Medical Plan Guide

Medical Plan Details

You may select from one of the three plans offered through Aetna. If you live in California, you also have the option of selecting the Kaiser HMO plan.

Each medical plan option includes prescription drug and basic vision coverage through VSP. With the Consumer Choice and PPO 85 plans, you have the option to see an out-of-network provider but will pay more for care.

For more information about the plans, please refer to the plan chart.

Consumer Choice 90 & Consumer Choice 80

The Consumer Choice plans have higher deductibles and lower employee contributions. Enrollees are responsible for paying for the full cost of services, instead of paying copays for services, until they meet the plan deductible. After you meet your deductible, you will pay a percentage of the cost, or coinsurance, for your care, until you reach the out-of-pocket maximum. With these plans, you have access to a Health Savings Account (HSA), which allows you to set aside pre-tax money for health care expenses. Plus, Acme contributes to the HSA twice during the year to help offset your out-of-pocket costs.

PPO 85

With the PPO 85 plan, you pay copays when you receive certain care and when you fill generic prescriptions. For some services, you will share costs with the plan by paying coinsurance after meeting your annual deductible. Copays, along with the deductible and coinsurance amounts, will apply to the PPO 85 out-of-pocket maximum.

Kaiser HMO

If you are a California resident, you have the option to enroll in an HMO provided through Kaiser Permanente. If you elect the Kaiser HMO option, you are able to utilize only medical and prescription drug services and providers within the Kaiser HMO network.

Medical Plans Comparison Chart

All plans cover preventive care — like your annual checkup and immunizations — at 100%, and you do not have to meet the deductible first. The below chart reflects in-network care only. For a detailed medical plan comparison chart, visit acmenorthamericabenefits.com

In-Network Comparison Chart

	Consumer Choice 90	Consumer Choice 80	PPO 85	Kaiser HMO (California residents only)
Annual Deductible (Employee Only/ Other Coverage Levels)	$1,400/$2,800	$2,100/$4,200	$300/$600	None
Acme HSA Contribution (Employee Only/ Other Coverage Levels)	$600/$1,200	$600/$1,200	N/A	N/A
Coinsurance	90% after deductible	80% after deductible	85% after deductible	Durable Medical Equipment: 80% All other services: N/A
Office Visits (PCP/Specialist)	90% after deductible	80% after deductible	You pay $20 copay/ $35 copay	You pay $10 copay/ $10 copay
Emergency Room	90% after deductible	80% after deductible	100% after $100 copay; deductible waived (copay waived if admitted)	100% after $50 copay
Urgent Care	90% after deductible	80% after deductible	You pay $35 copay	You pay $10 copay
Inpatient Hospital Services	90% after deductible	80% after deductible	85% after deductible, after you pay $250 copay per confinement	100% covered
Diagnostic X-ray and Lab	90% after deductible	80% after deductible	85% after deductible	100% covered
Short-Term Rehab	90% after deductible	80% after deductible	You pay $20 copay	You pay $10 copay outpatient/100% covered inpatient
Mental Health Counseling	90% after deductible	80% after deductible	You pay $35 copay for outpatient visit/85% after deductible, after you pay $250 copay per confinement for inpatient	You pay $10 copay for individual outpatient visit You pay $5 copay for group outpatient visit 100% covered inpatient
Transgender Services	90% after deductible	80% after deductible	85% after deductible	Limited coverage
Infertility Services	• 90% after deductible • Egg/sperm/embryo freezing 100% after deductible	• 80% after deductible • Egg/sperm/embryo freezing 100% after deductible	• 85% after deductible • Egg/sperm/embryo freezing 100% after deductible	• Limited coverage • Egg/sperm/ embryo freezing not covered
Hearing Aids	One hearing aid per ear every 3 years	One hearing aid per ear every 3 years	One hearing aid per ear every 3 years	Not covered
Out-of-Pocket Maximum (Employee Only/Family)	$2,800/$5,600	$4,000/$8,000	$3,500/$7,000	$1,500/$3,000