MEDICAL INSURANCE
PAR offers medical coverage through Meritain Health Plan, utilizing Aetna’s Open Choice PPO network. The chart below provides a brief overview of the plan.
Summary of Services
In-Network
Out-of-Network 1
Calendar Year Deductible Individual Family
None None
$200 $600
Out-of-Pocket Limit (co-pays) Individual Family Office Visits (Physician or Specialist) Urgent Care Center Mental Health
$1,000 $3,000
$2,200 $6,600
$20 co-pay
30% after deductible
Teladoc
$20 copay
N/A
Diagnostic Laboratory/Radiology
No Charge (LabCard/Quest)
30% after deductible
Maternity Smoking Cessation Hospitalization
10%
30% after deductible
Outpatient Surgery
No Charge
No Charge (deductible waived)
Emergency Room
10%
30% (deductible waived)
Prescription Drug Benefit (Retail) Tier 1 – Generic Tier 2 – Preferred Brand
$20 co-pay $40 co-pay $60 co-pay 10% co-pay
N/A
Tier 3 – Non–preferred Brand Tier 4 – Injectable
Prescription Drug Benefit (Mail Order, 90-day supply) Tier 1 – Generic
$40 co-pay $80 co-pay $120 co-pay 10% co-pay
N/A
Tier 2 – Preferred Brand Tier 3 – Non-preferred Brand Tier 4 – Injectable
1 Charges are subject to balance billing
Login to www.caremark.com to check coverage and copay information for specific medications. In most instances, a brand name drug will be designated as a non-preferred option when a generic equivalent is available.
Bi-weekly cost for coverage
Salary up to $50,000
Salary from $50,000 - $99,999
Salary from $100,000 - $149,999
Salary $150,000 and up
Employee Only
No Cost
No Cost
No Cost
No Cost
Employee + Spouse or Child
$80.00
$95.00
$135.00
$145.00
Employee + Family
$80.00
$100.00
$145.00
$155.00
The chart above provides a brief overview of the medical plans. This chart is intended only to highlight the benefits available and should not be relied upon to fully determine your coverage. If the above illustration of benefits conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is recommended that you review your exact description of services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage.
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