Aetna Medical
CrowdStreet offers three different medical plan options through Aetna. All of the available options give you access to high-quality, comprehensive care. They differ in the way the cost of care is structured and in the strategies that you can use to control your expenses:
AETNA OAMC PPO 500 AND AETNA OAMC PPO 2000
The Aetna PPO plan is a traditional plan that gives you the greatest flexibility, combined with lower costs when you choose a provider within its broad national network. Choosing health professionals who participate in the PPO network keep your costs lower and eliminate paperwork.
AETNA OAMC HDHP 3200
When you are covered by a HDHP, you are eligible to participate in a Health Savings Account (HSA). An HSA is an investment tool that helps you save for health care expenses, including deductibles and coinsurance. Contributions to your HSA account are pre-tax, and any interest earned on the account is tax-free.
In 2024, you may contribute via payroll deduction up to $4,150 (including employer HSA contribution of $600), if you have individual coverage, or up to $8,300 (including employer contribution of $1,200) if you are covering yourself and at least one additional family member. If you are age 55 or older, you may contribute an additional $1,000 to your account. Contributions to your HSA roll over from year to year and accumulate if not used. You may use the funds to pay for any qualified health expenses incurred after the account is opened. You may pay the bill directly via the HSA debit card, or you may use the HSA to reimburse yourself for payments that you make. Payments and withdrawals made from your HSA to cover qualified health care expenses are tax-free.
PLAN COMPARISON | AT A GLANCE
AETNA OAMC PPO 500 | AETNA OAMC PPO 2000 | AETNA OAMC HDHP 3200 |
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In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network | Out-of-Network | |
Calendar Year Deductible (single/family) | $500/$1,000 | $2,000/$6,000 | $2,000/$4,000 | $4,000/$12,000 | $3,200/$6,400 | $5,600/$16,800 |
Calendar Year Out-of-Pocket Max (single/family) | $1,500/$3,000 | $6,000/$18,000 | $6,000/$12,000 | $12,000/$36,000 | $4,000/$8,000 | $8,000/$24,000 |
Office Visit (primary/specialist) | $25/$50 | 50% after deductible | $35 / $60 | 50% after deductible | 20% Coinsurance | 50% Coinsurance |
Preventive Care | No charge (deductible waived) | 50% /visit after deductible (no charge for immunizations up to age 6) |
No Charge | 50% /visit after deductible (no charge for immunizations up to age 6) |
No Charge | 50% /visit after deductible (no charge for immunizations up to age 6) |
Urgent Care | $75 copay | 50% after deductible | $75 Copay | 50% after deductible | 20% coinsurance | 50%coinsurance |
Emergency Room (copay waived if admitted) | 20% / visit after $300 copay | 10% / visit after $300 copay | 20% coinsurance | |||
Inpatient Hospitalization | 20% after deductible | 50% after deductible | 10% after deductible | 50% after deductible | 20% coinsurance | 50% coinsurance |
Retail Prescription Drugs (Tier 1/Tier 2/Tier 3/Tier 4) | $15/$50/$90 | 30% after copay $15/$50/$90 |
$15/$50/$90 | 30% after copay $15/$50/$90 |
$10/$35/$70 | 30% after copay $10/$35/$70 |
Mail Order Prescription Drugs - 90 day supply (Generic/Brand/Brand Non-Preferred) | $37.50/$125/$225 | 30% after copay $37.50/$125/$225 |
$37.50/$125/$225 | 30% after copay $37.50 / $125 / $225 | $25/$87.50/$175 | 30% after copay $25/$87.50/$175 |
Please note that the information above only provides the highlights of our plan. Please refer to the full Plan Documents if you have questions about a plan or your coverage.
- Aetna OC PPO Certificate of Coverage
- Aetna OC PPO 500 Schedule of Benefits
- Aetna OC PPO 2000 Schedule of Benefits
- Aetna OAMC - Physician and Specialist Surgical services paid differently - Certificate of Coverage
- Aetna OAMC - Physician and Specialist Surgical services paid differently - Schedule of Benefits
- Aetna Plain Language Open Access Managed Choice Extraterritorial Riders
- Aetna Plain Language Open Access Managed Choice High Deductible Health Plan Extraterritorial Riders
- Aetna Plain Language Open Access Managed Choice Extraterritorial Riders - Physician and Specialist Surgical services paid differently
AETNA Resources
- Aetna Member Website - The AETNA Online website allows members to find network doctors, compare costs, find out what's covered, view claims and account balances and access wellness tools
- AetnaMobile Mobile App that allows members to connect with doctors 24/7. Shop and price prescriptions and much more.
- Beginning Right - Maternity program with support coaching
- Aetna Discount Program
- Aetna Informed Health LIie Member
- Talkspace - Virtual care for mild to moderate behavioral health needs that provides video and asynchronous chat therapy
Provider Resources
- Aetna OAMC Provider Directory (All Employees except MT)
- Aetna PPO Provider Directory(MT Employees Only)
- Aetna Behavioral Health AbleTo Support flyer
- Digital ID Card
- Discount Program Brochure
- CVS Pharmacy member Flyer
- Prescription Drug Claim Form
- Medical Claim Form
- Travel flyer
- Aetna Member Flyer
- Aetna Health App
- Aetna Maternity Program
- 24 Hour Nurse Line Member Flyer
- Behavioral Health
- Telehealth Services
- Talkspace
- Teladoc Mental Health
Deductible - The amount you must pay for medical services, before the plan pays a benefit. Preventative care is always covered at 100% with no deductible required.
Coinsurance - This is the percentage of the cost you pay for certain services after the deductible has been met. You can think of this as “cost sharing”. For example, once your deductible has been met you could pay 20% for the cost of certain services and the plan could pay 80%.
Copay - The flat fee paid by the member when a medical service is received, i.e. $20 for a doctor's visit or $20 for a prescription.
In Network Provider - An in-network provider is a hospital, doctor, medical group, and/or other healthcare provider contracted to provide services to insurance company customers for a discounted fee.
Using these providers will lessen your medical expenses when using your benefits.
Out of Network Provider - An out of network provider is a hospital, doctor, medical group, or other healthcare provider who are not contracted to provide services to insurance company customers. Because the fees are not negotiated in advance with the insurance company, the provider can charge the member as much as they wish.
Out of Pocket Maximum - The maximum amount a member would have to pay out of their pocket for medical expenses for the year, with the exception of benefit premiums (which come out of your paycheck). Your out-of-pocket maximum includes your deductible, any coinsurance paid and all co-payments (medical and prescription drug).