Medical Coverage

We realize that, for many employees, medical coverage is the most important benefit we offer. To ensure you have a good range of options, we will continue to offer three medical plans for 2021. In addition to these three medical plans, employees in California will continue to have the Kaiser HMO as a fourth option.

Genesys offers the following medical coverage options to eligible U.S. employees:

High Deductible Health Plan (HDHP) 1
High Deductible Health Plan (HDHP) 2
Preferred Provider Organization (PPO) Plan
Kaiser HMO Plan (available in CA only)

All medical options include prescription drug benefits. You do not need to make a separate prescription drug election. A brief summary of each plan is provided below.

What is an HDHP?

Two of your medical plan options are High Deductible Health Plans, or HDHPs. An HDHP provides you with more control over how you spend your health care dollars, as well as the flexibility to see any provider that you’d like. Please note that you should check to ensure your provider is considered in-network for savings (as compared to out-of-network providers). You also may be eligible to establish and contribute to a Health Savings Account (HSA), which allows you to spend pre-tax dollars on qualified health care expenses. Note: if you are enrolled in any other non-HDHP health plan, including Medicare, you are not eligible to contribute pre-tax dollars to an HSA.

What is an HSA?

A Health Savings Account, or HSA, is a tax-free savings account available to employees enrolled in an HDHP. Genesys contributes to your HSA, and you can also elect to contribute additional money up to IRS limits. Your HSA funds can be used to pay for current or future eligible health care expenses with tax-free dollars. Additionally, your HSA balance is portable if you leave Genesys — it’s a great way to save for health care, dental and vision expenses now and into retirement. Think of it as your health care 401(k).

What is a PPO?

One of your medical plan options is a traditional Preferred Provider Organization, or PPO. A PPO grants employees access to the same network as the HDHP plans; however, you’ll pay a copay for many services, and for this benefit, you’ll pay more out of your paycheck for the PPO plan. The Genesys PPO plan does not have a deductible.

What is an HMO?

If you currently work in California, you’re eligible to enroll in the Kaiser Health Maintenance Organization, or HMO plan. Just like with a PPO, you’ll also be asked to pay a copay at the time of service for both doctor visits and prescriptions.

Aggregate vs Embedded Deductible

What’s the difference?

If you’re considering enrolling yourself and your covered dependents in one of the HDHP medical plans, it’s important that you understand how the family deductible works under each of the options. As shown in the plan highlight chart below, HDHP Plan 1 has an “aggregate” family deductible, while HDHP Plan 2 has an “embedded” plan deductible. Here’s what those terms mean:

Aggregate Family Deductible:
The full family deductible must be met before the plan begins to pay a portion of expenses for any covered family members.

Embedded Plan Deductible:
If one covered family member has enough expenses in a calendar year to meet the individual deductible, the plan will begin paying a portion of that family member’s expenses for the remainder of the year. You do not have to meet the full family deductible before the plan begins to pay.

What is a Deductible?
The amount you need to pay each year before the plan starts paying benefits. For example, if your deductible is $2,000, your plan won’t pay anything until you’ve paid $2,000 for covered healthcare services, unless copays apply.

What is Coinsurance?
Coinsurance is a term used to describe the cost sharing which occurs between you and Genesys. After your deductible (if applicable) has been met, the plan begins to cover a percentage of your claims. For example, an employee on the HDHP 1 will pay 20% of claims costs after meeting his or her deductible of $2,000. This continues until the out-of-pocket maximum is met, at which point the plan covers 100% of all claims costs.

What is a Copay?
This is a fixed amount paid to an in-network provider for a service if you are enrolled in the PPO Plan. The plan pays any amount in excess of the copay.

What is Out-of-Pocket Maximum?
The deductible and your share of coinsurance and copays are collectively referred to as “Out-of-Pocket” expenses. For example, if your Out-of-Pocket Maximum is $4,000, once you have paid this amount, the plan pays 100% of all covered expenses for the remainder of the plan year.

Medical and Prescription Drug Options

Provider access available through the UnitedHealthcare Choice Plus^®Network, administered by UMR.

Plan Name	HDHP 1		HDHP 2		PPO
	IN-NETWORK	OUT-OF-NETWORK	IN-NETWORK	OUT-OF-NETWORK	IN-NETWORK	OUT-OF-NETWORK
Annual HSA Employer Contribution*	$750 individual* / $1,500 family*	$750 individual* / $1,500 family*	$750 individual* / $1,500 family*	$750 individual* / $1,500 family*	N/A	N/A
Annual Deductible	$2,000 individual / $2,800 family	$2,000 individual / $4,000 family	$2,800 individual / $4,000 family	$2,800 individual / $4,000 family	None	None
Copayments/ Coinsurance Primary Care office visit Specialist office visit	You pay 20%	You pay 40%	You pay 0%	You pay 30%	$20 copay $20 copay	You pay 50% You pay 50%
Family Deductible Type	Aggregate		Embedded		N/A	N/A
Annual Out-of-Pocket Maximum **	$4,000 individual / $6,550 family	$4,000 individual / $8,000 family	$2,800 individual / $4,000 family	$4,000 individual / $8,000 family	$5,000 individual / $10,000 family	$10,000 individual / $20,000 family
Preventive Care	You pay 0% Deductible waived	Not covered	You pay 0% Deductible waived	Not covered	You pay 0%	Not covered
Physician Office Visit	You pay 20% after deductible	You pay 40% after deductible	You pay 0% after deductible	You pay 30% after deductible	$20 copay	You pay 50%
Specialist Office Visit	You pay 20% after deductible	You pay 40% after deductible	You pay 0% after deductible	You pay 30% after deductible	$20 copay	You pay 50%
Urgent Care	You pay 20% after deductible	You pay 40% after deductible	You pay 0% after deductible	You pay 30% after deductible	$50 copay	You pay 50%
ER (true emergency)	You pay 20% after deductible		You pay 0% after deductible		You pay 30%
Pharmacy
Tier 1 (Generic)	You pay 20% after deductible	You pay 20% after deductible plus any network cost difference	You pay 0% after deductible	You pay 0% after deductible plus any network cost difference	$8 copay	$8 copay plus any network cost difference
Tier 2 (Brand-Preferred)	You pay 20% after deductible	You pay 20% after deductible plus any network cost difference	You pay 0% after deductible	You pay 0% after deductible plus any network cost difference	$30 copay	$30 copay plus any network cost difference
Tier 3 (Brand Non-Preferred)	You pay 20% after deductible	You pay 20% after deductible plus any network cost difference	You pay 0% after deductible	You pay 0% after deductible plus any network cost difference	$50 copay	$50 copay plus any network cost difference
Mail Order
Tier 1 (Generic)	You pay 20% after deductible	N/A	You pay 0% after deductible	N/A	$20 copay	N/A
Tier 2 (Brand-Preferred)	You pay 20% after deductible	N/A	You pay 0% after deductible	N/A	$75 copay	N/A
Tier 3 (Brand Non-Preferred)	You pay 20% after deductible	N/A	You pay 0% after deductible	N/A	$125 copay	N/A

* One fourth of the annual Genesys contribution is deposited in your HSA account each calendar quarter, on or near the first business day of each quarter. Must be employed and enrolled in a High Deductible Health Plan by the 1st day of each calendar quarter (January 1, April 1, July 1 and October 1) in which the funding occurs in order to receive the employer contribution for that quarter.

**All plans have an embedded Out-of-Pocket Maximum.

Kaiser HMO Plan

Provider access available through the Kaiser Permanente Network. Available only to employees in California.

Plan Name	Kaiser HMO Plan
	IN-NETWORK ONLY
Annual Deductible	None
Out-of-Pocket Maximum*	$1,500 individual / $3,000 family
Primary Care Physician	$15 copay
Specialist	$15 copay
Preventive Care	You pay 0%
Urgent Care Physician Services	$15 copay
Emergency Room	$100 copay **
Pharmacy
Tier 1 (Generic, includes diabetic supplies)	$15 copay for up to 100 days supply
Tier 2 (Brand Formulary)	$30 copay for up to 100 days supply
Tier 3 (Brand Non-Formulary)	N/A
Specialty	$30 copay for up to 30 days supply

* Out-of-Pocket Maximum includes copays except for prescription drug copays.

** $100 copay waived if admitted.

Key Features of Your Medical Plans

Preventive care services are covered at 100% with no deductible with in-network providers. An outline of preventive care services is listed in your Summary of Benefits and Coverage (SBC). Select your plan name under Medical Plans on the Resources Page of this site to find the Summary of Benefits and Coverage that corresponds with your plan.
Remember, out-of-network claims have a separate deductible to meet and services are covered at a much lower percentage.

Medical Premiums (per Semi-Monthly Pay Period)

Employee premiums for medical coverage are based on the plan and coverage level you select.

HDHP Plan 1
Employee Only	$18.00
Employee + Child(ren)	$75.00
Employee + Spouse/Domestic Partner	$93.00
Family	$136.50
HDHP Plan 2
Employee Only	$23.00
Employee + Child(ren)	$85.00
Employee + Spouse/Domestic Partner	$108.00
Family	$149.50
PPO Plan
Employee Only	$98.00
Employee + Child(ren)	$190.50
Employee + Spouse/Domestic Partner	$226.50
Family	$319.50
Kaiser HMO
Employee Only	$31.00
Employee + Child(ren)	$90.00
Employee + Spouse/Domestic Partner	$100.50
Family	$139.00

Preventive Care

Your medical benefits provide essential preventive care to keep you and your covered family members healthy. These services are provided at no cost to you and bypass the deductible. Preventive Care refers to a medical service category covered completely by your Genesys benefits when you utilize an in-network provider. Preventive care services are designated by the Affordable Care Act, and include screenings such as annual wellness checkups, preventive mammograms, certain immunizations, and more. For women, certain products are also included on this list such, as breastfeeding supplies, contraceptives, and certain supplements for pregnancy.

How to find an in-network provider:
In order for these services to be covered at 100% by your medical insurance, you must visit an in-network provider. If you need assistance with this process, employees enrolled in one of the HDHP Plans or the PPO Plan can always reach out to your Genesys Care Coordinators by visiting genesyshealthplan.com or by calling 1-877-498-3041. Kaiser HMO plan participants may find a provider by clicking here. Be sure to select your region (northern or southern California). Once done, you can search using a map or enter your zip code to view Kaiser doctors and locations in your area.

Healthcare Bluebook

(for HDHP and PPO Participants only)

Get rewarded when you use Healthcare Bluebook to find and use high-quality, cost-effective facilities and physicians for your medical care. Learn more about the tool and its financial rewards by clicking here. Your Genesys Care Coordinators are available to assist you online or by phone at (877) 498-3041 with any questions you may have about Healthcare Bluebook.

Your 2021 Medical ID Cards

All employees who enroll in the either a HDHP or the PPO plan will receive a new Medical ID card, even if you do not update your elections. Please be on the lookout to receive this card in the mail by the end of this year.

For more information on your prescription benefits, including details on retail versus mail-order prescriptions as well as a list of prescriptions covered under each plan, please visit the Prescription Drug Plan page of this site.

More Medical Plan Resources

For more resources, including summaries of benefits coverage please visit the Resources page of this site and look for the Medical Plan drop-down menu.

Your 2021 Benefits Resource