Medical Plans
Sony Pictures provides four medical plan options to meet the needs of you and your family.
THE SONY CONSUMER CHOICE PLAN IS A PREFERRED-PROVIDER PLAN (PPO) THAT INCLUDES A HEALTH SAVINGS ACCOUNT (HSA).
You may visit any doctor or specialist you choose, in- or out-of-network. You’ll have lower monthly premiums than with any of the other plans offered, but you’ll also have a higher annual deductible. Many of your prescription drugs are subject to your medical plan deductible so you’ll pay 100% of the cost for medications until you reach your combined medical prescription deductible; however, the plan does cover many preventive drugs at 100%.
The Sony Consumer Choice Plan works in conjunction with an HSA. Review the plan comparison chart here for more information.
Marisol has medical coverage for herself, her spouse and their two children. To date, these are the expenses that apply to the in-network family deductible. They will continue to pay 100% of care and prescriptions until they meet the $3,300 deductible. These expenses can be paid or reimbursed from Marisol's HSA.
Once they've met the deductible, the plan pays 80% of covered care and prescription drugs for the family until the out-of-pocket maximum is met. This is called coinsurance.
| Participant | Covered Expenses |
|---|---|
| Barbara | $1,350 |
| Spouse | $100 |
| Child 1 | $250 |
| Child 2 | $50 |
| TOTAL | $1,750 |
Once Marisol's family met the $3,300 in-network family deductible, the plan paid 80% of the covered care and prescription drugs for the family until the $8,000 family in-network and out-of-pocket maximum was reached.
As a result, the plan will not pay 100% of covered in-network care and prescription drugs for the rest of the plan year.
| Participant | Covered Expenses |
|---|---|
| Barbara | $12000 |
| Spouse | $4,500 |
| Child 1 | $1,000 |
| Child 2 | $500 |
| TOTAL | $8000 |
This plan allows you to visit any health care provider you want but pays more when you use in-network providers. The PPO Plan’s network is the same as the Consumer Choice Plan.
The plan covers in-network preventive care at 100%. For in-network office visits, you pay a copayment. For other care, you pay 100% of all expenses until you meet the deductible before the plan starts paying, except for in-network office visits, which are subject to a copayment, and in-network preventive care. If you cover dependents on your plan, each person must meet the individual deductible until the family deductible is met. You may meet the family deductible by any combination of covered medical expenses you and your covered family members incur.
How the deductible works in the PPO/EPO Plans (Examples are in-network)
| Participant | Covered Expenses |
|---|---|
| Robert | $700 |
| Spouse | $100 |
| Child | $200 |
| TOTAL | $1,000 |
coinsurance for the whole family until they meet the out-of-pocket
maximum. Once they meet that, the plan will pay 100% of covered
services for the rest of the plan year.
| Participant | Covered Expenses |
|---|---|
| Robert | $600 |
| Spouse | $200 |
| Child | $600 |
| TOTAL | $1,400 |
The EPO is an in-network-only PPO with a modest deductible. You may visit any doctor in the Aetna Select EPO network without a referral. You don’t have to choose a primary care physician (PCP) but having a PCP results in a higher level of care continuity.
This plan covers in-network preventive care at 100%. For in-network office visits, you pay a copayment. For other care, you pay 100% of all expenses until you reach the deductible.
How the deductible works in the PPO/EPO Plan (Examples are in-network)
| Participant | Covered Expenses |
|---|---|
| Robert | $700 |
| Spouse | $100 |
| Child | $200 |
| TOTAL | $1,000 |
coinsurance for the whole family until they meet the out-of-pocket
maximum. Once they meet that, the plan will pay 100% of covered
services for the rest of the plan year.
| Participant | Covered Expenses |
|---|---|
| Robert | $600 |
| Spouse | $200 |
| Child | $600 |
| TOTAL | $1,400 |
You must use health care providers and facilities in the Kaiser network only. You choose a primary care physician (PCP) who will refer you to specialists if necessary. Most services require a copay, and there is no deductible to meet.
Important Definitions
These terms will help you as you read through this guide.
When Your Doctor's Not On Our Network
Health care providers are either in-network or out-of-network. It sounds like a small difference but going out-of-network could throw off your whole health care budget.
In-network doctors partner with Aetna to offer discounted rates to Aetna members like you. You get the discounted rate and your doctor submits your claim to Aetna. What you pay out of pocket for covered expenses counts toward your deductible and out-of-pocket maximum. And, when you stay in-network, you keep health care costs down for you and Sony Pictures, which helps keep everybodyʼs rates down.
Out-of-network doctors donʼt offer these discounts so you spend more out of pocket — sometimes a lot more. Plus, out-of-network doctors donʼt file claims for you; you pay up front then file claims yourself.
To be a savvy health care consumer, here are some important reminders:
• Even if a doctor, clinic, lab or hospital “accepts” your insurance, it doesnʼt mean theyʼre in the Aetna network.
• Donʼt assume that because your doctor is in-network, the hospital (or lab, imaging center, pharmacy, etc.) is, too.
• Check to see if your doctor is in-network using Aetnaʼs Provider Search.
Your Cost For Medical Coverage
Below is a breakdown of your cost per month for each plan. How much you pay is based on the benefits you choose, your base salary when youʼre hired (and each September 1 after that), and who you cover under your plan.
Sony Pictures shares the cost of most of your benefits with you as part of our commitment to offering you the protection you need. Your payroll deductions are generally taken out of your pay on a pre-tax basis, which means you pay less income tax. Consult your tax advisor for details.
• Medical Plan Employee Contribution Rates (includes prescription drug coverage)
PRESCRIPTION COVERAGE
Prescription drug coverage is included with our medical plans.
All Sony Pictures medical plans:
• Offer prescription drug coverage – The benefit depends on the plan you choose and type of drug prescribed
• Cover the full cost of certain contraceptives, tobacco-cessation medications and other preventive drugs as required by the Affordable Care Act (ACA)
| Sony Consumer Choice/ Sony PPO/ Sony EPO | Kaiser HMO(California Only) | |||
|---|---|---|---|---|
| Retail (30-Day-Supply) | Mail (90-Day-Supply) | Retail (30-Day-Supply) | Mail (90-Day-Supply) | |
| YOU PAY | ||||
| Generic | $10 copay | $20 copay | $10 copay | $20 copay |
| Preferred | 30% coinsurance $25 minimum $75 maximum | 30% coinsurance $55 minimum $125 maximum | $20 copay | $40 copay |
| Non-Preferred | 40% coinsurance $40 minimum $100 maximum | 40% coinsurance $70 minimum $150 maximum | $20 copay | $40 copay |
Helpful Prescription Terms
EXPRESS SCRIPTS
You’ll receive a separate ID card from Express Scripts.
Extras From Aetna
You won’t find a bigger slingshot, but you will discover other great features.
With Sony Pictures' telemedicine program, you can call a doctor 24/7 for diagnosis and treatment of minor conditions. And it’ll probably cost you less than
the price of an office visit copay, depending on your plan.
If you’re in the Sony PPO or Sony EPO plan, you can visit for free. With Teladoc, you can get:
• Short-term prescriptions.
• Skin conditions diagnosed by sending a photo.
• Care for a loved one, even if they’re not on your plan. Register them on your Teladoc account, then initiate a consultation via three-way call.
And, Teladoc offers behavioral health counseling seven days a week for you and your covered dependents. Therapists provide help with anxiety/stress
management, relationships, depression, PTSD and many other issues. It’s confidential and convenient.
Call Teladoc at 1-855-Teladoc (1-855-835-2362).
As an Aetna member, you’ll have round-the-clock access to a registered nurse with the Informed Health Line at 1-800-556-1555.
Your Personal Health Record (PHR) provides a single, secure place to record and store your health information. Each time Aetna processes a new medical claim — like a doctor visit or a lab result — it’s automatically added to your record. Access your PHR through the Aetna member website.
The Aetna Concierge program delivers easy access to health resource consultants. It can provide you with information and guidance when you need it. The program can help with billing, provider, plan design and coverage questions. A concierge can give you the information you need to help you make informed choices as you navigate the health care system. You can reach Sony Pictures' team of concierges at 1-888-385-1053.
Use Aetna’s Plan Selection and Cost Estimator tools to estimate your out-of-pocket health care costs, compare plan offerings and determine which plan best meets your needs and those of your family. Log in at www.aetna.com.
Dental Coverage
For strong healthy teeth, get your canines regularly checked and cleaned.
There are two dental plan options to choose from: the High Plan and Standard Plan. The High and Standard plans use the Delta Dental PPO and Premier networks. You’ll receive benefits for services with any dentist, but Delta Dental’s PPO network provides you with the deepest discounts on your dental costs. If you can, it’s best to find Delta Dental PPO dentists and specialists to minimize your out-of-pocket costs and maximize your benefits.
Vision Coverage
When your vision is sharp, it’s easier to stay out of trouble.
VSP provides the vision plan. If you elect coverage you and your family are covered for eye exams, lenses and frames once per calendar year.
If you use an in-network provider, your plan covers your eye exam and glasses (frame and lenses) or contact lenses. You may also be eligible for discounts on additional products or services you buy during the same visit or even later in the same year.
If you use an out-of-network provider, your plan may or may not cover the full cost of your exam, and your glasses or contact lens allowance will vary by selection. You’ll find a list of certified network optometrists and ophthalmologists at www.vsp.com.
