RLP New Hire Overview 2017-18

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Medical Benefits Description—Aetna PPO, Aetna PPO (HDHP)
AETNA PPO
No Referral Required
AETNA PPO (HDHP)
No Referral Required
CRITERION In-Network Out-Of-Network In-Network Out-Of-Network
Deductible (8/1 through 7/31)
Individual
Family
$750
$1,500
$2,000
$4,000
$2,200
$4,400
$2,200
$4,400
Out of Pocket Maximum
(8/1 through 7/31)
Individual
Family
$3,000
$6,000
$6,000
$12,000
$3,400
$6,800
$3,400
$6,800
Coinsurance Coinsurance 20% Plan
Allowance.
Coinsurance 40% Plan
Allowance.
Coinsurance 20% Plan
Allowance.
Coinsurance 40% Plan
Allowance.
Routine/Preventive Visit Covered in Full Deductible, then 20%
Coinsurance Covered in Full Deductible, then 20%
Coinsurance
Primary Office Visit $30 Copay Deductible then 20%
coinsurance. 20% After Deductible Deductible then 40%coinsurance.
Specialist Services $30 Copay Deductible then
20% coinsurance. 20% After Deductible Deductible then 40%coinsurance.
Urgent Care $30 Copay Deductible then 20%
coinsurance.
No Charge After
Deductible
Deductible then 40%
coinsurance.
Emergency Room
(waived if admitted)
Deductible, then
20% Coinsurance
Plus $100 Copay
Paid as
In-Network Only 20% After Deductible Paid as
In-Network Only
Inpatient Hospital Services
$500 Copay; then 20%
coinsurance after De-
ductible
Deductible then 20%
coinsurance. 20% After Deductible Deductible then 40%coinsurance.
Prescription Plan $15 / $35 / $60
(Mail Order - 2 x copay)
Medical / Prescription Deductible Applied
First
$15 / $35 / $60
(Mail Order - 2 x copay)
Carrier Website
Plan Highlights
· PCP selection is NOT required.
· Referrals are not required, but some procedures may still require pre-authorization.
· HDHP includes an Integrated Medical and Prescription Deductible.
· Pharmacy expenses count towards the Out-of-Pocket Max.