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IBM PPO
The IBM PPO is available to all regular full-time employees at no cost for 2009 (there is a monthly contribution for spouse/domestic partner and child coverage). The IBM PPO offers "deductible free" routine and preventive care. If your physician is in-network, routine and preventive care is covered 100%. It features a broad nationwide network of providers who offer care at discounted rates, and gives you the flexibility to receive care out-of-network at a higher cost. No primary care physician (PCP) is required. After you meet your annual deductible, the plan pays a percentage of the actual charge (the percentage depends upon whether you use a PPO network provider), up to an annual out-of-pocket maximum (for 2009, $5,148 for an individual and $9,266 for a family in-network). If you reach that maximum, the plan will pay 100% for eligible expenses for the remainder of the year.

Participants in the IBM PPO receive prescription drug benefits through the IBM Managed Pharmacy Program (administered by Medco), and mental health benefits through the IBM Managed Mental Health Care Program (administered by OptumHealth Behavioral Solutions by United Behavioral Health).

Another feature of the IBM PPO is Care Advantage, which provides targeted outreach and one-on-one care management to participants with complex medical needs. In addition, Care Advantage offers expert assistance to those managing certain chronic illnesses, including asthma, congestive heart failure, coronary artery disease, depression and diabetes.

For more details about coverage and provisions under the IBM PPO, see the medical options comparison chart.



IBM PPO Plus
IBM PPO Plus is similar to the IBM PPO, with a different balance between the cost of coverage and the cost of care. With IBM PPO Plus, all medical services received in-network are "deductible-free," including hospital care. If you choose IBM PPO Plus, you'll pay a higher monthly contribution for coverage and — with no in-network deductible — potentially lower overall costs for care.

IBM PPO Plus features a broad nationwide network of providers who offer care at discounted rates, and gives you the flexibility to receive care out-of-network at a higher cost. No primary care physician (PCP) is required. The plan pays a percentage of the actual charge (the percentage depends upon whether you use a PPO network provider), up to an annual out-of-pocket maximum (for 2009, $3,308 for an individual and $4,963 for a family in-network). If you reach that maximum, the plan will pay 100% for eligible expenses for the remainder of the year.

Participants in the IBM PPO Plus receive prescription drug benefits through the IBM Managed Pharmacy Program (administered by Medco), and mental health benefits through the IBM Managed Mental Health Care Program (administered by OptumHealth Behavioral Solutions by United Behavioral Health).

Another feature of IBM PPO Plus is Care Advantage, which provides targeted outreach and one-on-one care management to participants with complex medical needs. In addition, Care Advantage offers expert assistance to those managing certain chronic illnesses, including asthma, congestive heart failure, coronary artery disease, depression and diabetes.

For more details about coverage and provisions under IBM PPO Plus, see the medical options comparison chart.



IBM High-Deductible PPO with Health Savings Account
The IBM High-Deductible PPO with Health Savings Account, available at no cost for employee-only coverage in 2009, is a high-deductible medical option with a unique feature — a health savings account (HSA) — which you can use to pay for eligible current out-of-pocket medical costs or save for future health care expenses. Participants who enroll in this option for 2009 will receive up to a $500 IBM contribution (pro-rated based on date of hire) for 2009. Your HSA is completely portable, and your account balance can be rolled over from year to year. You must enroll in the IBM High-Deductible PPO with Health Savings Account option to participate in the HSA.

This option features the same broad provider network as the other IBM PPO options, along with the flexibility to seek out-of-network care at a higher cost. The plan pays a percentage of the actual charge (the percentage depends upon whether you use a network provider), up to an annual out-of-pocket maximum (for 2009, $5,600 for an individual and $10,297 for a family in-network). It also offers deductible-free routine screenings and check-ups; however, to comply with Internal Revenue Service (IRS) guidelines for HSAs, all other services are subject to the deductible. Participants in the IBM High-Deductible PPO with Health Savings Account are subject to other terms and conditions mandated by the IRS.

Benefits for prescription drugs and mental health/substance abuse are provided through the health plan and are subject to the deductible in most cases.

Another feature of IBM High-Deductible PPO with Health Savings Account is Care Advantage, which provides targeted outreach and one-on-one care management to participants with complex medical needs. In addition, Care Advantage offers expert assistance to those managing certain chronic illnesses, including asthma, congestive heart failure, coronary artery disease, depression and diabetes.

For more details about coverage and provisions, see the medical options comparison chart.



IBM Exclusive Provider Organization (EPO)
The IBM Exclusive Provider Organization (EPO) is an "in-network only" option, which means that benefits are payable only if participants seek care exclusively from doctors, hospitals and other facilities that belong to the plan's provider network. Participants pay a higher cost for coverage, in exchange for "deductible-free" medical services and generally lower costs for all types of care.

The IBM Exclusive Provider Organization features the same broad nationwide network of providers available through the IBM PPO options. No primary care physician (PCP) is required. There is no coverage for services received outside the network except in emergencies. The annual out-of-pocket maximum for 2009 is $5,148 for an individual, and $9,266 for a family.

In addition to the preventive and routine care coverage offered by the IBM PPO options, the IBM Exclusive Provider Organization offers significant protection for serious or chronic medical conditions. With no deductible and fixed copayments for hospital and related services, participants are protected from the high out-of-pocket expenses associated with ongoing treatment.

Participants in this plan receive prescription drug benefits through the IBM Managed Pharmacy Program (administered by Medco), and mental health benefits through the IBM Managed Mental Health Care Program(administered by OptumHealth Behavioral Solutions by United Behavioral Health). However, mental health and substance abuse benefit levels differ from those offered by the IBM PPO options.

Another feature of IBM Exclusive Provider Organization is Care Advantage, which provides targeted outreach and one-on-one care management to participants with complex medical needs. In addition, Care Advantage offers expert assistance to those managing certain chronic illnesses, including asthma, congestive heart failure, coronary artery disease, depression and diabetes.

For more details about coverage and provisions under the IBM Exclusive Provider Organization, see the medical options comparison chart.



Health Maintenance Organizations (HMOs)
A health maintenance organization (HMO) provides comprehensive, coordinated health care services for a fixed prepaid fee through a network of providers. Participants are typically responsible for copayments for physician visits and other services. Generally, you aren't covered for services outside the network, except for emergencies. When you enroll in an HMO, you select a primary care physician (PCP) to coordinate your care.

Note: Participants in HMOs that IBM self-insures will receive prescription drug benefits through the IBM Managed Pharmacy Program, which is administered for IBM by Medco. Participants in fully insured HMOs will receive prescription drug benefits through the HMO.

For more details about the typical coverage and provisions under the HMOs IBM makes available, see the medical options comparison chart.



No coverage
IBM employees who decline medical coverage will receive $30 per month in cash. This amount, which is treated as taxable income, will be paid in your semi-monthly paycheck. If you have medical coverage available through a spouse's/domestic partner's employer or another source, you may want to consider this option.

Remember, if you decide not to enroll in medical coverage when you are first eligible, you won't be able to do so during the year unless you have a qualified status change that allows you to enroll.

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