Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.aetna.com.

	In-Network
Deductible (Individual/Family)	$2,000/$4,000
Out-of-Pocket Max (Individual/Family)	$6,350/$12,700
Member Coinsurance	20% after deductible
Preventive Care	100% covered
Primary Care Visit	$25 Copay
Teledoc	$25 Copay
Specialist Visit	$25 Copay
Inpatient Hospital	Deductible + coinsurance
Outpatient Hospital	Deductible + coinsurance
Urgent Care	$25 Copay
Emergency Room	$150 Copay, then deductible + coinsurance

	Prescription Drugs
Retail Drugs
Tier 1	$15 Copay
Tier 2	$50 Copay
Tier 3	$75 Copay
Mail Order Drugs
Tier 1	$37.50 Copay
Tier 2	$125 Copay
Tier 3	$187.50 Copay

	Monthly Employee Rate
Employee Only	$213.12
Employee + Spouse	$639.36
Employee + Child(ren)	$422.78
Employee + Family	$718.30

Downloads

Summary of Benefits

Benefit Plan Description

What to know before you go

Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.aetna.com.

	In-Network
Deductible (Individual/Family)	$3,300/$6,400
Out-of-Pocket Max (Individual/Family)	$4,000/$8,000
Member Coinsurance	10% after deductible up to total max
Preventive Care	100% covered
Primary Care Visit	Deductible + coinsurance
Specialist Visit	Deductible + coinsurance
Inpatient Hospital	Deductible + coinsurance
Outpatient Hospital	Deductible + coinsurance
Urgent Care	Deductible + coinsurance
Emergency Room	Deductible + coinsurance

	Prescription Drugs
Retail Drugs
Tier 1	Deductible + coinsurance
Tier 2	Deductible + coinsurance
Tier 3	Deductible + coinsurance
Mail Order Drugs
Tier 1	Deductible + coinsurance
Tier 2	Deductible + coinsurance
Tier 3	Deductible + coinsurance

	Monthly Employee Rate
Employee Only	$117.86
Employee + Spouse	$384.92
Employee + Child(ren)	$212.10
Employee + Family	$494.92

Downloads

Summary of Benefits

Benefit Plan Description

What to know before you go

Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.aetna.com.

	In-Network
Deductible (Individual/Family)	$5,000/$10,000
Out-of-Pocket Max (Individual/Family)	$5,000/$10,000
Member Coinsurance	0% after deductible
Preventive Care	100% covered
Primary Care Visit	Deductible, then plan pays 100%
Specialist Visit	Deductible, then plan pays 100%
Inpatient Hospital	Deductible, then plan pays 100%
Outpatient Hospital	Deductible, then plan pays 100%
Urgent Care	Deductible, then plan pays 100%
Emergency Room	Deductible, then plan pays 100%

	Prescription Drugs
Retail Drugs
Tier 1	Deductible, then plan pays 100%
Tier 2	Deductible, then plan pays 100%
Tier 3	Deductible, then plan pays 100%
Mail Order Drugs
Tier 1	Deductible, then plan pays 100%
Tier 2	Deductible, then plan pays 100%
Tier 3	Deductible, then plan pays 100%