Medical Plans Overview

All Pearson-sponsored medical programs provide coverage for Preventive Care Services. These services are free when you use an in-network provider. Preventive services are designed to help you stay healthy, detect health problems early, determine the most effective treatments, and prevent certain diseases. Preventive care services include items such as routine exams, check-ups, immunizations, and counseling, based on age and potential risk factors. Pearson-sponsored medical plans cover Preventive Services for all adults, children and women.

Pearson offers four National Medical PPO Plans (PDF, 125 KB). Each is administered by Aetna and Anthem. 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. You choose the network and plan that best suits your needs.

$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 & $3,300 Deductible PPO Plans

$1,850 and $3,300 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.

$1,850 Deductible PPO Plan with Dependents

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 Aptia365 at 855-237-6421 if you have any questions.

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 (PDF, 57 KB) 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 100%.

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 (PDF, 214 KB). 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.

$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 & $3,300 Deductible HPN Plans

$1,850 and $3,300 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.

$1,850 Deductible HPN Plan with Dependents

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 Aptia365 at 855-237-6421 if you have any questions.

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 (PDF, 57 KB) through retail pharmacies or by mail. All Affordable Care preventive Drugs are covered at 100%.

State-based plans are available to residents of California, Hawaii, and Puerto Rico.

Northern and Southern California Kaiser HMO Plan

In-Network Preventative Care

Covered at 100%

Out-of-Pocket Maximum: Individual

$1,500

Out-of-Pocket Maximum: Family

$3,000

Coinsurance

You pay 10%, plan pays 90%

Office Visit (Primary Care/Specialist)

Primary Care $25, Specialist $40

Emergency Room Visit

You pay $150 copay

Hawaii HMSA PPO Plan

In-Network Preventative Care

Covered at 100%

Out-of-Pocket Maximum: Individual

Medical $2,500, Pharmacy $3,600




Out-of-Pocket Maximum: Family

Medical $7,500, Pharmacy $4,200

Coinsurance

Varies by service

Office Visit Copay (Primary Care and Specialist)

Primary Care and Specialist $12

Emergency Room Visit

You pay 20%, plan pays 80%

Puerto Rico Triple S Plan

In-Network Preventative Care

Covered at 100%

Out-of-Pocket Maximum: Individual

$6,300 (Major Medical $2,000)

Out-of-Pocket Maximum: Family

$12,700 (Major Medical $6,000)

Coinsurance

Varies by service

Office Visit (Primary Care/Specialist)

Primary Care $10, Specialist $15

Emergency Room Visit

You pay $150 copay