Medical and Pharmacy Coverage
Teen Challenge offers the following Medical plans through Aetna and offers “in and out-of-network” benefits.
Insurance Carrier:
Aetna Medical Insurance
Medical Plan:
Copay Plan - $5k / 80%
HDHP w/HSA - $7k / 100%
In-Network: Office Visit Copay - Primary Care
$45
Deductible; then 100% Coinsurance
Office Visit Copay - Specialist Care
$80
Deductible; then 100% Coinsurance
Urgent Care Copay
$75
Deductible; then 100% Coinsurance
Emergency Room Care
$425 Copay; then 80% Coinsurance
Deductible; then 100% Coinsurance
Preventative Visit Copay
$0
$0
Diagnostic Testing (X-Ray / Blood Work)
Deductible; then 80% Coinsurance
Deductible; then 100% Coinsurance
Advanced Imaging
Deductible; then 80% Coinsurance
Deductible; then 100% Coinsurance
Coinsurance
80%
100%
Employee Deductible
$5,000
$7,000
Family Deductible
$10,000
$14,000
Employee Out-of-Pocket Max
$7,500 (includes deductible)
$7,500 (includes deductible)
Family Out-of-Pocket Max
$15,000 (includes deductible)
$15,000 (includes deductible)
Inpatient Hospital
Deductible; then 80% Coinsurance
Deductible; then 100% Coinsurance
Outpatient Hospital or Facility
Deductible; then 80% Coinsurance
Deductible; then 100% Coinsurance
Out-of-Network: Coinsurance
60%
30%
Employee Deductible
$10,000
$10,000
Family Deductible
$20,000
$20,000
Employee Out-of-Pocket Max
$20,000
$20,000
Family Out-of-Pocket Max
$40,000
$40,000
Prescription Drugs: ( 30 Day Supply) Rx Deductible
$0
Combined with Medical
Tier 1 - Generic
$15
$10
Tier 2 - Preferred
$35
$30
Tier 3 - Non-Preferred
$65
$60
Tier 4 - Specialty
$250
$250 / $500
Employee Bi-Weekly Deduction Employee Only
$61.39
$51.53
Employee + Spouse
$402.46
$337.80
Employee + Child(ren)
$368.36
$309.16
Family
$743.54
$624.06
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TEEN CHALLENGE 2024 BENEFITS GUIDE
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