Page 9 - Work Life and Benefits Booklet 2018 - SW

Glossary of Terms
OAMC/PPO Plan
The PPO plan gives you the freedom to direct your own care, self-refer to a
specialist and are not limited to the physicians within the Aetna network. DEDUCTIBLE COINSURANCE
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 amount of out-of- A cost sharing agreement
deductible must be met before certain services are covered. pocket expenses that you between the insurance
must pay for before any company and the insured
expenses are payable by where payment
OAMC/PPO the plan. responsibility is shared for
PLAN FEATURES Open Choice PPO Missouri all claims covered by the
OAMC All Other States policy, usually expressed as
Employee Premiums $ a percentage.

Out-of-Pocket Costs $$
Contribution, COPAY OUT-OF-POCKET
Cost Sharing Copay, Deductible, MAXIMUM
Coinsurance The flat dollar amount a Maximum: The annual

Network Size  covered individual is maximum amount of
In-Network Benefits ✓ required to pay for certain money you will pay in
services (could be before or
addition to copays and
Non-Network Benefits ✓ after meeting any deductibles.
applicable deductible).
Access to Providers Managed by You
- Primary Care Physician Not Required
- Referral for Specialist Not Required

FINDING A MEDICAL PROVIDER Educational Video
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 Deductibles, Copays, Coinsurance, and
Out-of-Pocket Maximums
network when prompted. In Missouri, the plan name is Open Choice PPO.
http://video.burnhambenefits.com/terms/