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
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,400/$6,800
Out-of-Pocket Max (Individual/Family)
$3,900/$7,800
Preventive Care
No charge
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
No charge
Preferred Brand
No charge
Non-Preferred Brand
No charge
Specialty
No charge
Mail-Order Rx (Up to 90-Day Supply)
Generic
No charge
Preferred Brand
No charge
Non-Preferred Brand
No charge
Specialty
No charge
Out-of-Network
Deductible (Individual/Family)
$3,400/$6,800
Out-of-Pocket Max (Individual/Family)
$3,900/$7,800
Preventive Care
20% 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% of submitted cost
Preferred Brand
20% of submitted cost
Non-Preferred Brand
20% of submitted cost
Specialty
20% of submitted cost
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Plan Cost
Employee Only: $43.00
Employee and Spouse: $316.00
Employee and Child(ren): $252.00
Employee and Family: $498.00
Aetna PPO 1250
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,250/$2,500
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
No charge
Primary Care Visit
$25 copay; no deductible
Specialist Visit
$35 copay; no deductible
Urgent Care
$25 copay; no deductible
Emergency Room
$125 copay; no deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$35 copay
Non-Preferred Brand
$50 copay
Specialty
$75 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$70 copay
Non-Preferred Brand
$100 copay
Specialty
$150
Out-of-Network
Deductible (Individual/Family)
$1,750/$3,500
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
20% after deductible
Primary Care Visit
20% after deductible
Specialist Visit
20% after deductible
Urgent Care
20% after deductible
Emergency Room
$125 copay; no deductible
Retail Rx (Up to 30-Day Supply)
Generic
20% of submitted cost
Preferred Brand
20% of submitted cost
Non-Preferred Brand
20% of submitted cost
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Plan Cost
Employee Only: $142.00
Employee and Spouse: $528.00
Employee and Child(ren): $452.00
Employee and Family: $815.00