Medical and Pharmacy Coverage
Outdoor Events offers the following plans through
Aetna and offers “in and out-of-network” benefits.
Insurance Carrier:
Aetna Medical Insurance
Medical Plan:
$3,000 / 100% Copay Plan $5,000 / 100% Copay Plan
$6,250 / 100% HDHP
In-Network: Office Visit Copay - Primary Care Teladoc Virtual Care - Primary Care Consultation Copay
$35
$35
Deductible; then 100% Coinsurance
$0
$0
Deductible; then 100% Coinsurance
Office Visit Copay - Specialist Care
$75
$75
Deductible; then 100% Coinsurance
Urgent Care Copay
$75
$75
Deductible; then 100% Coinsurance
$500 Copay after Deductible; then 100% Coinsurance
Emergency Room Copay
$500 (Copay waived if admitted)
$500 (Copay waived if admitted)
Preventative Visit Copay
$0
$0
$0
Diagnostic Testing (X-Ray / Blood Work)
Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance
Deductible; then 100% Coinsurance
Advanced Imaging
Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance
Deductible; then 100% Coinsurance
Coinsurance
100%
100%
100%
Employee Deductible
$3,000
$5,000
$6,250
Family Deductible
$6,000
$10,000
$12,500
Employee Out-of-Pocket Max
$6,000 (includes deductible)
$7,150 (includes deductible)
$6,900 (includes deductible)
Family Out-of-Pocket Max
$12,000 (includes deductible)
$14,300 (includes deductible)
$13,800 (includes deductible)
Inpatient Hospital
Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance
Deductible; then 100% Coinsurance
Outpatient Hospital or Facility
Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance
Deductible; then 100% Coinsurance
Out-of-Network: Coinsurance
50%
50%
50%
Employee Deductible
$6,000
$10,000
$10,000
Family Deductible
$18,000
$30,000
$30,000
Employee Out-of-Pocket Max
$16,000
$25,000
$20,000
Family Out-of-Pocket Max
$48,000
$75,000
$60,000
Prescription Drugs: ( 30 Day Supply) Tier 1A/1 - Generic
$3 T1A / $10 T1
$3 T1A / $10 T1
$3 T1A / $15 T1 Copay after Deductible
Tier 2 - Preferred
$45
$50
$50 Copay after Deductible
Tier 3 - Non-Preferred
$75
$80
$100 Copay after Deductible
Tier 4 - Specialty
20% up to $250 / 40% up to $500
20% up to $250 / 40% up to $500
20% up to $250 / 40% up to $500 after Deductible
Employee Bi-Weekly Deduction Employee Only
$81.73 $401.25 $361.31 $654.22
$73.72 $359.42 $323.71 $585.60
$59.93 $287.34 $258.91 $467.38
Employee + Spouse Employee + Child(ren)
Family
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OUTDOOR EVENTS 2023 BENEFITS GUIDE
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