Medical and Pharmacy Coverage
Community Action for Improvement, Inc. offers the following Medical plans through Aetna and offers “in and out-of-network” benefits. Insurance Carrier: Aetna Medical Insurance Medical Plan: $2,500 / 100% Copay Plan $5,000 / 100% Copay Plan In-Network: Office Visit Copay - Primary Care $25 $35 Office Visit Copay - Specialist Care $75 $75 Urgent Care Copay $75 $75 Emergency Room Care Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance Preventative Visit Copay $0 $0 Diagnostic Testing & Blood Work Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance Imaging Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance Coinsurance 100% 100% Employee Deductible $2,500 $5,000 Family Deductible $5,000 $10,000 Employee Out-of-Pocket Max $5,500 (includes deductible) $7,150 (includes deductible) Family Out-of-Pocket Max $11,000 (includes deductible) $14,300 (includes deductible) Inpatient Hospital Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance Outpatient Hospital or Facility Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance Out-of-Network: Coinsurance 50% 50% Employee Deductible $5,000 $10,000 Family Deductible $15,000 $30,000 Employee Out-of-Pocket Max $15,000 $25,000 Family Out-of-Pocket Max $45,000 $75,000 Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic $3 or $10 $3 or $10 Tier 2 - Preferred $45 $50 Tier 3 - Non-Preferred $75 $80 Tier 4 - Specialty 20% up to $250 or 40% up to $500 20% up to $250 or 40% up to $500 Employee Semi-Monthly Deduction Employee Only $53.34 $28.34 Employee + Spouse $185.02 $135.02 Employee + Child(ren) $167.40 $117.40 Family $284.91 $234.91
6 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
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