MEDICAL BENEFITS

The right plan for a healthier you.

MEDICAL BENEFITS

You will have the choice between three medical plan options. Those who choose to enroll in the HSA plan will be eligible for a Health Savings Account (HSA) and an employer HSA contribution. Our prescription drug benefits are offered through CVS. Once you choose and elect your medical plan, you will then be automatically enrolled in the associated prescription drug plan with that option. More information is listed in the pharmacy section below.

You will receive two ID cards upon enrolling — one from Aetna for medical services and one from CVS for prescription drugs.

Find a Doctor:

  • Go to www.aetna.com
  • Click on "Find a doctor" at the top of the page
  • In the "Don't have a member account?" section, click on "Plan from an employer"
  • In the "Continue as a guest" section, enter your home location information and click "Search"
  • Under "Select a plan," scroll down and select "Open Choice PPO" under "Aetna Standard Plans" and then click "Continue"
Locate a Pharmacy
Benefits
HSA
In-Network | Out-of-Network
HRA
In-Network | Out-of-Network
PPO
In-Network | Out-of-Network

Calendar Year Deductible

  • Individual
  • Family
$2,500 | $5,000
$5,000 | $10,000

$2,500 | $4,000

$4,000 | $8,000

$1,000 | $2,000 $2,000 | $4,000

Out-of-Pocket Maximum

  • Individual
  • Family
$6,000 | $12,000 $12,000 | $24,000
$4,000 | $5,000 $6,000 | $10,000
$4,500 | $9,000 $9,000 | $18,000

Annualized HSA/HRA Contribution from Veritext

Employee: $750
Employee + Spouse: $1,500
Employee + Child(ren): $2,000
Family: $2,000

Employee: $1,500 Employee + Spouse: $2,000 Employee + Child(ren): $2,000 Family: $2,500

N/A

Coinsurance

20% | 40%
10% | 30%
20% | 40%
Preventive Care
Covered at 100%
Covered at 100%
Covered at 100%
Child
20% | 40%
10% | 30%
$35 copay | 40%
Physician Office Visit
20% | 40%
10% | 30%
$35 copay | 40%
Specialist Office Visit
20% | 40%
10% | 30%
$50 copay | 40%
Complex Imaging
(X-RAY/MRI/CT/PET)
20% | 40%
10% | 30%
20% | 40%
Inpatient Hospital
20% | 40%
10% | 30%
20% | $300 per admission deductible, then plan pays 60%
Urgent Care
20% | 40%
10% | 30%
20%
Emergency Room
20%
10%
20%
Plan Documents & More Information
Click here for HSA Plan Summary Click here for HSA SPD
Click here for HRA Plan Summary
Click here for HRA SPD
Click here for PPO Plan Summary
Click here for PPO SPD

PRESCRIPTION DRUGS

Retail: 30 day supply

Generic/Preferred/Non-Preferred Brand
$15/$35/$55 (after deductible)*
$15/$35/$55
$15/$35/$55

Mail Order: 90 day supply

Generic/Preferred/Non-Preferred Brand
$30/$70/110 (after deductible)
$30/$70/$110
$30/$70/$110

To confirm a drug is covered* and the cost, click your plan below:

HRA Plan
HSA Plan
PPO Plan

*Certain preventive drugs are not subject to the deductible, click below.

Click here for more pharmacy information
Prescription Formulary
No Surprises Act Amendment

CVS WEIGHT MANAGEMNET

The CVS Weight Management program helps you live a healthier life while optimizing the use of weight loss medication. The program provides convenient and personal access to care that supports you by helping you with support to achieve success while on the medication.

Get access to:

  • Nutritional content
  • Coaching
  • Connected devices
  • Care team of clinicians

*NOTE: You are REQUIRED to enroll in the CVS Weight Management program if you are on a weight loss medication in order to maintain drug cost share coverage.

Weight Management

Tobacco Cessation

TOBACCO CESSATION FAQ:

Learn More About Quitting

Q: What is the tobacco-user rate?

A: The tobacco user rate will be applied to health plan participants who do not certify that they or their dependents have not used tobacco products or haven’t completed a tobacco cessation program in the past six months.

Q: How do I avoid paying the tobacco-user rate?

A: The tobacco-user rate will be added automatically to your health insurance premiums unless you certify that you and your dependents have not used tobacco products within the past 90 days or that you are a smoker and agree to participate in and complete a smoking cessation class or program.

Q: More than one of us in the family uses tobacco. Do I have to pay more than the family tobacco rate?

A: No. If more than one covered spouse/domestic partner uses tobacco, the spouse/domestic partner tobacco rate applies.

Q: What is considered tobacco use?

A: Tobacco use is smoking tobacco in such forms as a cigarette, pipe, or cigar, or using smokeless tobacco, such as snuff or chewing tobacco, within the past six months. Use of non-tobacco cigarettes, such as nicotine inhalers or electronic (green) cigarettes, does not qualify you as a tobacco user.

Q: How often do I need to certify my status as a tobacco user or a non-tobacco user?

A: Once your certification is received and processed, you need not recertify unless the status changes for you or a covered family member. You will need to recertify every year during Open Enrollment unless your status changes.

Q: I want to quit using tobacco but need help to do it. What should I do?

A: There are free resources through Aetna, state QuitLines, and more! Please reach out to Human Resources for more information.

Transparency and Coverage Machine Readable File

Q: Why has the tobacco-rate been implemented?

A: Tobacco is considered the leading preventable risk factor for illness and disease resulting in higher medical cost — an estimated $75 million a year for tobacco-related illnesses.

Q: I don’t smoke or use tobacco, but my spouse, who is on my plan, does. Do we have to pay the tobacco rate?

A: Yes. If you or any covered family members use tobacco products or have used tobacco products within the past 90 days, the tobacco rate applies unless you or your family member agree to participate in and complete a smoking cessation class or program.

Q: I just successfully completed a tobacco cessation program; do I still have to pay the tobacco rate?

A: 1. If you (your spouse/domestic partner) complete an approved tobacco cessation program by April 1, 2024, and provide proof of completion to Veritext your contributions will change to the non-tobacco rate retroactive to January 1, 2024. 2. If you (your spouse/domestic partner) complete an approved tobacco cessation program after April 1, 2024, you will be eligible for the non-tobacco rate the month following Veritext's receipt of a certificate of completion of a tobacco cessation program. 3. If you (your spouse/domestic partner) use tobacco/nicotine-based products and have not completed a tobacco cessation program, your employee contributions will be at the tobacco rate.

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