Page 9 - Remita Guide 2020 - CA FINAL

Kaiser Permanente | HMO Medical Plans Blue Shield | PPO Medical Plan
Two Kaiser Permanente HMO plan options are available The Blue Shield Preferred Provider

With the Kaiser Permanente Health Maintenance Organization Organization (PPO) plan allows you to direct
(HMO) plans, services must be obtained at a Kaiser Permanente your own care. You are not limited to the
facility, except in the case of emergency. All of your care must be physicians within the network and you may self
directed through your selected doctor, but you can choose and -refer to specialists. If you receive care from a
change your doctor at any time, for any reason. Kaiser physician who is a member of the PPO
Permanente integrates all elements of healthcare such as network, a greater percentage of the entire
physicians, medical centers, pharmacy, and administration in one cost will be paid by the insurance plan. You
convenient facility. In addition, Kaiser Permanente offers online may also obtain services using a non-network
tools so you can email your doctor’s office, make appointments, provider; however, you will be responsible for
refill prescriptions, and more. the difference between the covered amount
• Deductible HMO: This plan offers higher deductibles and and the actual charges and you may be
out-of-pocket expenses in exchange for paying less in your responsible for filing claims.
paycheck.
• HMO: This plan offers no deductibles and lower out-of-pocket Blue Shield | HSA PPO Medical
expenses, but you will pay more in your paycheck. Plans
The Health Savings Account (HSA) plan through
Blue Shield | HMO Medical Plans Blue Shield combines a high deductible health
Two Blue Shield HMO plan options are available plan (HDHP) with a special, tax-qualified
savings account. You may use your HSA funds
With the Blue Shield of California Health Maintenance
Organization (HMO) plans, you must choose a primary care to pay for current medical expenses or save
physician (PCP) within the network. These plans allows you to toward future expenses. You have the freedom
receive specialist referrals from your PCP who coordinates your to choose your doctor without the requirement
care, or you may self-refer to Trio ACO or Access+ specialists of selecting a PCP and you may self-refer to
(depending on your chosen plan). You will receive benefits only if specialists. If you receive care from a physician
you use the doctors, clinics, and hospitals that belong to the who is a member of the PPO network, a
provider network, except in the case of an emergency or with prior greater percentage of the entire cost will be
authorization. paid by the insurance plan. You may also
• Trio ACO HMO: This is the lowest cost plan. This smaller ACO obtain services using a non-network provider;
however, you will be responsible for the
network of providers is designed to reduce costs for you by difference between the covered amount and
eliminating unnecessary expenses without sacrificing the actual charges and you may be responsible
comprehensive, quality care. You benefit from collaboration, for filing claims. Remita Health will contribute
more effective coordination between providers, and the $250 toward employee health savings and
sharing of critical information that helps drive better overall $500 for family annually. In addition to the
health. It is your responsibility to ensure that all family company contributions, you may elect to make
members choose providers from the Trio ACO HMO network. contributions into the account up to the IRS
• Access+ HMO: This plan is similar to the Trio ACO HMO, but maximums.
uses a larger network of medical group providers. Since this
plan offers more provider options, you will experience higher
per paycheck premiums.

Finding a Medical Provider
• Kaiser HMO: Go to www.kaiserpermanente.org
• Blue Shield TRIO: Go to www.blueshieldca.com/networktriohmo
• Blue Shield HMO: Go to www.blueshieldca.com/networkhmo
• Blue Shield PPO: Go to www.blueshieldca.com/networkppo

Blue Shield Prescription Drug Formulary:
www.blueshieldca.com/wellness/drugs/formulary#heading2