Medical Benefits

Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit http://www.aetna.com/asa.

	In-Network
Plan Year Deductible (Individual/Family)	$1,500 / $3,000
Out-of-Pocket Max (Individual/Family)	$5,000 / $10,000
Coinsurance (BCBS pays/member pays)	80% / 20% after Deductible has been met
Coinsurance Maximum (Indiv/Family)	$2,500 / $5,000
Physician Visits
Primary Care, Specialist, Telehealth	$35 Copay per visit (includes eye exams)
Routine Preventive	Paid at 100% Some services include: Routine Screenings, Preventive Immunizations, Well-women visits/screenings, Contraceptive methods
Hospital Services
Inpatient & Outpatient Surgery	Deductible/Coinsurance
Outpatient Lab, Radiology & Advanced Imaging	Pays 100% up to $300 per covered person per benefit period, then Deductible/Coinsurance
Accidental Injury Services	Pays 100% up to $1,000 per person per benefit period, then Deductible/Coinsurance
Emergency Medical Transportation	Deductible/Coinsurance
Emergency Room	$100 Copay, then Deductible/Coinsurance
Mental/Behavioral Health
Inpatient	Deductible/Coinsurance
Outpatient	$35 Office Visit Copay
Recovery/Special Needs
Outpatient Rehabilitation	Deductible/Coinsurance
Hospice / Home Health Care	Deductible/Coinsurance
Prescription Drugs
Retail (Generic/Formulary/Non-Formulary)	$15 / $30 / $45
Mail Order	2.5 x Copay
Mandatory Generics	Designated Specialty Pharmacy
Quantity per Rx shall be the greater of a 34-day supply or 100-unit dosage, if defined as a maintenance drug