Medical Benefits
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit https://www.aetna.com. The medical network is Aetna Choice POS II.
Carroll County Memorial Hospital* |
In-Network |
Out-of-Network |
|
|---|---|---|---|
Deductible |
$0/$0 |
$1,500/$4,500 |
$4,000/$12,000 |
Maximum Coinsurance and Medical |
0% after Deductible |
20% after Deductible |
50% after Deductible |
Total Out-of-Pocket-Medical |
$0/$0 |
$4,000/$9,500 |
Unlimited |
Physician Office Visits |
$25 |
$30 |
N/A |
Urgent Care |
N/A |
$30 |
N/A |
Specialist Services |
$30 |
$60 |
N/A |
All Other Office Services |
0% after Copay |
0% after Copay |
N/A |
Emergency Room |
$50 |
$250, then reg benefits |
$250, then reg benefits |
Diagnostic Testing: Regular X-Rays & Labs |
|||
Physician’s Office |
100% after Copay on |
100% after Copay on |
50% after Deductible |
Outpatient & Pre-Admission Testing |
100%, Deductible |
80% after Deductible |
50% after Deductible |
Inpatient |
100%, Deductible |
80% after Deductible |
50% after Deductible |
Hospital Services (Inpatient & Outpatient |
100%, Deductible |
80% after Deductible |
50% after Deductible |
Physician Services (Inpatient & Outpatient) |
100%, Deductible |
80% after Deductible |
50% after Deductible |
Physician Services (Office) |
|||
Physician Office Visits |
100% after Copay |
100% after Copay |
50% after Deductible |
Urgent Care |
Not Covered |
80% after Deductible |
50% after Deductible |
Surgery |
100%, Deductible |
80% after Deductible |
50% after Deductible |
Preventive Care |
|||
Routine Well Adult Care |
100%, Deductible |
100%, Deductible Waived |
Services Not Covered |
Routine Well Child Care |
100%, Deductible |
80% after Deductible |
Services Not Covered |
*includes Jefferson Medical Group and Reid Medical Clinic |
Prescription Benefits |
Network Pharmacies (30 days) |
Network Pharmacies (90 days) |
|---|---|---|
Oral Contraceptives under ACA |
$0 Copay |
$0 Copay |
Generic Drugs |
Greater of $10 or 25% |
Greater of $25 or 25% |
Preferred Brand Drugs |
Greater of $30 or 25% |
Greater of $75 or 25% |
Non-Preferred Brand Drugs |
Greater of $60 or 25% |
Greater of $150 or 25% |
Specialty Drugs (only thru Specialty |
25% of cost with maximum 30 day supply allowed per fill |
25% of cost with maximum 30 day supply allowed per fill |
Out-of-Pocket Maximum |
$3,900 per Individual/$6,300 per Family |
$3,900 per Individual/$6,300 per Family |
Per Pay Period Cost |
With Wellness* |
Without Wellness |
|---|---|---|
Employee Only |
$32.40 |
$194.21 |
Employee + Spouse |
$121.42 |
$356.04 |
Employee + Child(ren) |
$158.63 |
$320.44 |
Employee + Family |
$312.10 |
$546.72 |
*The premium reduction an employee or spouse may receive will vary based on the number of points earned in the |