Aetna medical plans – U.S.

You have a choice of four medical plans administered by Aetna:

• Select Network Plan (multi-tier EPO)

• Choice PPO Plan (multi-tier POS)

• Enhanced HDHP (multi-tier HSA plan)

• Basic HDHP (HSA plan)

All Aetna plans:

• Provide preventive care — which generally includes annual exams, immunizations, and routine screenings — at no cost to you when you use in-network providers.

• Cover the same services, like doctor visits, hospital care, lab work, and X-rays.

• Offer access to a comprehensive network of doctors and other health care providers.

• Include prescription drug coverage administered by Aetna/CVS. Certain preventive care prescriptions are covered at 100% or are not subject to the deductible. Preventive prescriptions include drugs that help prevent heart attacks, heart disease, high blood pressure, stroke, blood clots, and diabetes.

• Give you free access to virtual reproductive health and family planning (Maven), cardiac care (Hello Heart), back and neck pain support(Hinge Health), and diabetes management (Aetna Transform Diabetes) programs. Click here to learn more about these programs.

But what and how you pay for care — through payroll contributions and your costs when you access care —are different.

See costs in the plan comparison chart below.

If you live in California, and you are looking for more information about the Kaiser Permanente Plan click here.

If you live in Puerto Rico, your medical plan is through Triple-S. Learn more about this plan.

• Compare Aetna medical plans

  Compare plan deductibles, copays, and coinsurance payments to find the plan that makes the most sense for you and your family.

  This year we have added the new Basic HDHP (HSA plan) — a high-deductible health plan (HDHP) — as a fourth option for individuals and families who wish to pay lower premiums each month with a higher deductible.

  How to choose the right plan with Emma^TM

  Your virtual benefits assistant, Emma, is available to assist you through the enrollment process. Emma can help you understand your options and make your choices.

  Emma is more than just a guide—she is a comprehensive tool designed to ensure you have a great enrollment experience!

  Just log in, answer a few questions about your personal situation, and Emma will help you determine which medical plan is right for you.

  Be prepared: Make sure you have handy a list of your preferred providers and medications, as well as those for your spouse/domestic partner and any dependents.

  Using in-network doctors can save you money. Find out if your doctors are in-network with your plan.

  • Go here for the Choice PPO Plan (multi- tier POS) or Enhanced HDHP (Multi-Tier HSA Plan)
  • Go here for the Select Network Plan (multi-tier EPO)
  • Enter your home zip code, and click "Start Your Search"
  • Follow the "Continue as a guest" option, enter your zip code again, and click "Search"
  • Click on a provider category or search for a specific provider

  In the search results, Tier 1 providers are indicated by "Maximum Savings" and Tier 2 are indicated by "Standard Savings".

  Flexible Spending Accounts
  

  If you choose the EPO or PPO plan or waive medical coverage, you can contribute to a Health Care Flexible Spending Account (FSA). With the Enhanced HDHP or Basic HDHP plans, you can contribute to a Health Savings Account (HSA) and a Limited Purpose FSA. In addition, all Mountaineers can contribute to a Dependent Care FSA. Learn more about tax-advantaged accounts here.

  Learn more about multi-tier networks

  The EPO, PPO, and Enhanced HDHP plans offer a multi-tier network. The Basic HDHP plan offers benefits under one network only.

  The multi-tier network gives you more options for saving money by assigning providers into two different tiers. Make sure you understand the benefits of each tier and which category your providers fall under before receiving care.

  Tier 1 (T1) – Providers in this tier offer the maximum savings. To save the most money, use these providers whenever possible.

  Tier 2 (T2) - By offering this broader network, we’re able to give you standard savings on more providers. Using these providers will save you money but not as much as using Tier 1 providers.

  The deductible and out of pocket amounts in the table below cross apply toward each other. Example: You enrolled in the Select Network Plan with individual coverage and have an x-ray at ABC Radiology – a Tier 1 provider. They bill Aetna $200, but their contracted rate with Aetna is $150. You have not met your deductible yet, so the $150 you paid out of pocket is applied to your deductible. Since the Tier 1 and Tier 2 deductibles cross apply, you have now met $150 of your $750 Tier 1 deductible and $150 of your $1,500 Tier 2 deductible.

  	Select Network Plan (multi-tier EPO)	Choice PPO Plan (multi-tier POS)	Enhanced HDHP (multi-tier HSA plan)	Basic HDHP (HSA plan)
  Annual deductible
  Individual	T1/$750 T2/$1,500	T1/$1,000 T2/$2,000 OON/$4,000	T1/$2,000 T2/$4,000 OON/$6,000	$4,000/$6,000
  Family	T1/$1,500 T2/$3,000	T1/$2,000 T2/$4,000 OON/$6,000	T1/$4,000 T2/$8,000 OON/$12,000	$8,000/$12,000
  Annual out-of-pocket maximum
  Individual	T1/$3,000 T2/$6,000	T1/$3,000 T2/$6,000 OON/$12,000	T1/$4,000 T2/$8,000 OON/$12,000	$8,000/$12,000
  Family	T1/$6,000 T2/$12,000	T1/$6,000 T2/$12,000 OON/$24,000	T1/$8,000 T2/$16,000 OON/$24,000	$16,000/$24,000
  Coinsurance % paid by member	T1/10% T2/20%	T1/20% T2/30% OON/40%	T1/20% T2/30% OON/40%	OON/30%/40%
  Hospital services
  Hospital admission	Ded & Coinsurance	Ded & Coinsurance	Ded & Coinsurance	Ded & Coinsurance
  Emergency room	$250 copay	Ded & 20%	Ded & 20% Coinsurance	Ded & 30% Coinsurance
  Outpatient surgery & other facility services	Ded + Coinsurance	Ded & Coinsurance	Ded & Coinsurance	Ded & Coinsurance
  Professional services
  Primary care office visit	$25 copay / Ded & Coinsurance	Ded & Coinsurance	Ded & Coinsurance	Ded & Coinsurance
  Primary care virtual visit
  Specialist office visit	$40 copay / Ded & Coinsurance	Ded & Coinsurance	Ded & Coinsurance	Ded & Coinsurance
  Radiology/laboratory/other professional services	Ded & Coinsurance	Ded & Coinsurance	Ded & Coinsurance	Ded & Coinsurance
  Pharmacy
  Retail
  Generic	$10	$10	Ded & 20%	Ded & 20%
  Preferred	35% ($45 min, $75 max)	35% ($45 min, $75 max)	Ded & 20%	Ded & 20%
  Non-preferred	35% ($75 min, $100 max)	35% ($75 min, $100 max)	Ded & 30%	Ded & 30%
  Mail
  Generic	$20	$20	Ded & 20%	Ded & 20%
  Preferred	35% ($112.50 min, $187.50 max)	35% ($112.50 min, $187.50 max)	Ded & 20%	Ded & 20%
  Non-preferred	35% ($187.50 min, $250 max)	35% ($187.50 min, $250 max)	Ded & 30%	Ded & 30%

  Key terminology
  
  Deductible
  The amount you need to pay out of pocket before your plan starts paying benefits.
  
  Coinsurance
  The amount you pay for care after you meet your deductible. Coinsurance is generally a percentage of the total cost of care for specific services.
  
  Out-of-pocket maximum.
  The most you’ll pay in a given year for all covered health care expenses. After you or any other eligible family member pays this amount, your plan pays 100% for the rest of the calendar year. Or, after the family out-of-pocket maximum has been met, the Plan pays 100% for each eligible family member’s expenses.

• Your cost

  Please click here to view a chart of your biweekly paycheck cost.

  You can also review these FAQs on salary bands.

  Salary-based medical rates are based on an employee’s “base” annual salary. This means that the amount you contribute towards your medical insurance from your paycheck may vary depending on your annual base salary. Your base salary as of October will determine your medical premium rate for the following plan year. If hired after October 1, your medical premium rate will be determined by your base salary as of your hire date.