Page 9 - Work Life and Benefits Booklet 2018 - SW.pub

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COINSURANCE A cost sharing agreement between the insurance company and the insured where payment responsibility is shared for all claims covered by the policy, usually expressed as a percentage. OUT-OF-POCKET MAXIMUM Maximum: The annual maximum amount of money you will pay in addition to copays and Medical Plan Choices

Glossary of Terms deductibles. Educational Video Deductibles, Copays, Coinsurance, and Out-of-Pocket Maximums h p://video.burnhambenefits.com/terms/

DEDUCTIBLE The amount of out-of- pocket expenses that you must pay for before any expenses are payable by COPAY The flat dollar amount a covered individual is required to pay for certain services (could be before or after meeting any applicable deductible).

the plan.
Medical Plan Choices

However, you will maximize your benefits and reduce your out-of-pocket costs if
you choose a provider who participates in the Aetna network. The calendar year
The PPO plan gives you the freedom to direct your own care, self-refer to a
Open Choice PPO Missouri   
specialist and are not limited to the physicians within the Aetna network.

OAMC/PPO OAMC All Other States $ $$ Contribution, Copay, Deductible, Coinsurance Managed by You Not Required Not Required
deductible must be met before certain services are covered.

FINDING A MEDICAL PROVIDER Go to www.aetna.com or call (877) 204-9186 for OAMC/PPO. OAMC/PPO members refer to the Open Choice PPO or Open Access Managed choice network when prompted. In Missouri, the plan name is Open Choice PPO.

OAMC/PPO Plan PLAN FEATURES Employee Premiums Out-of-Pocket Costs Cost Sharing Network Size In-Network Benefits Non-Network Benefits Access to Providers - Primary Care Physician - Referral for Specialist