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Medical Plans
Medical Coverage Options
Pechanga offers its full-time Team Members three different
medical plan options from which to choose based on your needs.
Each plan includes coverage for medically necessary services
including office visits, prescription drugs, and hospital care.
The available medical plan options are:
• Aetna HMO Gold Plan
• Aetna HMO Silver Plan
• Aetna Open Access Managed Choice Plan (OAMC/PPO)
Aetna HMO Plans
The Aetna HMO Gold and Silver plans are comprehensive
medical plans that include preventive care. You generally pay
only a fixed copay amount for most services. There are no
annual deductibles or lifetime maximum amounts.
HMO plans only cover services you receive from doctors,
hospitals and other providers who are participants in the
Aetna HMO provider network. You must select a Primary
Care Physician (PCP) to manage all of your care. The role of
your Aetna PCP is to provide you with day-to-day medical care and to coordinate your treatment with other network
specialists and providers when medically necessary. If you use a doctor who does not belong to the Aetna HMO, you pay
the full cost for all nonemergency treatment and services.
Aetna Open Access Managed Choice (OAMC/PPO) Plan
The Aetna Open Access Managed Choice Plan provides coverage for Preferred and Non-Preferred Care and contains
a $250 individual and $500 family annual deductible schedule. When you use Aetna OAMC Preferred Providers, your
out-of-pocket costs will generally be lower because these providers have agreed to offer their services for lower, pre-
negotiated rates and you are not required to pay any provider charges above the amount Aetna allows for that service.
Catamaran Prescription Plan
The PR&C prescription plan is administered by Catamaran. Team Members who enroll in a PR&C medical plan are
automatically enrolled in the prescription plan.
Generic Drugs
—are less expensive versions of brand name drugs that have the same intended use, dosage, effects,
risks, safety and strength. The active ingredients are identical to the original brand name drug. Under the PR&C
benefits program, generic prescriptions have a lower co-pay—make sure you talk with your physician to see if a generic
prescription will work for you.
90-Day Supply at Retail (Retail 90)
—Under the PR&C plan you have the option of filling a 84 to 90-day supply of
your maintenance medications at a participating retail pharmacy in addition to filling maintenance prescriptions through
mail order. Your Retail 90 copays are the same as the mail order copay amounts.
By purchasing generic drugs and obtaining a 90-day supply for your maintenance medications, you can receive the
lowest price on your prescription medications to maximize your long-term savings.
Contraceptives
—Under the PR&C plan, FDA approved contraceptive methods and devices are covered at a $0 copay.
Quantity limits may apply.
Important Note About ID Cards
When you enroll in an Aetna medical plan (HMO or OAMC), you will receive two (2) ID cards – one for
the Aetna medical plan and one for your prescription plan through Catamaran.
Catamaran Pharmacies
To locate participating Catamaran
Pharmacies (HMO or OAMC/PPO), go to
.
