2012 PPO MEDICAL PLAN OFFERINGS 
(PREFERRED PROVIDER ORGANIZATION)

The following chart provides detailed information about coverage for the PPO plan options. This information below assumes you use in-network providers. Where out-of-network coverage, you will pay a higher amount for services.

 

Feature	$400/90%/%RX	$900/80%/%RX
Deductible* (individual/family)	$400/$1,200	$900/$2,700
Coinsurance after you pay the deductible** (paid by the plan/your share)	90%/10%	80%/20%
Annual out-of-pocket maximum, including deductible (individual/family)	$3,000/9,000***	$3,500/$10,500***
Office Visit (individual/family)	$25/$35	$25/$35
Emergency room/urgent care****	$150/$75 copay	$150/$75 copay
Prescription drugs at retail (what you pay for generic/brand formulary/brand non-formulary drugs)	$7/30%/45% Administered by Medco	$7/30%/45% Administered by Medco
Per-prescription retail maximum	$100	$100

*The deductible is the amount you will pay out of pocket for certain services before the plan pays.

**Coinsurance is the percentage of the cost of services you and First Data pay for certain services, such as outpatient procedures and hospital visits.

***Prescription drug costs do not apply. You will continue to pay prescription drug costs and copayments after you reach the out-of-pocket maximum.

****When diagnosed as a true medical emergency.

 Aetna members located in an Aetna Aexcel network must use Aexcel specialists in order to be covered at the in-network benefit level.

*New for 2012 - United members must use a UnitedHealth Premium designated specialist to pay the $35 specialist copay. If you receive specialty care from a non-premium provider, you will pay a $50 specialist copay. United Premium Providers are designated with two stars in UnitedHealthcare's online provider directory located at www.myuhc.com. You must select a UnitedHealth Premium Provider for care in these specialty services:  

Allergy service; Cardiac service; Endocrinology; Nephrology;  Neurology; Pulmonary; Rheumatology

Your personal situation will be different from other First Data employees. You may want to pay less in paycheck contributions, but the trade-off is you'll pay more if you need certain medical services. When reviewing your choices, keep in mind this trade-off between your paycheck contributions and your out-of-pocket costs.

Both options include the same prescription drug benefits, administered by Medco. See the Prescription Drug section for copay and coinsurance amounts.

Aetna is the administrator for all states except Colorado, Florida, Hawaii, Iowa, Nebraska and New York. For these six states United HealthCare is the administrator.

If you are in the Aetna PPO, your Group # is: 719964

If you are in the UnitedHealthcare PPO, your Group # is: 215930