Page 9 - Work Life and Benefits Booklet 2018 - SDC.END.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

PCP will coordinate all of your care, including any specialty care, as that generally requires
within the Aetna network of providers for you and all your covered family members. Your
The PPO plan gives you the freedom to direct your own care, self-refer to a specialist and
a referral or authorization. Benefits are covered under your assigned medical group and
With the Deductible HMO & HMO plan, you must choose a Primary Care Physician (PCP)
OAMC/PPO $$$ $$ Contribution, Copay, Deductible, Coinsurance    Managed by You Not Required Not Required
services received outside of the HMO network are not covered, except in the case of an
are not limited to the physicians within the Aetna network. However, you will maximize
participates in the Aetna network. The calendar year deductible must be met before
your benefits and reduce your out-of-pocket costs if you choose a provider who

FULL HMO $$ $ Contribution, Copay    PCP Managed Required Required

DED HMO $ $ Contribution, Deductible, Copay    PCP Managed Required Required Go to www.aetna.com or call (866) 529-2517 for HMO | (877) 204-9186 for OAMC/PPO. HMO members refer to the Deductible HMO or HMO network and OAMC/PPO members refer to the Open Access Managed Choice
HMO Plans (available in CA only)

emergency. OAMC/PPO Plan certain services are covered. PLAN DIFFERENCES 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 FINDING A MEDICAL PROVIDER network when prompted.