Medical

HOW ARE THE PLANS ALIKE?

Both plans:

• Cover the same services, such as doctor’s office visits, hospitalization, emergency room care, and prescription drugs.
• Require you to complete a Baseline Visit within 120 days after the start of the plan year to receive $0 copay and 0% coinsurance benefits. All members and dependents 18 or older in a Curative plan must complete a Baseline Visit to receive richer benefits.
• Pay 100% for in-network preventive care, such as routine physicals, well-woman exams, well-baby exams, blood pressure checks, cholesterol tests, and cancer screenings.
• Pay 100% for in-network virtual visits.
• Let you see any doctor but offer savings when you use in-network doctors.

How the Plans Work

Here are some important things to know about the plans.

Medical Plans at a Glance

Both the Curative PPO and EPO plans have the same benefits, except benefits are not covered out-of-network in the EPO plan. All covered services are subject to medical necessity as determined by the plan. All out-of-network services are subject to reasonable and customary (R&C) limitations. Find a provider or facility near you by visiting the Curative Member Portal or calling 855.428.7284.

^*After Deductible.

^**Out-of-network benefits are not covered under the EPO plan.

¹Inpatient Hospital: Pre-certification required.

²Care Coordination must be notified within two days. Coverage for true emergencies only.

³Expenses that count toward meeting your out-of-pocket maximum include medical plan coinsurance and copays, prescription drug coinsurance and copays, and amounts you pay toward the deductible. Amounts above the reasonable and customary charge for out-of-network care do not count toward your out-of-pocket maximum.

Additional Medical Care

Additional programs are included with your Curative medical coverage:

Care for acute and chronic musculoskeletal pain and conditions: Airrosti provides you personalized care for hip, back, neck, shoulder, foot, and other acute and chronic musculoskeletal pain conditions. If you are enrolled in a Curative plan, you can use Airrosti at no charge with a baseline visit. Virtual or in-person treatment plans include:

• Thorough assessments and orthopedic testing to provide an accurate diagnosis and injury education.
• Conservative manual treatment to restore function, increase mobility, and reduce pain.
• Personalized, active rehab and at-home exercises designed to speed recovery and prevent future injuries.

Call Airrosti at 800-404-6050 to begin your recovery plan.

Care anywhere: Virtual Care connects you with a board-certified doctor in your home or wherever you are. Telemedicine providers can treat adults and children for many non-emergency conditions as an alternative to visiting an urgent care or emergency room. Visit the Curative Member Portal or call 512-421-5678 to set up care.

Kaiser HMO at a Glance (California only)

If you live in California, you have another medical option available: the Kaiser HMO.

With this plan, you must use in-network doctors to receive benefits — there is no out-of-network coverage except for urgent care and emergencies. You pay set copays for services, and there’s no deductible to meet. To find a provider, visit kp.org or call 800-464-4000.

1. Plan pays 100% for preventive care based on Kaiser’s preventive care guidelines.
2. Expenses that count toward meeting your out-of-pocket maximum include medical plan copays and prescription drug copays and coinsurance.

Curative PPO and EPO Paycheck Costs

Here are the premiums for the PPO and EPO.

Kaiser HMO Paycheck Costs (California Only)

Here are your premium costs for the Kaiser HMO.