Hughston Benefits Guide
7
SPOTLIGHT ON URGENT CARE
Is your medical issue a true emergency? While you may encounter urgent issues, they are not always life threatening. In these cases, you can save yourself both time and money by visiting an Urgent Care Center or using the Telemedicine benefit instead of the Emergency Room! Search the Aetna Signature Administrators PPO network for convenient Urgent Care Centers around your home or office, and register with the Teladoc today!
Medical - Allied Benefit (TPA) Aetna Signature Administrators PPO Network Coinsurance (Member pays) Calendar Year Deductible - Individual - Family Out-of-Pocket Maximum (Deductible included) - Individual -Family
HSA 3000
In-Network
Out-of-Network
0%
40%
Non-Embedded $3,000 $6,000
Non-Embedded $10,000 $20,000
$4,000 $8,000*
$15,000 $30,000
Office Visit -Primary - Specialist - Preventive
SPOTLIGHT ON MAIL ORDER
Deductible Deductible 100% Covered
40% after Deductible 40% after Deductible 40% after Deductible
Emergency Room Services (Copay waived if admitted)
Deductible
Deductible
Urgent Care
Deductible Deductible Deductible
40% after Deductible 40% after Deductible 40% after Deductible
Take regular prescription medications on an ongoing, daily basis?
Inpatient Services Outpatient Services
Prescriptions (30 Day Supply) Deductible Tier 1 Tier 2 Tier 3 Tier 4 (Specialty Drugs) Mail Order (90 Day Supply) Tier 1 Tier 2 Tier 3 Medical Rates (Bi-Weekly) Employee Employee + Spouse Employee + Child(ren) Family
If so, take advantage of Liviniti’s mail order program! Filling your prescriptions in a 90 day supply may help you stay healthy because having a 90 day supply of your medication on hand typically means you’re less likely to miss a dose. It also means you can make fewer visits to the pharmacy to refill your medication, and depending on your plan, you may be able to save money by filling your prescriptions 90 days at a time.
Prescription Drug Coverage Administered by Liviniti
Subject to Medical Deductible $10 Copay after Deductible $30 Copay after Deductible $60 Copay after Deductible $120 Copay after Deductible
$20 Copay after Deductible $60 Copay after Deductible $120 Copay after Deductible
$24.10 $367.21 $266.69 $672.97
*$7,000 out-of-pocket maximum for an individual in a family plan.
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