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Learn about the benefits of Aetna's comprehensive health care plan, including the choice between POS and HMO coverage, payroll deduction amounts, and how to qualify for coverage changes. Explore the benefits of POS Point of Service and HMO plans, as well as the pharmacy benefits, employee assistance program, dental coverage, and flexible spending accounts. Take immediate next steps in reviewing plan summaries, making benefit elections, and designating beneficiaries.
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Comprehensive Health Care Plan • Choice of POS or HMO or no coverage • Payroll deduction amounts: • Qualified change in status - report within 30 days in order to have coverage
POS - Point of Service • Aetna Open Access Managed Choice POS • Network of participating providers • Negotiated fees • No primary care physician required (no gatekeeper) • No referrals
POS - Point of Service - cont’d • Benefits available for out-of-network care • Cost sharing • In-network provider - co-payments and coinsurance • Out-of-network provider - deductible and coinsurance
HMO - Health Maintenance Organization • Aetna Choice POS • Participating providers only • Primary Care Physician (PCP) required • Referrals not required • Lower out-of-network benefits • Cost sharing: • In-network care: co-payments • Out-of-network: deductible and coinsurance
POS - Pharmacy Benefits • Aetna Open Access • Pre-certification may be required • Retail (up to a 30 day supply) • $15 copay for generic drugs • $25 copay for formulary brand-name drugs • $40 copay for non-formulary drugs • Mail Order (up to a 31-90 day supply) • $30 copay for generic drugs • $50 copay for brand-name drugs • $80 for non-formulary brand-name drugs
HMO - Pharmacy Benefits • Aetna Choice • Pre-certification may be required • Retail (up to a 30 day supply at participating pharmacies) • $15 copay for generic drugs • $35 copay for formulary brand-name drugs • $50 copay for non-formulary drugs • Mail Order (up to a 31-90 day supply) • $30 copay for generic drugs • $70 copay for brand-name drugs • $100 for non-formulary brand-name drugs
Employee Assistance Program • Aetna EAP • Counseling sessions (up to face-to-face visits per counselable issue, per year • Work/life services (legal, financial) • Personal services (health & wellness, daily life) • Complementary & alternative medicine resources (discounts on fitness centers, activities, and magazines) • 24-hour telephonic access: 1-800-AETNA-EAP • Web access: www.aetnaeap.com • Program: Aetna EAP • Company ID: MYMEIEAP
Vision One Discount Program • Available to all Aetna participants • Eyewear discount program administered by Aetna • Find participating providers - www.aetnanavigator.com
Dental - PPO • Aetna Dental PPO • Individual calendar year deductible • $50 for individual • $150 for family • Preventative care benefit = 100% • Minor restorative care: 80% after deductible • Major restorative care: 50% after deductible • Annual benefit maximum: $2,000 • Orthodontia: • 50% after deductible • Only for children - must apply before age 20 • Lifetime maximum: $2,500
Dental - DMO • Aetna Dental DMO • Primary Care Dentist directs care • Diagnostic & preventative care benefit = 100% • Restorative care & oral surgery = fixed prices • Orthodontia: • Screening Exam = $30 • Diagnostic Records = $150 • Adolescent Treatment = $1,945 • Adult Treatment = not covered • Orthodontic Retention = $275
Flexible Spending Accounts • Set aside pre-tax dollars • Lower your taxable income • Two separate accounts - one for Health Care, one for Dependent Care • Must enroll within 30 days of hire date • Submit claims for reimbursement - processed by ADP (Automated Data Processing) • Use it or lose it • Changes during the year only within 30 days of a qualifying life event
FSA - Cont’d • Health Care Account • $5,000 calendar year maximum • Eligible expenses include co-payments, coinsurance, deductibles, and eligible over-the-counter drugs • Health care premiums are not eligible expenses • Dependent Care Account • Dependent Care - child care for dependent(s) under 13 while parents work or attend school full time • Care for incapacitated/elderly adults you claim on taxes • $5,000 calendar year maximum (may be less for highly-compensated associates)
Life Insurance • Non-contributory Life • Company pays for life insurance of 3 times annual eligible earnings • Contributory Life • Associate may elect to pay for additional life insurance of up to 2 times annual eligible earnings • Apply within 30 days of hire, no statement of health necessary
Retirement Program Company 6% 6% 12% Associate 6% Match 401(k) Vanguard Company contribution based on 100% of base pay Maximum annual contributions subject to IRS limits.
Resources • Aetna Benefits: • http://www.aetnanavigator.com • POS Member Services: 1-888-632-3862 • POS Pre-certification: 1-800-962-6842 • HMO Member Services: 1-877-402-8742 • Dental Member Services: 1-877-238-6200 • Prescription Line for Providers: 1-800-238-6279 • Vision One Customer Service: 1-800-793-8616 • MEI Retirement Plan: • http://www.vanguard.com • 1-800-523-1188 • Flexible Spending Accounts: • http://www.flexdirect.adp.com • 1-800-252-6277
Immediate Next Steps • Review your plan summaries • Make benefits elections for medical, dental, flexible spending, and life insurance coverages • Designate life insurance and retirement plan beneficiaries