Page 9 - Sample Calendar Layout EE Guide

Kaiser HMO Glossary of Terms
With the Kaiser Permanente Health Maintenance Organization (HMO) plan, services must
be obtained at a Kaiser 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 DEDUCTIBLE COINSURANCE
time, for any reason. Kaiser integrates all elements of healthcare such as physicians,
medical centers, pharmacy, and administration in one convenient facility. The amount of out-of- A cost sharing agreement
pocket expenses that you between the insurance
Aetna OAMC/PPO Plan must pay for before any company and the insured
The 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 OAMC/PPO network. However, you expenses are payable by where payment
will maximize your benefits and reduce your out-of-pocket costs if you choose a provider the plan. responsibility is shared for
who participates in the Aetna network. The calendar year deductible must be met before all claims covered by the
certain services are covered. policy, usually expressed as
a percentage.

PLAN DIFFERENCES KAISER HMO AETNA OAMC/PPO OUT-OF-POCKET
Employee Premiums $$ $$$ COPAY MAXIMUM
Out-of-Pocket Costs $$ $$ The flat dollar amount a Maximum: The annual
Contribution, covered individual is maximum amount of
Contribution,
Cost Sharing Deductible, Copay Copay, Deductible, required to pay for certain money you will pay in
Coinsurance services (could be before or addition to copays and
Network Size   after meeting any deductibles.

In-Network Benefits ✓ ✓ applicable deductible).
Non-Network Benefits ✓
Access to Providers PCP Managed Managed by You
- Primary Care Physician Not Required Not Required
- Referral for Specialist Required Not Required

Educational Video
FINDING A MEDICAL PROVIDER
Kaiser: www.kp.org or call (888) 865-5813 Deductibles, Copays, Coinsurance, and
Aetna: www.aetna.com or call (866) 529-2517 OAMC/PPO members refer Out-of-Pocket Maximums
to the Open Access Managed Choice network when prompted. http://video.burnhambenefits.com/terms/