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 Medical CDHP-HSA
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,500/$5,000
Out-of-Pocket Max (Individual/Family)
$6,350/$6,350
Preventive Care
No charge (deductible waived)
Primary Care Visit
10% after deductible
Specialist Visit
10% after deductible
Urgent Care
10% after deductible
Emergency Room
10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay after deductible
Preferred Brand
$30 copay after deductible
Non-Preferred Brand
$50 copay after deductible
Mail-Order Rx (Up to 30-Day Supply)
Generic
$20 copay after deductible
Preferred Brand
$60 copay after deductible
Non-Preferred Brand
$100 copay after deductible
Out-of-Network
Deductible (Individual/Family)
$5,000/$10,000
Out-of-Pocket Max (Individual/Family)
$9,000/$18,000
Preventive Care
30% after deductible
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room
10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
30% after deductible and copay
Preferred Brand
30% after deductible and copay
Non-Preferred Brand
30% after deductible and copay
Mail-Order Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Per-Pay-Period Plan Cost
The total amount that you pay for your benefits coverage depends on the plans you choose, how many dependents you cover, and for medical coverage, how much you earn. Your healthcare costs are deducted from your pay on a pre-tax basis — before federal, state, and Social Security taxes are calculated — so you pay less in taxes.
Aetna Medical EPO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$1,000/$2,000
Out-of-Pocket Max (Individual/Family)
$2,000/$4,000
Preventive Care
No charge (deductible waived)
Primary Care Visit
0% after deductible
Specialist Visit
0% after deductible
Urgent Care
$75 copay
Emergency Room
$100 copay
Retail Rx (Up to 30-Day Supply)
Generic
$15 copay after deductible
Preferred Brand
$50 copay after deductible
Non-Preferred Brand
$70 copay after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30 copay after deductible
Preferred Brand
$100 copay after deductible
Non-Preferred Brand
$140 copay after deductible
Per-Pay-Period Plan Cost
The total amount that you pay for your benefits coverage depends on the plans you choose, how many dependents you cover, and for medical coverage, how much you earn. Your healthcare costs are deducted from your pay on a pre-tax basis — before federal, state, and Social Security taxes are calculated — so you pay less in taxes.