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: In-Network: Primary Care Visits
$1,500 / 80% Copay Plan
$5,000 / 100% Copay Plan
$25 Copay
$35 Copay
Specialist Care Visits
$75 Copay
Deductible; then $75 Copay
Urgent Care
$75 Copay
$75 Copay
Emergency Room Care
Deductible; then $300 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 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
$5,500 (includes deductible)
$8,150 (includes deductible)
Family Out-of-Pocket Max
$11,000 (includes deductible)
$16,300 (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
50%
50%
Employee Deductible
$3,000
$15,000
Family Deductible
$9,000
$45,000
Employee Out-of-Pocket Max
$13,000
$30,000
Family Out-of-Pocket Max
$39,000
$90,000
Prescription Drugs 30 Day Supply Tier 1 - Generic
$3 Copay / $10 Copay
$3 Copay / $10 Copay
Tier 2 - Preferred
$45 Copay
$50 Copay
Tier 3 - Non-Preferred
$75 Copay
$80 Copay
Tier 4 - Specialty
20% up to $250
20% up to $250
Employee Weekly Deduction Employee Only
$69.33
$46.71
Employee + Spouse
$200.37
$149.07
Employee + Child(ren)
$183.99 $304.10
$136.27 $230.10
Family
6 GIGGLING OTTER ENTERPRISES, INC. 2025 BENEFITS GUIDE
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