MEDICAL BENEFITS
Comprehensive and preventive healthcare coverage is important in protecting you and your family from the financial risks of unexpected illness and injury . The Suquamish Tribe offers you a PPO medical plan administered by HMA . The plan provides excellent coverage of preventive services , such as routine physical exams and immunizations , that are very important to your and your family ’ s health . Prescription drug coverage is also included with the medical plan , through OptumRx .
$ 2,000 DEDUCTIBLE PPO PLAN
No matter where you are in the United States , you will be covered under your HMA Plan . If you are temporarily in or reside outside of the Pacific Northwest ( Washington , Oregon , Idaho , and Utah ), you have access to the network and savings discounts negotiated with healthcare providers in each state .
� Always carry your current HMA member ID card with you
� To find in-network doctors and hospitals , log in to the HMA member portal at accesshma . com and select “ Find a doctor or hospital .”
� Click on the image of the state or region where you would like to search .
� Enter the city , state , and zip code where you would like to search .
� Call HMA ’ s Customer Care Team at 1-888-450-4491 available 6 am – 6 pm PT , Monday – Friday for any required pre-certification or pre-authorization .
� When you arrive at the in-network doctor ’ s office or hospital , show them your HMA member ID card . On the back of the card , the provider can find the information and contact details to inquire about your benefit coverage and to find out how to submit the claim .
TELEHEALTH
Consult with a board-certified doctor 24-hours a day , 7 days a week by phone , secure video , or through the MDLIVE App .
When you ’ re not feeling well , making your way into a doctor ’ s office can be a real pain … from missing work or getting off the couch , to getting stuck in a waiting room . With your telehealth benefit , you can save time and money by seeing an MDLIVE doctor for non-emergency conditions . MDLIVE doctors can even send a prescription to your nearest pharmacy ( if needed ). Below are some of the conditions that MDLIVE doctors can treat .
COPAY & COINSURANCE
A copay is a flat dollar amount you pay for a medical service . Coinsurance is when you pay a percentage of the cost .
CALENDAR YEAR DEDUCTIBLE
This is the amount you pay before your plan begins covering expenses not subject to a copay . If you are enrolled with one or more family members on the plan , once the total family deductible is met , no one else in the family has to pay the balance of their deductible .
OUT-OF-POCKET ( OOP ) MAXIMUM
The OOP maximum is the most you pay in a calendar year for in-network covered medical services . Once the OOP maximum is met , the plan will pay 100 % of the allowed amount for the remainder of the calendar year for in-network covered services . On a family plan , each person has their own OOP maximum . However , once the total family OOP is met , no one else in the family has to pay the balance of their OOP maximum .
OUT-OF-NETWORK
When you use out-of-network providers , your plan will pay for services based upon their allowed amount . You will be responsible for the remaining costs . When you use out-of-network services , your plan will only pay a percentage of the allowable amount . You may be responsible for the balance .
Prepared by Gallagher for the Employees of The Suquamish Tribe 5