Page 6 - Lake Avenue Church Benefits Guide 2020

Medical Benefits

Medical Insurance

Aetna | HMO Plans
With the Aetna Value Network HMO plans, 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.

• Deductible HMO - Aetna Value Network HMO 500/20/40/80%
This base plan, provides you the more affordable premium when I comes to your payroll deductions. When you get care,
you'll pay the full charges for covered services until you reach a set amount known as your deductible. After you reach
your deductible, you'll start paying less – a copay or a percentage of the charges (a coinsurance) for the rest of the year.
Full charges, copays, and coinsurance count toward your out-of-pocket maximum, which helps limit how much you pay
for care. After you reach your out-of-pocket maximum, you won't have to pay for most covered services for the rest of
the year.

• No Deductible HMO - Aetna Value Network HMO 20/40 3day/80%
You have to option buy-up and pay a nominal amount to enroll in the HMO plan without a deductible, meaning lower out
of pocket expenses as you use the plan.

Aetna | PPO Medical Plan
The Aetna Preferred Provider Organization (PPO) plan 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 Aetna Aetna
Plan Differences Value Network Value Network Managed Choice
Deductible HMO No Deductible HMO PPO

Employee Premiums $ $ $$

Out-of-Pocket Costs $ $ $$

Cost Sharing Contribution, Copay, Contribution, Copay Contribution, Copay,
Deductible, Coinsurance Deductible, Coinsurance

Network Size   

In-Network Benefits ✓ ✓ ✓

Non-Network Benefits ✓

Access to Providers Managed by Your PCP Managed by Your PCP Managed by You
- Primary Care Physician Required Required Not Required
- Referral for Specialist Required Required Not Required

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