How Your Medical Plan Works 4 of 33 For all you do, the Company offers comprehensive benefit plans to support you. Learn how your medical plan works, so you can make the most of the high-quality coverage the Company provides. Important: Always Use In-Network Providers This guide is for associates who are enrolled in the PPO Plan. PPO stands for Preferred Provider Organization. It’s important to understand that you will receive a much higher level of benefits when you use in-network providers: doctors and facilities that are part of the plan’s network. Paying for Your Medical Plan Coverage Your contribution (also called a rate or premium) is the amount you pay to have coverage under the Company’s medical plan. Your contribution is deducted from each weekly paycheck. Paying for Healthcare Deductible The annual deductible is the amount you pay out of your own pocket for covered medical services before the plan begins to pay benefits. The deductible resets every January 1. The PPO Plan has an embedded deductible for family coverage. This means once a family member meets the individual deductible, the plan begins sharing costs for that family member’s care. Charges for all covered family members will continue to count toward the family deductible. Once the family deductible is met, the plan will share costs with you for all family members. For more on the deductible, see page 13. Copays and Coinsurance Once you meet the deductible, you and the plan share costs for all covered healthcare expenses. For some healthcare services, you will pay a copay: a flat fee that you pay each time you see a doctor or fill a prescription. For other services, you will pay coinsurance, or a percentage of the cost. For example, “30% coinsurance” means that if the plan pays 70% of an expense, you are responsible for the remaining 30%. Out-of-Pocket Maximum The annual out-of-pocket maximum is the most you will have to pay for covered healthcare expenses out of your own pocket in a calendar year. If you meet the out-of-pocket maximum, the plan will cover 100% of your healthcare expenses for the rest of the year. Deductibles and coinsurance count toward your out-ofpocket maximum. For more on the out-of-pocket maximum, see page 14. Before You Go How You Pay for Care Special Programs and Services Learn More Take Care of Your Health with Preventive Care For certain services, like preventive care, you do not have to pay the deductible before the plan begins to pay benefits. Preventive care includes screenings, check-ups, patient counseling and other routine care intended to prevent health problems.
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