Page 6 - Casting Network Benefits Guide 2020

Medical Plan Choices

HMO Plans (available in CA only) Glossary of Terms
With the Kaiser HMO & Blue Shield HMO plans, you must choose a Primary Care
Physician (PCP) within the Kaiser or Blue Shield network of providers for you and all DEDUCTIBLE COINSURANCE
your covered family members. Your PCP will coordinate all of your care, including any
specialty care, as that generally requires a referral or authorization. Benefits are The amount of out-of- A cost sharing agreement
covered under your assigned medical group and services received outside of the pocket expenses that you between the insurance
HMO network are not covered, except in the case of an emergency. must pay for before any company and the insured

PPO Plan expenses are payable by . . . . . . . . . . . . . . . where payment
The Blue Shield PPO plans gives you the freedom to direct your own care, self-refer to the plan. responsibility is shared for
a specialist and are not limited to the physicians within the Blue Shield network. all claims covered by the
However, you will maximize your benefits and reduce your out-of-pocket costs if you policy, usually expressed
choose a provider who participates in the Blue Shield network. The calendar year as a percentage.
deductible must be met before certain services are covered.

PLAN KAISER HMO BLUE SHIELD BLUE SHIELD BLUE SHIELD COPAY OUT-OF-POCKET
DIFFERENCES HMO PPO GOLD PPO PLATINUM MAXIMUM
Employee Premiums $ $ $$ $$$ The flat dollar amount a The annual maximum
covered individual is amount of money you will
Out-of-Pocket Costs $ $ $$$ $$
required to pay for certain pay in addition to copays
Contribution, Contribution, services (could be before . . . . . . . . . . . . and deductibles.
Contribution, Contribution, Copay, Copay,
Cost Sharing or after meeting any
Copay Copay Deductible, Deductible,
Coinsurance Coinsurance applicable deductible).
Network Size    
In-Network Benefits ✓ ✓ ✓ ✓
Non-Network Benefits ✓ ✓

Access to Providers Managed by Managed by
- Primary Care PCP Managed PCP Managed You You
Physician Required Required Not Required Not Required
- Referral for Required Required Not Required Not Required Educational Video

Specialist Deductibles, Copays, Coinsurance, and
Out-of-Pocket Maximums
http://video.burnhambenefits.com/terms/
6 Medical Plan Choices