Page 6 - Ria Benefits Guide 2020 FINAL CA

MEDICAL PLANS

Aetna and Kaiser Medical Plan Choices

KAISER PERMANENTE | HMO PLAN
With the Kaiser Permanente Health Maintenance Organization (HMO) plan, you must obtain services at a Kaiser
Permanente facility, except in the case of emergency. All of your care must be directed through your selected doctor, but
you can choose and change your doctor at any time, for any reason. Kaiser Permanente integrates all elements of
healthcare such as physicians, medical centers, pharmacy, and administration in one convenient facility. In addition,
Kaiser Permanente offers online tools so you can email your doctor’s office, make appointments, refill prescriptions, and
more.

AETNA | HMO PLAN
With the Aetna HMO plan, you must choose a primary care physician (PCP) or medical group within the Aetna Value
Network (AVN). All of your care must be directed through your PCP or medical group. Any specialty care you need will
be coordinated through your PCP and will generally require a referral or authorization. You will receive benefits only if
you use the doctors, clinics, and hospitals that belong to the medical group in which you are enrolled, except in the case
of an emergency. Each family member covered through your plan can choose his or her own PCP and can change them
at any time.

AETNA | PPO PLAN (OAMC)
The PPO plan requires that you meet a calendar year deductible before Aetna starts paying for certain services. Once the
deductible has been met, most services will be covered at a coinsurance or a copay. For certain services, such as office
visits and urgent care, Aetna has waived the deductible and only your copay applies. You are free to seek medical
care from both in and out-of-network providers. In order to receive the highest level of coverage under the plan, simply
obtain care from an in-network provider.

AETNA | HIGH DEDUCTIBLE PLAN WITH HSA (OAMC)
You must pay all of the costs from providers up to the deductible amount before the plan begins to pay (this
excludes preventative care, which is covered at 100%). With the HSA, you can pay for qualified healthcare expenses
now and grow your savings for future healthcare needs. This plan combines a High Deductible Health Plan (HDHP) with a
special, tax-qualified Health Savings Account (HSA). You can contribute tax-free money to your HSA up to IRS
maximums. The money in your account is yours to pay for current healthcare expenses - or you can save toward future
healthcare expenses. More details about the HSA medical plan are located on page 9. Similar to the traditional PPO plan,
you can seek care from in network and out of network providers.

FINDING A MEDICAL PROVIDER

For Kaiser, go to www.kp.org and click on “Locations”

For Aetna, go to www.aetna.com. From the Aetna website, click on the link “Find a Doctor.” Next, under
“Guests”, select “Plan from an employer.” Enter your search criteria. You will then be instructed to
select a plan:

• AVN HMO - Plan Category: State Based Plan | Plan: Aetna Value Network HMO
• PPO & HDHP - Plan Category: Aetna Open Access Plans | Plan: Managed Choice® POS (Open Access)

6 RIA EMPLOYEE BENEFITS 2020