aetna medical plans

Take a quick look at key features of the 2016 Aetna medical plans.

For details review the Core Plan summary plan description and the High Deductible Plan summary plan description.

plan features

	Core Medical		High Deductible Medical
	Network	Non-Network	Network/Non-Network
Annual Deductible
Employee Only	$300	$600	$1,300
Employee + One/Family	$600	$1,200	$2,600
Out-of-Pocket Maximum
Employee Only	$1,500	$2,500	$3,000
Employee + One/Family	$3,000	$5,000	$6,000
Lifetime Maximum	Unlimited		Unlimited
Health Savings Account Contribution	N/A		Employee only: $3,350 Employee + One/Family: $6,750 Catch Up: $1,000 (age 55 or older)

covered services

	Core Medical		High Deductible Medical
	Network	Non-Network	Network	Non-Network
	What You Pay Services subject to deductible unless otherwise specified.
Preventive Care Routine physicals Well child care Flu shots PSA test Women’s health screenings/exam Colorectal cancer screening	$0 copay, no deductible	30%	0%, no deductible	30%
Office Visits
Primary care physician	$20 copay	30%	20%	30%
Specialist	$40 copay	30%	20%	30%
Vision Care
Routine exam	$0 copay	30%	0%, no deductible	30%
Materials	Not covered	Not covered	Not covered	Not covered
Chiropractic Care (maximum 25 visits/year)	10%	30%	20%	30%
Other Medical Expenses Surgery, diagnostic X-rays not billed by physician, lab, ambulance	10%	30%	20%	30%
Hospital/Surgical Center Inpatient/outpatient	10%	30%	10%	30%
Mental Health/ Substance Abuse Treatment
Inpatient/outpatient facility	10%	30%	10%	30%
Outpatient office visit	$20 copay	30%	20%	30%
Emergency Room (No benefits for non-emergency use of emergency room)	10%	10%	10%	30%

prescription drugs
(through Express Scripts)

	Core Medical	High Deductible Medical
	What You Pay Services subject to deductible unless otherwise specified.
Deductible	No deductible	You pay the full cost of drugs until the annual deductible is met
Out-of-Pocket (OOP) Drug Limit	$1,000 separate annual OOP maximum per person	No separate annual OOP drug limit
Retail (up to 30-day supply)
Generic	$10 copay	$10 copay
Preferred Brand	$30 copay	25%, Min $10/Max $50
Non-Preferred Brand	$50 copay	25%, Min $25/Max $100
Mail Order (up to 90-day supply)
Generic	$20 copay	$20 copay
Preferred Brand	$60 copay	25%, Min $20/Max $100
Non-Preferred Brand	$100 copay	25%, Min $50/Max $200

related sites

Aetna »

Express Scripts »

Find a Provider »

forms/docs

Aetna Medical Claim Form »

dig deeper

Core Plan SPD »

High Deductible Plan SPD »

Express Scripts Formulary »

Preventive Prescription Drugs »

Save With Network Providers

You can use any provider, but you'll save money when you use providers in these networks:

Core Medical Plan: Aetna Choice POS II (Open Access)
High Deductible Medical Plan: Aetna Choice POS II (Aetna Health Fund).

24/7 Nurseline

Have a health question or concern? You have 24-hour, toll-free access to registered nurses who can provide information on a variety of health topics at 800-556-1555.