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?

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

National Medical Plans

Plans Description
$400 & $900 Deductible 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 & $2,850 Deductible Plans The $1,850 and $2,850 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. And, like the $400 and $900 Deductible plans, you can see providers within or outside the network.

* Aetna provides a narrower network than Anthem and Cigna, 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.

 

Click here to see a more detailed summary of the four National Plans.

The prescription drug portion of the National Medical 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%. To see the coverage specifications for the National Medical plans, click here.

A word about the $1,850 Deductible Plan

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 the Pearson BenefitsMercer Marketplace at 855-237-6421 if you have any questions.

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)