Page 6 - Watermark 2022 Benefits Guide - CA
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Medical and Pharmacy Plan Overview

        Watermark offers a choice of three medical plan options through UHC and one medical plan through Kaiser.
        All of the medical options include coverage for prescription drugs through the carrier. To select the plan that
        best suits your family, you should consider the key differences between the plans, the cost of coverage
        (including payroll deductions), and how the plan covers services throughout the year.

                           Health Maintenance Organization –   Health Savings Account w/ HDHP –   Preferred Provider Organization
                                      HMO                     Consumer Driven Plan      (PPO) – Select and Enhanced Plan
                                                          You receive the highest level of   You receive the highest level of
                            For an HMO plan, you can only   coverage if you go to providers in   coverage if you go to providers in
                           use in-network providers (unless   the plan network. You can also   the plan network. You can also
         Network
                              it’s a qualified emergency   use providers outside of the   use providers outside of the
                                    situation).           network, but your out-of-pocket   network, but your out-of-pocket
                                                            costs will be much higher.    costs will be much higher.
                                                          You must first meet your annual
                           For certain benefits, you may or                             For certain benefits, you may or
                                                          deductible before the plan will
                              may not have to meet the                                    may not have to meet the
         Deductible                                       start paying for certain services.
                            deductible first before the plan   This may also include some   deductible first before the plan
                                   starts paying.                                               starts paying.
                                                               prescription drugs.
                                                                                       The PPO has built in some copays
                                                           The HDHP plan does not have
                           For certain services, you will pay a                          for certain services like office
                                                           copays for medical services.
                           flat copay at the time of service.                           visits. These copays do not count
         Copayments                                       Copays only apply to in-network
                            That copay covers the services                                 towards your deductible;
                                                           prescription drugs, after the
                             performed during that visit.                               however, they do count toward
                                                            deductible has been met.
                                                                                         your out-of-pocket maximum.
                             Certain services in the HMO   You must meet the deductible   You must meet the deductible
                           require you to share in the cost of   before coinsurance will start   before coinsurance will start
                             the service with coinsurance.   paying towards services.      paying towards services.
         Coinsurance
                              Coinsurance amounts vary      Coinsurance amounts vary      Coinsurance amounts vary
                            depending on how the plan is   depending on how the plan is   depending on how the plan is
                                    designed.                      designed.                     designed.
         Preventive Care                          All preventive care is covered at 100% in-network.
                          You must select a PCP from within
                            the HMO plan network and you
         Primary Care                                     You are not required to select a   You are not required to select a
                           must receive a referral from your
         Physician (PCP)                                             PCP.                          PCP.
                          PCP before receiving services from
                                    a specialist.
        Understanding how your plan works


          1. Your deductible              2. Your coverage                           3. Your out-of-pocket maximum
          You pay out-of-pocket for most    For the Select and Enhanced plans, deductibles   When you reach your out-of-pocket
          medical and pharmacy expenses   will only apply for services other than an office   maximum, the plan pays 100% of
          until you reach the deductible.   visit copay or a pharmacy copay.         covered medical and pharmacy
                                                                                     expenses for the rest of the plan
          You can pay for these expenses   The Consumer Driven requires that all claims   year. Your deductible, copays and
          with your Health Savings Account
                                          apply to the deductible. Your deductible must be   coinsurance apply toward the out-
          (HSA) if enrolled in the Consumer
                                          met before your pharmacy copays begin.     of-pocket maximum.
          Driven Plan or Flexible Spending

          Account (FSA).
                                          Once your deductible is met, you and the plan
                                          share the cost of covered medical and pharmacy
                                          expenses with coinsurance. The plan will pay a
                                          percentage of each eligible expense,
                                          and you will pay the rest.


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