While each medical plan covers in-network preventive screenings in full, the plans vary on annual deductibles, copays, and levels of coinsurance. Each plan has its own set of strengths. The ideal medical plan should cover your health needs within your budget.
| Benefit | Kaiser HMO | Aetna EPO APCN+ | Aetna CDHP w/HSA | Aetna Choice POS II |
|---|---|---|---|---|
| Primary Care Physician required | ✓ | ✓ | x | x |
| Referrals needed for specialists | ✓ | ✓ | x | x |
| Annual deductible to satisfy | ✓ | ✓ | ✓ | ✓ |
| Copayment for services | ✓ | ✓ | ✓ | ✓ |
| Coinsurance for services | ✓ | ✓ | ✓ | ✓ |
| In-network coverage | ✓ | ✓ | ✓ | ✓ |
| Out-of-network coverage | x | x | ✓ | ✓ |
Looking for a plan that helps you save now and plan for the future? The CDHP combines lower monthly premiums with a higher deductible. It’s designed to put you in charge of how your health care dollars are spent, and it pairs with a Health Savings Account (HSA) to help you save money tax-free for current and future medical expenses.
Consider the CDHP if:
| Plan Features | Kaiser HMO* | Aetna EPO APCN+ | Aetna CDHP w/HSA | Aetna Choice POS II | ||
|---|---|---|---|---|---|---|
| In-Network Only | In-Network Only | In-Network | Out-of-Network** | In-Network | Out-of-Network** | |
| Annual Deductible Individual/Family |
$750 / $1,500 | $750 / $1,500 | $2,000 / $4,000 | $2,700 / $5,400 | $1,500 / $3,000 | $2,500 / $5,000 |
| Annual OOPM Individual/Family |
$3,400 / $6,800 | $1,500 / $3,000 | $3,000 / $6,000 | $4,000 / $8,000 | $3,000 / $6,000 | $5,000 / $10,000 |
| Big 5 Annual HSA Contribution Individual/Family |
N/A | N/A | $250 / $500 | N/A | ||
| You pay: | You pay: | You pay: | You pay: | |||
| Preventive Care Visit | Covered in full | Covered in full | Covered in full | 50%*** | Covered in full | 50%*** |
| Telemedicine/Virtual Visit | Covered in full | $30 copay | 20%*** | 50%*** | 20% | 50%*** |
| Primary Care Visit | $20 copay | $30 copay | 20%*** | 50%*** | 20% | 50%*** |
| Specialist Visit | $30 copay | $50 copay | 20%*** | 50%*** | 20%*** | 50%*** |
| Lab & X-ray | $10 copay | 10%*** | 20%*** | 50%*** | 20%*** | 50%*** |
| Urgent Care | CA: $20 copay Other States: $30 copay |
$30 copay | 20%*** | 50%*** | 20% after $25 copay |
50%*** |
| Emergency Room (copay waived if admitted) |
20%*** | $150 copay | 20%*** | 20%*** | $150 copay + 20% |
$150 copay + 20% |
| Outpatient Hospital Services | 20%*** | 10%*** | 20%*** | 50%*** | 20%*** | 50%*** |
| Inpatient Hospital Services | 20%*** | $500 copay*** | 20%*** | 50%*** | 20%*** | $500 copay + 50%*** |
| Outpatient Mental Health Services | 20%*** | $30 copay | 20%*** | 50%*** | 20%*** | 50%*** |
| Chiropractic (20 visits per year) |
20%*** | $50 copay | 20%*** | 50%*** | 20%*** | 50%*** |
| Acupuncture (visit limitations vary) |
20%*** | $50 copay | 20%*** | 50%*** | 20%*** | 50%*** |
| Prescription Drugs: Retail (up to a 30-day supply) | ||||||
| Generic | $10 copay | $15 copay | $15 copay | N/A | $15 copay | N/A |
| Formulary Brand | $30 copay | $25 copay | $25 copay | $25 copay | ||
| Non-Formulary Brand | N/A | $50 copay | $50 copay | $50 copay | ||
| Specialty | 20% up to $250 max | 50% up to $150 max | 50% up to $150 max | 50% up to $150 max | ||
| Prescription Drugs: Mail Order (90-day Aetna & 100-Day Kaiser supply) | ||||||
| Generic | $20 copay | $30 copay | $30 copay | N/A | $30 copay | N/A |
| Formulary Brand | $60 copay | $50 copay | $50 copay | $50 copay | ||
| Non-Formulary Brand | 20% up to $250 max | $100 copay | $100 copay | $100 copay | ||
*Plan available in 4 states: CA, OR, WA, CO.
**Receiving services out-of-network may result in balance billing.
***After deductible.
| My Health Manager (Kaiser Plan Members Only) | HealthJoy/Aetna Navigator (Aetna Plan Members Only) |
|---|---|
If you are enrolled in the Kaiser medical plan, you have access to My Health Manager, a FREE online resource that allows you to:
Visit kp.org to get started. | If you are enrolled in an Aetna medical plan, you have access to Aetna Navigator. This FREE program allows you to:
Visit aetna.com or healthjoy.com/download to get started. |
Employees enrolled in an Aetna medical plan are automatically enrolled in the Aetna Maintenance Choice Program to help save money on regular prescriptions.
You and your family members can receive up to a 90-day supply of maintenance medications at a discounted rate. There are two ways to save with this program; utilize the CVS Caremark Mail Service Pharmacy, or visit a CVS Pharmacy near you.
If you are new to the program or starting a new medication, you will need to ask your doctor for a 90-day prescription after your first two refills in order to continue receiving the discounted price. You can opt-out at any time. However, if you do not opt-out and continue to receive 30-day supplies after your first two refills, you will pay the full cost of your medications.
Visit aetna.com and sign into your account to submit an order online, or call Rx Member Services toll-free at 888.RX.AETNA (888.792.3862).