The Benefits Home for Toys"R"Us Team Members
Choosing a medical option can be an overwhelming task. But, if you take it step-by-step, it can be easier than you think.
How Our Medical Options Work
There are several components to the cost of health care coverage. The premium cost share between you can the Company, your out-of-pocket costs, called deductibles and coinsurance, and whether your provider is in-network.
Your share of the premium cost is deducted from your paycheck on a pre-tax basis and depends on the medical option you elect. For example, the Aetna Gold option offers a higher level of coverage when you receive care, however, your premium cost for that plan will be the highest. The Aetna Bronze option offers the lowest level of coverage but has the lowest premium cost.
Your annual deductible is the dollar amount you have to pay for medical care and prescriptions before the plan starts paying a portion of the cost. Each medical plan has a different deductible amount.
Most plan participants never reach their deductible. So when you’re choosing an option you should look at your premium cost, which you will pay no matter what, versus your deductible, which you will only pay if you need care.
When your deductible is met, the Company will share in the cost of your care until you reach your annual out-of-pocket maximum. The percentage you pay depends on the medical plan option you elect.
Annual Out-of-Pocket Maximum
Your annual out-of-pocket maximum is the most you would pay in a given year. For example, let’s say you have an unfortunate accident or need a costly surgery. The out-of-pocket maximum feature ensures in most circumstances, you’ll pay no more than that amount out of your own pocket.
Network of Providers
Each medical plan option has a “network” – a specified group of doctors, specialists and facilities that have agreed to set fees for services in advance. The Aetna Gold, Silver and Bronze medical options let you see any doctor, whether in-network or out of the network. However, you will generally pay less when you go to in-network providers. With the Kaiser CA option, you must use in-network providers or you will be responsible for the full cost of services.
With all plan options, the full cost of your in-network preventive care, including annual wellness visits and age-appropriate vaccinations, are paid for by the Company. If you use an in-network provider, you don’t have to consider the cost of preventive care when choosing a plan.