Medical Program Overview

Depending on your location, you have a choice of the following medical options:

  • Enhanced Preferred Provider Organization (PPO): 90% coverage in-network/70% coverage out-of-network; copayments for in-network office visits
  • Basic Preferred Provider Organization (PPO): 80% coverage in-network/60% coverage out-of-network; copayments for in-network office visits
  • Health Maintenance Organization (HMO) in select areas: no out-of-network coverage

If you waive medical/prescription drug coverage, you won’t be able to enroll until the next annual enrollment period (unless you have a qualified life event).

If you don’t waive and don’t enroll, you will receive the default medical coverage provided under the Basic PPO.

To find out which plans are available in your geographic area, log into Fusion. Select Benefits > View Current and Future Benefits.

The Basic and Enhanced PPO plans are available through both Anthem and Cigna. Although the insurance administrators are different, the plan designs and monthly contributions are the same. However, since the doctors, hospitals and other health care providers may vary by network, be sure to check the administrator’s websites to select the network most appropriate for you and your family.

Before you decide on your medical coverage, consider the following

  • Who do you need to cover?
  • What are your family’s typical medical expenses?
  • How important is it to choose any doctor for your medical care? Are you willing to pay more for that choice?
  • What is the availability of network providers in the area where you live or work?
  • Can you get coverage through your spouse’s employer? If so, what is the cost and how much does that plan pay?

Keep in mind that you can be reimbursed from the Health Care FSA for medical expenses that exceed maximum plan benefits or for many services or expenses not covered by the plan you elect.

Check out Pearson Health Choice before you enroll!

Pearson Health Choice can help you be informed and get connected — by helping you choose the medical plan that is best for you and your family.

To use this online tool, all you need to do is answer some simple questions and provide information about your anticipated medical needs. Pearson Health Choice will then:

  • Provide a cost comparison of your medical plan options, including your contributions and out-of-pocket costs,
  • Compare your medical plan options to your spouse’s plan, if you’re eligible, and
  • Show you which plan provides the best value based on your anticipated needs.
  • Provide an estimate of how much you may save in taxes by participating in the Health Care Flexible Spending Account.

To use Pearson Health Choice, log on to: http://www.pearsonhealthchoice.com/.