The Palo Alto Foundation Medical Group (PAFMG) benefits includes the following:
Medical Insurance
PAFMG EPO
- $15 office visit copay, no hospital copay
- $5 generic Rx
- $15 formulary brand Rx
- $30 non-formulary brand Rx
- Must seek care in network. No coverage out of network except emergency.
PAFMG PPO
- $300 per individual annual deductible ($900/family)
- $15 office visit copay
- 90% in-network benefit
- 70% out-of-network benefit
- $5 generic Rx; $15 formulary brand Rx
- $30 non-formulary brand Rx
PAFMG HDHP
- $2,500 per individual annual deductible ($5,000/family)
- No office visit copay
- 100% in-network benefit
- 70% out-of-network benefit
- Rx 100% after deductible
- PAFMG funding into a Health Savings Account (HSA)
Spending Accounts: UMR & Fidelity
- Maximum Medical FSA Election = $2,550
- Maximum Dependent Care Election = $5,000
- HSA through Fidelity
Child Care: KinderCare
- Access to backup care when regular child care arrangements are unavailable
- 10% tuition discount at participating child care centers
Dental Insurance: Metlife
- $25/individual annual deductible ($75/family) – waived for
- Preventive care
- $2,000/individual maximum annual benefit
- 100% for preventive care, 80% coverage for basic care and 50% coverage for major care
- Ortho care: covered at 50% to lifetime maximum of $1,500 for child(ren) only
Vision Insurance: VSP
- $15 materials copay
- Lenses or contacts every 12 months
- Frames every 24 months
Short-Term Disability: Standard
- 60% of your base weekly salary
- Maximum Benefit: $4,500 per week
- Elimination Period: 29 days of disability
Long-Term Disability: Standard
- 50% of your monthly base earnings
- Maximum Benefit: $30,000 per month
- Elimination Period: 180 days of disability
- Individual policy of 10% to $2,500 (with option to buy up to $10,000) available if you qualify
Life Insurance: Standard
- Flat $50,000 plus additional voluntary coverage in $50,000 Increments
- Maximum Combined Benefit: $1,000,000
- Name a personal beneficiary of your choice
EAP: Concern
- Confidential consultation services
- Up to 5 in-person counseling sessions
Long Term Care: UNUM
- $4,000 Facility Benefit
- 3 Year Benefit Period
- Buy Up Options Available
Retirement Plans: Fidelity
- Contribute between 1% and 75% of eligible pay on a pre-tax basis up to $18,000 annually to a 401k Plan or a Roth 401K
- Over age 50 catch-up may contribute an additional $6,000 annually
Physician Benefits Plans
PAFMG sponsors the cost of medical coverage at 100% for the physician and 80% for dependents. The monthly premium contribution that physicians will pay for dependent medical coverage will be based on the plan type and level of dependent coverage. All other benefits are provided at no cost to the employee, with the exception of voluntary coverages, spending accounts and retirement funds.
This link leads to machine-readable files that are required as part of the Transparency in Coverage Rule. These files include negotiated rates for in-network services as well as the allowed amount for out-of-network services that are incurred under the PAFMG health plan. These files are formatted to allow computer systems to import, manipulate and analyze the data.