2017 Employee Benefit Guide

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Type of Plan GA Silver OAMC 4000 100/70 HSA Emb GA Bronze OAMC 6450 100/70 HSA Emb
In-Network Calendar Year Deductible
Single $4,000 $6,450
Family $8,000 $12,900
Single $4,000 $6,450
Family $8,000 $12,900
Lifetime Maximum Unlimited
(Some benefits may have limitations)
Unlimited
(Some benefits may have limitations)
In-Network Coinsurance Plan Pays 100%
after Deductible
Plan Pays 100%
after Deductible
Primary Care Plan Pays 100%
after Deductible
Plan Pays 100%
after Deductible
Specialty Care
Plan Pays 100%
after Deductible
Plan Pays 100%
after Deductible
Walk-in Clinics Plan Pays 100%
after Deductible
Plan Pays 100%
after Deductible
Urgent Care Plan Pays 100%
after Deductible
Plan Pays 100%
after Deductible
Emergency Room Plan Pays 100%
after Deductible
Plan Pays 100%
after Deductible
Non-Emergency Room care Not Covered Not Covered
Preventive Care Services
Plan pays 100%,
Not subject to Deductible
Plan pays 100%,
Not subject to Deductible
Advanced Imaging Plan Pays 100%
after Deductible
Plan Pays 100%
after Deductible
Physical Therapy
(limited to 40 visits)
Plan Pays 100%
after Deductible
Plan Pays 100%
after Deductible
Hospital Inpatient Expenses
(Preauthorization Required)
Plan Pays 100%
after Deductible
Plan Pays 100%
after Deductible
Hospital/Outpatient Facility Expenses
(Preauthorization Required)
Plan Pays 100%
after Deductible
Plan Pays 100%
after Deductible
In-Network Mental Health and Alcohol/Drug Abuse Services
Inpatient Mental Health Plan Pays 100%
after Deductible
Plan Pays 100%
after Deductible
Outpatient Mental Health Plan Pays 100%
after Deductible
Plan Pays 100%
after Deductible
Level 1 Plan Pays 100%
after Deductible
Plan Pays 100%
after Deductible
Level 2 Plan Pays 100%
after Deductible
Plan Pays 100%
after Deductible
Level 3 Plan Pays 100%
after Deductible
Plan Pays 100%
after Deductible
Level 4 Plan Pays 100%
after Deductible
Plan Pays 100%
after Deductible
Out of Network Benefits
See Summary of
Benefits and Coverage
See Summary of
Benefits and Coverage
Eligibility Date
Contact Information
888-802-3862
Effective on the 1st of the month following 30 days of full-time employment
Medical Coverage Options - Aetna - High Deductible Health Plans (POS)
Prescription Drugs - Retail Pharmacy (30 day supply) Mail Order Available.
In-Network Calendar Year Out of Pocket Maximum
In-Network Physician and Hospital Services
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