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 Teladoc today!
Medical - Allied Benefit (TPA) Aetna Signature Administrators PPO Network Coinsurance (Member pays)
HSA 3000
In-Network
Out-of-Network
0%
40%
Calendar Year Deductible - Individual - Family Out-of-Pocket Maximum (Deductible included) - Individual -Family
Non-Embedded $3,000 $6,000
Non-Embedded $10,000 $20,000
SURCHARGES
$4,000 $8,000*
$15,000 $30,000
Office Visit -Primary - Specialist - Preventive
Bi-Weekly
Surcharge
Deductible Deductible 100% Covered
40% after Deductible 40% after Deductible 40% after Deductible
Employee Tobacco User** Spouse Eligible for Other Coverage***
$50
Emergency Room Services (Copay waived if admitted)
$75
Deductible
Deductible
Urgent Care
Deductible Deductible Deductible
40% after Deductible 40% after Deductible 40% after Deductible
** Your health plan is committed to helping you achieve your best health. Rewards for participating in a wellness program are available to all employees. If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify for an opportunity to earn the same reward by different means. Contact us at 706.494.3447 and we will work with you (and if you wish, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status. *** If your spouse has access to medical coverage under his/her employer’s health plan, and you elect to cover them under the Hughston medical plan, you will pay a bi-weekly surcharge.
Inpatient Services Outpatient Services
Prescripctions (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 *$7,000 per individual in a family plan
The Prescription Benefit Coverage is Administered by ProAct
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
$30.19 $133.22 $121.08 $211.97
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