Page 8 - PriMed 2022 Benefits Guide

Medical Coverage

Nothing is more important than your health. At PriMed, our goal is to help you be the best version of you.
Choosing the right plan to meet your needs is the first step to living a healthy life.
Choosing the Right Medical Plan

When deciding which medical plan is the best fit for you and your family, it’s important to consider the total
cost of coverage. This includes what you pay in premiums out of your paycheck and what you pay for services.
Your Medical Plan Options

Health Maintenance Organization (HMO) Plan

With an HMO plan, you select a Primary Care Physician (PCP) who will coordinate your health care needs,
including referrals to specialists. You typically pay a flat dollar amount (copay) for qualified health care
services. The HMO plan offers in-network coverage only. If you visit a provider outside of the plan’s network,
you will be responsible for the full cost of services.

PriMed is offering 3 HMO plans to choose from for medical coverage for the 2022 plan year. The plan
components for all 3 plans are the same, the only difference is the size of the network you have access to.
CanopyCare HMO is an HMO product designed for those employees residing in the 9 county San Francisco Bay
Area and consists of over 5,000 doctors and 20 hospitals. SmartCare and Full Network HMO’s are designed for
those employees who do not live in this area. Please be sure to confirm which Health Net network your
provider is in before enrolling in the CanopyCare, SmartCare, or Full Network HMO.
Preferred Provider Option (PPO) Plan

A PPO plan gives you the option to seek medical treatment from a contracted medical provider, at negotiated
rates, or from an out-of-network provider, at an additional cost. You may pay copay for select services, with
the exception of preventive care, which is covered in full. Other services may be subject to the annual
deductible and coinsurance. Once you reach the out-of-pocket maximum, the plan will pay 100% for all eligible
expenses for the remainder of the plan year. While you can visit any doctor, you’ll save the most money by
using in-network providers.
Effective September 1, 2021, the PPO Plan is available to employees who work outside of California but
within the 48 contiguous United States, who do not have access to an HMO coverage area within California,
or who do not have access to Hill Physicians Medical Group.

Find a Health Net Medical Provider

1. Log on to: http://www.healthnet.com
2. Select, “Provider Search”
3. Enter your search criteria (ex. Primary Care Physician)

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