RSM 2024 Benefit Guide

Benefits for 2024

Medical

SUMMARY OF COVERAGE

Aetna Choice POS II Network

HSA

BUY-UP

Employer Funding (Single/Family)

$600/$1,200

N/A

Deductible (Single / Family)

$3,000/$6,000

$1,000/$2,000

Out of PocketMaximum (Single/ Family)

$5,000/$10,000

$3,000/$6,000

Coinsurance

20% After Deductible

10% After Deductible

Preventive Care

100% Covered

100% Covered

Primary Care & Specialist Visit

20% After Deductible

$25Copay/ $40Copay

Inpatient Hospital

20% After Deductible

10% After Deductible

Outpatient Hospital

20% After Deductible

10% After Deductible

Urgent Care

20% After Deductible

$50Copay

Emergency Room

20% After Deductible

$150Copay

RxCopays

Deductible then $10 / $35 / $60

$10 / $35 / $60

OUT OF NETWORK*

Deductible

$2,500 / $5,000

$2,000 / $4,000

Coinsurance

40% After Deductible

40% After Deductible

Out of PocketMaximum

$6,250 / $12,500

$6,250 / $12,500

*If you see an out of networkprovideryou may be charged the difference betweenthe providerbill and the usualand customary amount ** For illustrativepurposes only. Please refer to the benefit summary on the HealthJoy app for all plan details

This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.

2024 Employee Benefit Guide

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