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Aetna Medical and Prescription Drug Plans

Aetna Medical and Prescription Drug Plans

FREE Covid Test Information:

https://www.aetna.com/individuals-families/member-rights-resources/covid19/otc-in-home-test-faqs.html

Government Website to order 4 FREE Covid-19 tests per household:
The government will ship out 4 FREE Covid-19 tests per household later this month if you sign up at this website https://special.usps.com/testkits

Coverage to Build a Foundation of Good Health

At Smithers, we understand the importance of good health as the foundation for a productive life at home and at work. That is why we offer medical and prescription coverage, administered through Aetna, to fit your needs and budget.

Keep in mind that you have the flexibility to select the provider or facility of your choice. If you choose an in-network provider, your Aetna benefits will be paid at the highest level. You are able to search for in-network providers on aetna.com.

DEFINITIONS FOR THE MEDICAL PLANS

Preventive Care: The plan pays 100% for in-network preventive care.

Annual Deductible: For non-preventive care there is an annual deductible that must be met. The annual deductible is per person up to the Family deductible.

Coinsurance: Your percentage share of the costs of a healthcare service, for example 20%. You start paying coinsurance after you’ve paid your plan’s deductible.

Copay: A fixed dollar amount, $15 for example, you pay for a covered health care service like an office visit. The copay lets you know ahead of time exactly how much you will owe. Note, if you have any lab testing, X-ray or diagnostic testing done at a providers office these are not covered by the copay and are subject to the plan deductible and coinsurance.

Out-of-Pocket Maximum: This is the most that you will have to pay for covered services in a plan year. All medical and prescription drug deductibles, copayments and coinsurance apply toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum then the plan pays 100% of your eligible expenses, including the cost of all office visits and prescription drugs, for the remainder of the year.

Cost per pay: The pre-tax dollar amount removed from each bi-weekly pay.

Aetna Health App and Web Access

Manage your claims, HRA/FSA, virtual visits, and more with the Aetna Health App or Web Access!

  • App – Download from the app store
  • Web Access Medical Insurance portal at www.aetna.com
AetnaApp

AETNA

YOU HAVE A CHOICE OF THREE MEDICAL PLANS

In-network benefits are reflected. Refer to the benefit summaries for your out-of-network benefit.

Aetna
Standard Managed Choice Medical Plan
$1,000
Deductible Plan
$3,000
Deductible Plan with HRA
$4,000
Deductible Plan with HRA
Calendar Year Deductible:
Single / Family
$1,000/ $2,000 $3,000/ $6,000 $4,000/ $8,000
Coinsurance 20% after deductible 20% after deductible 20% after deductible
Maximum Out of Pocket Limit:
Single /Family (Includes the deductible)
$5,000 / $10,000 $6,000 / $12,000 $7,150 / $14,300
Primary Care Office Visit $10 copay $15 copay $15 copay
Specialist Office Visit $40 copay $50 copay $50 copay
Teladoc
General Medicine
Specialist
Behavioral Health

$0
$40
$10

$0
$50
$15

$0
$50
$15
Surgical Services 20% after deductible 20% after deductible 20% after deductible
Complex X-Ray and Lab – CT, PET, MRI, MRA etc. 20% after deductible 20% after deductible 20% after deductible
Urgent Care Centers $25 Copay $25 Copay $25 Copay
Emergency Medical Care 20% after deductible
+ $300 copay
*copay waived if admitted
20% after deductible
+ $300 copay
*copay waived if admitted
20% after deductible
+ $300 copay
*copay waived if admitted
In-Patient Hospital Services 20% after deductible 20% after deductible 20% after deductible
Out-Patient Hospital Services 20% after deductible 20% after deductible 20% after deductible
Prescription Drugs:
Tier 1: Retail (30 day)
Tier 1: Mail Order (90 day)
$20 copay
$50 copay
Tier 2: Retail (30 day)
Tier 2: Mail Order (90 day)
$45 copay
$112.50 copay
Tier 3: Non-Formulary Retail (30 day)
Tier 3: Non-Formulary Mail order (90 day)
$75 copay
$187 copay