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Making a People Operations Wiki on Coda

Making a People Operations Wiki on Coda

Benefits

Medical Plans

Which medical plan should I choose?

If you don’t find the information you are looking for below, please

submit it here

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This communication is for informational purposes only. Plan documents and/or the insurance certificates shall govern in the event of a conflict.

Medical Plans

Medical Plans

Plan Characteristics

HMO

PPO

HDHP (HSA)

HSA Eligible

PCP Required

Referral Required for Specialist

In Network Coverage

Out of Network Coverage

Tax Advantage contributions

Flexibility

Low

High

There are no rows in this table

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This is a quick overview of the medical plans Coda offers for our US-based employees. For a more detailed summary of benefits, please login into SequoiaOne and select Healthcare. You’ll be able to see and compare all the plans offered in your state.

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Summary of Medical Plans

HMO

Plans: Anthem HMO 10 (Nor CA), Anthem HMO 10 (So CA), Kaiser HMO 15 (Nor CA) and Kaiser HMO 15 (So CA)

To find an in-network provider go to

kp.org⁠

anthem.com/ca⁠

You go to your Primary Care Physician (PCP) first and they will refer you an specialist if needed

Available to California residents only.

You receive medical care from hospitals and doctors in the HMO network.

Your selected Primary Care Physician (PCP) coordinates all your healthcare, including office visits, prescription medications, and referrals to specialists. To select your PCP, contact Anthem/Kaiser or log into your anthem.com or kp.org portal directly at any point in the year.

In-network preventive medicine is covered 100% by your plan.

For other office visits and procedures, you pay a set amount (called a copay).

The accumulators such as deductible and out- of-pocket maximum reset each calendar year, on January 1st.

PPO

Plans: Anthem PPO 250, Nevada Only PPO Plan, Hawaii Only Plan

Available in all states

You can choose to receive medical care from hospitals and doctors of your choice, but you get the greatest cost savings when you utilize providers in the PPO network.

To find an in-network provider go to

anthem.com/ca⁠

and select the following plan names:

PPO CA: Blue Cross PPO Prudent Buyer (Large Group)

PPO Non-CA: National PPO (BlueCard PPO)

PPO Utah: Traditional PPO

You can see specialists at any time without needing a referral from your primary doctor.

PPO plans have an annual deductible, or set dollar amount, you must pay before the insurance carrier begins paying their portion of medical expenses.

After the deductible amount is met, you are responsible for the coinsurance or copayment, up to the out-of-pocket max, at which point the plan pays 100% of all costs.

You pay nothing out-of-pocket for in-network preventive care.

Out-of-Network reimbursements are based on the insurance carrier’s “allowed amount”. You are responsible for the amount your provider charges above the “allowed amount”.

The accumulators such as deductible and out- of-pocket maximum reset each calendar year, on January 1st.

HDHP (+HSA)

Plans: Anthem HSA 2800 and Cigna 2800 (available only for SC residents)

Available in all states

You can choose to receive medical care from hospitals and doctors of your choice, but you get greater cost savings when you utilize providers in the network.

A high-deductible health plan (HDHP) is a type of health insurance plan with a higher deductible than traditional health plans.

HDHPs have a high annual deductible, a set dollar amount that you must pay before the insurance carrier begins paying for medical expenses.

After the deductible amount is met, you are responsible for the coinsurance, which is a percentage of the total cost for services, up to the out-of-pocket max, at which point the plan pays 100% of all costs.

You pay nothing out-of-pocket for in-network preventive care.

Out-of-Network reimbursements are based on the insurance carrier’s “allowed amount”. You are responsible for the amount your provider charges above the “allowed amount”.

The accumulators such as deductible and out-of-pocket maximum reset each calendar year, on January 1st.

Please visit

HSA & FSA⁠

for more details

Per state requirements for PEOs, employees residing in Nevada and Hawaii will be offered non-Sequoia hosted plans at time of enrollment (noted as Hawaii Only and Nevada Only plans in the summary) in addition to your full Sequoia benefits program. Those plans are outside of the Sequoia One Program and will only be displayed to employees residing in those states (if applicable). The system is designed to only show any given employee the plans they specifically qualify for.

What is the difference between a PPO and an HDHP?

A PPO refers to the network structure of a plan, whereas HDHP refers to its pay structure. An HDHP can be a PPO or a HMO (at Coda we only have HDHP paired with PPO at Anthem). A high deductible health plan (HDHP), sometimes referred to as an HSA plan, simply works differently than more traditional plans in that there are no copays. With an HDHP, you will pay everything out-of-pocket until you reach your deductible. After that, the plans coinsurance kicks-in, and the insurer picks up a percentage of the bills until you reach your out-of-pocket maximum. The beautiful thing about Coda is that we cover the deductible by contributing to your HSA account.

Anthem and Cigna Plan Deductibles

Embedded deductibles apply to all Anthem and Cigna plans offered by Coda. This means that when a family member meets his or her individual deductible, for example $2,800 on the Anthem HSA plan, the insurance company will begin paying according to the plan’s coverage for that member. Each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible. After the family deductible has been met, the coinsurance kicks in for all family members. No one member on the plan will pay more than the per person deductible.

Expand for Medical Plan Summaries