Medical
Medical coverage provides healthcare protection for you and your family. You can visit any provider, but in-network doctors offer the highest level of benefits and lower out-of-pocket costs by charging reduced, contracted rates. Out-of-network providers set their own fees, so you may be responsible for charges above the Reasonable and Customary (R&C) limits. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100% when you use in-network providers. The main differences between plan options are how much you pay per paycheck and what you pay when you receive care.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Aetna HDHP “Core”
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,000/$5,000 (combined with out-of-network)
Entire deductible must be met before benefits will be paid for any family member.
Out-of-Pocket Max (Individual/Family)
$8,500/$8,500 (combined with out-of-network) Entire OOP max must be met before benefits will be paid 100% for any family member.
Preventive Care
$0
Primary Care Visit
20% after deductible
Specialist Visit
20% after deductible
Urgent Care
20% after deductible
Emergency Room
20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
20% after deductible
Preferred Brand
20% after deductible
Non-Preferred Brand
20% after deductible
Specialty
20% after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
20% after deductible
Preferred Brand
20% after deductible
Non-Preferred Brand
20% after deductible
Specialty
20% after deductible
Out-of-Network
Deductible (Individual/Family)
$5,000/$15,000 (combined with in-network) Entire deductible must be met before benefits will be paid for any family member.
Out-of-Pocket Max (Individual/Family)
$30,000/$30,000 (combined with in-network) Entire OOP max must be met before benefits will be paid 100% for any family member.
Preventive Care
40% after deductible
Primary Care Visit
40% after deductible
Specialist Visit
40% after deductible
Urgent Care
40% after deductible
Emergency Room
20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
20% after deductible
Preferred Brand
20% after deductible
Non-Preferred Brand
20% after deductible
Specialty
20% after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
20% after deductible
Plan Cost
Employee Only: $100.00
Employee and Spouse: $317.00
Employee and Child(ren): $277.00
Employee and Family: $485.00
Aetna PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,000/$3,000
Out-of-Pocket Max (Individual/Family)
$5,000/$12,500
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$35 copay
Urgent Care
$35 copay
Emergency Room
$250 copay + 20% after deductible (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Rx Out-of-Pocket Max (Individual/Family)
$1,000/$3,000
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay
Specialty
$60 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$120 copay
Specialty
$120 copay
Out-of-Network
Deductible (Individual/Family)
$5,000/$15,000
Out-of-Pocket Max (Individual/Family)
$15,000/$37,500
Preventive Care
40% after deductible
Primary Care Visit
40% after deductible
Specialist Visit
40% after deductible
Urgent Care
40% after deductible
Emergency Room
$250 copay + 20% after deductible (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay + 20% after deductible
Preferred Brand
$30 copay + 20% after deductible
Non-Preferred Brand
$60 copay + 20% after deductible
Specialty
$60 copay + 20% after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay + 20% after deductible
Preferred Brand
$60 copay + 20% after deductible
Non-Preferred Brand
$120 copay + 20% after deductible
Specialty
$120 copay + 20% after deductible
Plan Cost
Employee Only: $326.00
Employee and Spouse: $799.00
Employee and Child(ren): $644.00
Employee and Family: $1,109.00
Aetna HDHP Basic
Benefit Highlights
In-Network
Deductible (Individual/Family)
$7,000 / $14,000
Out-of-Pocket Max (Individual/Family)
$8,000 / $16,000
Preventive Care
$0
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room
30% after deductible
Retail Rx (Up to 30-Day Supply)
Rx Out-of-Pocket Max (Individual/Family)
30% after deductible
Generic
30% after deductible
Preferred Brand
30% after deductible
Non-Preferred Brand
30% after deductible
Specialty
30% after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
30% after deductible
Preferred Brand
30% after deductible
Non-Preferred Brand
30% after deductible
Specialty
30% after deductible
Out-of-Network
Deductible (Individual/Family)
$30,000 / $60,000
Out-of-Pocket Max (Individual/Family)
50% after deductible
Preventive Care
$XX
Primary Care Visit
50% after deductible
Specialist Visit
50% after deductible
Urgent Care
50% after deductible
Emergency Room
30% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
20% coinsurance after copay
Preferred Brand
20% coinsurance after copay
Non-Preferred Brand
20% coinsurance after copay
Specialty
20% coinsurance after copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
20% coinsurance after copay
Preferred Brand
20% coinsurance after copay
Non-Preferred Brand
20% coinsurance after copay
Specialty
20% coinsurance after copay
Plan Cost
Employee Only: $50
Employee and Spouse: $100
Employee and Child(ren): $70
Employee and Family: $200