Page 7 - 2022 Oerlikon Benefits Guide

Medical Coverage

HDHP / HSA PPO
In-Network Out-of-Network In-Network Out-of-Network
Medical Provisions
Company contribution to HSA
• Individual $500
• Individual + Spouse or Child(ren) $1,000 NA
• Family $1,500
Annual Deductible
(Individual/Family) $1,500/$3,000 $3,000/$6,000 $500/$1,000 $10,000/$20,000
Out-of-Pocket Limit
(Includes Coinsurance) $1,825/$3,650 $3,300/$6,600 $2,000/$4,000 $15,000/$30,000
Out-of-Pocket Maximum
(Includes Deductible, Coinsurance, Copays) $3,325/$6,650 NA/NA $2,600/$5,100 NA/NA
Preventive Care 100% 70%* 100% 60%*
Primary Care Office Visit 90%* 70%* $20 copay 60%*
Specialist Office Visit 90%* 70%* $40 copay 60%*

X-Ray and Lab 90%* 70%* 100%* 60%*
Inpatient Hospital Services 90%* 70%* 90%* 60%*
Outpatient Hospital Services 90%* 70%* 90%* 60%*
Urgent Care 90%* 70%* $40 copay 60%*
Emergency Room 90%* $150 copay (waived if admitted)

*After deductible

This is a summary of coverage only. For more information, please visit Paylocity.
The HDHP / HSA plan has a non-embedded deductible and out-of-pocket maximum. The PPO plan has an embedded deductible
and out-of-pocket maximum.
• Under a non-embedded approach, there is one family limit that applies to all of you. When one or a combination of family
members has expenses that meet the family deductible or out-of-pocket maximum, it is considered to be met for all of you.
Then, the plan will begin paying its share of eligible expenses for the whole family for the rest of the year.
• Under an embedded approach, each person only needs to meet the individual deductible and out-of-pocket maximum before
the plan begins paying its share for that individual. (And, once two or more family members meet the family limits, the plan
begins paying its share for all covered family members.)

Call a Health Coach
You just got a bee sting. What should you do? You are going to see your doctor. What questions should you ask?
A health coach provides information and support — at no cost to you. Health coaches are specially trained to
answer your questions and support you in making informed health decisions. Call a coach if:

• You have diabetes and need information to change your diet.
• Your cholesterol is a little high, but you don’t understand what the numbers mean.
• Your soccer player may have sprained his ankle. Should he go to the emergency room?
• Your family has a history of heart disease. What can you do to protect yourself?
• You have trouble managing your weight. How can you stay on track?
You can reach a health coach by calling 888-258-3428.

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