Medical Benefits
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/asa.
Aetna ASA |
In-Network |
Out-of-Network |
|---|---|---|
Deductible |
$1,500 / $3,000 |
$4,500 / $9,000 |
Out-of-Pocket Max |
$4,000 / $8,000 |
$12,000 / $24,000 |
Member Coinsurance |
0% |
30% |
Preventive Care |
No Charge |
Deductible + 30% Coinsurance |
Primary Care Visit |
$45 Copay |
Deductible + 30% Coinsurance |
Specialist Visit |
$70 Copay |
Deductible + 30% Coinsurance |
X-Ray |
Deductible |
Deductible + 30% Coinsurance |
Labs |
Deductible |
Deductible + 30% Coinsurance |
Inpatient Hospital |
Deductible |
Deductible + 30% Coinsurance |
Outpatient Surgery |
Deductible |
Deductible + 30% Coinsurance |
Urgent Care |
$75 Copay |
Deductible + 30% Coinsurance |
Emergency Room |
$500 then Deductible |
$500 then Deductible |
Retail Prescriptions |
||
Tier 1 |
$15 Copay |
50% Coinsurance |
Tier 2 |
$50 Copay |
50% Coinsurance |
Tier 3 |
$90 Copay |
50% Coinsurance |
Tier 4 |
25% Coinsurance up to $350 Copay |
50% Coinsurance |
Mail Order |
2.5 x Retail Copay |
N/A |
Per Pay Period Cost |
|
|---|---|
Employee Only |
$66.34 |
Employee + Spouse |
$360.90 |
Employee + Child(ren) |
$327.28 |
Employee + Family |
$495.35 |
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/asa.
Aetna ASA |
In-Network |
Out-of-Network |
|---|---|---|
Deductible |
$3,000 / $6,000 |
$9,000 / $18,000 |
Out-of-Pocket Max |
$7,900 / $15,800 |
$23,500 / $47,000 |
Member Coinsurance |
20% |
50% |
Preventive Care |
No Charge |
Deductible + 50% Coinsurance |
Primary Care Visit |
$45 Copay |
Deductible + 50% Coinsurance |
Specialist Visit |
$70 Copay |
Deductible + 50% Coinsurance |
X-Ray |
Deductible + 20% Coinsurance |
Deductible + 50% Coinsurance |
Labs |
Deductible + 20% Coinsurance |
Deductible + 50% Coinsurance |
Inpatient Hospital |
Deductible + 20% Coinsurance |
Deductible + 50% Coinsurance |
Outpatient Surgery |
Deductible + 20% Coinsurance |
Deductible + 50% Coinsurance |
Urgent Care |
$75 Copay |
Deductible + 50% Coinsurance |
Emergency Room |
$500 then Deductible |
$500 then Deductible |
Retail Prescriptions |
||
Tier 1 |
$15 Copay |
50% Coinsurance |
Tier 2 |
$50 Copay |
50% Coinsurance |
Tier 3 |
$90 Copay |
50% Coinsurance |
Tier 4 |
25% Coinsurance up to $350 Copay |
50% Coinsurance |
Mail Order |
2.5 x Retail Copay |
N/A |
Per Pay Period Cost |
|
|---|---|
Employee Only |
$52.05 |
Employee + Spouse |
$283.17 |
Employee + Child(ren) |
$256.80 |
Employee + Family |
$388.66 |
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/asa.
Aetna ASA |
In-Network |
Out-of-Network |
|---|---|---|
Deductible |
$4,000 / $8,000 |
$15,000 / $30,000 |
Member Coinsurance |
$6,000 / $12,000 |
$18,150 / $36,300 |
Out-of-Pocket Max |
0% |
30% |
Preventive Care |
No Charge |
Deductible + 30% Coinsurance |
Primary Care Visit |
Deductible |
Deductible + 30% Coinsurance |
Specialist Visit |
Deductible |
Deductible + 30% Coinsurance |
X-Ray |
Deductible |
Deductible + 30% Coinsurance |
Labs |
Deductible |
Deductible + 30% Coinsurance |
Inpatient Hospital |
Deductible |
Deductible + 30% Coinsurance |
Outpatient Surgery |
Deductible |
Deductible + 30% Coinsurance |
Urgent Care |
Deductible |
Deductible + 30% Coinsurance |
Emergency Room |
Deductible |
Deductible |
Retail Prescriptions |
||
Tier 1 |
Deductible + $15 Copay |
Deductible + 50% Coinsurance |
Tier 2 |
Deductible + $50 Copay |
Deductible + 50% Coinsurance |
Tier 3 |
Deductible + $90 Copay |
Deductible + 50% Coinsurance |
Tier 4 |
Deductible + 25% Coinsurance |
Deductible + 50% Coinsurance |
Mail Order |
Deductible + 2.5 x Retail Copay |
N/A |
Per Pay Period Cost |
|
|---|---|
Employee Only |
$47.81 |
Employee + Spouse |
$260.09 |
Employee + Child(ren) |
$235.86 |
Employee + Family |
$356.87 |