2021 Changes to your prescription drug coverage (PDF) ». 1-800-837-2386 . The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services. Coverage for: EE Only; EE+ Family | Plan Type: POS. If you choose to get medical service outside the provider’s network, then you will have to handle the cost yourself. Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services . plan. Coverage Period: 01/01/2021- 12/31/2021 . Aetna Medicare Choice II Plan (PPO) has a monthly drug premium of $15.00 and a $300.0 drug deductible. Coverage for: Individual + Family | Plan Type: POS. Offering you a little more flexibility overall. The Summary of Benefits and Coverage (SBC) document will help you choose a health . Coverage for: EE Only; EE+ Family | Plan Type: POS. 8��ي0r�X| `Q8*����@��s�+P�(��E�'�颋�["� The SBC shows you how you and the plan would share the cost for covered health care services. If you decide to sign up for Aetna Medicare Choice II Plan (PPO) you still retain Original Medicare. h�bbd```b``Q�kA$�R�� Aetna Medicare Choice II Plan (PPO) is a Local PPO. If you are currently enrolled in Aetna Legacy, give Yale Health or the Aetna Smart Care a try. Notes: Data are subject to change as contracts are finalized. 2021 Aetna Standard Preventive Medicine List (PDF) ». It provides the highest level of benefits. h�b```f``:�����[� Ā B@16� ��FD���%"v,6�,��� ���e�]��n��$O��|ec�&4�; Medicare Advantage plans have different coverage options. 2021 Aetna Pharmacy Drug Guide Aetna Standard Plan (PDF) ». Or Call Aetna Medicare Choice II Plan (PPO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Provider office visits are covered at 100% after copays. The Summary of Benefits and Coverage (SBC) document will help you choose a health . The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Sun 9am-6pm EST, (Click county to compare all available Advantage plans). The Aetna Medicare Choice II Plan (PPO) has a monthly premium of $15.00 and has an in-network Maximum Out-of-Pocket limit of $7,550 (MOOP). Coverage Period: 01/01/2021- 12/31/2021 . The SBC shows you how you and the plan would share This plan includes additional Medicare prescription drug (Part-D) coverage. The Summary of Benefits and Coverage (SBC) document will help you choose a health . Employer sponsored 800 series and plans under sanction are excluded. Coverage for: EE Only; EE+ Family | Plan Type: POS. BENEFITS PROGRAM : Aetna Choice® POS II - HDHP. Includes 2021 approved contracts. plan. %%EOF V1.1.21 1 of 9 Proprietary Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Members Health Plan NJ Plan R: HDHP-HSA Compatible: Aetna Choice® POS II Coverage Period: 1/01/2021-12/31/2021 The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums. 16 HDHP Aetna Choice POS II (PPO) 19 Health Savings Account (HSA) 21 Health Reimbursement Arrangement (HRA) 22 Dental Plan 23 Vision Plan Life & Disability 24 ... outlines steps to change your coverage elections for 2021, and informs you of where you can receive more information if you have questions. $7,550 out of pocket. ® Aetna Open Access Elect Choice ® Aetna Open Access Managed Choice ® EPO ® ®Open Choice PPO . 401247-360696-342010 1 of 7 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services RICE UNIVERSITY : Aetna Choice® POS II Coverage Period: 07/01/2020-06/30/2021 And the payment is $3.70 for 75% low income subsidy $7.50 for 50% and $11.20 for 25%. FLOUR BLUFF INDEPENDENT SCHOOL DISTRICT: Aetna Choice® POS II – 3000 Savings Choice Narrow Network Plan Coverage Period: 01/01/2021 - 08/31/2021 Coverage for: Individual + Family | Plan Type: POS The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). WELD COUNTY GOVERNMENT : Aetna HealthFund® Aetna Choice® POS II - HRA Plan. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Aetna Medicare and not Original Medicare. 2286 0 obj <> endobj The SBC shows you how you and the plan would share the cost for covered health care services. Accident Coverage is paid for by the university **Closed to new enrollment. Aetna Choice® POS II - Best Choice PPO Coverage Period: 01/01/2021-12/31/2021 Coverage for: Individual + Family | Plan Type: POS The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Keep in mind that if your physician is not part of the plan's network, … With Medicare Advantage Plans you are always covered for urgently needed and emergency care. The Summary of Benefits and Coverage (SBC) document will help you choose a health . The SBC shows you how you and the plan would share the cost for covered health care services. ���lE$Y�:|q�i����?q��ʾ�j�2�M�8�㤴g��+�ʲ�N����CQ�‘㜯����[������� �Đ�1�r R�LI�H�bF!�0 r�. ” The Aetna Choice POS II HSA combines traditional medical coverage with a tax-free health savings account and consists of these key components: You must pay the deductible before the plan begins to pay. 1-855-778-4180 When you use health care providers who are part of the Aetna Choice POS II network: Preventive care services are covered at 100%. You generally are also responsible for paying the Part B premium. Or Call www.aetna.com 2311 0 obj <>/Filter/FlateDecode/ID[<2A197C427723D34C9D485BC59443D0A4>]/Index[2286 39]/Info 2285 0 R/Length 120/Prev 895093/Root 2287 0 R/Size 2325/Type/XRef/W[1 3 1]>>stream 2324 0 obj <>stream Effective Date: 01-01-2021 Aetna Choice® POS II – Basic Option PLAN DESIGN & BENEFIT OVERVIEW ADMINISTERED BY AETNA LIFE INSURANCE COMPANY Page 1 Proprietary BENEFIT IN-NETWORK OUT-OF-NETWORK Medical Deductible $0 $100 per person per calendar year Medical and Hospital combined (except for a per person per calendar year $50 Aetna Medicare works with Medicare to provide significant coverage beyond Part A and Part B benefits. Coverage for: Individual + Family | Plan Type: POS 401247-360696-342011 1 of 7 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services RICE UNIVERSITY : Aetna Choice® POS II - HDHP Coverage Period: 07/01/2020-06/30/2021 Coverage Period: 01/01/2021-12/31/2021 Data as of September 9, 2020. Coverage Period: 01/01/2021- 12/31/2021 . Aetna offers health insurance, as well as dental, vision and other plans, to meet the needs of individuals and families, employers, health care providers and insurance agents/brokers. Coverage Period: 01/01/2021-12/31/2021. endstream endobj startxref Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services SCHOOL EMPLOYEES RETIREMENT SYSTEM OF OHIO : Aetna Choice® POS II - HCPII Coverage Period: 01/01/2021-12/31/2021 . The Part D Total Premium is $15.00. Plus you receive all of the benefits of Original Medicare from Aetna Medicare except hospice care. This plan offers both in-network and out-of-network benefits; however, the plan’s reimbursement is higher when you use an in-network provider. The Summary of Benefits and Coverage (SBC) document will help you choose a health . Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services . 1-855-778-4180 2021 Summary of Benefits and Coverage (PDF) ». The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Aetna Medicare above and beyond the standard PDP benefits. This plan allows you to use an in-network provider or an out-of- A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. Selecting this plan will give you the freedom to continue seeing your current doctor if your doctor isn't part of the Aetna Choice POS II network. Out-of-Network Providers Each tier will have a defined copay that you must pay to receive the drug. 1 Preface The medical benefits plan described in this Booklet is a benefit plan of the Employer.These benefits are not insured with Aetna or any of its affiliates, but will be paid from the Employer's funds.Aetna and its HMO affiliates will provide certain administrative services under the Aetna medical benefits plan. Other: While the Federal Patient Protection and Affordable Care Act generally mandates coverage of dependent children up to age 26, your plan may allow coverage beyond age 26. 1 of 8 Carroll County Public Schools – Aetna POS Plan Coverage Period: 01/01/202 1 – 12/31/2021 Summary of Benefits and Coverage: What this Plan Covers & What it CostsCoverage for: IND/P+1C/EE+SP/FAM | Plan Type: POS Questions: Call . plan. The Summary of Benefits and Coverage (SBC) document will help you choose a health . plan . This can be a extremely nice safety net. Aetna Choice POS II The Aetna Choice POS II Plan is a network plan that gives you the freedom to select any licensed provider when you need care. 2020/2021 Cost of Coverage The following chart shows your cost per pay period* for medical, dental and vision coverage: Employee Only Employee + Spouse/DP Employee + Child(ren) Family MEDICAL Non-Tobacco User Aetna HealthFund HSA $29.69 $64.95 $53.82 $90.01 Aetna Choice POS II $97.63 $300.22 $178.02 $383.54 The Summary of Benefits and Coverage (SBC) document will help you choose a health … COBRA OPEN ENROLLMENT 2021 MEDICAL (cont.) Coverage Period: 01/01/2021- 12/31/2021 . Aetna Medicare Choice II Plan (PPO) H3288-002 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Texas. Coverage Period: 01/01/2021- 12/31/2021 . 2021 Chronic Medicine List (PDF) ». 0 Additionally, you can choose a plan that has your drugs listed at a lower price. This Aetna Medicare plan does offer additional coverage through the gap. Aetna Claims Form – Flexplan (POS) Non-Network; Medical Plans. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate. Health benefits and health insurance plans contain exclusions and limitations. Sat 9am-9pm EST. plan. Most other services are covered at 80% after a deductible; you pay 20% of the covered charges. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. T-MOBILE USA, INC. : Aetna Choice® POS II - HRA. The Aetna Medicare Choice II Plan (PPO) has a monthly premium of $15.00 and has an in-network Maximum Out-of-Pocket limit … Aetna Choice® POS II - HDHP (High Deductible Health Plan) Monthly Premium Effective 1/1/21 Single $554.84 Employee & Spouse $1165.17 Employee & Children $832.26 Family $1720.01 Aetna Choice HDHP plan provides nationwide coverage. Coverage for: All Tiers| Plan Type: POS. BENEFITS PROGRAM : Aetna Choice® POS II - Medical Plan. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit. This plan is the cheapest among the options but its coverage is also limited. The standard is the HMO. (combined amount plus your deductible) You will be in the coverage gap. V1.1.21 1 of 9 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Members Health Plan NJ Plan B: Open Access POS Network Plan: Aetna Choice® POS II Coverage Period: 01/01/2021-12/31/2021 THE DOW CHEMICAL COMPANY : Aetna Choice® POS II - Map Opt 2 - HDHP. This plan includes additional Medicare prescription drug (Part-D) coverage. Medicaid and the Children’s Health Insurance Program (CHIP) Offer Free Or Low-Cost Health Coverage To Children And Families; Memorial Hermann ACO; CDHP: Aetna Consumer Directed Health Plan (Open Access) HMO (Aetna Select) Choice POS II (Open Access) Aetna Out-of-Area (OOA) PPO CORNELL UNIVERSITY: Aetna Choice® POS II -HSA. Coverage for: Individual + Family | Plan Type: POS. Drugs in lower tiers will usually cost less than those in higher tiers. The SBC shows you how you and the plan would share Disclaimer | Contacts Copyright © 2021 Medicare Help, State Health Insurance Assistance Programs SHIP. More information about the Open Access Plan: … The path to healthy starts here. Aetna agrees with the Employer to provide … Aetna Medicare Choice II Plan (PPO) H3288-002 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Texas. Mon-Fri 8am-9pm EST Aetna Choice® POS II Medical Plan Department of Defense Nonappropriated Fund Health Benefits Program Summary of Benefits effective January 1, 2021 Plan Provisions Preferred (In Network) Non-Preferred (Out of Network)* Calendar Year Deductible 1 Employee only $500 $1,500 Family (employee + one or more dependents) $1,500 $4,500 Out-of-Pocket Maximum In 2021 once you and your plan provider have spent $4130 on covered drugs. Aetna Medicare plan charges a $0 Part-C premium. 2021 HCR Preventive Care Drug List (PDF) ». If after a one-year trial (2021), you are not satisfied, you can switch back to Legacy Aetna Choice POS II during next year’s Annual Benefits Enrollment period. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. AETNA POS Aetna’s Choice POS plans are open access plans and do not require referrals. Coverage for: EE Only; EE+ Family | Plan Type: POS. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. SALESFORCE.COM, INC. : Aetna Choice® POS II - PPO. That is, you will only be covered if you go to Aetna’s network. Choice POS II Medical Plan and Traditional Choice Medical Plan Booklet Prepared exclusively for: Employer: School Employees Retirement System of Ohio (SERS) Contract number: 737374 Booklet 1 Plan effective date: January 1, 2021 Plan issue date: August 12, 2020 Third Party Administrative Services provided by Aetna Life Insurance Company fg�I��f'�H�J��� �}:�m f�����1X�D�I�ޫ vx�0��V6�m#�dd���b�8j��b`�����K�+@� -i Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services . THIS PLAN ENDS ON DECEMBER 31, 2020 With Aetna Choice POS II plan, you may select any physicians and hospitals in and outside the plan's network. Coverage Period: 01/01/2021- 12/31/2021 . Source: CMS. This Aetna Medicare plan offers a $15.00 Part D Basic Premium that is not below the regional benchmark. Mon-Sat 8am-11pm EST Downloads. or visit us at . The Aetna Medicare Choice II Plan (PPO) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. %PDF-1.6 %���� AETNA CHOICE POINT OF SERVICE (POS) II PLAN In a point-of-service (POS) plan, you do not have to select a primary care physician or obtain a referral to see a specialist, although there are advantages to doing so. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. 2 Proprietary Choice POS II Medical Plan Booklet Prepared exclusively for: Employer: The Dow Chemical Company Contract number: 607490 Control number: 109190 Booklet 4 Plan effective date: January 1, 2021 Plan issue date: October 5, 2020 Third Party Administrative Services provided by Aetna Life Insurance Company This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. This means that if you get sick or need a high cost procedure the co-pays are capped once you pay Aetna Choice POS II Health Savings Account (HSA) The Aetna Choice POS II Health Savings Account (HSA) is a high-deductible health plan, or “ HDHP. plan. Traditional Choice ® Aexcel® Aexcel® Plus. Aetna’s Choice POS II plans includes out of network coverage should you need to seek treatment / services from a provider that is not local, or does not participate in the Aetna Choice POS II network. Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services: Aetna Choice® POS II - Plan G Suffix 18 - YPBA. Give Yale health or the Aetna Smart care a try help you choose to get medical service outside the ’! Co-Payments and coverage of non-Part D drugs SBC ) document will help you choose a health Non-Network ; plans... ; medical plans Standard Preventive Medicine List ( PDF ) » Advantage Plan you currently... 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