Medical Overview
Medical coverage offers health care protection for you and your family. By visiting an in-network provider, you are offered the highest level of benefits. Network providers charge members reduced, contracted fees instead of their typical fees.
Preventive care — like physical exams, flu shots and screenings — is always covered 100% when you use in-network providers.
Plan Comparison
| Aetna HDHP Plan | Aetna EPO Plan | Aetna PPO Plan | ||
|---|---|---|---|---|
| In-Network | In-Network | In-Network | Out-of-Network | |
| You Pay | ||||
| Calendar Year Deductible | ||||
| Individual | $1,700 | $2,000 | $750 | $3,000 |
| Family | $3,400 | $4,000 | $2,250 | $5,000 |
| Calendar Year Out-of-Pocket Maximum (Includes Deductible) | ||||
| Individual | $5,000 | $6,000 | $4,000 | $6,000 |
| Family | $6,650 / $10,000 | $12,000 | $7,550 | $10,000 |
| Coinsurance / Copays | ||||
| Preventive Care | $0 | $0 | $0 | Not covered |
| Primary Care Physician | 30% coinsurance* | $55 copay (First five visits are free) | $30 copay | 50% coinsurance* |
| Specialist | 30% coinsurance* | $75 copay | $50 copay | 50% coinsurance* |
| Urgent Care | 30% coinsurance* | 30% coinsurance* | $60 copay | 50% coinsurance* |
| Emergency Room | 30% coinsurance* | $500 copay + 30% coinsurance* | $500 copay + 20% coinsurance* | |
*After deductible
| Aetna HDHP Plan Formerly "Essential Care" | Aetna EPO Plan Formerly "Choice Care" |
|
|---|---|---|
| In-Network Only | In-Network Only | |
| You Pay | ||
| Calendar Year Deductible | ||
| Individual | $1,650 | $2,000 |
| Family | $3,300 | $4,000 |
| Calendar Year Out-of-Pocket Maximum (Includes Deductible) | ||
| Individual | $5,000 | $6,000 |
| Family | $10,000 | $12,000 |
| Coinsurance / Copays | ||
| Preventive Care | $0 | $0 |
| Primary Care Physician | 30%* | $55 copay** **First five visits are free |
| Virtual Primary Care Physician | $0 copay* | $0 copay |
| Specialist | 30%* | $75 copay |
| Telemedicine | $20 consult fee $40 specialist consult fee | $20 consult fee $40 specialist consult fee |
| Urgent Care | 30%* | 30%* |
| Emergency Room | 30%* | $500 copay + 30%* (copay waived if admitted) |
| Aetna PPO Plan Formerly "Critical Care" |
|
|---|---|
| In-Network | Out-of-Network |
| You Pay | |
| Calendar Year Deductible | |
| $600 | $3,000 |
| $1,800 | $5,000 |
| Calendar Year Out-of-Pocket Maximum (Includes Deductible) | |
| $3,500 | $6,000 |
| $6,850 | $10,000 |
| Coinsurance / Copays | |
| $0 | 50%* |
| $30 copay | 50%* |
| $0 copay | |
| $50 copay | 50%* |
| $20 consult fee $40 specialist consult fee | Not covered |
| $60 copay | 50%* |
| $500 copay + 20%* (copay waived if admitted) |
|
*After deductible
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 including 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.