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Aetna QHDHP Option ($3,000 Ded)
Benefit Plan
QHDHP Option
In-Network
QHDHP Option
Out-of-Network
Deductible
(plan year)
Single
$3,000
$6,000
Family
$6,000
$12,000
Coinsurance
(plan pays/you pay)
100% / 0%
80% / 20%
Out-of-Pocket Limit
(including the deductible + coinsurance)
Single
$3,000
$12,000
Family
$6,000
$24,000
Copayments
Primary Physician Visit
Deductible, then you pay 0%
Deductible, then you pay 20%
Specialist Physician Visit
Deductible, then you pay 0%
Deductible, then you pay 20%
Preventive Care
Plan pays 100%
Deductible, then you pay 20%
Major Diagnostic Lab
Deductible, then you pay 0%
Deductible, then you pay 20%
Emergency Room Visit
Deductible, then you pay 0%
In Network Ded., then you pay 0%
Urgent Care Center Visit
Deductible, then you pay 0%
Deductible, then you pay 20%
Prescription Drug Coverage
Retail Pharmacy
Deductible, then you pay 0%
Deductible, then you pay 20%
Mail Order Pharmacy
Deductible, then you pay 0%
Not Covered
2017 Employee QHDHP Option Medical Contributions
Employee Semi-Monthly Cost
Previous
2016 Cost
New
2017 Cost
2017 Aetna with Wellness and
Non-Tobacco Discounts
Employee
$45.89
$45.92
$38.42
Employee & Spouse
$243.16
$250.80
$243.30
Employee & Child(ren)
$203.49
$209.19
$201.69
Employee & Family
$300.62
$310.89
$303.39
Highlights of QHDPs
■
Annual preventive/wellness exams are not subject to the deductible and are covered at 100% if services are received from an
Aetna participating provider. Diagnostic office visits and hospital services will apply to your deductible.
■
Prescription drugs are subject to the deductible. Once the deductible has been satisfied, prescriptions will be covered at 100%.
■
If you remain in-network, you will benefit from Aetna’s contracts with their network providers. Only the discounted
“allowable” charges will apply to your deductible, not the full bill.
■
When selecting coverage under the QHDHP benefit offering, you may be eligible to open a health savings account (HSA).
Information about HSAs is outlined on Page 21.