Overview of Coverage - PPO Savings Plan
Deductible | |
---|---|
Individual | $1,600 |
Family | $3,200 |
Coinsurance Out-of-Pocket Maximum | |
Individual | $1,975 |
Family | $3,950 |
Total Out-of-Pocket Maximum | |
Individual | $3,575 |
Family | $7,150 |
Member Coinsurance (after deductible) | |
Percentage | 10% |
Services | |
Preventive Care | Covered at 100% |
Office Visits | Deductible and Coinsurance |
Specialist | Deductible and Coinsurance |
Urgent Care | Deductible and Coinsurance |
Emergency Room (waived if admitted) | Deductible and Coinsurance |
COVID-19 Testing: Aetna is waiving all cost sharing for diagnostic testing related to COVID-19, including serological (anti-body) tests. This includes deductibles, copays, and coinsurance. Aenta will also waive cost sharing on the associated provider, urgent care center, or emergency room visit that resulted in an order for or administration of the test. Under federal law, this waiver will remain in place for so long as the federal emergency remains in effect. |
|
Prescription (after deductible) | |
Retail (30-day supply) | |
Generic Drugs | 10% Coinsurance |
Preferred Brand Drugs | 20% Coinsurance |
Non-Preferred Brand Drugs | 40% Coinsurance |
Mail (90-day supply) | |
Generic Drugs | 10% Coinsurance |
Preferred Brand Drugs | 20% Coinsurance |
Non-Preferred Brand Drugs | 40% Coinsurance |
Specialty Medications | |
Preferred Brand Drugs | 20% coinsurance, $65 Minimum |
Non-Preferred Brand Medications | 40% coinsurance, $100 Minimum |
Out-of-Pocket Maximums | Integrated with Medical |
* NO DEDUCTIBLE, COINSURANCE ONLY | |
Preventive Drug List | |
Generic Drugs | 10% coinsurance |
Preferred Brand Drugs | 20% coinsurance |
Non-Preferred Brand Drugs | 40 % coinsurance |
To help calculate the costs for your medications, use the pharmacy pricing tools below:
- PPO Savings Plan Pharmacy Pricing Tool (Before Deductible is Met)
- PPO Savings Plan Pharmacy Pricing Tool (After Deductible is Met)
Documents
- 2020 PPO Savings Plan Schedule of Benefits
- 2020 PPO Savings Overview of Coverage
- 2020 Summary of Benefits Coverage - Technical Service
- 2020 Summary of Benefits Coverage - Faculty and Staff