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HSA PPO plan overview

The HSA PPO blends traditional health coverage with a unique tax free fund to help you pay for covered medical expenses. You decide how to spend your benefit dollars using the available tools to help you shop smart. Here's how it works:

  1. Decide where to go for care
  2. Pay your deductible with help from the funds you and VMware contribute to your personal Health Savings Account (HSA) through HealthEquity
  3. Share the costs with the plan until you reach your Out-of-pocket Maximum
  4. The plan pays 100% of covered expenses for the rest of the calendar year after you reach your Out-of-pocket Maximum

For more information, also refer to the HSA PPO summary of benefits [PDF].

1. Decide where to go for care

You can go to any licensed doctor or hospital — in or out of the Aetna network. Remember, your choice can impact how much you pay.

  • Stay in the network – After the deductible, the plan will pay 90% and you pay 10%. In-network doctors agree to negotiated rates and cannot charge more for the service. That means your 10% share is calculated from a lower starting point.

  • Go outside the network - After the deductible, the plan will pay 70% and you pay 30%. We have no contract with these doctors, so we don’t know how much they’ll charge. It’s usually higher than our negotiated rates. Also, the coinsurance split (70%/30%) is based on the Aetna “allowed” amount. Some doctors will charge you for the difference.

  • Choose a high-performance specialist – You never need a referral to see any specialist. But how do you know if you’re choosing well? You can feel confident when you pick from the Aexcel® network. Aetna carefully selects specialists to be included in its elite group based on past performance, outcome statistics, cost efficiency and other factors. When you use DocFind to find a specialist, look for the blue stars that indicate high-performance specialists. Find DocFind on Aetna Navigator.

  • Compare hospitals – The hospital comparison tool lets you choose a specific service and do a side-by-side comparison of area hospitals. Make your choice based on cost and outcomes. Find the hospital comparison tool on Aetna Navigator.

  • Choose an urgent care center or walk-in clinic instead of the emergency room – If it’s not life threatening, go to an urgent care center or walk-in clinic instead. You’ll wait less and you’ll pay less — sometimes much less. Stay in the network for even greater savings.

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See if your doctor is in the Aetna network

You can check right now on the DocFind directory. When prompted to select a plan, scroll down to Aetna HDHP Choice POS II and choose. Follow the prompts to look up a doctor’s name, or search your area for other doctors.

2. Pay your deductible with help from your Health Savings Account

A deductible is the amount you owe for health care services before your health plan begins to pay. The deductible is an aggregate deductible which means one or more enrolled members in the plan must meet the full deductible before traditional coinsurance is paid at 90% (in network).  The deductible is based on coverage levels:

  Employee only $1,500
  Employee + Spouse or Child(ren) $3,000
  Employee + Family $3,000

As a qualified IRS high deductible plan you are able to save pre tax monies into an HSA account through pre-tax payroll contributions.  VMware also will contribute to your HSA account with funds based on coverage level (see below). 

The IRS sets a calendar year limit on how much can be funded each year pre tax into your HSA account and includes an additional catch up contribution for enrollees age 55 or over in the year. 

Your maximum contribution to this plan is reduced by the amount VMware funds on your behalf.  Please refer to www.healthequity.com/vmware to review IRS limits.

The advantage to funding your HSA account with pre-tax monies means, you can use it to offset your deductible and coinsurance if you wish,or,save the monies for future retirement medical expenses, and pay out of pocket. 

In 2018 VMware will fund your HSA as follows:

  Employee Only $750   
  Employee + Spouse/Domestic Partner $1,500
  Employee + Child(ren) $1,500
  Employee + Family $1,500

When you have an eligible medical or prescription drug out-of-pocket expense you can use your HealthEquity debit card to pay for first dollar expenses such as the deductible. 

IMPORTANT: Note prescription expenses are part of the deductible under the HSA PPO. 

If you do not use the monies saved in your HSA each calendar year, provided you enroll in the HSA PPO the following year, you have the opportunity to save pre tax monies again for the new calendar year.  The monies in your HSA are yours and there is no “use it or lose it” provision like a Health Flexible Savings Account (FSA).  You can use these funds throughout your lifetime for medical expenses tax free and take it with you even if you leave the company.

Preventive Care covered at 100% (in-network) — no deductible!

Routine in-network preventive care services such as physical exams, well-child exams, immunizations, gynecological care exams, mammograms, cancer screenings, eye exams and hearing exams are covered 100% by the Plan.  The deductible is waived and it doesn’t use your HSA or count as part of your deductible.

3. Share the costs with the plan until you reach your Out-of-pocket Maximum

Once you’ve met the deductible, the plan covers additional expenses under coinsurance.  You and the company share in the costs of your health care.  You can decide if you wish to use your personal HSA towards your coinsurance cost by using your HealthEquity debit card.

Coinsurance for medical expenses
Below is an outline of what you and the plan will pay for covered medical expenses including prescription drugs once you have met the deductible.

Medical Expenses

  The Plan pays: You pay:
In-network 90% after the deductible 10% after the deductible
Out-of-network 70% after the deductible 30% after the deductible

Coinsurance for Retail (30 day) and Mail Order (90 day) prescription drugs

Generic The Plan pays: You pay:
In-network 90% after the deductible 10% after the deductible
Out-of-network1 50% after the deductible 50% after the deductible

 

Brand The Plan pays: You pay:
In-network 85% after the deductible 15% after the deductible
Out-of-network1 50% after the deductible 50% after the deductible

 

Non Formulary The Plan pays: You pay:
In-network 80% after the deductible 20% after the deductible
Out-of-network1 50% after the deductible 50% after the deductible

1Mail order prescriptions are not covered when out-of-network

Your coinsurance is calculated as a percent (for example, 10%) of the covered service. If an office visit in network costs $150 and you’ve met your deductible, your coinsurance payment of 10% would be $15. As a reminder, routine in-network preventive care services are covered 100% by the Plan.

Out-of-network coverage for up to a 30-day supply is 50% of the actual cost, after meeting the combined medical/Rx deductible.

Preventive care prescription drugs

As a way to help you take care of yourself, the HSA PPO waives the deductible for applicable preventive prescription drugs. The plan will pay appropriate coinsurance depending on the preventive drug tier (e.g. generic, brand).

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4. The plan pays 100% of covered expenses for the rest of the calendar year after you reach your Out-of-pocket Maximum (OOP)

There is a limit to how much you will spend out of your own pocket each calendar year. This is called the Out-of-pocket Maximum. When your out-of-pocket costs reach the maximum, the plan pays 100% of eligible covered expenses including prescription drugs for the rest of the calendar year.

  In-Network   Out-of-Network  
  Employee Only $2,500 Employee only    $6,000  
  Employee + 1 $5,000 Employee + 1 $12,000
  Employee + Family $5,000 Employee + Family $12,000

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