IQVIA Benefits Handbook
ANSWERS TO FREQUENTLY ASKED QUESTIONS
What does the annual medical out-of-pocket maximum include?
The annual out-of-pocket maximum includes the calendar year deductible, office visit copays and coinsurance. It does not include any costs not covered by the plan—like costs above Maximum Reimbursable Charges (MRC).
How does the family deductible and out-of-pocket maximum work in the $1,850 and $2,850 Deductible Plans with HSA?
In the $1,850 Deductible Plan with HSA administered by Aetna, if you cover dependents, you and your covered family members must meet the family deductible before the plan pays benefits for any family member. Medical and prescription drug expenses for one family member or for all family members can add up to the deductible.
The same rule applies to the out-of-pocket maximum before the plan pays 100% of covered expenses for any family member.
If you enroll in the $1,850 Deductible Plan with HSA administered by Kaiser or $2,850 Deductible Plan with HSA administered by Aetna or Kaiser, each individual only needs to meet the individual deductible before the plan pays benefits for that individual member. The same rule applies to the out-of-pocket maximum before the plan pays 100% of covered expenses for that individual member.
What happens if my doctor drops out of the network?
You will need to choose another doctor from the Aetna provider directory to receive network benefits. Keep in mind that you can go to any doctor in the network, and you do not have to choose a primary care physician. You can continue to see a doctor who has dropped out of the network, but you will receive lower benefits for out-of-network care. If you choose Kaiser, you will need to find another doctor from the Kaiser network.
When do I receive my health plan ID card after I enroll as a new hire?
You should receive ID cards (depending on your elections) within 2-3 weeks to your home address:
  • Aetna: Each family will be issued two (2) ID cards. If you wish to print additional cards, please sign into your Aetna account at www.aetna.com, or download the Aetna app to your mobile device, where you can also view an electronic ID card.
  • Kaiser: Each covered member will receive an ID card, which will serve as a combined medical and prescription card. If you wish to print additional cards, you can do so at https://healthy.kaiserpermanente.org.
How can I view my claims status?
You can view the status of your claims:
If you're not registered to use the Aetna or Kaiser websites, use these instructions below:
  • Aetna: Go to www.aetna.com and click "Log In/Register." You will need to enter your member ID, which is located on your ID card, first and last name, date of birth, zip code and an email address. Then, click "Continue" and follow the prompts to set up your account.
  • Kaiser: Go to https://healthy.kaiserpermanente.org and click "Register." Then click "I have a Kaiser Permanente plan and want to use online services." You will need to enter your first and last name, date of birth, preferred language, region and medical record number (MRN) from your ID card. Note: Northern CA employees do not need to include the "11" prefix in the MRN.