KCOI is continuing a Domestic Tier, which allows employees to take advantage of services done at KCOI.

The PPO plan gives you the freedom to seek care from the provider of your choice. However, you will maximize your benefits and reduce your out-of-pocket costs if you choose a provider who participates in the Aetna Choice® POS II network. The calendar-year deductible must be met before certain services are covered.

Here’s how the plans work:

• • • Annual Deductible: You must meet the entire annual deductible before the plan starts to pay for non-preventive medical and prescription drug expenses.
    • Copay: This is a fixed amount that you pay for a covered health care service. This amount is typical required before the service is performed.
    • Coinsurance: Once you have met the plan’s annual deductible, you are responsible for a percentage of your medical expenses, which is called coinsurance. For example, the plan may pay 80 percent and you may pay 20 percent.
    • Out-of-Pocket Maximum: Once your deductible and coinsurance add up to the plan’s annual out-of-pocket maximum, the plan will pay 100 percent of all eligible covered services for the rest of the calendar year.

Like the PPO plan, a Qualified High-Deductible Health Plan (QHDHP) gives you the freedom to seek care from the provider of your choice. You will maximize your benefits and reduce your out-of-pocket costs if you choose a provider who participates in the Aetna Choice® POS II network or the KC Care Network. In addition, the QHDHP comes with an optional health savings account (HSA) that allows you to save pretax dollars to pay for any qualified health care expenses as defined by the IRS, including most out-of-pocket medical, prescription drug, dental and vision expenses.

Health Savings Account (HSA) The QHDHP Broad Network and QHDHP KC Care Network come with an optional type of savings account called a health savings account, or HSA. The HSA lets you set aside pre-tax dollars to help offset your annual deductible and pay for qualified health care expenses. Your HSA is administered by Wex.

Here’s how the HSA works:

• • • You contribute pre-tax funds to the HSA through automatic payroll deductions.
    • Once your HSA cash account balance reaches the minimum amount required by the custodian, you can transfer funds to an HSA investment account. You can choose from a selection of mutual funds and setup and allocation model for future transfers like you would for a 401(k) Plan.
    • Your contributions, in addition to any company contributions, may not exceed the annual IRS limits:

Employee Only – $4,300

Family – $8,550

Catch-up (age 55+) – $1,000

• • • You can withdraw HSA funds tax-free to pay for current qualified health care expenses, or save them for the future, also tax-free. Unused funds roll over from year to year and are yours to keep, even if you change medical plans or leave your employer.

Specialty drugs will be supported outside of the health plan by PayerMatrix.

Who is Payer Matrix?
Payer Matrix is a team of dedicated healthcare professionals who partner with your employer to reduce the cost of your high dollar prescription drugs. We do that by working directly with you in order to obtain alternative funding though the manufacturer, foundations and grants.

What does Payer Matrix do:
Payer Matrix advocates on your behalf with drug manufacturer. Our Reimbursement Care Coordinators facilitate the process with multiple entities to lower the cost of your specialty prescription drugs. Often times members end up paying nothing out of their own pockets once they are admitted into our programs.

What this means for you:
If you are prescribed a specialty drug now or in the future, our goal is to obtain alternate funding for your specialty prescriptions. A Reimbursement Care Coordinator will be assigned to work directly with you to obtain the information needed to start the process. There is paperwork that will need to be completed by you with the assistance of your Reimbursement Care Coordinator. Your Care Coordinator will assist you with the process and answer any questions you may have. Their function is to assist and facilitate your paperwork through the patient assistance process. If you are close to a drug fill, your Reimbursement Care Coordinator will be able to acquire that for you as well.

How do I find Payer Matrix?
You can call us at 877-305-6202 or send an email to customerservice@payermatrix.com.