit a request through your UCPath account. Prudential will reach out by email with a statement of health for you to complete.
• AD&D — Complete the UCPath Benefits eForm: Submit New Form; in the Reason For Request, select Change AD&D.

These plans are designed to supplement other health insurance plans; they are not a replacement for them. If you receive services for a covered accident, illness or hospital stay, you will get a cash benefit from Prudential paid directly to you — over and above what any other insurance plan pays. You decide how to use the funds.

Medical plans are designed to pay doctors and hospitals for specific medical services after you pay your deductible or copayment/coinsurance. The supplemental health plans don’t pay doctors or hospitals — they pay you.

Disability plans provide regularly scheduled monthly income replacement payments for non-occupational injuries/illnesses. The supplemental health plans do not provide monthly income. They pay one-time lump-sum cash benefits to you. Once you’ve spent the money, you don’t get more.

on Thursday, Oct. 26, 2023, by clicking the “Enroll Now” button at the top of the page. You can continue to make changes until Open Enrollment closes at 5 p.m. on Friday, November 17. Please note, you can only open the “Open Enrollment event” once each day.>What plans are available during Open Enrollment?

The following plans will be available during Open Enrollment this year:

• Medical
• Dental
• Vision
• Accident, Critical Illness and Hospital Indemnity
• ARAG Legal
• Health Savings Account (paired with UC Health Savings Plan)
• Health Flexible Spending Account
• Dependent Care Flexible Spending Account
• Accidental Death and Dismemberment (open year-round)
• Pet Insurance (open year-round; enroll through Nationwide at petinsurance.com/uc)

The Supplemental and Dependent Life insurance plans, as well as Short-Term and Long-Term Voluntary Disability insurance plans, are open all year for enrollment; however, outside of your Period of Initial Eligibility (usually when you are first hired), evidence of insurability is required, except for children added to Dependent Life.>Do I need to take action if I am not making any changes?

If you don’t take action, your current 2024 benefits will carry over to the 2025 plan year with the exception of enrollment in your Health and Dependent Care Flexible Spending Account (FSA). Your premiums will increase to 2025 amounts. You will need to re-enroll if you would like to continue participating in an FSA in 2025.

You will receive a Submission Statement via email upon submitting your elections. Allow 24 hours to receive your statement.

You can also sign in to UCPath online at ucpath.universityofcalifornia.edu the day after you have submitted your changes to confirm that your elections went through as intended.

Go to Employee Actions> Health and Welfare > Benefits Summary, change the date to January 1, 2024, and click Go. If you don’t see your changes recorded, please submit an inquiry by clicking on “Ask UCPath.” Select “Open Enrollment” as the topic in the dropdown.

You will receive a final email Confirmation Statement for your 2024 benefit choices by the second week of December, regardless of whether you made changes during Open Enrollment.

You will see your new benefit premium rates on January 2, 2025, for monthly employees and on December 6, 2024, for bi-weekly employees. 

If you are on a leave of absence with pay, you will have the opportunity to make open enrollment elections online via UCPath during the Open Enrollment period. Your benefits will be effective Jan. 1, 2025.

If you are on a leave of absence without pay, you will also have the opportunity to make open enrollment elections. However, the effective date and method of enrollment depend on whether you elected to continue benefits while on leave without pay.

• If you are not enrolled in direct billing, you will select your open enrollment changes when you return from leave. Contact the UCPath Center for more information. 
• If you are enrolled in direct billing, you will submit your open enrollment elections via the Open Enrollment form which you should receive by mail. Contact the UCPath Center for more information.

If you are a new hire you will receive your New Hire packet along with an Open Enrollment packet with instructions on submitting your Open Enrollment benefits for the 2025 plan year.

If you are hired during the Open Enrollment period, you may see multiple benefit events in the Open Benefit Events Section in UCPath. If this is the case, you must complete the New Hire event before you complete the Open Enrollment event. 

Please note:

• If you only complete your new hire event, your 2024 elections automatically roll over to 2025, with the exception of your FSA elections (you must re-enroll in the FSA every year).
• If you only complete the 2025 Open Enrollment event, you will not have benefits until Jan. 1, 2025, when those elections become effective.

While making your Open Enrollment elections, you may select the “Waive” option for any benefit that you want to cancel. You may cancel/waive any plan that is editable during Open Enrollment. To cancel/waive a plan that is not listed in the Open Enrollment event, you may contact the UCPath Center.

First-time users will see the following steps:

1. Go to UCRAYS at retirementatyourservice.ucop.edu.
2. At your first login, and after agreeing to UC’s privacy statement and terms of use, you will be asked questions to confirm your identity.
3. Create a new password for your UCRAYS account.
4. If you’re using a computer or smartphone that is secure, register your trusted device. This can reduce the steps in the login process.
5. Add your cell phone number and personal email address, if they’re not already on file.

It may be helpful to clear your browser’s cache/cookies/browsing history and open a new browsing session before you start your login or registration process – especially if you just received a one-time password. To find out how, search “clear browsing history” in your browser’s help bar.

If you’re still receiving an error message, please call the RASC at 800-888-8267.

Sending a secure message through UCRAYS is the safest, most efficient way to communicate with the RASC. To send a secure message, including attachments, through UCRAYS, just click on “Messages” in the left menu. Our goal is to respond within two business days.