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HMO/Choice Plans

HMO/Choice Plans.

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HMO/Choice Plans

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  1. HMO/Choice Plans In the event that the content of this document or any oral representations made by any person regarding the plan conflict with or are inconsistent with the provisions of the plan document, the provisions of the plan document are controlling. As permitted by applicable law, Caterpillar Inc. reserves the right to amend, modify, suspend, replace or terminate any of its plans, policies or programs, in whole or in part, at any time and for any reason, by appropriate company action.

  2. What is an HMO? • HMO stands for Health Maintenance Organization • A health plan designed to manage cost and improve quality by using network providers.

  3. Why are HMOs offered? • Current Preferred Provider Organization (PPO) networks in some areas may be limited, so HMO offerings may include more provider choices • In remote locations it may be more difficult to negotiate discounted network PPO rates • HMO plan offerings are based on residential zip code and service area

  4. HMO criteria • Close alignment to Caterpillar PPO plan design • Quality of services offered by network hospitals and providers • Adequate number of quality HMO providers for our employees (preferred hospitals and providers) • Cost for HMO is comparable to PPO product

  5. How is an HMO different than a PPO? • $0 benefits for out-of-network services except in an emergency or in some HMO’s, urgent care • If enrolled in FSA – will require manual submission of claim for reimbursement • Many HMO’s do not have a deductible • All HMO’s have have a maximum out of pocket, similar to a PPO • Co-insurance levels may be different than the PPO plan (including Rx co-pays)

  6. How is an HMO different than a PPO? • Most HMOs offer a co-pay structure for services (Office visits, hospital, ER) • Vision, preventive coverage may be different than PPO • Prescription drug plan may be administered by HMO, so co-pays and covered drugs may be different than PPO coverage

  7. Information you should know • A Summary Plan Description (Benefits Book) is provided by the HMO • Contact your HMO for a Summary Plan Description • Caterpillar does not “administer” the HMO so we are not able to provide this summary • Refer to Caterpillar Summary Plan Description for dental, life insurance, FSA details

  8. During annual enrollment • Review your information received from Aon Hewitt • Eligibility could change due to the annual service area zip code changes • Review covered services, co-insurance, co-pays • Verify your network physicians and hospitals are still available • CIGNA administers the dental coverage for all plans

  9. Thank You

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