Medical

At VMware we are proud to offer a comprehensive program of medical benefits. Our plans ensure you have the choice and flexibility you need to make smart and cost-effective healthcare decisions. All medical plans include prescription drug coverage and in-network preventive care services. Two of our plans are available to all benefit eligible employees, while the third is offered to benefit eligible employees residing in Northern California.

Our two PPO plans are administered by Aetna via the same Aetna Choice Plus II network. Both the HSA PPO and the Traditional PPO plans have the same network of doctors and hospitals. Both have co-pays when seeing a doctor and co-insurance when filling a prescription. What is different about the two PPO plans is how they pay; the deductible is higher in the HSA PPO plan which qualifies it for a Health Savings Account or HSA plan. Also, the HSA PPO plan has a quarterly VMware funding to your HSA that helps cover the higher deductible. With the Kaiser HMO plan, you are restricted to using providers within the HMO network and the plan requires that you select a Primary Care Physician (PCP) to coordinate all your health care needs, including arranging for hospitalization and referrals to specialists.

Other differences between the plans include the annual deductible, out-of-pocket maximum, employee contributions and VMware funding. The comparison chart below provides more details.

2017 Medical Plan Comparison

HSA PPO1
In-Network
HSA PPO1
Out-of-Network
Traditional PPO
In-Network
Traditional PPO
Out-of-Network
Kaiser HMO (N. CA only)
VMware Funding per Quarter2 Individual: $187.50
Family: $375
Individual: $187.50
Family: $375
N/A N/A N/A
Annual Deductible Individual: $1,500
Family: $3,000
Individual: $1,500
Family: $2,700
Individual: $500
Family: $1,500
Individual: $500
Family: $1,500
None
Annual Out-of-Pocket (OOP) Maximum3 Individual: $2,500
Family: $5,000
Individual: $6,000
Family: $12,000
Individual: $2,350
Family: $7,050
Individual: $6,250
Family: $18,750
Individual: $1,500
Family: $3,000
Employee Coinsurance 10% after deductible 30% of UCR4,
after deductible
10% after deductible 30% of UCR4,
after deductible
Applies to certain medical procedures only
Preventive (Annual Physicals, Well Care Exams) 100% covered, not subject to deductible 30% of UCR4,
after deductible
100% covered,
not subject to deductible
30% of UCR4,
after deductible
100% covered, not subject to co-pay
Physician Visit 10% after deductible 30% of UCR4,
after deductible
Primary Care: $20 co-pay
Specialist: $30 co-pay
30% of UCR4,
after deductible
$15 per visit
Lab and X-Ray 10% after deductible 30% of UCR4,
after deductible
10% after deductible 30% of UCR4,
after deductible
100% covered if part of office visit
Emergency Room 10% after deductible 10% of UCR5,
after deductible
$100 co-pay,
then 10% of UCR5
$100 co-pay, then 10% $50 per visit
Ambulance 10% after deductible 30% of UCR4,
after deductible
10% after deductible 30% of UCR4,
after deductible
$50 per trip
Hospitalization 10% after deductible 30% of UCR4,
after deductible
10% after deductible 30% of UCR4,
after deductible; $500 per confinement deductible
$250 co-pay per admit
Chiropractic Care 10% after deductible
Up to 20 visits per year
30% after deductible
Up to 20 visits per year
$30 co-pay per visit
Up to 20 visits per year
30% after deductible
Up to 20 visits per year
$15 co-pay per visit
Up to 30 visits per year
Acupuncture 10% after deductible
Up to 12 visits per year
30% after deductible
Up to 12 visits per year
$30 co-pay per visit
Up to 12 visits per year
30% after deductible
Up to 12 visits per year
$15 co-pay per visit
Referral required
Speech Therapy5 10% after deductible 30% after deductible $30 co-pay per visit 30% after deductible $15 co-pay per visit for covered cases
Infertility/Fertility Preservation 50% after deductible up to $10,000 lifetime max ($7,000/$3,000 for med/Rx) Not Covered 50% after deductible up to $10,000 lifetime max ($7,000/$3,000 for med/Rx) Not Covered 50% coinsurance per visit (does not include GIFT, ZIFT or IVF)6

1 Individual deductible and OOP maximum only apply to employees enrolled in employee-only tier. Members in dependent tiers must satisfy the family deductibles and OOP maximums. Paid Interns are only eligible to enroll in the HSA PPO plan.
2 VMware funding based on coverage at the end of each quarter. Must be active on the last day of the quarter. Paid Interns are not eligible for VMware funding. HealthEquity accounts funded the pay period following the close of quarter.
3 OOP maximum includes Prescription Rx for all plans.
4 Usual, customary and reasonable charges.
5 Available to those with conditions of medical necessity.
6 GIFT is a gamete intrafallopian transfer. ZIFT is a zygote intrafallopian transfer. IVF is in-vitro fertilization.

Prescription Drugs (Rx)

HSA PPO
In-Network
HSA PPO
Out-of-Network
Traditional PPO
In-Network
Traditional PPO
Out-of-Network
Kaiser HMO (N. CA only)
Retail (30-day supply)1
Generic/Brand/Non- Formulary
 10%/15%/20% after deductible 50% after deductible 10%/25%/40%
after deductible
50% after deductible $10/$20/$20
co-pay
Mail Order (90-day supply)1
Generic/Brand/Non- Formulary
10%/15%/20% after deductible Not covered 10%/25%/40%
after deductible
Not Covered 100-day supply
$20/$40/$40
co-pay

1 Deductible waived for preventive medications.

Paying for Medical Coverage

Any premiums paid by you are on a pretax basis, other than for domestic-partner coverage. By paying your premiums pretax (before federal, state and Social Security taxes are withheld), you reduce your taxable income, lower the amount of taxes you must pay and increase your net take-home pay. You must pay for coverage of a domestic partner and a domestic partner’s children on a post-tax basis, and the value of the Company subsidy is included in your taxable income. This is called “imputed income.” See the Domestic Partner Imputed Income Rate Table for details.

Employee Contributions for 2017

Per Paycheck Rates

Plan Employee Only Employee + Spouse/Domestic Partner Employee + Child(ren) Employee + Family
HSA PPO $0 $54.02 $38.90 $97.24
Traditional PPO $57.83 $154.20 $127.22 $231.30
Kaiser HMO (N. CA Only) $46.06 $119.76 $101.33 $181.17

Per paycheck contributions are 24 times per year.

Dependent Eligibility

  • Your spouse or domestic partner. Please note: after tax contributions and imputed income may apply when covering a domestic partner. See the Domestic Partner Imputed Income Rate Table for details
  • Your child(ren), your spouse’s / domestic partner’s child(ren), your foster child(ren) are eligible for medical coverage until age 26, regardless of student status.

Contact Us

Aetna
Phone 1-877-204-9186
Visit website


Benefit Center
Phone 1-888-VMWARE8, option ‘US Benefits’
hrbenefitadmin@vmware.com


Kaiser
Phone 1-800-464-4000
Visit website

Resources

ALEXTM Your Virtual Benefits Adviser
Aetna Plan Selection and Cost Estimator Tool
Benefits Contact Quick Reference Guide
Benefits Enrollment Site [VMware network access required]
Domestic Partner Imputed Income Rate Table
Palo Alto Medical Foundation Care-A-Van Mobile Clinic
Palo Alto Kaiser Mobile Health Vehicle