Medical and Pharmacy Coverage
Community Action for Improvement offers the following medical plans through Aetna and offers “in and out-of-network” benefits.
Insurance Carrier:
Aetna Medical Insurance
Medical Plan:
$5,000 / 100% Copay Plan
$5,500 / 80% HDHP w/ HSA Plan
In-Network: Office Visit Copay - Primary Care
$35
Deductible; then 20% Coinsurance
Office Visit Copay - Specialist Care
$75
Deductible; then 20% Coinsurance
Urgent Care Copay
$75
Deductible; then 20% Coinsurance
Emergency Room Care
$300 Copay
Deductible; then 20% Coinsurance
Preventative Visit Copay
$0
$0
Diagnostic Testing & Blood Work
Deductible; then 0% Coinsurance
Deductible; then 20% Coinsurance
Imaging
Deductible; then 0% Coinsurance
Deductible; then 20% Coinsurance
Plan Coinsurance
100%
80%
Employee Deductible
$5,000
$5,500
Family Deductible
$10,000
$11,000
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 0% Coinsurance
Deductible; then 20% Coinsurance
Outpatient Hospital or Facility
Deductible; then 0% Coinsurance
Deductible; then 20% Coinsurance
Out-of-Network: Plan Coinsurance
50%
50%
Employee Deductible
$10,000
$10,000
Family Deductible
$30,000
$30,000
Employee Out-of-Pocket Max
$25,000
$20,000
Family Out-of-Pocket Max
$75,000
$60,000
Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic
$3 or $10
Deductible; then 20% Coinsurance
Tier 2 - Preferred
$50
Deductible; then 20% Coinsurance
Tier 3 - Non-Preferred
$80
Deductible; then 20% Coinsurance
Tier 4 - Specialty
20% up to $250
Deductible; then 20% Coinsurance
Employee Semi-Monthly Deduction Employee Only
$75.28 $168.80 $157.10 $242.83
$48.30 $106.39
Employee + Spouse Employee + Child(ren)
$99.13
Family
$152.38
6 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2023 BENEFITS GUIDE
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