To stay in compliance with federal regulations, VPP offers medical plans through two different carriers: Aetna and Meritain. Both carriers will offer the same great benefits including deductibles, coinsurance, and out-of-pocket limits. Please note: each carrier has their own pharmacy coverage as well. Please see the below chart for the details on the RX & Prescription Benefit Manager (PBM) for each carrier. Medical Coverage
How To Confirm Your Carrier
Refer to AGM Enrollment Support. View your Paycom Benefits account. Check your health insurance card.
HDHP Core Plan (Bronze)
Choice Plan (Silver)
Choice Plus Plan (Gold)
In-Network Coverage
VPP HSA Contribution
$1,100 (funded bi-weekly)
N/A
N/A
Aetna Open Access Plans Meritain Health Broad Medical Networks
Network
Plan Year Deductible (Individual / Family)
$3,500 / $7,000
$5,000 / $10,000
$2,000 / $4,000
Deductible
Embedded
Embedded
Embedded
Out-of-Pocket Max (Individual / Family) Out-of-Pocket Preventive Care Primary Care Visit
$6,550 / $13,100
$7,900 / $15,800
$7,150 / $14,300
Embedded
Embedded
Embedded
100% covered
100% covered
100% covered
$40 after deductible $60 after deductible $40 after deductible 10% after deductible 10% after deductible 10% after deductible $75 after deductible $200 after deductible $200 after deductible
$50 $75 $50
$35 $60 $35
Specialist Visit
Virtual Visit
Outpatient Procedure
30% after deductible 30% after deductible 30% after deductible
10% after deductible 10% after deductible 10% after deductible
Inpatient Visit
Lab Tests / Diagnostics*
Urgent Care
$75
$75
Emergency Room
30% after deductible
10% after deductible
Imaging
$200
$200
Rx Retail (31 days) Rx Mail Order (90 days)
$10 / $30 / $50 after deductible $25 / $75 / $125 after deductible
$20 / $40 / $60 $50 / $100 / $150
$15 / $35 / $50 $38 / $88 / $125
Out-of-Network Coverage Plan Year Deductible (Individual / Family)
$6,000 / $12,000
$10,000 / $20,000
$5,000 / $10,000
Coinsurance
50% after deductible
50% after deductible
50% after deductible
Out-of-Pocket Max (Individual / Family)
$10,000 / $20,000
$15,000 / $30,000
$10,000 / $20,000
*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.
9
Made with FlippingBook - PDF hosting