Health Maintenance Organization (HMO) Option The Scripps Health Plan HMO provides a wide range of quality health care services through a network of Scripps providers within San Diego County. All routine care (office visits and annual screenings) must be provided by your elected Primary Care Physician (PCP). Your PCP is responsible for coordinating referrals to specialists within the same medical group. If you are outside of your medical group's service area or San Diego County, only services that are urgent or emergent will be covered. If you are living outside of San Diego County and cannot reasonably return for routine care, you cannot choose the HMO plan. PCPs and their medical groups coordinate and assume responsibility for your care. You must designate a PCP for yourself and each covered family member when you enroll. When choosing a new PCP, make sure you are selecting a provider who is accepting new patients. Your PCP coordinates your health care, maintains your medical records, provides routine care, and refers you to specialists and other services when medically necessary. You can select your PCP from the following Plan Medical Groups (PMGs) that participate in the HMO plan option: • Mercy Physicians Medical Group • Optum Care Network - North County SD • Rady Children's Health Network • Scripps Clinic Medical Group • Scripps Coastal Medical Center • Optum Care Network SDPMG You have access to hospitals, specialty care, and urgent care centers from the providers affiliated with your PMG. Visit MyScrippsHealthPlan.com to find the affiliated hospitals and urgent care facilities for each PMG. Scripps Medical Plans With My Scripps Benefits you can choose between two medical plans. Scripps offers two medical plan options: HMO and EPO. The differences between the medical plan options are: • Your payroll contribution • What you pay when you receive medical services • Provider networks • Out-of-pocket maximums • Referral requirements Refer to the table on page 25 for a side-by-side summary of your options. HEALTH AND WELLNESS Quick Facts ELIGIBILITY/ENROLLMENT • F ull-time and part-time benefit-eligible employees are eligible the first of the month following 60 days of employment; must enroll within 60 days of hire • D epartment Directors and above, Fellows and Residents are eligible the first day of employment; must enroll within 31 days of hire OPTIONS • HMO • EPO COVERAGE TIERS • Employee only • Employee plus adult • Employee plus child(ren) • Employee plus adult & child(ren) OPEN ENROLLMENT/MID-YEAR CHANGES • Current employees can make changes during the Open Enrollment period or within 31 days of a Qualifying Life Event • Enroll or make changes online using the benefits web enrollment system RESOURCES • HMO Customer Service – 844-337-3700: benefits, eligibility, claims, and pre-authorization • EPO Member Services – 877-552-7247: eligibility, claims, and pre-authorization • MyScrippsHealthPlan.com: plan documents, provider network information • Scripps HR Service Center – 858-678-MyHR (6947): to report a Qualifying Life Event during the year, general questions 22
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