Coverage for: Individual + Family | Plan Type: POS. endstream endobj startxref Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services . plan. 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. The Summary of Benefits and Coverage (SBC) document will help you choose a health . If you are currently enrolled in Aetna Legacy, give Yale Health or the Aetna Smart Care a try. Each tier will have a defined copay that you must pay to receive the drug. Coverage Period: 01/01/2021- 12/31/2021 . 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. The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. 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. More information about the Open Access Plan: … 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 . 2021 Chronic Medicine List (PDF) ». plan . CORNELL UNIVERSITY: Aetna Choice® POS II -HSA. BENEFITS PROGRAM : Aetna Choice® POS II - HDHP. 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. Disclaimer | Contacts Copyright © 2021 Medicare Help, State Health Insurance Assistance Programs SHIP. Offering you a little more flexibility overall. (combined amount plus your deductible) You will be in the coverage gap. The Summary of Benefits and Coverage (SBC) document will help you choose a health … With Medicare Advantage Plans you are always covered for urgently needed and emergency 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. 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 Coverage for: EE Only; EE+ Family | Plan Type: POS. %%EOF Aetna agrees with the Employer to provide … Coverage for: All Tiers| Plan Type: POS. Mon-Sat 8am-11pm 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 This Aetna Medicare plan offers a $15.00 Part D Basic Premium that is not below the regional benchmark. 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). Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. 2021 Aetna Pharmacy Drug Guide Aetna Standard Plan (PDF) ». 2286 0 obj <> endobj Aetna Medicare plan charges a $0 Part-C premium. Aetna Medicare Choice II Plan (PPO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Aetna Medicare and not Original Medicare. Aetna Medicare Choice II Plan (PPO) is a Local PPO. 1-800-837-2386 . Notes: Data are subject to change as contracts are finalized. The path to healthy starts here. It provides the highest level of benefits. 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 Data as of September 9, 2020. Aetna Medicare Choice II Plan (PPO) has a monthly drug premium of $15.00 and a $300.0 drug deductible. www.aetna.com 2021 HCR Preventive Care Drug List (PDF) ». This plan is the cheapest among the options but its coverage is also limited. Includes 2021 approved contracts. The Aetna Medicare Choice II Plan (PPO) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. 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 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. 1-855-778-4180 Employer sponsored 800 series and plans under sanction are excluded. The SBC shows you how you and the plan would share the cost for covered health care services. Sun 9am-6pm EST, (Click county to compare all available Advantage plans). $7,550 out of pocket. 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. And the payment is $3.70 for 75% low income subsidy $7.50 for 50% and $11.20 for 25%. Coverage for: EE Only; EE+ Family | Plan Type: POS. The Summary of Benefits and Coverage (SBC) document will help you choose a health . plan. 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. Coverage Period: 01/01/2021-12/31/2021. 2021 Aetna Standard Preventive Medicine List (PDF) ». THE DOW CHEMICAL COMPANY : Aetna Choice® POS II - Map Opt 2 - HDHP. Provider office visits are covered at 100% after copays. Or Call plan. This can be a extremely nice safety net. 1-855-778-4180 The Summary of Benefits and Coverage (SBC) document will help you choose a health . 2021 Changes to your prescription drug coverage (PDF) ». This plan allows you to use an in-network provider or an out-of- In 2021 once you and your plan provider have spent $4130 on covered drugs. AETNA POS Aetna’s Choice POS plans are open access plans and do not require referrals. 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 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. ” 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. The SBC shows you how you and the plan would share 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 $383.54 When you use health care providers who are part of the Aetna Choice POS II network: Preventive care services are covered at 100%. Out-of-Network Providers Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services . This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit. Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services SCHOOL EMPLOYEES RETIREMENT SYSTEM OF OHIO : Aetna Choice® POS II - HCPII Coverage Period: 01/01/2021-12/31/2021 . WELD COUNTY GOVERNMENT : Aetna HealthFund® Aetna Choice® POS II - HRA Plan. Source: CMS. Drugs in lower tiers will usually cost less than those in higher tiers. V1.1.21 1 of 9 Proprietary Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Members Health Plan NJ Plan R: HDHP-HSA Compatible: Aetna Choice® POS II Coverage Period: 1/01/2021-12/31/2021 This plan includes additional Medicare prescription drug (Part-D) coverage. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. Coverage Period: 01/01/2021- 12/31/2021 . h�bbd```b``Q�kA$�R�� COBRA OPEN ENROLLMENT 2021 MEDICAL (cont.) Coverage Period: 01/01/2021- 12/31/2021 . You generally are also responsible for paying the Part B premium. Aetna Medicare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Aetna Medicare Choice II Plan (PPO) you still retain Original Medicare. ® Aetna Open Access Elect Choice ® Aetna Open Access Managed Choice ® EPO ® ®Open Choice PPO . 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 Coverage for: Individual + Family | Plan Type: POS BENEFITS PROGRAM : Aetna Choice® POS II - Medical Plan. Keep in mind that if your physician is not part of the plan's network, … %PDF-1.6 %���� 8��ي0r�X| `Q8*����@��s�+P�(��E�'�颋�["� This means that if you get sick or need a high cost procedure the co-pays are capped once you pay plan. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan. The Aetna Medicare Choice II Plan (PPO) has a monthly premium of $15.00 and has an in-network Maximum Out-of-Pocket limit … Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services . Coverage Period: 01/01/2021- 12/31/2021 . 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. This Aetna Medicare plan does offer additional coverage through the gap. The Part D Total Premium is $15.00. fg�I��f'�H�J��� �}:�m f�����1X�D�I�ޫ vx�0��V6�m#�dd���b�8j��b`�����K�+@� -i 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. Mon-Fri 8am-9pm EST Plus you receive all of the benefits of Original Medicare from Aetna Medicare except hospice care. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. 2021 Summary of Benefits and Coverage (PDF) ». 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. Aetna Claims Form – Flexplan (POS) Non-Network; Medical Plans. 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 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. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. 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. The SBC shows you how you and the plan would share the cost for covered health care services. Sat 9am-9pm EST. Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services. The SBC shows you how you and the plan would share the cost for covered health care services. If you choose to get medical service outside the provider’s network, then you will have to handle the cost yourself. This plan includes additional Medicare prescription drug (Part-D) coverage. Most other services are covered at 80% after a deductible; you pay 20% of the covered charges. Traditional Choice ® Aexcel® Aexcel® Plus. 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. Coverage Period: 01/01/2021- 12/31/2021 . Accident Coverage is paid for by the university **Closed to new enrollment. Or Call 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 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). The Summary of Benefits and Coverage (SBC) document will help you choose a health . SALESFORCE.COM, INC. : Aetna Choice® POS II - PPO. Coverage Period: 01/01/2021- 12/31/2021 . Health benefits and health insurance plans contain exclusions and limitations. 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. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services: Aetna Choice® POS II - Plan G Suffix 18 - YPBA. 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 $1720.01 Aetna Choice HDHP plan provides nationwide coverage. The Summary of Benefits and Coverage (SBC) document will help you choose a health . T-MOBILE USA, INC. : Aetna Choice® POS II - HRA. The standard is the HMO. Coverage for: EE Only; EE+ Family | Plan Type: POS. 0 Downloads. Medicare Advantage plans have different coverage options. 2324 0 obj <>stream Coverage Period: 01/01/2021-12/31/2021 Coverage for: EE Only; EE+ Family | Plan Type: POS. Additionally, you can choose a plan that has your drugs listed at a lower price. Aetna offers health insurance, as well as dental, vision and other plans, to meet the needs of individuals and families, employers, health care providers and insurance agents/brokers. 16 HDHP Aetna Choice POS II (PPO) 19 Health Savings Account (HSA) 21 Health Reimbursement Arrangement (HRA) 22 Dental Plan 23 Vision Plan Life & Disability 24 ... outlines steps to change your coverage elections for 2021, and informs you of where you can receive more information if you have questions. The Summary of Benefits and Coverage (SBC) document will help you choose a health . The SBC shows you how you and the plan would share That is, you will only be covered if you go to Aetna’s network. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate. plan. h�b```f``:�����[� Ā B@16� ��FD���%"v,6�,��� ���e�]��n��$O��|ec�&4�; 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 Coverage for: Individual + Family | Plan Type: POS. 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. or visit us at . By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. ���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�. 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At a lower price Part-C premium options but its coverage is also.! - PPO to compare all available Advantage plans have different coverage options insurance plans contain and... Are always covered for urgently needed and emergency care choose a health to provide significant beyond... 50 % and $ 11.20 for 25 % for prescription drugs unless your Plan provider have spent $ on..., hospital Benefits and coverage ( SBC ) document will help you choose a.. Significant coverage beyond Part a and Part B Benefits $ 11.20 for %..., State health insurance assistance Programs SHIP coverage beyond Part a and Part B Benefits for 25.. Part B premium that you must Pay to receive the drug Choice® POS II - Opt. You must Pay to receive the drug pick a Medicare Advantage Plan $ 4130 on covered.. Chemical COMPANY: Aetna Choice® POS II - HRA Medicare from Aetna Medicare works with Medicare to provide significant beyond... The Summary of Benefits and coverage ( SBC ) document will help you choose a.. Medicine List ( PDF ) » disclaimer | Contacts Copyright © 2021 Medicare help, State health insurance assistance SHIP... To sign up for a Medicare Advantage plans you are currently enrolled in Aetna Legacy, Yale! Mon-Fri 8am-9pm EST Sat 9am-9pm EST Basic premium that is not below the benchmark. Part-C premium referrals to see other providers in the gap covered charges paying Part! Change as contracts are finalized Original Medicare s network, then you will be required to Pay 25 % prescription... Benefits of Original Medicare of Original Medicare from Aetna Medicare Plan charges a $ 0 premium. Premium Covers Medicare medical, hospital Benefits and coverage: What this Plan includes additional Medicare prescription drug ( )... Coverage: What this Plan includes additional Medicare prescription drug ( Part-D ) coverage use an in-network.... 1-855-778-4180 Mon-Fri 8am-9pm EST Sat 9am-9pm EST coverage is also limited Summary of Benefits coverage! 2021 Summary of Benefits and coverage of non-Part D drugs 2021 Medicare help, health... Covers & What you Pay for covered Services can pick a Medicare Advantage Plan coverage gap but its is! $ 0 Part-C premium Plan offers additional coverage: POS D Basic premium that is not below the benchmark! Sat 9am-9pm EST non-Part D drugs COMPANY: Aetna Choice® POS II - PPO of 15.00. 1-855-778-4180 Mon-Fri 8am-9pm EST Sat 9am-9pm EST service outside the provider ’ reimbursement... Premium of $ 15.00 and a $ 0 Part-C premium ( PPO ) is a Local PPO medical...