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2022 Benefits Guide
ENTERBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
Welcome to
Benefits!
At Activision Blizzard, our employees build immersive worlds that impact popular NOTE ON MEDICARE:
culture across the globe. We encourage you to take the same approach with your benefits. If you (and/or your dependents) have Medicare or
This guide will help you explore, learn and build the best benefits to enhance your will become eligible for Medicare in the next 12
months, a federal law gives you more choices
quality of life. Check out www.benefitsforeveryworld.com for more resources to help you
about your prescription drug coverage. Please see
find the right coverage and value for you and your family.
Important Notices for more details.
HOW TO ENROLL HEALTHCARE BENEFITS@PLAY WEALTHCARE TERM LIFE & ADDITIONAL HOW TO
Enrollment Steps Medical Options Programs Activision Blizzard DISABILITY BENEFITS GET HELP
Choose Carefully
> CDHP Plan > Activity Tracking 401(k) Plan INSURANCE Legal Services Providers
> PPO 500 Plan > Food Tracking Fidelity 529 College
Who is Eligible Term Life Insurance Identity Guard
> In-Network Plan (not open > Sleep Tracking Savings Plan This enrollment guide
> Dependent Eligibility Verification to new enrollments) > Company Paid Auto/Home/Renters Insurance constitutes a Summary of
> Find Fair Prices Financial Wellbeing
> Kaiser HMO (CA only) > Supplemental Material Modifications (SMM)
> Brain Health and Training Pet Insurance to the 2022 summary plan
>C
entivo Coordinated Care Plan Accident Insurance (AD&D) description (SPD). It is meant
>F
ertility and Pregnancy
(So. CA only) Travel Assistance
Tracking to supplement and/or replace
> Waiving Medical Coverage > Company Paid certain information in the SPD,
> Gym Membership Discounts Care Providers
> Supplemental so retain it for future reference
Additional Care Support > Parenting Support along with your SPD. Please
Disability Insurance 24 Hour Fitness
>A
dditional Care available > Personalized Health Coach share these materials with your
to Collective Health Plans Medical Benefits Abroad covered family members.
> Mental Health Wellbeing > Core STD and LTD
>A
dditional Care available This guide is intended as an
> Financial Coaching > Buy-up STD and LTD Mothers at Work
to All Plans overview of benefits available
Medical Plan Comparison Annual Incentive Maximums Supplemental Term Life & Call of Duty Endowment to regular full time employees
Income Protection or part time employees who
Rx Happiest Baby Snoo are benefit eligible. Temporary
> Whole Life Insurance employees who work more than
Dental > Accident Insurance Other Perks 30 hours per week should refer
to the Benefits Summary for
Vision > Critical Illness
Temporary Employees located on
Employee Contributions www.benefitsforeveryworld.
Spending Accounts com
> Health Savings Account
> Flexible Spending Accounts
Employee Contributions < 2 >
> Medical Plan SurchargesBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
How to Enroll
Explore this guide and review your
options with ALEX®, our virtual benefits Your Deadline to Enroll
STEP 1 counselor, who can help you pick the
DISCOVER right benefits for your needs. You can • Current Employees: You must enroll October 27 - November 12, 2021.
find more information at If you don't enroll, your current 2021 benefit elections will be carried into
www.benefitsforeveryworld.com. 2022, except for flexible spending accounts. You have to enroll in those
every year.
• New Employees: You must enroll within 30 days from your
It's important to make sure your
hire date. If you miss the deadline, you will be auto-enrolled
STEP 2 providers are within the medical, dental
MAP and vision networks to receive lower
as described on page 5.
out-of-pocket costs. Questions? Try www.benefitsforeveryworld.com first. If you still have
questions, email the Benefits team at benefits@activisionblizzard.com.
STEP 3 Build your benefits and enroll online
BUILD through Workday
Watch for ID Cards
•M
edical: After open enrollment, you’ll receive a new medical ID card from
Collective Health, Centivo, or Kaiser, if you made changes to your elections.
You will also have access to a new digital ID card through your medical
plan that complies with the disclosure requirements of the Consolidated
Appropriations Act, 2021 (H.R. 133).
STEP 4 Review your benefit selections and
REVIEW print your confirmation statement. • Dental: If you enroll in the Dental DHMO plan, you will receive a new ID
card from Delta Dental with a new dentist selected for you according to
your zip code. You need to see your assigned Dental provider otherwise
you will be responsible for 100% of the cost. You will need to contact Delta
Dental to make a change to your dentist. If you enroll in the Dental PPO
plan, you will receive a new ID card from Collective Health, which will also
STEP 5
Provide SSN/National IDs and include your vision card as well.
PROVIDE documentation for each eligible w
If you enroll outside of open enrollment, you can expect your ID cards
dependent you add to your coverage.
approximately two weeks after you've made your elections.
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
CHOOSE CAREFULLY NEED TO MAKE A MID-YEAR
Your Choices Last for the Plan Year BENEFIT CHANGE?
The benefit elections you make start on the first of the month following your date of hire, or immediately
Remember, you must enroll within
if hired on the first of the month, and will be in effect for the rest of the plan year.
30 days of a “qualified life event,” such
You cannot make changes to your benefits during the year, unless: as marriage, divorce, birth of a child, or
special enrollment period.
•Y
ou have a “qualified life event” (such as marriage, divorce, birth, death or employment
status change). If you don’t enroll within 30 days,
Enrollment Steps you’ll have to wait until the next
•Y
ou qualify for a “special enrollment period” (such as if you waive medical, dental or
open enrollment to change your
Choose Carefully vision coverage to participate in a spouse’s plan and your coverage under that plan ends).
benefit elections.
Who is Eligible If you are eligible to make mid-year changes, you must enroll within 30 days of the event. Otherwise, you
will have to wait until the next enrollment period to make changes to your benefit elections.
>D
ependent Eligibility
Verification For more information, please contact the Benefits Department at benefits@activisionblizzard.com.
Meet ALEX® – Your Virtual Benefits Counselor
Choosing the right medical plan to best fit your needs is an important decision.
ALEX is here to help!
ALEX is an online tool that helps you select the best benefit plan for you and
your family. When you connect with ALEX, you’ll be asked a few questions
about your health care needs (e.g., what type of medical care you might need
this year), and then ALEX will crunch some numbers, and point out what makes
the most sense for you.
ALEX takes the amount each medical plan would cost you out of your paycheck (your contributions) and
adds that to the amount it would cost for the services you indicate you might use during the year. ALEX
then recommends the least expensive plan for your needs.
Most users spend about seven minutes with ALEX, but how much time you spend depends on how much
guidance you’d like.
All information you share with ALEX is kept completely confidential.
Learn more and give ALEX a try when you visit www.benefitsforeveryworld.com.
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
WHO IS ELIGIBLE
You’re eligible for benefits if you’re:
•A
full-time or part-time, regular U.S. employee of Activision Blizzard, Activision Publishing, Blizzard
Entertainment, or King, and
• Regularly scheduled to work at least 30 hours a week.
You can also cover your eligible dependents:
Enrollment Steps Your Spouse/Domestic Partner
• Your legal spouse
Choose Carefully
• Your same-gender or opposite-gender domestic partner
Who is Eligible
Your Children
>D
ependent Eligibility
Verification • Children up to age 26. That means you may enroll your adult child even if they:
— No longer live with you
— Are not a dependent on your tax return
— Are no longer a student
— Are married (although, your child’s spouse and children are not eligible for coverage)
• Dependent children of any age who are mentally or physically disabled
Keep in mind, enrolling your domestic partner (or your domestic partner's children) for medical, dental and vision
coverage could affect your taxes.
New Hires Must Enroll Within 30 Days
You must enroll for benefits within 30 days of your hire date. Otherwise, you’ll receive the following benefits (and will
not be able to make changes until the next open enrollment unless you experience a qualified life event):
IF YOU DO NOT ELECT… YOU WILL…
Medical …be auto-enrolled in the CDHP Plan for yourself only
Dental and Vision … have no dental or vision coverage
Life Insurance and AD&D …be enrolled for two times your annual salary
Short-Term Disability … be enrolled for 60% of your weekly salary
Long-Term Disability … be enrolled for 50% of your monthly salary
Benefits start on the first of the month following your date of hire or immediately if you are hired on the first day of the month.
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
Dependent Eligibility Certification
If you’re enrolling dependents for medical, dental and vision coverage during enrollment, you must add your
dependents’ SSN/National IDs in Workday and upload appropriate documentation within 30 days to support the
enrolled dependent.
If you want your dependent to receive important benefits related emails from the company, please add their email to
Workday under their dependent information. Below is a list of acceptable documents.
Dependent verification will also be required during the year if you make mid-year changes due to a qualified life
event, such as adding a newborn baby, adopting a child, or acquiring a new dependent through marriage or by
Enrollment Steps entering into a domestic partnership.
Choose Carefully To enroll a domestic partner outside of open enrollment, you must do so within 30 days of meeting the initial
6-month minimum period of living together as defined in the Domestic Partner Affidavit form.
Who is Eligible
>D
ependent Eligibility DEPENDENT REQUIRED DOCUMENTATION
Verification
Spouse • Copy of marriage license/certificate
Domestic Partner • A state-issued Domestic Partner Declaration, or
• An Activision Blizzard Affidavit of Domestic Partnership
Dependent Children • Birth certificate
• Document from hospital with name and date of birth
• Adoption certificate/documentation
• Proof of legal guardianship
• Qualified medical child support order
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
Healthcare
Medical Options
> CDHP Plan
BENEFITS TO HELP YOU STAY NEED DETAILS ABOUT
> PPO 500 Plan
> In-Network Plan
HEALTHY AND PREPARED OUR PROVIDERS?
Your benefit options include medical, dental and vision coverage for you and your eligible family members Collective Health
> Kaiser HMO (CA only)
to help you stay healthy, avoid serious conditions and deal with unexpected illness or accidents.
>C
entivo Coordinated Care Use the Collective Health Open Enrollment
Plan (So. CA only) Medical Options Portal to view details of Collective Health,
our medical provider. You can also view
> Waiving Medical Coverage You have a choice of medical plans so you can choose the coverage that works best for you and your
dental and vision.
family. The plan comparison charts on pages 15-24 show you how all the plans compare and the cost
Additional Care saving features each offer. If you prefer, you can waive coverage. Your options include:
Support
• CDHP Plan
>A
dditional Care available
to Collective Health Plans • PPO 500 Plan
>A
dditional Care available • In-Network Plan (not open to new enrollments)
to All Plans • Kaiser HMO (CA only)
Medical Plan • Centivo Coordinated Care Plan (So. CA only)
Comparison Each medical plan option provides coverage for a full range of medical services, including office visits,
Rx preventive care, inpatient care, prescription drugs and mental healthcare. Choose carefully.
Dental
Vision
Spending Accounts
> Health Savings Account
>F
lexible Spending
Accounts
Employee
Contributions
> Medical Plan Surcharges
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
Consumer Directed Health Plan (CDHP) Option
If you enroll in the CDHP Plan administered by Collective Health, you must meet key requirements to open a Health
Savings Account (HSA). See page 31 for more information or you can go to www.benefitsforeveryworld.com. The
per pay period cost of this plan has not changed in over eight years and is less than the PPO 500 Plan, Kaiser HMO,
Centivo Coordinated Care Plan, and In-Network Plan, but it has a higher annual deductible and it operates very
differently. The CDHP Plan offers you the ability to choose your own providers and encourages greater control over
your healthcare spending, but you should only enroll in it if you understand all of its features.
The CDHP Plan works in two ways:
Medical Options 1. C
ost protection: Offered at no cost to you for employee-only coverage and at much
> CDHP Plan lower rates for family coverage.
> PPO 500 Plan 2. Tax protection: Save and pay for current and future healthcare expenses in a tax-advantaged
way with the HSA.
> In-Network Plan
> Kaiser HMO (CA only)
>C
entivo Coordinated Care
Plan (So. CA only) Cost protection
> Waiving Medical Coverage •A ffordable (no-cost single/low-cost family)
• Your choice of in-network (with the Blue Shield/BlueCard
Additional Care High Nationwide network) or out-of-network providers
Support Deductible
Health • Protection from catastrophic medical expenses
>A
dditional Care available Plan • 100% coverage for in-network preventive care with
to Collective Health Plans no deductible
CDHP
>A
dditional Care available
to All Plans
Medical Plan
Comparison Health
Savings Tax protection
Rx Account • In addition to your own pre-tax contributions, the company
(HSA)
will contribute the following pre-tax amounts: up to $1,250
Dental employee only coverage and $2,250 employee + dependent(s)
Vision • Tax-free reimbursements
Spending Accounts • Tax-free account growth
> Health Savings Account • Take it with you if you leave the company
• Long-term savings vehicle
>F
lexible Spending
Accounts • IRS limits apply: $3,650 maximum for employee only coverage
and $7,300 maximum for employee + dependent(s)
Employee
Contributions
> Medical Plan Surcharges
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
Here’s a brief summary of how the CDHP Plan works
HEALTH SAVINGS ACCOUNT (HSA) PREVENTIVE CARE
Is the CDHP Plan right
If you enroll in the CDHP Plan and meet key Preventive care (including generic preventive
for you?
requirements, you can open an HSA. See page 31 prescription drugs) is covered at 100% with no
for more information. It’s a lot like a checking account deductible, as long as you use in-network providers. Whether this plan is right for
that you can use to pay for qualified medical expenses. You can get your annual check-up, health you depends on many factors,
If you don’t use your entire HSA balance during the screenings, and generic preventive prescription including:
year, you can roll it over to next year, and even take drugs at no cost to you. Make sure your provider
your balance with you if you leave the company. bills your preventive services as preventive or •Y
our comfort with a high deductible
Medical Options Your HSA is made up of three types of contributions: routine instead of diagnostic. and out-of-pocket limit (remember the
automatic company contributions, earned company company helps fund more than half of
> CDHP Plan NON-PREVENTIVE CARE
contributions, and your own contributions. the deductible by contributing up to
> PPO 500 Plan For other types of healthcare services, including $1,250 for employee-only coverage and
ACTIVISION BLIZZARD CONTRIBUTION
> In-Network Plan doctor visits for illness and non-preventive $2,250 for employee + dependent(s)).
The annual deductible is higher than our other plans. prescription drugs, you can go to the provider of
> Kaiser HMO (CA only) To help fund it, Activision Blizzard will make a $250 your choice and pay for your care using your HSA. • If you have the resources to contribute
>C
entivo Coordinated Care contribution to each enrolled employee's HSA in You may also choose to pay for your care out of to the HSA and gain the tax advantages
Plan (So. CA only) January of each year. your own pocket if you want to save your HSA funds (consider depositing the savings in
> Waiving Medical Coverage for future use. To maximize your benefit, we premiums you would pay for another
BENEFITS@PLAY CONTRIBUTIONS
encourage you to use Collective Health in-network more expensive plan).
Additional Care If you are enrolled in the CDHP Plan with an HSA you providers. A list of Collective Health network
can earn an additional $1,000 for employee-only •T
he amount of non-preventive services
Support providers can be found here.
coverage and $2,000 for employee + dependent(s) you expect to use, like ER visits,
>A
dditional Care available coverage by engaging in healthy activities in the HSA DOLLARS ROLL OVER physician and hospital services you
to Collective Health Plans Benefits@Play program (see more information on If you don’t use all of your HSA dollars, they roll over might receive if you are ill.
>A
dditional Care available page 36). to the next year, and if you leave the company, your
to All Plans •W
hether you plan to engage in the
HSA is yours to take with you.
YOUR OWN CONTRIBUTIONS Benefits@Play healthy activities to earn
Medical Plan You can also deposit your own funds, tax-free, to IF YOU HAVE AN HSA—NO FSA OR HRA incentive payments to help offset the
Comparison your HSA up to the IRS limits listed in the table on Because the HSA is a tax-advantaged account, the deductible.
page 31. Please keep in mind that employer IRS will not allow you to have both an FSA or HRA
Rx contributions (automatic and earned) are subject to
It is important to understand that all eligible
and an HSA. If you are covered by any other health
non-preventive services and prescriptions
Dental the annual IRS limits. plan that does not have a qualifying high deductible,
you receive are applied toward your
you are also not eligible to participate in the HSA.
Vision COINSURANCE deductible until it is met and then the plan
Once you satisfy the annual deductible, the plan pays 80% of in-network charges. You can use
Spending Accounts begins paying a percentage of your costs for eligible your HSA account to pay for these eligible
> Health Savings Account healthcare and prescription drug benefits. Keep in out-of-pocket medical expenses.
mind that your costs will be lower if you use in-
>F
lexible Spending
network providers.
Accounts
Employee
Contributions
> Medical Plan Surcharges
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
PPO 500 Plan Option Centivo Coordinated Care
Like the CDHP Plan, the PPO 500 Plan is Plan (So. CA only) Is the Centivo Coordinated Care
administered by Collective Health and offers you a
The Centivo Coordinated Care Plan is designed to Plan right for you?
choice every time you need care. You can receive
help you use the healthcare system in Southern Centivo Coordinated Care Plan is a different
care from an in-network provider or an out-of-
California (UCLA Health, MemorialCare, and Scripps type of health plan administrator that helps
network provider without a referral. The plan
Health providers and facitlities) more effectively provide highquality care at lower costs to
includes a national network of doctors, hospitals and
and offers you affordable healthcare with no or employees and their families by working
other healthcare providers that provide services at
extremely low out-of-pocket costs. directly with local healthcare providers you
contracted rates. The PPO 500 Plan also includes
Medical Options the Blue Shield network (Blue Card nationwide) This plan is built around a partnership between you know and trust. With Centivo, you’ll get an
which is a broad network of doctors and facilities. and your primary care doctor that you choose to lead affordable health plan that’s easy to use.
> CDHP Plan
your Primary Care Team. Your Team will coordinate
> PPO 500 Plan When you receive care from an No one health plan is right for everyone. Be
your care and refer you to the right places to make
in-network provider: sure to consider the following points before
> In-Network Plan sure you get high quality care and keep you in-
network for the greatest coverage level.
deciding if this plan is right for you and your
> Kaiser HMO (CA only) • You have a lower annual deductible family:
• You have a lower out-of-pocket maximum When you coordinate your care and get referrals
>C
entivo Coordinated Care •T
his plan has no deductible, and as long
Plan (So. CA only) from your Team, deductibles are eliminated, and
• Your copay/coinsurance is less your primary care, specialist visits and procedures as you coordinate your care, primary care,
> Waiving Medical Coverage and surgeries are covered with no out-of-pocket specialist visits and covered procedures and
Additional Care In-Network Plan Options costs. If you or a family member needs emergency surgeries are covered with no out-of-pocket
or urgent care, you only pay a small copay. costs. If you or a family member needs
Support Depending on your location, choose from:
emergency or urgent care, you only pay a
Please Note: Before you get care, you’ll need to
>A
dditional Care available • Kaiser HMO (CA only) small copay.
to Collective Health Plans activate your in-network primary care doctor in
• In-Network Plan (not open to new enrollments) the Centivo Coordinated Care Plan member app •C
entivo Coordinated Care Plan requires that
>A
dditional Care available or portal, and receive referrals for specialty care.
The In-Network plan is frozen to new elections, you designate an in-network primary care
to All Plans
unless you are currently enrolled in the plan. If you Otherwise, your care is considered uncoordinated and doctor to lead your Primary Care Team. You
Medical Plan decide to leave that plan, you will not be eligible to you’ll pay the higher out-of-network rate. Referrals are
coordinate your care through that Team —
Comparison re-enroll in the future. Network-only plans generally not required for OB/GYN, emergency or urgent care
meaning you must receive a referral before
cover only those services provided by in-network visits or behavioral health providers.
going to a specialist— in exchange for no
Rx providers, except for certain emergency situations.
Centivo Coordinated Care Plan will be with you too, deductible and affordable care.
In the HMO, you choose a primary care physician
Dental providing an easy-to-use member app and portal
(PCP) who coordinates your care and makes •C
entivo's network is made up of UCLA
with all your plan information. If you prefer, you can
Vision referrals to in-network specialists. Each family
talk with the Centivo Coordinated Care Plan Member Health, MemorialCare, and Scripps Health
member may select a different PCP. (The In-Network providers and facilities in Southern California.
Care Team at 833-666-1322 for one-on-one help.
Spending Accounts Plan is administered by Collective Health and does
> Health Savings Account not require coordination through a PCP.) Most
services are covered in full after you pay a copay.
>F
lexible Spending
Accounts
Employee
Contributions
> Medical Plan Surcharges
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
Waiving Medical Coverage
You may waive medical coverage if you have WANT MORE INFORMATION?
healthcare coverage through another source (for You'll find it all at:
example, your spouse’s employer’s health plan).
www.benefitsforeveryworld.com or just
Note: If your circumstances change and you (or if applicable, click the direct links below:
your spouse and/or dependent child(ren) are no longer
enrolled in an employer-sponsored group health plan, you will Collective Health website
not be eligible to participate in, or have access to, your HRA.
Please notify Benefits@activisionblizzard.com in the https://join.collectivehealth.com/
Medical Options event that you, or your spouse and dependent children, are no activisionblizzard
> CDHP Plan longer enrolled in an employer-sponsored group health plan.
CVS/Caremark Pharmacy website
> PPO 500 Plan
https://www.caremark.com/wps/portal
> In-Network Plan
Kaiser website
> Kaiser HMO (CA only)
https://healthy.kaiserpermanente.org/
>C
entivo Coordinated Care
Plan (So. CA only) Centivo website
> Waiving Medical Coverage
https://abk.centivo.com
Additional Care Delta Dental website
Support
https://www.deltadentalins.com/
>A
dditional Care available
to Collective Health Plans activisionblizzard/
>A
dditional Care available Vision Service Provider (VSP) website
to All Plans
https://www.vsp.com/
Medical Plan
EAP website
Comparison
http://www.magellanascend.com
Rx
Dental
Vision
Spending Accounts
> Health Savings Account
>F
lexible Spending
Accounts
Employee
Contributions
> Medical Plan Surcharges
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
ADDITIONAL CARE SUPPORT DOCTOR ON DEMAND
Additional Medical Programs available on Collective Health and ADVANTAGES
Centivo Coordinated Care plans Convenient. Now get care 24/7 no matter
where you are in the U.S.
Healthcare Cost Transparency Tool Expert Second Opinions & Personal
from Healthcare Bluebook Care Team Support Fast. No waiting for an appointment. Get
an immediate diagnosis and, if needed, a
Healthcare Bluebook helps you see which providers Grand Rounds gives you and your immediate or prescription, and start treating your condition
Medical Options are most cost-effective per procedure- prices for the extended family members (includes spouse/DP, right away.
same in-network procedure can vary by up to 500%. children, legal dependents, parents, siblings, and in-
> CDHP Plan Save money. It’s a cost-effective alternative to
Healthcare Bluebook can help you easily compare laws) fast access to a care team to answer all health
> PPO 500 Plan prices to know if you're paying more than necessary, questions and a second opinion from a leading expert- urgent care or the emergency room.
> In-Network Plan for free. To access the HCBB website or app login to all at no cost. Grand Rounds allows you to connect Superior care. You’ll be talking face-to-face
your Benefits@Play Castlight account. with nationally recognized experts for a second over video with a network board-certified
> Kaiser HMO (CA only) opinion, either on the phone, over the web, or through physician who will share a report with your
Bonus: you can earn points in Benefits@Play and cash
>C
entivo Coordinated Care the Grand Rounds mobile application. If you're not regular doctor.
Plan (So. CA only) rewards for using Healthcare Bluebook.
sure where to start with your care, Grand Rounds can
To get started, go to www.DoctorOnDemand.
> Waiving Medical Coverage Televideo Medicine from Doctor help you find a high quality in-network doctor and
com/ab or call 800-997-6196.
On Demand even assist with scheduling doctor's appointments on
Additional Care your behalf. Get started on the right treatment path
Support Doctor On Demand allows you to see a doctor from from day one so you can get better, faster.
home via live video chat- Doctor On Demand's medical
>A
dditional Care available doctors can diagnose, treat, and write prescriptions To get started call 800-929-0926, visit the Grand
to Collective Health Plans to your local pharmacy for most non-emergency Rounds website, or open the app.
>A
dditional Care available conditions. Meet with a board-certified doctor or
Note: Grand Rounds services are available and covered
to All Plans licensed psychologist or psychiatrist through live video
at no cost to you, however any follow-up treatment or
with the Doctor On Demand app.
Medical Plan doctors visits may have associated costs.
Comparison Acute telemedicine visits for PPO 500, Centivo
Fertility Treatment from Kindbody
Coordinated Care Plan and In-Network plans are $0
Rx copay and $49 for users on the Collective Health CDHP Starting January 1, 2022, Activision Blizzard will
if they have not met the deductible (the plan covers be offering enhanced fertility & family building
Dental
80% of the cost after the deductible has been met). benefits through Kindbody for you and your
Vision Behavioral health telemedicine visits for the PPO
spouse/partner.
Spending Accounts 500 and In-Network plans are a $20 copay, Centivo Kindbody believes that everyone should have
Coordinated Care Plan are a $0 copay, and the cost access to convenient, affordable fertility and
> Health Savings Account varies for telemedicine visits in the CDHP plan if they family-building care. Kindbody services range
>F
lexible Spending have not met the deductible (the plan covers 80% of from fertility treatments, including IVF and egg
Accounts the cost after the deductible has been met). freezing, to gynecology, wellness, and a strong
focus on inclusivity for LGBTQ+ members.
Employee To use the program, simply download the app and
Contributions create an account with your insurance information. Regular full-time employees and their spouse/
partners enrolled in the Collective Health or
> Medical Plan Surcharges
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
Centivo Plans (including temporary full-time phone at 855-423-2286. Kindbody’s Patient Care
employees enrolled in Collective Health) are Navigators are available to explain the details
eligible for 2 KindCycles of fertility services of the coverage, assist with finding a Kindbody
including IVF, IUI, and egg/embryo/sperm Signature Clinic or a network Partner Clinic, and
preservation. If after 2 KindCycles you have not guide Activision Blizzard members through the
achieved a live birth, you will be eligible for 1 process every step of the way.
additional KindCycle. The fertility benefit will
cover no more than a total of 3 KindCycles per Diabetes Support from mySugr
lifetime. KindCycle coverage is subject to any It takes a lot of time and energy to live well with
applicable plan copays, coinsurance and deductible diabetes but mySugr can help make diabetes suck
Medical Options requirements on your Collective Health or Centivo less! mySugr is an app-based diabetes solution
> CDHP Plan plans. (Note: any fertility services obtained under that brings together smart diabetes technology,
the prior Progyny benefit will count towards the unlimited testing supplies, and personalized
> PPO 500 Plan
new lifetime maximum.) coaching from Certified Diabetes Educators to help
> In-Network Plan you reach your health goals.
All regular full time employees are eligible for
> Kaiser HMO (CA only) up to $20,000 per lifetime for eligible third party Feel supported between visits, spot issues before
>C
entivo Coordinated Care reproduction (donor and surrogacy) and adoption they escalate, and be prepared with unlimited
Plan (So. CA only) services. This benefit will be available the first supplies shipped right to your door. mySugr’s
day following the completion of 6 months of easy-to-use app with automatic data syncing
> Waiving Medical Coverage
service. (Note: temporary full-time employees and will help you track all your health metrics and
Additional Care spouses/partners are not eligible for the third party hack your diabetes! To get started visit
Support reproduction and adoption benefit.) https://activisionblizzard.mysugr.com/ or
call 855-337-7847.
>A
dditional Care available With the Kindbody benefit, all members will
to Collective Health Plans have access to: Pre-diabetes and Type 2 Diabetes
>A
dditional Care available • A dedicated Patient Care Navigation Team Reversal from Virta
to All Plans available to support you through your journey Virta is a clinically-proven treatment that reverses
Medical Plan •O
rganizations and resources to help navigate pre-diabetes and type 2 diabetes. The published
Comparison donor, surrogacy and adoption services results of Virta’s clinical trial show that their
patients reduce their blood sugar and A1c, all
Rx • LGBTQ+ family building options
while removing diabetes medications, losing
•P
ersonalized patient portal with appointment weight, and reducing inflammation. Virta uses
Dental scheduling and provider messaging nutritional ketosis to treat the root causes of type
Vision capability, giving you convenient and 2 diabetes - insulin resistance and carbohydrate
transparent around-the clock visibility intolerance. There is NO calorie counting,
Spending Accounts •K
indbody’s virtual wellness/holistic health starvation, new medications, or required exercise.
> Health Savings Account services at a discounted rate Virta offers continuous medical supervision from
a doctor, personal one-on-one health coaching
>F
lexible Spending • White-glove guidance for care path from nutrition and behavior experts, biomarker
Accounts
• Live and virtual events testing supplies (scale, meter, blood glucose
Employee Questions?
and blood ketone strips, and more), access to a
Contributions private patient community, and exclusive library of
If you have any questions, contact Kindbody resources, including how-to videos, meal plans,
> Medical Plan Surcharges at employeebenefits@kindbody.com or by recipes, and guides.
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
Additional Medical Programs available to all Plans
Family Support from Whil, Family Care Coordination VIRTUAL PHYSICAL THERAPY
A Rethink Division from Wellthy FROM PHYSERA
Raising kids is tough. Whil, a Rethink Division Wellthy helps individuals and families manage Back, shoulder, neck, or knee aches? With
provides family upport when you need it. and coordinate care for a chronically ill, aging, or Physera, you’ll be able to quickly connect with
disabled loved one. an expert physical therapist from home, work,
Through Whil, you gain 24/7 access to consultations that nice shady spot in the park, or wherever.
with a dedicated behavior expert and unlimited With Wellthy, you’ll get connected with a Care No referral is necessary to start. After an
use of the website filled with step-by-step videos, Coordinator who has skills and experience that match
Medical Options initial live video visit, you'll be prescribed a
resources, and exclusive content developed to help your needs. Your Care Coordinator will then create a personalized treatment plan. But don’t worry,
> CDHP Plan families raising children with learning, social or personalized plan for you and get to work researching, you won’t be left hanging. The app makes
> PPO 500 Plan behavioral challenges, or developmental disabilities. calling, and getting things done, so you can focus on it easy to stay connected with your physical
The program has no age restriction, requires no taking care of yourself or your loved one. therapist, who’ll monitor your progress, adjust
> In-Network Plan diagnosis, and is completely confidential.
Wellthy is available at no additional cost to you. To your exercises as needed, and provide support
> Kaiser HMO (CA only) throughout treatment – all at no cost to you.
Employees have access to 3 hours of 1-on-1 virtual get started visit the Wellthy website and register or
>C
entivo Coordinated Care consultations with a Whil behavioral therapist or call 877-588-3917. Don’t you feel better already?
Plan (So. CA only) special educator. To get started, visit the Physera website
> Waiving Medical Coverage
Employee Assistance Program (EAP) and sign up for a personalized version of the
To get started, simply visit the Rethink website from Magellan Physera app.
Additional Care and use code ABK to enroll or text RETHINK to
797979. Magellan’s Employee Assistance Program (EAP)
Support provides helpful tools, resources, and services to help
>A
dditional Care available Chronic Disease Prevention you live well. From counseling and coaching support
to Collective Health Plans from Newtopia for challenges from stress, anxiety, grief, relationship ADDITION SUPPORT FROM
>A
dditional Care available Newtopia is designed to help people who are at
concerns and more. Magellan is there to support you WORKIT HEALTH
to All Plans with resources when you need it most. You and your
risk of developing diseases related to obesity (this Workit Health allows you to receive expert
household members get up to eight free in-person or
can include type 2 diabetes, heart disease, and addiction support from home via live chat and
Medical Plan virtual counseling sessions per issue, per 12 months.
stroke). Newtopia is available at no cost to eligible video. Workit Health’s recovery counselors
Comparison employees. Login to your Castlight account to take Virtual therapy is available through BetterHelp help you moderate or quit drinking, drugs,
Rx their quick eligibility test to see if you are eligible. and allows you to access therapy quickly (typically smoking, or behaviors like gambling. Meet
Bonus: you can earn points in Benefits@Play and for within 24 hours) via text message, live chat, phone with a licensed counselor weekly to stay
Dental conference, and video conference. Virtual therapy accountable to your recovery goals. Work
participating in Newtopia’s coaching plans.
Vision sessions count towards the eight free EAP sessions through a customized curriculum built on the
available to you and your household members latest evidence-based techniques to overcome
Spending Accounts per issue, per 12 months. To get started, register addiction.
and complete the questionnaire online at All Workit Health online therapy programs are
> Health Savings Account
BetterHelp.com/Magellan/ or call Magellan at no cost to you, your spouse/domestic partner,
>F
lexible Spending at 800-327-2593. and your dependent children over the age of 18
Accounts if enrolled in our medical plan.
Employee
Contributions
> Medical Plan Surcharges
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
MEDICAL PLAN COMPARISON
CDHP AND PPO 500 OPTIONS
CDHP PPO 500
Features In-Network Out-Of-Network In-Network Out-Of-Network
Activision Blizzard
$250 N/A N/A N/A
Medical Options HSA Contribution
> CDHP Plan
> PPO 500 Plan
Incentive Earnings up to $2,000 up to $1,000
> In-Network Plan
> Kaiser HMO (CA only)
>C
entivo Coordinated Care Annual Deductible
$1,500/$3,000 $4,000/$8,000 $500/$1,000 $1,000/$2,000
Plan (So. CA only) Individual/Family
> Waiving Medical Coverage
Additional Care Coinsurance Employer/Indi-
80/20 50/50 90/10 70/30
vidual
Support
>A
dditional Care available
to Collective Health Plans Annual Out-of-Pocket Max-
imum $4,500/$9,000 $6,350/$12,700 $3,000/$6,000 $4,000/$8,000
>A
dditional Care available Individual/Family
to All Plans
COVERED EXPENSES
Medical Plan
Comparison What You Pay
Rx
Primary Care Physician
20% after deductible 50% after deductible $20 copay 30% after deductible
Dental Office Visits
Vision
Spending Accounts Specialist Office Visits 20% after deductible 50% after deductible $45 copay 30% after deductible
> Health Savings Account
>F
lexible Spending
Accounts
Employee
Contributions
> Medical Plan Surcharges
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
CDHP AND PPO 500 OPTIONS
CDHP PPO 500
Features In-Network Out-Of-Network In-Network Out-Of-Network
Preventive Care
• Adult and children from age 17
• Well-child care through age 16
No charge 50% after deductible $0 copay 30% after deductible
• Gender neutral services
Medical Options
Lab and X-ray
> CDHP Plan pre-certification required for non-
20% after deductible 50% after deductible 10% after deductible 30% after deductible
emergent advanced radiology
> PPO 500 Plan services (MRI, PET, etc.)
> In-Network Plan
Initial visit: $20 copay
> Kaiser HMO (CA only)
for primary care
>C
entivo Coordinated Care physician
Plan (So. CA only)
Maternity Care 20% after deductible 50% after deductible $45 copay for specialist 30% after deductible
> Waiving Medical Coverage
10% after deductible
Additional Care for postnatal and physician’s
charges
Support
>A
dditional Care available
to Collective Health Plans
Inpatient Care 20% after deductible 50% after deductible 10% after deductible 30% after deductible
>A
dditional Care available
to All Plans
Medical Plan
Comparison Outpatient Care 20% after deductible 50% after deductible 10% after deductible 30% after deductible
Rx
Dental
No charge after No charge after
Vision Ambulance $0 copay $0 copay
deductible deductible
Spending Accounts
> Health Savings Account
>F 20% 20% $50 copay; $50 copay:
lexible Spending Urgent Care
Accounts after deductible after deductible no deductible no deductible
Employee
Contributions
> Medical Plan Surcharges
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
CDHP AND PPO 500 OPTIONS
CDHP PPO 500
Features In-Network Out-Of-Network In-Network Out-Of-Network
TELEMEDICINE IN-NETWORK PROVIDER
PCP/Specialist Virtual
Ded/coinsurance Ded/coinsurance $20 / $45 copay 30% after deductible
Office Visit
Medical Options
> CDHP Plan Network Behavioral Health
Ded/coinsurance Ded/coinsurance $20 copay 30% after deductible
Virtual Visit
> PPO 500 Plan
> In-Network Plan TELEMEDICINE - DOCTOR ON DEMAND
> Kaiser HMO (CA only)
Acute Telemed Visit $0 after ded/coin met Not available $0 copay Not available
>C
entivo Coordinated Care
Plan (So. CA only)
> Waiving Medical Coverage Behavioral Health
Ded/coinsurance Not available $20 copay Not available
Telemed Visit
Additional Care
Support
>A
dditional Care available
to Collective Health Plans
>A
dditional Care available
to All Plans
Medical Plan
Comparison
Rx
Dental
Vision
Spending Accounts
> Health Savings Account
>F
lexible Spending
Accounts
Employee
Contributions
> Medical Plan Surcharges
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
CDHP AND PPO 500 OPTIONS
CDHP PPO 500
Features In-Network Out-Of-Network In-Network Out-Of-Network
$200 copay; $200 copay;
20% 20%
Emergency Room Visits no deductible no deductible
after deductible after deductible
(waived if admitted) (waived if admitted)
Durable Medical No charge 50%
Medical Options Equipment after deductible after deductible
$0 copay 30% after deductible
> CDHP Plan
Short-Term
> PPO 500 Plan Rehabilitative Therapy and
> In-Network Plan Chiropractic Care $20 copay for primary care
includes 90 total visits, combined 20% 50% 30%
physician;
> Kaiser HMO (CA only) between physical, occupational, after deductible after deductible after deductible
and speech therapy, 60 visits of
$45 copay for specialist
>C
entivo Coordinated Care chiropractor care per year, and
unlimited access to Physera
Plan (So. CA only)
> Waiving Medical Coverage Treatment of Autism
Includes office visits; speech,
Additional Care occupational and physical therapy;
$20 copay could apply
Support psychotherapy; and ABA therapy to
manage behavioral issues related to
20% 50%
for certain services or $45
30%
autism. Includes unlimited therapy after deductible after deductible after deductible
>A
dditional Care available copay for specialist
sessions and unlimited access to
to Collective Health Plans Whil, a Rethink Division with
3 hours of tele-consultation.
>A
dditional Care available
to All Plans
Treatment of Gender Charge based on Charge based on Charge based on Charge based on
Medical Plan Dysphoria site of service site of service site of service site of service
Comparison
Coverage is through Coverage is through
Rx Kindbody, a concierge Kindbody, a concierge
fertility benefit. It provides fertility benefit. It provides
Dental members with a two members with a two
Fertility Treatment + one KindCycle per Not covered + one KindCycle per Not covered
Vision provided by Kindbody
lifetime and a full suite of lifetime and a full suite of
fertility treatment options. fertility treatment options.
Spending Accounts Additional KindCycle applies Additional KindCycle applies
> Health Savings Account if 1st/2nd fail. if 1st/2nd fail.
>F
lexible Spending Inpatient Mental Health/ 20% 50% 10% 30%
Accounts Substance Abuse after deductible after deductible after deductible after deductible
Employee
Contributions Outpatient Mental Health/ 20% 50% 30%
$20 copay
Substance Abuse after deductible after deductible after deductible
> Medical Plan Surcharges
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
MEDICAL — NETWORK-ONLY OPTIONS
KAISER HMO COLLECTIVE HEALTH
(CA ONLY) IN-NETWORK*
Features In-Network In-Network
Incentive Earnings up to $500 for employee and $1,000 for employee + dependents
Medical Options Annual Deductible
None None
Individual/Family
> CDHP Plan
Annual Out-of-Pocket Maximum
> PPO 500 Plan $1,500/$3,000 $1,500/$3,000
Individual/Family
> In-Network Plan
COVERED EXPENSES
> Kaiser HMO (CA only)
What You Pay
>C
entivo Coordinated Care
Plan (So. CA only) Primary Care Physician Office Visits $20 copay $20 copay
> Waiving Medical Coverage
Specialist Office Visits $35 copay $35 copay
Additional Care
Support Preventive Care
• Adult and children from age 17
>A
dditional Care available $0 copay $0 copay
• Well-child care through age 16
to Collective Health Plans
• Gender neutral services
>A
dditional Care available Lab and X-ray
to All Plans In-Network plan only. Pre-certification required for $0 copay $0 copay
non-emergent advanced radiology (MRI, PET, etc.)
Medical Plan
Initial visit: $20 copay for
Comparison
primary care physician
$0 copay for office visits
Rx Maternity Care $35 copay for specialist
$250 copay for delivery
$0 for subsequent visits
Dental
$300 copay for delivery
Vision
Inpatient Care $250 copay $300 copay
Spending Accounts
> Health Savings Account
Outpatient Care $100 copay $100 copay
>F
lexible Spending
Accounts
Ambulance $0 copay $0 copay
Employee
Contributions *Not open to new enrollments. The In-Network plan is frozen to new elections, unless you are currently enrolled in the plan. If you decide
to leave that plan, you will not be eligible to re-enroll in the future.
> Medical Plan Surcharges
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
MEDICAL — NETWORK-ONLY OPTIONS
KAISER HMO COLLECTIVE HEALTH
(CA ONLY) IN-NETWORK*
Features In-Network In-Network
TELEMEDICINE IN-NETWORK PROVIDER
PCP/Specialist Office Virtual Visit $0 copay $20 / $35 copay
Medical Options
> CDHP Plan
Network Behavioral Health Virtual Visit Not available $20 copay
> PPO 500 Plan
> In-Network Plan TELEMEDICINE - DOCTOR ON DEMAND
> Kaiser HMO (CA only)
>C
entivo Coordinated Care Acute Telemed Visit Not available $0 copay
Plan (So. CA only)
> Waiving Medical Coverage
Behavioral Health Telemed Visit Not available $20 copay
Additional Care
Support
>A
dditional Care available
to Collective Health Plans
>A
dditional Care available
to All Plans
Medical Plan
Comparison
Rx
Dental
Vision
Spending Accounts
> Health Savings Account
>F
lexible Spending
Accounts
Employee
Contributions
> Medical Plan Surcharges
HOW TO ENROLL HEALTHCARE BENEFITS@PLAY WEALTHCARE LIFE & DISABILITY ADDITIONAL BENEFITS HOW TO GET HELP < 20 >
INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
MEDICAL — NETWORK-ONLY OPTIONS
KAISER HMO COLLECTIVE HEALTH
(CA ONLY) IN-NETWORK*
Features In-Network In-Network
$100 copay $200 copay
Emergency Room Visits
(waived if admitted) (waived if admitted)
Urgent Care $20 copay $50 copay
Medical Options
> CDHP Plan
Durable Medical Equipment $0 copay $0 copay
> PPO 500 Plan
> In-Network Plan $20 copay per office visit for physical
Short-Term Chiropractic Care $20 copay for primary care physician
> Kaiser HMO (CA only) Includes physical, speech, occupational, chiropractic,
occupational and speech therapy
pulmonary rehabilitation, and cognitive therapy $35 copay for specialist; unlimited visits
>C
entivo Coordinated Care $10 copay (30 visits/year)
Plan (So. CA only)
Short-Term Rehabilitative Therapy $20 copay per office visit for physical
> Waiving Medical Coverage Includes physical, speech, occupational, chiropractic, $20 copay for primary care physician
pulmonary rehabilitation, and cognitive therapy
occupational and speech therapy
Additional Care Collective Health members also have unlimited access to Physera $10 copay for a group session
$35 copay for specialist; unlimited visits
Support
>A
dditional Care available Treatment of Autism
Includes office visits; speech, occupational and physical Covered the same as other illness/Rx
to Collective Health Plans therapy; psychotherapy; and ABA therapy to manage Covered the same as other illness/Rx (subject to applicable specialist copay)
behavioral issues related to autism. Includes unlimited therapy (subject to applicable specialist copay)
>A
dditional Care available sessions and unlimited access to Whil, a ReThink Division with Unlimited maximum per calendar year
to All Plans 3 hours of tele-consultation.
Medical Plan Charge based on site Charge based on site
Treatment of Gender Dysphoria
Comparison of service of service
Rx Coverage is through Kindbody, a concierge
Coverage includes services for the fertility benefit. It provides members with a
Dental Fertility Treatment diagnosis and treatment of involuntary two + one KindCycle per lifetime and a full
provided by Kindbody for Collective Health members
infertility; 50% coinsurance suite of fertility treatment options. Additional
Vision KindCycle applies if 1st/2nd fail.
Spending Accounts
Inpatient Mental Health/Substance Abuse $250 copay $300 copay
> Health Savings Account
>F
lexible Spending $20 copay
Accounts Outpatient Mental Health/Substance Abuse $20 copay
(individual visit)
Employee *Not open to new enrollments. The In-Network plan is frozen to new elections, unless you are currently enrolled in the plan. If you decide to leave that plan, you will not be eligible to
Contributions re-enroll in the future.
> Medical Plan Surcharges
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
CENTIVO COORDINATED CARE PLAN
In-Network Out-of-Network
Features
Coordinated Care through PCP Non-PCP Directed Care
Activision Blizzard
N/A N/A
HSA Contribution
Incentive Earnings up to $500 for employee and $1,000 for employee + dependents
Medical Options
> CDHP Plan Annual Deductible
None $3,000/$6,000
Individual/Family
> PPO 500 Plan
> In-Network Plan
Coinsurance
None 50% after deductible
> Kaiser HMO (CA only) Employer/Individual
>C
entivo Coordinated Care
Plan (So. CA only) Annual Out-of-Pocket Maximum
$1,500/$3,000 $6,000/$12,000
Individual/Family
> Waiving Medical Coverage
COVERED EXPENSES
Additional Care
Support What You Pay
>A
dditional Care available
Primary Care Physician
to Collective Health Plans $0 copay 50% after deductible
Office Visits
>A
dditional Care available
to All Plans
Specialist Office Visits $0 copay 50% after deductible
Medical Plan
Comparison
Preventive Care
Rx • Adult and children from age 17
$0 copay 50% after deductible
• Well-child care through age 16
Dental • Gender neutral services
Vision
Lab and X-ray
Spending Accounts Pre-certification required for
$0 copay 50% after deductible
non- emergent advanced
> Health Savings Account radiology services (MRI, PET, etc.)
>F
lexible Spending
Accounts Maternity Care $0 copay 50% after deductible
Employee
Contributions
> Medical Plan Surcharges
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INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
CENTIVO COORDINATED CARE PLAN
In-Network Out-of-Network
Features
Coordinated Care through PCP Non-PCP Directed Care
COVERED EXPENSES
What You Pay
Inpatient Care $0 copay 50% after deductible
Medical Options
> CDHP Plan
Outpatient Care $0 copay 50% after deductible
> PPO 500 Plan
> In-Network Plan
Ambulance $0 copay $0 copay
> Kaiser HMO (CA only)
>C
entivo Coordinated Care
Plan (So. CA only) Urgent Care $50 copay $50 copay
> Waiving Medical Coverage
Additional Care PCP/Specialtist Virtual
$0 copay Not covered
Support Office Visit
>A
dditional Care available
to Collective Health Plans Network Behavioral Health
$0 copay Not covered
Virtual Visit
>A
dditional Care available
to All Plans
Emergency Room Visits $200 copay (waived if admitted) $200 copay (waived if admitted)
Medical Plan
Comparison
Rx Durable Medical Equipment $0 copay 50% after deductible
Dental
Vision
Spending Accounts
> Health Savings Account
>F
lexible Spending
Accounts
Employee
Contributions
> Medical Plan Surcharges
HOW TO ENROLL HEALTHCARE BENEFITS@PLAY WEALTHCARE LIFE & DISABILITY ADDITIONAL BENEFITS HOW TO GET HELP < 23 >
INSURANCEBENEFITS FOR EVERY WORLD 2022 BENEFITS GUIDE
CENTIVO COORDINATED CARE PLAN
In-Network Out-of-Network
Features
Coordinated Care through PCP Non-PCP Directed Care
COVERED EXPENSES
What You Pay
Short-Term Rehabilitative
Therapy and Chiropractic Care
Medical Options Includes 90 total visits, combined
between physical, occupational, $0 copay 50% after deductible
> CDHP Plan and speech therapy, 60 visits of
chiropractor care per year, and
> PPO 500 Plan
unlimited access to Physera
> In-Network Plan
Treatment of Autism
> Kaiser HMO (CA only)
Includes office visits; speech, oc-
>C
entivo Coordinated Care cupational and physical therapy;
Plan (So. CA only) psychotherapy; and ABA therapy
to manage behavioral issues re- $0 copay 50% after deductible
> Waiving Medical Coverage lated to autism. Includes unlimit-
ed therapy sessions and unlimited
Additional Care access to Whil, a Rethink Division
Support with 3 hours of tele-consultation
>A
dditional Care available
to Collective Health Plans
Treatment of Gender Dysphoria 100% covered 50% after deductible
>A
dditional Care available
to All Plans
Coverage is through Kindbody, a concierge fertility benefit.
Medical Plan Fertility Treatment It provides members with a two + one KindCycle per life-
Not covered
provided by Kindbody time and a full suite of fertility treatment options.
Comparison Additional KindCycle applies if 1st/2nd fail.
Rx
Inpatient Mental Health/
$0 copay 50% after deductible
Dental Sustance Abuse
Vision
Outpatient Mental Health/
$0 copay 50% after deductible
Spending Accounts Sustance Abuse
> Health Savings Account
>F
lexible Spending
Accounts
Employee
Contributions
> Medical Plan Surcharges
HOW TO ENROLL HEALTHCARE BENEFITS@PLAY WEALTHCARE LIFE & DISABILITY ADDITIONAL BENEFITS HOW TO GET HELP < 24 >
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