Medical Plan Highlights
HDHP Core Plan (Bronze)
Choice Plan (Silver)
Choice Plus Plan (Gold)
IN-NETWORK
$1,100 (funded biweekly)
N/A
N/A
VPP Contribution
Aetna Aetna Open Access Plans Meritain Health Broad Medical Networks
Aetna Aetna Open Access Plans Meritain Health Broad Medical Networks
Aetna Aetna Open Access Plans Meritain Health Broad Medical Networks
Network
Deductibles (Individual / Family)
$3,500 / $7,000
$2,000 / $4,000
$5,000/$10,000
Deductible
Embedded
Embedded
Embedded
Preventive Care
100% Covered
100% Covered
100% Covered
Primary Care Visit
$35
$40 after deductible
$50
Specialist Visit
$60
$60 after deductible
$75
Virtual Visit
$35
$40 after deductible
$50
Outpatient Procedure
10% after deductible
10% after deductible
30% after deductible
Inpatient Visit
10% after deductible
10% after deductible
30% after deductible
Lab Tests / Diagnostics**
10% after deductible
10% after deductible
30% after deductible
Urgent Care
$75
$75 after deductible
$75
Emergency Room
10% after deductible
$200 after deductible
30% after deductible
Imaging
$200
$200 after deductible
$200
$10 / $30 / $50 after deductible $25 / $75 / $125 after deductible
Pharmacy / Rx- Retail (31 days) Pharmacy / Rx- Mail Order (90 days)
$15 / $35 / $50 $38 / $88 / $125
$20 / $40 / $60 $50 / $100 / $150
Out-of-Pocket Max (Individual / Family)
$6,550 / $13,100
$7,150 / $14,300
$7,900 / $15,800
Out-of-Pocket
Embedded
Embedded
Embedded
OUT OF NETWORK Deductibles (Individual / Family)
$6,000 / $12,000
$5,000 / $10,000
$10,000 / $20,000
Coinsurance
50% after deductible
50% after deductible
50% after deductible
Out-of-Pocket Max (Individual / Family)
$10,000 / $20,000
$10,000 / $20,000
$15,000 / $30,000
11 **The above plan summaries are for illustrative purposes only. Always check your Aetna and Meritain Health benefit summaries and certificates of coverage for final detailed plan information.
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