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Overview

The National HMO plan* is administered by Aetna and designed for people who are able to pay higher premiums out of their paycheck in exchange for lower out-of-pocket costs when they use health care services. You pay copays for your medical care within the same robust Aetna network used by all other Aetna options, but you don’t receive any out-of-network benefits that are offered with the Basic, HSA and PPO plans. This plan is designed for people who are able to pay higher premiums for out-of-network benefits.

How the Plan Works

The National HMO plan offers free preventive care and copays for all in-network covered services with no deductible. If you meet your out-of-pocket maximum, you pay nothing for in-network covered services.

The National HMO plan does not require a referral to see a specialist, but you must choose in-network providers for all of your medical care. You will pay the full cost of any out-of-network care you receive, with the exception of care relating to a life-threatening emergency.

If you reach the annual out-of-pocket maximum, you won’t pay anything for covered services for the rest of the year.

Note: Due to differences in network coverage in some areas of the U.S., you may be offered a local HMO option in addition to the National HMO plan when you log in to enroll. Please contact the Sysco Benefits Center if you have any questions.

* The National HMO medical plan is not available in certain areas.

The table below references the 2022 plan. To review the PPO Plan Summary for 2023, download the PDF at the top of the page.

What You Pay in the National HMO Plan (2022)

In-Network Out-of-Network
Deductible* $0 Individual
$0 Family
N/A
Out-of-Pocket Maximum $3,000 Individual
$6,000 Family
N/A
Preventive Care Covered at 100% You pay the full cost
Telehealth (provided by Teladoc) General Medical Visit: $25 copay
Dermatology Visit: $40 copay
Behavioral Health Visit: $25 copay
N/A
Telemedicine (through other in-network providers) General Medical Visit: $25 copay
Dermatology Visit: $40 copay
Behavioral Health Visit: $25 copay
N/A
Primary Care Office Visit $25 copay You pay the full cost
Specialist Office Visit $40 copay
Urgent Care $60 copay
Emergency Room $250 copay (waived if admitted) $250 copay (waived if admitted)
Hospitalization $300 copay You pay the full cost
Surgery $300 copay You pay the full cost
Lab, X-Ray, Imaging 100% covered (office visit copay may apply) You pay the full cost
Behavioral Health $25 copay You pay the full cost
Prescription Drugs** – You don’t have to meet your deductible before you receive a benefit for prescription drugs, as long as you use a network pharmacy.
Pharmacy-Filled Generic $12 copay You pay the full cost
Pharmacy-Filled Formulary You pay 30%
($40 min. / $80 max.)
Pharmacy-Filled Non-formulary You pay 50%
($80 min. / $160 max.)
Value Drugs
(A select list of preferred generic and brand over-the-counter drugs available at a reduced copay)
$0 Copay
Mail Ordered Generic $30 copay You pay the full cost
Mail Ordered Formulary You pay 30%
($80 min. / $160 max.)
Mail Ordered Non-formulary You pay 50%
($180 min. / $350 max.)

*In-network and out-of-network deductibles are separate. Only in-network services apply toward your in-network deductible, and only out-of-network services apply to your out-of-network deductible.  

**If you (as a plan participant) receive a brand name drug in place of a generic in either of the situations below, the plan will only cover the cost of the generic drug, requiring you to pay the cost difference between the generic drug and the brand name drug:

  • The doctor writes a prescription for a brand name drug and indicates the patient (plan participant) should not be switched to the generic.
  • The patient (plan participant) tells the pharmacist that they are only to have the brand name drug and that they do not want to be switched to a generic.