Page 4 - 2025 US Neuro LLC - Benefit Guide

Medical Option:

Meritain Health (Aetna POS II)

2025 H.S.A Bronze Silver Gold We offer our full-time employees and
Effective 7-1-25 Plan Plan Plan Plan
Bi-Weekly (26) Per Pay Period their eligible dependents coverage.
Children can join or remain on a parent’s
Employee Only $ 72.56 $ 60.81 $ 75.93 $ 86.95 medical plan until age 26. When a child

Employee + Spouse $193.57 $170.08 $200.32 $222.36 turns 26, they will lose medical coverage
on the last day of their birth month.
Employee + Child(ren) $160.55 $141.64 $165.98 $183.72
Employee + Family $303.27 $269.32 $313.02 $344.87

H.S.A Plan Bronze Plan Silver Plan Gold Plan
Brief Member
In-Network Summary $5,000 Deductible $5,000 Deductible $3,000 Deductible $2,000 Deductible
IN & OUT of NEWORK IN and OUT of NETWORK IN and OUT of NEWORK IN and OUT of NEWORK
Higher cost option with FIRST Dollar
Difference Between HSA-Compatible High Deductible Lower cost option with FIRST Dollar cover- Mid COST option with FIRST Dollar cover- coverage with Copays (CYD Waived) on
age with Copays (CYD Waived) on MOST
age with Copays (CYD Waived) on MOST
Plans Health Plans (HDHP) Day to Day Services Higher CYD / OOP Day to Day Services. Mid-range CYD / OOP MOST Day to Day Services. Lower CYD /
OOP
Network Aetna Choice POS II Aetna Choice POS II Aetna Choice POS II Aetna Choice POS II
(CYD) Calendar Year Individual: $5,000 Individual: $5,000 Individual: $3,000 Individual: $2,000
Family: $10,000 Family: $10,000 Family: $6,000 Family: $4,000
Deductible (Jan .1st to Dec. 31st)
Coinsurance Carrier: 100% Carrier: 80% Carrier: 80% Carrier: 80%
(After CYD) Member: 0% Member: 20% Member: 20% Member: 20%
Annual (OOP) Out of Individual: $5,000 Individual: $8,150 Individual: $6,000 Individual: $5,000
Pocket Maximum Family: $10,000 Family: $16,300 Family: $12,000 Family: $10,000
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(PCP) Primary Care Under Age 19: $30 Copay ge 19: $30 Copay Under Age 19: $25 Copay
Physician 0% after CYD Over Age 19: $30 Copay Over Age 19: $30 Copay Over Age 19: $25 Copay
Specialist Physicians 0% after CYD $60 Copay $60 Copay $50Copay
and Providers
Dr. Consultation Member Pays $56 Cost $0 Copay $0 Copay $0 Copay
Virtual Visits Per Consultation
Basic: Lab, X-Rays & Basic: Covered 100%
Diagnostic Basic: Covered 100% CYD Waived Basic: Covered 100% Basic: Covered 100%
Major: Diagnostic & CYD Waived Major: $200 Copay/$100(USIN) CYD Waived CYD Waived
Imaging *US Imaging Major: 0% after CYD See Page 8 For Info Major: $200 Copay/$100(USIN) Major: $200 Copay/$100(USIN)
Network® (USIN) See Page 8 For Info See Page 8 For Info
See Page 8 for Info
Annual Preventive
Covered 100% Covered 100% Covered 100% Covered 100%
Care Certain Rx are (No CYD, Coins. Copay) (No CYD, Coins. Copay) (No CYD, Coins. Copay) (No CYD, Coins. Copay)
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Urgent Care 0% after CYD
(CYD apply to other services) (CYD apply to other services) (CYD apply to other services)
$300 Copay + 20% Coins $300 Copay + 20% Coins $300 Copay + 20% Coins
Emergency Room 0% after CYD
(NO CYD) (NO CYD) (NO CYD)
Hospitalization: 0% after CYD 20% after CYD 20% after CYD 20% after CYD
In / Outpatient
Prescription Drugs - 31 Tier 1 $0 Copay r 1 $0 Copay r 1 $0 Copay
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Day Supply Retail 0% after CYD Tier 2 $10 Copay r 2 $10 Copay r 2 $10 Copay
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90 Day Supply Mail Tier 3 $50 Copay Tier 3 $50 Copay Tier 3 $50 Copay
Order 2.5 Times Retail Tier 4 $100 Copay Tier 4 $100 Copay Tier 4 $100 Copay
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