Page 45 - OpenX 2022 Book of Benefits
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FAQ
FREQUENTLY ASKED QUESTIONS
Q: What are out-of-pocket maximums?
A: An out-of-pocket maximum is the most you will pay in out-of-pocket costs for covered health services
during the plan year.
Q: What is Coinsurance?
A: Coinsurance is the amount you might be asked to pay toward your total bill. The amount depends on
the type of service you’re getting. In-network services are typically reimbursed at a higher coinsurance
percentage.
Q: What is the deductible in the Consumer Driven Health Plan (CDHP), and how does it work?
A: The in-network individual deductible in the Consumer Driven Health Plan is $2,500, and the in-
network family deductible is $5,000. Your deductible must be met before the plan pays benefits. After
that, your coinsurance and prescription drug copays will apply and accumulate toward the plan’s out-
of-pocket maximum amount.
Q: Must I pay in full for the cost of the RX before I receive the advantage of co-pays in the CDHP Plan?
A: Yes. You are responsible for the full cost of the prescribed drug until your deductible is satisfied;
then retail co-pays for generic, brand and non-formulary drugs apply. The deductible is waived for
preventive drugs, and co-pays will apply. Preventive drugs include blood thinners, insulins, high blood
pressure medications, etc. Please refer to the plan documents for a complete list.
Q: What is the difference between the Health Care FSA and Limited-Purpose FSA? Can I sign up for both?
A: The Health Care FSA is available to employees enrolled in the Aetna or Kaiser Plan. The Limited-Purpose
FSA is available to employees enrolled in a Qualified Consumer Driven Health Plan (CDHP) and can be
used for dental and vision benefits only.
Q: When will I get my dental ID card?
A: Aetna will not automatically mail dental ID cards; instead, you may download them from Aetna’s
website/app, or contact Aetna directly to request an ID card.
Q: Where can I get my VSP ID card?
A: VSP does not issue ID cards for vision. You may download a generic ID card via www.VSP.com.
