Page 10 - Work Life and Benefits Booklet 2020 - Global Post

Kaiser HMO Glossary of Terms
With the Kaiser HMO plan, services must be obtained at a Kaiser facility, except in case of
emergency. Kaiser integrates all elements of healthcare such as physicians, medical centers,
pharmacy and administration in one convenient facility. DEDUCTIBLE COINSURANCE

PPO and HSA Plans The amount of out-of-pocket A cost sharing agreement
The OAMC/PPO plan gives you the freedom to direct your own care, self-refer to a specialist expenses that you must pay between the insurance
and you are not limited to the physicians within the Aetna network. However, you will
maximize your benefits and reduce your out-of-pocket costs if you choose a provider who for before any expenses are company and the insured
participates in the Aetna network. The calendar year deductible must be met before certain payable by the plan. where payment
services are covered. responsibility is shared for
On the HSA, you must meet all claims covered by the
The HSA plan is a high deductible PPO plan with the same PPO features, except it allows you your deductible before any policy, usually expressed as
to take advantage of building a medical fund with pre-tax dollars and stays with you forever!
benefits are paid including a percentage.
prescription drugs.
PLAN FEATURES KAISER HMO HSA PPO OAMC/PPO

Employee Premiums $$ $$ $$$ OUT-OF-POCKET
Out-of-Pocket Costs $$ $$ $$ COPAY MAXIMUM
Contribution, Copay, Contribution, Contribution, The flat dollar amount a The annual maximum
Copay,
Cost Sharing Deductible, Deductible, Deductible, covered individual is required amount of money you will
Coinsurance Coinsurance Coinsurance to pay for certain services pay in addition to copays

Network Size    (could be before or after and deductibles. After you
reach your out-of-pocket
meeting any applicable
In-Network Benefits ✓ ✓ ✓ deductible). maximum, benefits are
Non-Network Benefits ✓ ✓ ✓ free (in-network only).

Access to Providers You Manage You Manage You Manage
- Primary Care Physician Not Required Not Required Not Required
- Referral for Specialist Not Required Not Required Not Required

Educational Video
FINDING A MEDICAL PROVIDER
Go to www.aetna.com or call (877) 204-9186 for OAMC/PPO. OAMC/PPO Deductibles, Copays, Coinsurance, and
members refer to the Open Choice PPO or Open Access Managed choice network Out-of-Pocket Maximums
when prompted.
http://video.burnhambenefits.com/terms/
For Kaiser, go to www.kp.org or call (877) 204-9186.