Page 9 - Hitachi Benefits Booklet Final

Aetna | HMO Plan (Available to California Residents Only)
With the HMO plan, you must choose a primary care physician (PCP) or medical group within the network. 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.
Kaiser Permanente | HMO Medical Plan (Available to California Residents Only)
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 | PPO Medical Plans
The Aetna Preferred Provider Organization (PPO) plans allow you to direct your own care with access to a large
national provider network. You are not limited to the physicians within the Managed Choice® (Open Access) network
and you may self-refer to specialists. If you receive care from a physician who is a member of the PPO network, a
greater percentage of the entire cost will be paid by the insurance plan. You may also obtain services using a non-
network provider; however, you will be responsible for the difference between the covered amount and the actual
charges and you may be responsible for filing claims. Please take special care when accessing services with non-
contracted providers as the Plan only reimburses you up to an allowance. Any excess balance billing will not apply to
the out-of-pocket maximum.

Aetna | HSA Medical Plan
The Health Savings Account (HSA) plan through Aetna is also a PPO plan. It combines a high deductible health plan
(HDHP) with a special, tax-qualified savings account. Important - you have to meet your plan deductible before health
care and prescription drug benefits are paid by the plan. You may use your HSA funds to pay for current medical
expenses or save toward future medical expenses. Similar to the PPO plan, you have the freedom to choose your
doctor without the requirement of selecting a PCP and you may self-refer to specialists. You may use a network
provider whose negotiated rates provide richer levels of benefits with claim forms filed by the providers. You may also
obtain services using a non-network provider; however, you will be responsible for the difference between the covered
amount and the actual charges and you may be responsible for filing claims. Important: Outside of preventive care
(i.e. annual physical, mammography, etc.), you must satisfy the plan deductible before Aetna pays any benefits
including prescription drugs. You may elect to make contributions into the bank account up to the IRS maximums:

HSA Contributions 2020 Annual IRS Team Member Contributions Maximum
Team Member $3,550
Team Member + Family $7,100
Catch-Up for Team Members Ages Additional $1,000
55+

Additional information on how the HSA plan option works is located on page 14 of this guide.