Webb Construction - 2022 Benefit Guide

Medical and Pharmacy Coverage

Webb Construction offers the following plans through Aetna. Please reference the Summary Plan Description for more details.

Insurance Carrier:

Aetna Medical Insurance

Medical Plan:

$4,000 / 100% Copay Plan

$7,350 / 100% Integrated Rx

In-Network: Office Visit Copay - Primary Care Office Visit Copay - Specialist Care

$35 $70 $75

$40 $80

Urgent Care Copay Emergency Room Care Preventative Visit Copay

$100

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

$0

$0

Diagnostic Testing & Blood Work

Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance

Imaging

Coinsurance

100%

100%

Employee Deductible Family Deductible

$4,000 $8,000

$7,350 $14,700

Employee Out-of-Pocket Max Family Out-of-Pocket Max

$6,500 (includes deductible) $13,000 (includes deductible)

$8,150 (includes deductible) $16,300 (includes deductible)

Inpatient Hospital

Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance

Outpatient Hospital or Facility

Out-of-Network: Coinsurance Employee Deductible

50%

50%

$8,000 $24,000 $23,000 $69,000

$22,050 $66,150 $42,050 $126,150

Family Deductible

Employee Out-of-Pocket Max Family Out-of-Pocket Max

Prescription Drugs: ( 30 Day Supply) Rx Deductible - Integrated Rx

$0

Tier 2-4 subject to deductible

Tier 1 Tier 2 Tier 3 Tier 4

$3 / $10

$3 / $10

$45 $75 N/A

$50 $80 N/A

Preferred Specialty

20% up to $250 40% up to $500

20% up to $250 40% up to $500

Non-Preferred Specialty

Employee Weekly Deduction Employee Only

$25.58 $174.77 $156.12 $292.88

$18.31 $121.46 $108.56 $203.12

Employee + Spouse Employee + Child(ren)

Family

Webb Construction 2022 Enrollment Guide

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