Page 10 - Work Life and Benefits Booklet 2020 SW

PPO and HSA Plans Glossary of Terms
The OAMC/PPO plan gives you the freedom to direct your own care, self-refer to a
specialist and you are not limited to the physicians within the Aetna network.
However, you will maximize your benefits and reduce your out-of-pocket costs if DEDUCTIBLE COINSURANCE
you choose a provider who participates in the Aetna network. The calendar year
deductible must be met before certain services are covered. The amount of out-of-pocket
A cost sharing agreement
The HSA plan is a high deductible PPO plan with the same PPO features, except it expenses that you must pay between the insurance
allows you to take advantage of building a medical fund with pre-tax dollars and for before any expenses are company and the insured
stays with you forever! payable by the plan. where payment
responsibility is shared for
The Aetna national provider network is called Open Choice for members residing On the HSA, you must meet all claims covered by the
in Missouri. In all other states, the network is called Open Access Managed Choice.
your deductible before any policy, usually expressed as
benefits are paid including a percentage.
PLAN FEATURES HSA PPO OAMC/PPO prescription drugs.
Employee Premiums $ $
Out-of-Pocket Costs $$ $$ COPAY OUT-OF-POCKET
MAXIMUM
Contribution, Contribution,
Copay,
Cost Sharing Deductible, Deductible, The flat dollar amount a The annual maximum
Coinsurance Coinsurance covered individual is required amount of money you will
pay in addition to copays
to pay for certain services
Network Size   (could be before or after and deductibles. After you
In-Network Benefits ✓ ✓ meeting any applicable reach your out-of-pocket
Non-Network Benefits ✓ ✓ deductible). maximum, benefits are
free (in-network only).
Access to Providers You Manage You Manage
- Primary Care Physician Not Required Not Required
- Referral for Specialist Not Required Not Required

FINDING A MEDICAL PROVIDER
Go to www.aetna.com or r call (877) 204-9186 for OAMC/PPO. OAMC/PPO Educational Video
members refer to the Open Choice PPO or Open Access Managed choice Deductibles, Copays, Coinsurance, and
network when prompted. In Missouri, the network name is Open Choice PPO. Out-of-Pocket Maximums
http://video.burnhambenefits.com/terms/