Your health and well-being are important to your success both on the job and in your personal life. KPMG provides an array of programs aimed at balancing and enriching work and life.
Aetna Choice POS II Plan
As long as you live within a network area, you can participate in the Choice POS II Plan. The Choice POS II Plan is a network based plan with in-network and out-of-network benefits, which allows you to receive medical care from any provider you choose. If you receive care from an in-network provider you pay a lower deductible and less out-of-pocket than if you receive care from an out-of-network provider. You do not need to select a primary care provider or obtain a referral for specialist services.
Aetna Health Fund
As long as you live within a network area, you can participate in the Aetna Health Fund, a "consumer driven" health plan designed to give you and your family greater ability to manage your care. Your covered medical expenses are applied to your deductible and then paid from your health fund. Once your fund is exhausted, you will need to satisfy the balance of the deductible. When your deductible is met, covered expenses will be reimbursed at a higher level if you choose an in-network provider or a lower percent if you choose out-of-network provider.
This option, available only if you live outside of a network area, is just as its name implies a medical plan with a $300 annual individual deductible ($600 for all other family categories). With this benefit option, you pay 20 percent of covered expenses and the plan pays 80 percent after the annual deductible is met.
Med 2500 is a high deductible medical plan that enables you to set aside money in a Health Savings Account (HSA). Once the deductible is satisfied, $2,500 for individual coverage or $5,000 for family coverage, eligible expenses will be covered at 75%. Preventive exams and prescriptions considered preventive will be covered at 100%, prior to satisfying the deductible. Non-preventive prescriptions are covered at 75%, and are subject to the deductible. Once the out-of-pocket maximum is satisfied, eligible expenses will be covered at 100%.
TThe MED 5000 plan, available if you live in or outside of a network area, is a medical plan with a $5,000 annual individual deductible for in-network services ($10,000 for all other family categories) and a $6,000 annual individual deductible for out-of-network services ($12,000 for all other family categories).
With this benefit option, the plan pays 100 percent of covered expenses (including prescriptions) after the annual deductible is met. Preventive care and preventive prescriptions are covered at 100%, without having to satisfy the deductible. This high deductible plan enables you to set aside money tax-free in a savings vehicle known as a Health Savings Account.
Health Savings Accounts
KPMG offers high deductible health plans that are compatible with establishing a Health Savings Account (HSA). An HSA permits you to make tax-deductible contributions that may be accumulated over the years and distributed on a tax-free basis to pay for any medical expense qualified under Section 213(d) of the Code. You may establish an HSA with the vendor of your choice; however, you may not establish an account with a restricted entity.
HMOs are available in most locations and generally require that you select a primary care provider. Most HMOs only provide coverage if you receive care from a network provider.
Health Care Flexible Spending Account
You may elect to have up to $5,000 (pre-tax) deducted from your pay per calendar year to cover medical expenses not reimbursed through another source. The Health Care Flexible Spending Account includes an FSA Card that you may use to pay for expenses. Note: You are not eligible to contribute to a Health Savings Account (HSA) if you are enrolled in a Health Care Flexible Spending Account.
Prescription Drug Program Coverage
Participants in the Choice POS II, Aetna Health Fund and MED 300 plans are covered automatically under the Prescription Drug Program. There are two aspects to the program: retail card and mail order. Prescription drugs for participants in MED 5000 are covered at 100 percent after you have satisfied your deductible and for participants in MED 2500 are covered at 75 percent. Preventive drugs (based on Aetna's list of covered preventive drugs) are covered at 100%, not subject to the deductible. Prescription coverage for HMO participants will vary by HMO.
You may purchase short-term prescriptions, up to a 30 day supply, through participating pharmacies. Co-pays are $10 for formulary generic drugs, $40 for formulary brand-name drugs, $60 for drugs not listed on the formulary and $120 for specialty drugs. The combined retail and mail order out-of-pocket maximum you will have to pay is $1,500 per covered person.
You may purchase longer-term prescriptions by mail. Administered by Aetna Rx Home Delivery, a leading mail-order pharmacy, the service enables you to obtain prescriptions for up to 90 days. Co-pays are $20 for formulary generic drugs, $80 for formulary brand-name drugs, and $120 for drugs not listed on the formulary. The combined retail and mail order out-of-pocket maximum you will have to pay is $1, 500 per covered person.