Medical Plans

Pearson provides benefits that help you and your family stay healthy. We want you to feel confident in your choices so you can make the most of your benefits. So, we’ll provide you with information about what is available and give you the freedom to choose the benefits that work best for you.

Which Medical Plan is Right For You?

1. National Medical PPO Plans

Pearson offers four (4) National Medical PPO Plans. Each is administered by *Aetna and Anthem. You choose the network and plan that best suits your needs.

National Medical PPO Plans

Plans	Description
$400 & $900 Deductible PPO Plans	These are traditional PPO plans that contain copays for doctor’s visits and has lower out-of-pocket costs. You are not required to choose a primary care physician (although it is recommended) or to get a referral in order to see a specialist. You can receive care through a network of physicians at a significantly lower cost to you, or you can select providers outside the network and pay a greater share of your medical expenses.
$1,850 & $3,200 Deductible PPO Plans	$1,850 and $3,200 plans are consumer-directed health plans (CDHPs) that put you in charge of your spending through lower per-paycheck contributions, higher deductibles and out-of-pocket maximums, and a tax-free Health Savings Account (HSA). Pearson will contribute up to $500 if you cover yourself only and up to $1,000 if you cover yourself and dependents. You must contribute to the HSA to receive Pearson’s contribution. And, like the $400 and $900 Deductible PPO plans, you can see providers within or outside the network.

Plans

Description

$400 & $900 Deductible PPO Plans

These are traditional PPO plans that contain copays for doctor’s visits and has lower out-of-pocket costs. You are not required to choose a primary care physician (although it is recommended) or to get a referral in order to see a specialist. You can receive care through a network of physicians at a significantly lower cost to you, or you can select providers outside the network and pay a greater share of your medical expenses.

$1,850 & $3,200 Deductible PPO Plans

$1,850 and $3,200 plans are consumer-directed health plans (CDHPs) that put you in charge of your spending through lower per-paycheck contributions, higher deductibles and out-of-pocket maximums, and a tax-free Health Savings Account (HSA). Pearson will contribute up to $500 if you cover yourself only and up to $1,000 if you cover yourself and dependents. You must contribute to the HSA to receive Pearson’s contribution. And, like the $400 and $900 Deductible PPO plans, you can see providers within or outside the network.

Prescription Drug Coverage Under the PPO Plans

The prescription drug portion of the National Medical PPO plans is administered by CVS/Caremark. You will receive a separate CVS/Caremark ID card for your prescription drug coverage. Through CVS Caremark network you can obtain prescription drugs through a national network of participating pharmacies through retail pharmacies or by mail. All Affordable Care preventive Drugs are covered at 10%.

* Aetna provides a narrower network than Anthem but with lower per-paycheck contributions and out-of-pocket costs. It is only available in certain states based on your home zip code. If you live in an area where this is available, you will see the option as you enroll.

2. Anthem’s High Performance Network (HPN)

Offered in select areas of the country, Anthem’s HPN is an Exclusive Provider Organization (EPO) that provides a narrow network of hand-selected doctors and facilities, curated to provide access to higher-quality, more affordable care. This lower cost option provides in-network-only coverage. However, urgent and emergency care are covered even if you are seeing a provider that is not in the network. And, like the other national plans offered through Pearson, you do not need a referral from your Primary Care Physician to see a specialist. If you live in an area where this is available, you will see the option as you enroll.

Anthem’s HPN Plans

Plans	Description
$400 & $900 Deductible HPN Plans	These are in-network only plans that contain copays for doctor’s visits and has lower out-of-pocket costs. You are not required to choose a primary care physician (although it is recommended) or to get a referral in order to see a specialist. You receive care through a network of physicians at a significantly lower cost to you. Out-of-network care is not available except in the case of emergencies.
$1,850 & $3,200 Deductible HPN Plans	$1,850 and $3,200 HPN plans are consumer-directed health plans (CDHPs) that put you in charge of your spending through lower per-paycheck contributions, higher deductibles and out-of-pocket maximums, and a tax-free Health Savings Account (HSA). Pearson will contribute up to $500 if you cover yourself only and up to $1,000 if you cover yourself and dependents. You must contribute to the HSA to receive Pearson’s contribution. And, like the $400 and $900 Deductible HPN plans, you can only see providers within the network.

Plans

Description

$400 & $900 Deductible HPN Plans

These are in-network only plans that contain copays for doctor’s visits and has lower out-of-pocket costs. You are not required to choose a primary care physician (although it is recommended) or to get a referral in order to see a specialist. You receive care through a network of physicians at a significantly lower cost to you. Out-of-network care is not available except in the case of emergencies.

$1,850 & $3,200 Deductible HPN Plans

$1,850 and $3,200 HPN plans are consumer-directed health plans (CDHPs) that put you in charge of your spending through lower per-paycheck contributions, higher deductibles and out-of-pocket maximums, and a tax-free Health Savings Account (HSA). Pearson will contribute up to $500 if you cover yourself only and up to $1,000 if you cover yourself and dependents. You must contribute to the HSA to receive Pearson’s contribution. And, like the $400 and $900 Deductible HPN plans, you can only see providers within the network.

Prescription Drug Coverage Under the HPN Plans

The prescription drug portion of Anthem’s HPN plans is administered by CVS/Caremark. You will receive a separate CVS/Caremark ID card for your prescription drug coverage. Through CVS/Caremark network you can obtain prescription drugs through a national network of participating pharmacies through retail pharmacies or by mail. All Affordable Care preventive Drugs are covered at 10%.

A word about the $1,850 Deductible PPO & HPN Plans

If you enroll in the $1,850 Deductible Plan and cover any dependents, the full family deductible must be met before the Plan pays benefits for any family member. Any covered family member can contribute to the family deductible. The individual deductible only applies if you elect the employee-only coverage tier. Please call Mercer Marketplace at 855-237-6421 if you have any questions.

3. State-Based Plans

Depending on the state where you live, you may have the opportunity to enroll in one of the State-Based plans described below.

State-Based Plans

	Kaiser HMO Plan No & So California	HMSA PPO Plan Hawaii	Triple S Plan Puerto Rico
In-Network Care	What you pay	What you pay	What you pay
Preventive care	Covered at 100% in-network, so you pay nothing.	Covered at 100% in-network, so you pay nothing.	Covered at 100% in-network, so you pay nothing.
Out-of-pocket maximum (individual/ family)	$1,500/$3,000	$2,500 / $7,500 (medical) $3,600 / $4,200 (pharmacy)	$6,350/$12,700 Major Medical: $2,000/$6,000
Coinsurance	You pay 10%, plan pays 90%	Varies by service	Varies by service
Office visit (primary care/specialist)	You pay $25/$40 copay	You pay $12 copay	You pay $10/$15 copay
Emergency room visit	You pay $150 copay	You pay 20%, plan pays 80%	You pay $75 copay / $35 if recommended by Teleconsulta (Triage)

Enrollment

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