Medical/Rx
Bates College partners with Aetna to offer a comprehensive medical benefits program for employees. You may choose from two medical plan options, both of which cover most healthcare services.
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.
New in 2026 – The Maintenance Choice® Program!
Members can save time and money with prescriptions while enjoying the convenience of delivery options from participating mail service and retail providers. With this benefit you can decide where you fill your prescriptions for medications you take regularly. After two retail fills, you can get a 90-day supply of your maintenance drugs at a discounted rate from a participating mail service pharmacy or at selected participating retail providers. If you’re filling your prescription at a local participating 90-day retail provider, your pharmacist can change your prescription to 90-day refills. If you’re not filling your prescription at a participating 90-day retail provider and would like to switch to a mail service pharmacy, call Aetna customer care at 888-792-3862.
You can opt out of Maintenance Choice® for all your maintenance medicines. Just let Aetna know that you’d like to continue to fill your 30-day supply at your retail pharmacy. If you opt out, you’ll pay the regular retail copay for your 30-day supply. If you don’t opt out, you’ll pay the full cost of your medications on the third fill
Insurance Plan Definitions
- 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 with Health Savings Account
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
You pay 20% after deductible
Specialist Visit
You pay 20% after deductible
Urgent Care
You pay 20% after deductible
Emergency Room
You pay 20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
No charge after deductible
Preferred Brand
No charge after deductible
Non-Preferred Brand
No charge after deductible
Specialty
No charge after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
No charge after deductible
Preferred Brand
No charge after deductible
Non-Preferred Brand
No charge after deductible
Specialty
No charge after deductible (up to 30-day supply)
Out-of-Network
Deductible (Individual/Family)
$3,400/$6,800
Out-of-Pocket Max (Individual/Family)
$3,900/$7,800
Preventive Care
You pay 20% after deductible
Primary Care Visit
You pay 40% after deductible
Specialist Visit
You pay 40% after deductible
Urgent Care
You pay 40% after deductible
Emergency Room
You pay 20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
You pay 20% of submitted cost
Preferred Brand
You pay 20% of submitted cost
Non-Preferred Brand
You pay 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
| Monthly Plan Cost | Bi-Weekly Plan Cost |
|
| Employee Only: | $43.00 | $19.85 |
| Employee and Spouse: | $316.00 | $145.85 |
| Employee and Child(ren): | $252.00 | $116.31 |
| Employee and Family: | $498.00 | $229.85 |
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
$75 (up to 30-day supply)
Out-of-Network
Deductible (Individual/Family)
$1,750/$3,500
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
You pay 20% after deductible
Primary Care Visit
You pay 20% after deductible
Specialist Visit
You pay 20% after deductible
Urgent Care
You pay 20% after deductible
Emergency Room
$125 copay; no deductible
Retail Rx (Up to 30-Day Supply)
Generic
You pay 20% of submitted cost
Preferred Brand
You pay 20% of submitted cost
Non-Preferred Brand
You pay 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
| Monthly Plan Cost | Bi-Weekly Plan Cost |
|
| Employee Only: | $142.00 | $65.54 |
| Employee and Spouse: | $528.00 | $243.69 |
| Employee and Child(ren): | $452.00 | $208.62 |
| Employee and Family: | $815.00 | $376.15 |