benefits
Medical
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.
Your Medical Plans
HRA Plan
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 premium
- Employer funded contributions
- HRA funds roll over each year and may accumulate up to your out of pocket max
| HRA Option | |||
| Deductible | Single | $2,500 | |
| Plus One | $5,000 | ||
| Family | $7,000 | ||
| HRA (employer funded, first dollar benefit) | Single | $1,000 | |
| Plus One | $2,000 | ||
| Family | $3,000 | ||
| Out of Pocket Max | $5,000 per participant, up to $12,700 | ||
| HRA Rollover | Up to out of pocket max | ||
| Behavioral Healthcare Office Visits | Up 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 | |||
PPO Plan
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 or roll over funds
- High Premium
| 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 Visit | Up 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 | ||
HSA Plan
An HSA plan works a lot like the HRA plan, 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 annual HSA contribution 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 & 2026 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.
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.
24 Hour Nurse Line
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
Virtual Digestive Health Clinic
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
Women's Health Support Center & Enhanced Maternity Center
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
Transgender & Gender Diverse Support
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
Informed DNA - Guided Genetic Health Program
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.
Gene, Cellular & Innovative Therapies
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
Health Decision Support with Emmi & Healthwise
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.
MyActiveHealth App
The MyActive Health app is like a personal health coach in your pocket that is easy to use and designed to keep you on track in reaching your health goals.
- See your personalized health score
- Choose your pathway
- Receive guidance to help you along the way
- Check in and track your goals
Log into your Aetna Member website here to get started with MyActiveHealth.
Transform Oncology Cancer Support
With Transform Oncology you’ll receive a dedicated advocate with experience in cancer diagnosis and treatments who will provide you and your caretaker with personalized support whenever you need it.
Your personal navigator can:
- Answer insurance questions
- Help with prior authorizations and appeals
- Connect you with care management
- Assist in finding local resources
- Set up provider consultations
Aetna Cancer Support Center:
- Trusted source for information and guidance on what to expect while managing cancer treatment and care
- Provides details about diagnostic tests, treatments and benefits specific to you health plan coverage
- Self-service support for breast, colorectal, prostate, lung, ovarian, uterine and other cancers
Visit Aetna.com/cancersupport or
text “cancercare” to 66902 to receive a link to log into the support center
Health & Wellness Discounts
Save on a variety of expenses, including eye care, fitness, weight management, dental care and nutrition services.
- At home products
- Natural products & services
- Fitness
- Lasik
- Vision care
- Dental health
- Hearing
- Weight management
- Senior wellness
To access Aetna’s health and wellness discounts, log into your member site and navigate to Health & Wellness Discounts from the Health & Wellness menu.
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:
- Visit aetna.com and navigate to your member website
- Visit aetna.com/cancersupport
- 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
Melissa Lizotte
Cameron Hum
Cheryl Boccadoro
Lisa McCann
Dana Maletzke
Janice Rogers
Nancy Murray
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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.
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.