Medical and Pharmacy Coverage
Horizons Diagnostics, LLC offers the following Medical plans through Aetna and offers “in and out-of-network” benefits.
Insurance Carrier:
Aetna Medical Insurance
Medical Plan:
$3,000 / 100% Copay Plan $6,000 / 100% Copay Plan $6,000 / 100% HDHP Plan
In-Network: Office Visit Copay - Primary Care
$30
$40
Deductible; then 100% Coinsurance
Office Visit Copay - Specialist Care
$75
$75
Deductible; then 100% Coinsurance
Urgent Care Copay
$75
$75
Deductible; then 100% Coinsurance
Emergency Room Care
Deductible; then $500 Copay
$500 Copay
Deductible; then 100% Coinsurance
Preventative Visit Copay
$0
$0
$0
Diagnostic Testing (X-Ray / Blood Work)
Deductible; then $45 Copay
Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance
Advanced Imaging
Deductible; then $500 Copay
Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance
Plan Coinsurance
100%
100%
100%
Employee Deductible
$3,000
$6,000
$6,000
Family Deductible
$9,000
$12,000
$12,000
Employee Out-of-Pocket Max
$5,600 (includes deductible)
$8,000 (includes deductible)
$6,900 (includes deductible)
Family Out-of-Pocket Max
$16,800 (includes deductible)
$16,000 (includes deductible)
$13,800 (includes deductible)
Inpatient Hospital
Deductible; then $750 Copay
Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance
Outpatient Hospital or Facility
Deductible; then 100% Covered
Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance
Out-of-Network: Plan Coinsurance
70%
70%
70%
Employee Deductible
$6,000
$10,000
$10,000
Family Deductible
$18,000
$20,000
$20,000
Employee Out-of-Pocket Max
$12,000
$20,000
$20,000
Family Out-of-Pocket Max
$36,000
$40,000
$40,000
Prescription Drugs: ( 30 Day Supply)
Rx Deductible
$0
$0
Combined with Medical Deductible
Tier 1 - Generic
$15
$20
Deductible; then 100% Coinsurance
Tier 2 - Preferred
$35
$45
Deductible; then 100% Coinsurance
Tier 3 - Non-Preferred
$65
$90
Deductible; then 100% Coinsurance
Tier 4 - Specialty
Deductible; then 100% Coinsurance
Preferred - $250 / Non-Preferred - $500
Preferred - $250 / Non-Preferred - $500
Employee Monthly Deduction
Tobacco $686.80
Non-Tobacco
Tobacco $615.59
Non-Tobacco
Tobacco $528.00
Non-Tobacco
$686.80
$615.59
$528.00
Employee Only
$1,373.62
$1,373.62
$1,231.19
$1,231.19
$1,056.03
$1,056.03
Employee + Spouse
$1,304.94 $2,197.81
$1,304.94 $2,197.81
$1,169.63 $1,969.90
$1,169.63 $1,969.90
$1,003.22 $1,689.65
$1,003.22 $1,689.65
Employee + Child(ren)
Family
6 HORIZONS DIAGNOSTICS LLC 2024 BENEFITS GUIDE
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