Medical Plans
We are pleased to provide a choice of three medical plans: two Health Maintenance Organization (HMO) plans and one Preferred Provider Organization (PPO) plan, administered by Blue Shield and Kaiser Permanente.
HMOs center on the relationship between you and your Primary Care Physician (PCP). When you enroll you must choose a PCP who will be responsible for directing your care within a larger group of healthcare professionals (a medical group). If necessary, your PCP will refer you to any specialist within your medical group as well as take the appropriate steps to pre-authorize any facility-based care (excluding emergencies) and you will only be responsible to pay your deductible / co-payment amount.
PPOs give you the freedom to visit any licensed professional without a referral from your personal doctor. When you choose to visit a doctor within the Blue Shield PPO network, you will benefit from lower coinsurance amounts and significant savings by receiving the contracted discounted rates after any applicable deductibles. If you choose a non-contracted doctor you will pay more for your health care.
Medical Plans:
Ancillary Plans:
- Delta Dental DHMO Plan
- Delta Dental PPO Plan
- Mutual of Omaha Critical Illness Insurance
- Mutual of Omaha Hospital Care Coverage
- VSP Vision Plan
- Mutual of Omaha Basic & Voluntary Life Plans
- Mutual of Omaha Voluntary Short Term Disability Plan
- Mutual of Omaha Long Term Disability Plan
- Mutual of Omaha Employee Assistance Plan (EAP)
- Mutual of Omaha Travel Insurance
- Voluntary Pet Insurance Plans
These summaries are intended to highlight the most common procedures to assist employees in choosing the type of plan most suitable to their needs. They are not intended to be relied upon to fully determine coverage. Unless stated otherwise, the amounts shown are based on what you would pay. Any one plan may not cover all health care expenses. Please refer to your Certificate of Coverage for a complete listing of services, limitations, exclusions and a description of all terms and conditions of coverage. If these summaries/descriptions conflict in any way with the policies issued, the policies will prevail.
Medical
Choosing a medical plan is an important decision to make because of its direct impact to you and your family’s health care services. The benefit comparison chart below highlights the differences between the medical plans offered. You may want to review the Summary Plan Description for specific coverage information. The plan that is best for your depends on you and your family’s individual needs.
| IN-NETWORK BENEFITS SHOWN (Please refer to the carrier plan summaries for final benefit details. The carrier plan details will supersede the benefit overview below) |
BLUE SHIELD ACCESS+ HMO PLAN Policy #: W3001477 Phone #: 888-256-1915 |
KAISER PERMANENTE HMO PLAN SoCal Policy #: 331103 | NorCal Policy #: 605516 Phone #: 800-464-4000 |
|---|---|---|
| Individual Deductible | $0 | $0 |
| Family Deductible | $0 | $0 |
| Individual Out of Pocket Max | $2500 | $3000 |
| Family Out of Pocket Max | $5000 | $6000 |
| Office Visit – Primary / Specialist | $25 / $40 copay | $35 / $50 copay |
| Diagnostic Lab / X-ray | $0 / $0 copay | $10 copay |
| Chiropractic Services | $10 copay / 30 Visit Max | Not covered |
| Prescription Deductible | $0 | $0 |
| Tier 1 Prescriptions | $10 copay | $15 copay |
| Tier 2 Prescriptions | $20 copay | $35 copay |
| Tier 3 Prescriptions | $35 copay | $35 copay |
| Tier 4 Prescriptions | 20% up to $250 max | $35 copay |
| Inpatient Hospital Services | $750 copay per admission | $500 per day |
| Outpatient Hospital Services |
|
$250 per procedure |
| Emergency Room | $150 copay (waived if admitted) | $150 copay |
| Urgent Care | $25 copay | $35 copay |
Remember, PPOs give you the freedom to visit any licensed professional without a referral from your personal doctor. When you choose to visit a doctor within the Blue Shield PPO network, you will benefit from lower co-insurance amounts and significant savings by receiving the contracted discounted rates after any applicable deductibles. If you choose a non-contracted doctor you will pay more for your health care.
| IN-NETWORK BENEFITS SHOWN (Please refer to the carrier plan summaries for final benefit details. The carrier plan details will supersede the benefit overview below) |
BLUE SHIELD FULL PPO PLAN Policy #: W3001477 Phone #: 888-256-1915 |
|---|---|
| Individual Deductible | $250 |
| Family Deductible | $750 |
| Individual Out of Pocket Max | $3750 |
| Family Out of Pocket Max | $7500 |
| Office Visit – Primary / Specialist | $25 / $30 copay(deductible waived) |
| Diagnostic Lab / X-ray | $25 / $25 (deductible applies) |
| Chiropractic Services | $25 copay (deductible waived) |
| Prescription Deductible | $0 |
| Tier 1 Prescriptions | $10 copay |
| Tier 2 Prescriptions | $20 copay |
| Tier 3 Prescriptions | $35 copay |
| Tier 4 Prescriptions | 30% up to $250 max |
| Inpatient Hospital Services | 10% ( deductible applies) |
| Outpatient Hospital Services |
|
| Emergency Room | $150 copay+10%(deductible waived) |
| Urgent Care | $25 copay (deductible waived) |
