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Unlock the secret to staying ahead of health hiccups – early detection is key! Embrace the power of an annual wellness exam, fostering a robust bond with your doctor. Plus, revel in the fact that our plans not only cover preventive services but does it at a glorious 100% when you choose an in-network doctor.

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Your Medical Plans

Your medical plan options include a preferred provider (PPO) and two Healthcare Reimbursement Arrangements (HRA) and a Health Savings Account (coming 2025) with Aetna.  All the plans cover in-network preventative care at 100%, provide access to the same network of providers and cover both in- and out- of network services (although you’ll pay more when you don’t use an in -network provider).  You also have the flexibility to self refer to a specialist. 

With an HRA plan, you get a reimbursement account that is funded by Diversified to help pay for medical expenses as you work toward your deductible.  The reimbursement account is first dollar.  This means, all expenses are paid by the reimbursement account first.  Once the money in the reimbursement account is depleted, then you are responsible for paying the costs of services out of pocket at 100% until you meet your deductible.  Once your deductible is met, you have a 20% co-insurance up to your annual out of pocket maximum.

Let’s take look at how it works IRL.  You or a covered family member visit the doctor for an illness or injury and the cost of that visit is $150.  With an HRA plan, you do not pay at time of service. Rather, the doctor bills your insurance the cost of the visit.  Aetna will look at your account and see that you have an HRA balance of $1,500 for example.  The full cost of the visit, $150 will be paid for with your HRA fund.  You do not pay for services incurred out of pocket until your HRA fund is depleted, after which, you pay out of pocket for the cost of services until your deductible is met.    

Highlights

  • Low premiums
  • Employer funded  contributions
  • Rollover HRA funds up to your out of pocket max

  HRA Option 1HRA Option 2

Deductible

Single     $2,500$1,800
Plus One$5,000$3,300
Family$7,000$4,800

HRA (employer funded, first dollar benefit)

Single     $1,000$500
Plus One$2,000$1,000
Family$3,000$1,500
Out of Pocket Max$5,000 per participant, up to $12,700
HRA Rollover Up to out of pocket max
Behavioral Healthcare Office VisitsUp to 12 visits covered 100% first, then subject to deductible and co-insurance

Prescriptions (deductible not required)

$10 Co-pay generic
$30 co-pay preferred
$65 Co-pay non-preferred

With a PPO plan you pay a co-pay at the time of service and the costs of services until you meet your deductible.  Once the deductible is met, you have a 20% co-insurance up to your annual out of pocket maximum.

Highlights

  • Low deductible
  • No employer contributions
  • No roll over funds

 

PPO Option

 

In-Network Deductible

Single$600
Plus One$1,200
Family$1,800

 

Out-Of -Network Deductible

Single$1,800
Plus One$3,600
Family$5,400

 

Out of Pocket Max

In-Network: $3,000 per participant up to $9,000 max
Out-Of-Network: $9,000 per participant up to $27,000 max
HRA (employer funded, first dollar benefit)

 

N\A

Behavioral Healthcare Office VisitUp to 12 visits covered 100% first, then subject to deductible and co-insurance

 

Prescriptions (deductible not required)

$10 Co-pay generic
$30 co-pay preferred
$65 Co-pay non-preferred
An HSA plan works a lot like the HRA plans, where you do not pay for services incurred at the time of service.  Your provider works with Aetna to relay the negotiated or plan discount for services incurred and due payable by you.  Unlike the HRA, an HSA puts you in control.  The HSA is your own cash account that is funded by you and your employer.  Since the HSA is employee owned, you decide how you want to use the funds in the account to pay for your healthcare expenses. You have the option to either utilize your Health Savings Account (HSA) to pay for incurred services, or save your HSA money, allowing it to earn interest and pay the expenses out of pocket.  Let’s go through a real life example to illustrate how a HSA health plan works: Sarah contributes $2K of her own pre-tax money into her HSA throughout the year.  Additionally, Sarah receives an annual employer contribution of $1K.  This brings her total HSA balance to $3K. Sarah visits a doctor for knee pain, which costs $200.  Since she has not yet met her deductible of $1,800, Sarah owes the $200 for the visit.  Sarah has the option to pay for the services out of pocket or she may choose to use her HSA funds to cover this expense.  Over the next couple of months, Sarah incurs additional medical expenses and has met her $1,800 deductible.  With the deductible now being met, Sarah is only responsible for 20% of the cost of services in excess of the deductible, and the plan pays 80%. Sarah elected to pay for some of the medical expenses she incurred through out the year out of pocket, and some expenses she paid with her HSA.  Sarah saves all of her receipts. Any unused funds in Sarah’s HSA roll over to the next year and can be saved for future medical expenses or invested for growth.

Highlights

  • Low premiums
  • Employer funded  contributions
  • Rollover of HSA funds is unlimited
  • Funds in the HSA are yours to keep (including employer contributions), even if you change plans or leave the organization
  • Funds in the HSA can be invested to earn dividends
  • Triple tax benefit

 

Health Savings Account (HSA) Option
Deductible Single $1,800
Plus One $3,300
Family $4,800
HSA Employer Contributions* Single $500
Plus One $1,000
Family $1,500
HSA Annual Contribution Limits Single $4,300
Plus One $8,550
Family $8,550
HSA Funds Rollover Unlimited
Behavioral Healthcare Office Visit After deductible, up to 12 visits covered 100%
Prescriptions (deductible required prior to tiered co-pay) $10 Co-pay generic
$30 co-pay preferred
$65 Co-pay non-preferred

*2025 Introductory year advantage – receive an extra $500 in employer contributions.

Preventative Care

Stay healthy by taking advantage of your preventative care benefits. It’s the ultimate self -care with no out-of pocket costs.

  • Routine check ups for adults and children
  • Cholesterol and diabetes screenings
  • Immunizations like flu, COVID, pneumonia
  • Routine gynecological exams and mammograms
  • Routine prostate-specific antigen exams

A smarter, simpler, more convenient way to take charge of your healthcare benefits.

  • Make your plan

    Check your plan summary - located in your Aetna member account, for detailed information on what's covered by your plan. Track your spending and understand your progress toward meeting your individual and family deductibles.

  • Connect to care

    Use tools on your Aetna member account to help you choose quality, in-network and local providers and facilities, including convenient retail clinics and urgent care. Get cost estimates for visits and procedures before getting care, even talk to a doctor anytime by phone or video chat from home.

  • View claims

    Check recently incurred claims for your whole family and know your portion of the costs.

  • Improve your health

    Set personalized reminders to schedule your preventative screenings.

Did you know...

Your Aetna Health Plan is equipped with more than basic healthcare coverage. With your enrollment in Aetna the following resources are available to you.

Explore the Aetna benefits brochure. 

Questions about upcoming medical visits and choices? You can talk to a registered nurse for information about tests, procedures and treatment options, 24/7 and the call is free.

1-800-556-1555

Oshi Health, included with your Aetna health plan, is a virtual GI clinic providing access to expert GI doctors, nurse practitioners, dieticians and behavioral health providers.  With Oshi Health, you have access to unlimited dietary and behavioral health support. 

Oshi Health offers specialized care for Chron’s, ulcerative colitis, irritable bowel, GERD, and other GI concerns, even if you are already seeing a provider. 

  • Dedicated care team of GI providers, dieticians, behavioral health providers and more
  • Get an appointment within 2 days so you can start treatment quickly
  • Personalized care plan to meet your goals including dietary and behavioral health recommendations
  • Unlimited virtual visits and chat messaging to stay connected to your care team

Get Started with Oshi Health

Explore a curated hub tailored to the diverse health needs of women, spanning from adolescence to post-menopause. Dive into a wealth of resources designed to accompany you through various life stages and events, empowering you with knowledge and support along the way.

  • Reproductive Health
  • Menstrual Health & Menopause
  • Maternity Support Center
  • and more!

To access, navigate to Health & Wellness in your Aenta.com member account. 

The maternity journey is different for everyone. Aetna’s Maternity Support Center and Enhanced Maternity Program supports you throughout the entire experience.

  • Personalized support – maternity nurses guide you through each stage of your pregnancy journey
  • Fertility services
  • Preeclampsia prevention
  • Adopting a newborn
  • Genetic counseling and screening for pregnancy planning
  • Education and resources

Text BABY to 66902 or call 1-800-272-3531 weekdays from 8am – 7pm EST.

Aetna’s National Infertility Unit is staffed by a dedicated team of registered nurses and infertility coordinators.  They can help you with determining eligibility for benefits and pre-certification.  Call 1-800-575-5999

Personalized support and guidance for your unique health needs – from first steps in exploring gender to accessing gender affirming care and more. 

  • Dedicated transgender and gender diverse support representatives
  • Know and understand your benefits and costs
  • Locate a care team that provides gender-affirming care
  • Resources for all stages

Genetic counseling and testing to assess your risk of developing inherited cancer and guide your treatment. With the Guided Genetic Health program, you can:

  • Access a free online questionnaire to determine if genetic counseling and testing is right for you
  • Participate in convenient, at-home genetic testing and counseling
  • Receive personalized and actionable health
    recommendations that you can share with your provider

 

To access, navigate to Health & Wellness in your Aenta.com member account. 

You may never need treatment for a rare disease. But you can rest a little easier if you do because you have access to this special program.

  • Access to facilities specializing in treating genetic conditions
  • Nurse care Managers with specialized experience
  • Dedicated claims and member services staff

Contact your Aetna Concierge 1-855-586-6958

Emmi provides video resources to help you prepare for procedures, manage a health condition, explore treatment options and more. 

Healthwise is a knowledgebase for health conditions, treatments, medications and more.

 

To access, navigate to Health & Wellness in your Aenta.com member account. 

Aetna Cancer Support Center

The Aetna Support Center brings resources to your fingertips, serving as your trusted source for information and guidance on what to expect while managing cancer treatment and care. 

For more information, visit the Aetna Cancer Support Center

Three ways to login: 

  1. Visit aetna.com and navigate to your member website

  2. Visit aetna.com/cancersupport

  3. Text “cancer care” to 66902 and receive a link to log in to the support center

Related Content

Looking for assistance with your healthcare? We're here for you.

From guidance in choosing the best options for you, what resources are available to understanding how the plans work.  The information you need is at your fingertips. 

Your HR Team

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View your HRA fund balance, monitor your deductible and maximum out of pocket costs, and more on your Aetna member website.

Money Saving Tips

See in-network providers– They’ve agreed to the plan’s negotiated rates. Visit your plan website to search for in -network providers near you.

Ditch the ER – Opt for Urgent Care centers.  HRA & PPO plans cover visits to urgent care facilities at 80% with no deductible.

Stack Your Benefits – Ask your behavioral health provider if they are in the Aetna EAP network.  If they are, you could be eligible for up to 22 free behavioral health visits with an HRA or PPO plan. 

Optimize Your HSA – Take advantage of the triple tax advantage offered with HSA accounts and contribute the maximum annually.

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Ask your Aetna Concierge

Get personalized support and the answers you need.

  • Is this covered under my plan?
  • Help me understand my bill.
  • I have a family history of cancer, what preventative care resources are available to me through Aetna
  • Help me find an in-network provider accepting new patients.
Call 1-855-586-6958

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