Medical

Promoting a healthy lifestyle is what PSEB is all about. That’s why we offer associates important medical benefits, including prescription coverage. Read more about your medical plan options below…

Aetna Medical Plans

In-network physicians and facilities will submit claims for you and have agreed not to charge more than Aetna’s allowed amount for covered services. If you receive treatment from an out-of-network physician or facility, they may require you to pay the entire amount at the time of service and then you can submit a claim for reimbursement. If they charge more than the allowed amount, you will be responsible for anything over and above that amount.

You may choose to visit in or out-of-network providers and facilities. However, you will have lower out-of-pocket costs when care is received in-network.

Benefits Guide

Details about all of your benefit options are included here on The PSEB Collective. To download a printable benefits guide, click the link below.

Preventive Care

Coverage for specific preventive care services is free when you see an in-network provider. A list of preventive services is available at
www.healthcare.gov/coverage/preventive-care-benefits.

Find an Aetna Doctor

To help evaluate your medical plan selections, visit the Aetna website to see if your doctor is in-network or to find a doctor. Click on the links below for more information, or follow the step-by-step instructions below.

Step-by-Step Instructions:
  • Visit www.aetna.com/docfind
  • Continue as a guest
  • Enter home zip code and select “Search”
  • Select your plan from the “Select a Plan” menu:
    • For HealthFund Choice POS II (HRA)
      • Search under “Aetna HealthFund Plans”
      • Select “Aetna Choice POS II (Aetna HealthFund)”
    • For Choice POS II (PPO)
      • Search under “Aetna Open Access Plans”
      • Choose the “Aetna Choice POS II (Open Access)” network
  • Select “Medical Doctors & Specialists” or choose to search for another type of provider like “Urgent Care” or “Pharmacy”
  • You may then select your desired provider/facility type and the provider listing will appear
  • Your provider listing will include specific providers currently accepting your Aetna plan. Be sure to call and check with the provider before scheduling your appointment or receiving services to confirm that they are still participating in Aetna’s Choice POS II network
  • To print your provider listing, select “Print”

Triple-S Salud

The Triple-S Salud plan offers access to a broad provider network. There is no in-network deductible. However, a deductible would apply for out-of-network services.

You may choose to have your treatment provided by an in or out of-network provider. However, you will have lower out-of-pocket costs when care is received from an in-network physician.

Benefits Guide

Details about all of your benefit options are included here on The PSEB Collective.  To download a printable benefits guide, click the link below.

Triple-S Salud Bi-Weekly Rates & Benefits

 BI-WEEKLY RATESTOBACCO USER
Associate Only$27.82$73.82
Associate + Spouse$67.82$113.82
Associate + Child(ren)$59.36$105.36
Associate + Family$82.97$128.97
BENEFITMEDICAL & HOSPITAL (IN-NETWORK)MAJOR MEDICAL (OUT-OF-NETWORK)
Annual Deductible – DED$100 per person; $300 family max$100 per person; $300 family max
Out-of-Pocket Maximum$6,350 per person; $12,700 family max$2,000 per person; $4,000 family max
Lifetime MaximumUnlimitedUnlimited
Preventive Care100% coveredDED then you pay 20%
Office Visit
(Primary (PCP) / Specialist)
$10 copayDED then you pay 20%
Maternity (Prenatal/Postnatal Services)No chargeDED then you pay 20%
Lab & Radiology ServicesNo chargeDED then you pay 20%
Virtual doctor (Teleconsulta MD)$10 copayNot covered (Nurseline)
Outpatient Surgery$100 copayDED then you pay 20%
Inpatient Hospitalization$100 copayDED then you pay 20%
Emergency RoomIllness: $50 copay
Accident: No charge
Illness Visit: $50 copay
Accident Visit: No charge
Mental HealthOutpatient: $10 copay
Inpatient: $100 copay per admission
Inpatient: $50 copay per partial admission
DED then you pay 20%
Short-Term Rehabilitative Therapy & Chiropractic Services$5 copay per visit
(60-day maximum per plan year for all therapies combined)
DED then you pay 20%
(60-day maximum per plan year for
all therapies combined)

Emergencies in the U.S.

Because an emergency can happen anytime and anywhere, Blue Card Program® and Blue Card Worldwide® provide access to medical healthcare whether you are in the United States or around the world.

The Blue Card Program provides access to medical services in the United States. If you have major medical coverage, Blue Card World Wide offers access to emergency hospital services at Blue Cross and Blue Shield Centers around the world.

Preventive Care

Coverage for specific preventive care services is free when you see an in-network provider. A list of preventive services is available at
www.healthcare.gov/coverage/preventive-care-benefits.

Find a Doctor

Follow the instructions below to visit the Triple-S Salud website to see if your doctor is in-network or to find a new doctor:

  1. Visit https://services.ssspr.com/salud/provider/search
  2. Select “Comercial (PPO)” from the drop down and follow on-screen prompt

Health Education

Triple-S Salud plan members can benefit from online access to general information, as well as guidelines for the recognition and treatment of the health conditions below. Visit www.ssspr.com to learn more about:

  • Wellness
  • Attention Deficit Hyperactivity Disorder
  • Bipolar Disorder
  • Depression
  • Diabetes
  • Weight Management
  • Men’s and Women’s Health
  • Smoking & Addictions

Disease Management

Through the Total Well-Being Program you have access to services in disease management, prenatal education, and health education. The disease management program is geared towards the management of the chronic conditions that are most common among Puerto Ricans:

  • Diabetes
  • Asthma
  • Hypertension
  • Heart failure
  • Chronic Obstructive Pulmonary Disease (COPD)

If you have any of these conditions, this program will be greatly beneficial. The disease management program includes services such as clinical treatment (provided by your physician) and follow-up and guidance by nursing professionals and health educators.

*APRIL 15, 2020 – HMAA HAS ANNOUNCED THAT 100% OF TESTING AND TREATMENT COSTS ASSOCIATED WITH COVID-19 WILL BE COVERED FOR HMAA MEMBERS.

HMAA PPO

The Hawaii Medical Assurance Association (HMAA) PPO plan offers access to HMAA’s provider network. For both in and out-of-network providers, you must meet the annual deductible before the plan’s coinsurance begins.

With the PPO plan, you have a choice every time you need care. Your network physicians will submit claims for you. If you receive treatment from an out-of-network physician, they may require you to pay the entire amount at the time of service and then submit a claim for reimbursement.

You may choose to have your treatment provided by an in or out-of-network provider. However, you will have lower out-of-pocket costs when care is received from an in-network physician.

Benefits Guide

Details about all of your benefit options are included here on The PSEB Collective. To download a printable benefits guide, click the link below.

Coverage Waiver Requirements

If you choose not to enroll in medical coverage with PSEB, you are required to complete the State of Hawaii’s Form HC-5 every calendar year. Select the link below to complete your form and submit to the Benefits Team by your enrollment deadline.

HMAA Bi-Weekly Rates & Benefits

 BI-WEEKLY RATES
Associate Only$5.66
Associate + Spouse$75.65
Associate + Child(ren)$82.52
Associate + Family$106.60
BENEFITIN-NETWORKOUT-OF-NETWORK
Calendar Year DeductibleAssociate: $100
Associate + Dependent(s): $300
Associate: $100
Associate + Dependent(s): $300
Calendar Year Out-of-Pocket MaximumMedical: $2,000 per person;
$6,000 family max
Prescription: $5,500 per person; $9,000 family max
Medical: $2,000 per person;
$6,000 family max
Prescription: $5,500 per person; $9,000 family max
Lifetime MaximumUnlimitedUnlimited
Preventive Care100% coveredNo charge
Office Visit
(Primary (PCP) / Specialist)
$15 copay$15 copay
Maternity (Prenatal/Postnatal Services)You Pay 10%You Pay 10%
Diagnostic Lab ServicesYou Pay 20%You Pay 20%
Virtual doctor (HiDoc)100% coveredN/A
Urgent Care$25 copay$25 copay
Emergency RoomYou pay 20%You pay 20%
Outpatient SurgeryYou pay 20%You pay 20%
Inpatient HospitalizationYou pay 20%You pay 20%
Ground Ambulance/Air AmbulanceYou pay 20%/DED then you pay 20%You pay 20%/DED then you pay 20%
Mental Health (Outpatient)You pay 20%You pay 20%
Outpatient Short-Term Rehabilitative TherapyDED then you pay 20%DED then you pay 20%

Preventive Care

Coverage for specific preventive care services is free when you see an in-network provider. A list of preventive services is available at
www.healthcare.gov/coverage/preventive-care-benefits.

Find a Doctor

Follow the instructions below to to see if your doctor is in-network or to find a new doctor:

  1. Visit www.hmaa.com
  2. Select “Find a Provider”
  3. Select “HWMG: Medical & Dental Providers in Hawaii”
  4. Follow the on-screen prompts to find a doctor in your area

Learn More

Spousal Surcharge

In line with national healthcare trends, PSEB is implementing a spousal surcharge. Associates who choose to cover a spouse who has the option to elect healthcare coverage through his/her own employer will pay a $46 surcharge per pay period.

You will be asked to attest to whether or not your covered spouse has declined benefits through his or her employer when you complete your online enrollment in UltiPro.

To help you determine if the surcharge applies to your situation, please select the “+” to open each topic below.

Tobacco Status

If you or your enrolled spouse are tobacco users, you will not receive the non-tobacco discount on your medical premiums. If either of you would like help cutting the tobacco habit, contact the Benefits Team to learn more about our Tobacco Cessation program. Once you complete the program, you will be eligible to receive the non-tobacco discount.

Understanding the Aetna
Healthfund Choice POS II (HRA) Plan

In the Health Reimbursement Account (HRA) plan, you may see a provider in the Aetna HealthFund Choice POS II HRA network or outside of the network. However, providers outside of the network are more expensive so you’ll spend the money in your HRA Fund more quickly using these providers. Please take the time to review both plans and compare them against individual plan requirements for your state in selecting health plan coverage.  

So how does the HRA Plan work? You might think of the HRA Plan as a “pay-as-you-go” medical plan. PSEB puts money into a health fund “account” for you, and you use that money to pay for your benefit expenses (such as deductibles). When company money runs out, you are responsible for paying out of pocket, up to the remaining deductible. Once you’ve met the deductible, the plan pays a percentage of your medical expenses and you pay “coinsurance.” You are rewarded for seeing network providers: your plan pays 90% and you pay 10% for in-network care, whereas you pay 50% for out-of-network care.

If you don’t use all the money in your HRA Fund within the plan year, that money rolls over and is added to your health fund for the following year—up to a maximum of $2,250 for individuals and $4,500 for Associate + 1 or more dependents. If you “spend smart” on your benefits, you can save a lot of money using this plan. However, if you need major coverage, this plan is designed to give you and your family the protection you need.

Family Coverage

For family coverage, the HRA plan has an aggregate, or collective, family deductible and an embedded out-of-pocket maximum. This means that if you enroll one or more family members, together you are required to meet the full family deductible before the plan starts to pay expenses for any one individual. However, each member only needs to meet the individual out-of-pocket maximum before the plan starts to pay 100% of eligible expenses for that individual.

Aetna HRA Bi-Weekly Rates & Benefits

 HRA BI-WEEKLY RATESTOBACCO USER
Associate Only$32.02$78.02
Associate + Spouse$77.75$123.75
Associate + Child(ren)$69.98$115.98
Associate + Family$110.91$156.91
BENEFITIN-NETWORKOUT-OF-NETWORK
Plan Year HRA Fund ContributionAssociate: $500
Associate + Dependent(s): $1,000
Associate: $500
Associate + Dependent(s): $1,000
Plan Year Deductible (aggregate)Associate: $3,000
Associate + Dependent(s): $6,000
Associate: $4,000
Associate + Dependent(s): $8,000
Plan Year Out-of-Pocket MaximumAssociate: $6,000
Associate + Dependent(s): $12,000
Associate: $8,000
Associate + Dependent(s): $16,000
Lifetime MaximumUnlimitedUnlimited
Preventive CareNo charge
(Deductible waived)
DED then you pay 50%
Office Visit – Primary (PCP)DED then you pay 10%DED then you pay 50%
Office Visit – SpecialistDED then you pay 10%DED then you pay 50%
Maternity
(Prenatal/Postnatal Services)
Prenatal: No charge
Postnatal: DED then you pay 10%
DED then you pay 50%
Lab & Radiology ServicesDED then you pay 10%DED then you pay 50%
Virtual Doctor (Teladoc)DED then you pay 10%N/A
Urgent CareDED then you pay 10%DED then you pay 50%
Inpatient HospitalizationDED then you pay 10%DED then you pay 50%
Outpatient SurgeryDED then you pay 10%DED then you pay 50%
Emergency Room$250 copay then DED then you pay 10%$250 copay then DED then you pay 10%
AmbulanceDED then you pay 10%DED then you pay 10%
Mental Health/Substance Abuse
(Outpatient)
DED then you pay 10%DED then you pay 50%
Short-Term Rehabilitative Therapy
(Physical, Occupational & Speech)
DED then you pay 10%
(60 visit maximum per plan year for all therapies combined)
DED then you pay 50%
(60 visit maximum per plan year for all therapies combined)
Chiropractic ServicesDED then you pay 10%
(30 visit maximum per plan year)
DED then you pay 50%
(30 visit maximum per plan year)

Understanding the Aetna
Choice POS II (PPO) Plan

In the PPO plan, you may see any provider you wish, but you will pay less when you see healthcare providers in the Aetna Choice POS II PPO network. On the PPO plan, you pay a copay whenever you see a network provider for an office visit. Please take the time to review both plans and compare them against individual plan requirements for your state in selecting health plan coverage.  

You continue to pay medical expenses until you meet your deductible, which is the amount you pay each year before your health plan begins to pay. Most copays are not subject to the deductible.

Once you’ve met the deductible, the plan pays a percentage of your medical expenses. You are rewarded for seeing in-network providers. If you receive network care, your plan pays 80% and you pay 20%. For out-of-network care, your plan pays 60% and you pay 40%. Your portion of costs is called coinsurance.

When the total that you pay for covered services including copays, deductible, and coinsurance reaches your out-of-pocket maximum, or the most you’d pay in a plan year for eligible services, the plan pays 100% of the cost of covered medical expenses for the rest of the plan period.

Family Coverage

For family coverage, the Aetna Choice POS II (PPO) plan has an embedded family deductible and out-of-pocket maximum. This means that the family deductible and out-of-pocket maximum can be met by a combination of family members; however, no single individual within the family will be subject to more than the individual deductible or out-of-pocket maximum. Once the family deductible or out-of-pocket maximum is met, no matter if one member or multiple members help meet it, all family members will be considered as having met their deductible or out-of-pocket maximum for the remainder of the plan year.

Aetna PPO Bi-Weekly Rates & Benefits

 PPO BI-WEEKLY RATESTOBACCO USER
Associate Only$95.05$141.05
Associate + Spouse$237.48$283.48
Associate + Child(ren)$212.24$258.24
Associate + Family$337.81$383.81
BENEFITIN-NETWORKOUT-OF-NETWORK
Plan Year DeductibleAssociate: $1,500
Associate + Dependent(s): $3,000
Associate: $3,000
Associate + Dependent(s): $6,000
Plan Year Out-of-Pocket MaximumAssociate: $3,000
Associate + Dependent(s): $9,000
Associate: $6,000
Associate + Dependent(s): $18,000
Lifetime MaximumUnlimitedUnlimited
Preventive Care100% coveredDED then you pay 40%
Office Visit – Primary (PCP)$20 copayDED then you pay 40%
Office Visit – Specialist$40 copayDED then you pay 40%
Maternity (Prenatal/Postnatal Services)Prenatal: No charge
Postnatal Outpatient: $40 copay (deductible waived)
Postnatal Inpatient: DED then you pay 20%
DED then you pay 40%
Lab & Radiology ServicesDED then you pay 20%DED then you pay 40%
Virtual Doctor (Teladoc)$20 copayN/A
Urgent Care$40 copayDED then you pay 40%
Emergency Room$250 copay then DED then you pay 20%$250 copay then DED then you pay 20%
Inpatient HospitalizationDED then you pay 20%DED then you pay 40%
Outpatient SurgeryDED then you pay 20%DED then you pay 40%
AmbulanceDED then you pay 20%DED then you pay 20%
Mental Health/Substance Abuse
(Outpatient)
$40 copay per office visit (deductible waived)DED then you pay 40%
Short-Term Rehabilitative Therapy
(Physlcal, Occupational & Speech)
$40 copay per office visit
(Deductible waived)
(60 visit maximum per plan year for all therapies combined)
DED then you pay 40%
(60 visit maximum per plan year for all therapies combined)
Chiropractic Services$40 copay (deductible waived)
(30 visit maximum per plan year)
DED then you pay 40%
(30 visit maximum per plan year)

Aetna Programs

Regardless of which Aetna medical plan you select, you will also have access to supplemental programs to help you achieve your maximum wellness.

Online Health Assessment

The online health assessment can give you an idea of the current state of your health. Based on your confidential responses, you will learn whether you are at risk for certain conditions like diabetes or high blood pressure. The health assessment and related tools are available at no extra cost to associates enrolled in an Aetna medical plan. After completing the assessment you will receive a custom action plan to help prevent health problems and feel your very best.

Your Health Assessments are secure and will not be shared with PSEB or used to affect your health insurance costs. These programs provide the support you need to get healthy and stay healthy. To begin your health assessment, log on to www.aetna.com after your coverage begins.

Aetna Maternity Program

The Aetna Maternity Program gives you the tools and information you need for a healthy pregnancy and helps you make good decisions for you and your baby. Get help from the time you start planning a family, through your pregnancy, and well after your baby is born. Once you’ve enrolled in the Aetna Maternity Program, you may receive:

  • Educational materials (available in English and Spanish) on prenatal care, labor and delivery, newborn care, and more
  • Information for Dad or partner
  • A pregnancy risk survey to help find out if you have any pregnancy risks or issues
  • A pre-term labor program to support high-risk women
  • Access to specially trained nurses for high-risk mothers-to-be
  • One-on-one counseling to help pregnant women quit smoking
  • Help coping with postpartum depression

Visit Aetna Women’s Health online at https://www.aetna.com/individuals-families/womens-health.html for more information.

Kaiser HMO Bi-Weekly Rates & Benefits

 KAISER BI-WEEKLY RATESTOBACCO USER
Associate Only$95.05$141.05
Associate + Spouse$237.48$283.48
Associate + Child(ren)$212.24$258.24
Associate + Family$337.81$383.81
BENEFITIN-NETWORK
CALIFORNIA HMO
(ANAHEIM, CA)
IN-NETWORK
WASHINGTON HMO
(BELLEVUE, WA)
Plan Year DeductibleAssociate: $750
Associate + Dependent(s): $1,500
Associate: $750
Associate + Dependent(s): $1,500
Plan Year Out-of-Pocket MaximumAssociate: $3,000
Associate + Dependent(s): $6,000
Associate: $3,500
Associate + Dependent(s): $7,000
Lifetime MaximumUnlimitedUnlimited
Preventive Care100% covered100% covered
Office Visit – Primary (PCP)$25 copay (deductible waived)$25 copay (deductible waived)
Office Visit – Specialist$25 copay (deductible waived)$25 copay (deductible waived)
Maternity (Prenatal/Postnatal Services)Prenatal: No charge
Postnatal: DED then you pay 20%
Prenatal & Postnatal:
DED then you pay 20%
Lab & Radiology Services
/Imagining (CT/PET scans, MRI’s)
$10 per encounter/
DED then you pay 20% up to $150 per procedure
$15 per visit/
$100 per visit
Virtual Doctor (Kaiser)100% covered100% covered
Urgent Care$25 copay (deductible waived)$25 copay (deductible waived)
Emergency Room$250 copay (waived if admitted)$250 copay, then DED then you pay 20% (waived if admitted)
Outpatient SurgeryDED then you pay 20%DED then you pay 20%
Inpatient HospitalizationDED then you pay 20%DED then you pay 20%
Ambulance$150 per tripYou pay 20%
Mental Health/Substance Abuse
(Outpatient)
$25 copay (deductible waived)$25 copay (deductible waived)
Rehabilitation servicesInpatient: DED then you pay 20%. Outpatient: $25 per visitInpatient: DED then you pay 20%. Outpatient: $25 per visit

Welcome.

The PSEB Collective is your one-stop resource for benefits information at PSEB, PacSun, and Eddie Bauer. Select a location from the menu below to get started.