Medical and Pharmacy Coverage
Giggling Otter Enterprises offers the following Medical plans through Aetna and offers “in and out-of-network” benefits.
Insurance Carrier:
Aetna Medical Insurance
Medical Plan:
$1,500 / 80% Copay Plan
$5,000 / 100% Copay Plan
In-Network: Office Visit Copay - Primary Care
$15
$35
Office Visit Copay - Specialist Care
$75
Deductible; then $75 Copay
Urgent Care Copay
$50
$75
Emergency Room Care
Deductible; then $500 Copay; then 20% Coinsurance
Deductible; then $500 Copay
Preventative Visit Copay
$0
$0
Diagnostic Testing (X-Ray / Blood Work)
Deductible; then 20% Coinsurance
Deductible; then 100% Coinsurance
Advanced Imaging
Deductible; then $250 Copay; then 20% Coinsurance
Deductible; then 100% Coinsurance
Plan Coinsurance
80%
100%
Employee Deductible
$1,500
$5,000
Family Deductible
$3,000
$10,000
Employee Out-of-Pocket Max
$6,500 (includes deductible)
$7,500 (includes deductible)
Family Out-of-Pocket Max
$13,000 (includes deductible)
$15,000 (includes deductible)
Inpatient Hospital
Deductible; then 20% Coinsurance
Deductible; then $250 Copay
Outpatient Hospital or Facility
Deductible; then 20% Coinsurance
Deductible; then $250 Copay
Out-of-Network: Plan Coinsurance
N/A
50%
Employee Deductible
N/A
$15,000
Family Deductible
N/A
$45,000
Employee Out-of-Pocket Max
N/A
$30,000
Family Out-of-Pocket Max
N/A
$90,000
Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic
$2 / $15
$3 / $10
Tier 2 - Preferred
$85
$50
Tier 3 - Non-Preferred
$125
$80
Tier 4 - Specialty
Preferred - $275 / Non-Preferred - $575
20% up to $250
Employee Weekly Deduction Employee Only
$66.54
$42.66
$188.98
$134.81
Employee + Spouse
$173.67 $285.92
$123.27 $207.77
Employee + Child(ren)
Family
6 GIGGLING OTTER ENTERPRISES, INC. 2024 BENEFITS GUIDE
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