Page 10 - PageGroup | 2022 Benefits Guide | Temp Employees

BRIEF SUMMARY OF AETNA MEDICAL PLAN BENEFITS
BENEFIT HIGHLIGHTS
Deductible Coinsurance Out-of-Pocket Maximum Adult Preventative Care Primary Care Office Visit Copay Specialty Care Office Visit Copay Complex Imaging Hospital Outpatient Diagnostic X-Ray/Labs Hospital Inpatient Emergency Room Lifetime Maximum
Pharmacy Copays (Retail Store) Pharmacy Copays Mail Order
Minimum Value Base Plan
In-Network Coverage
$6,000 Individual / $12,000 Family
$6,450 Individual / $12,900 Family
Covered 100% after deductible
Covered 100% after deductible
Covered 100% after deductible
Out-of-Network Coverage
$7,000 Individual / $14,000 Family
$7,500 Individual / $15,000 Family
20% after deductible
20% after deductible
20% after deductible
Covered 100%
20%
No Charge
20% after deductible
Covered 100% after deductible
20% after deductible
Covered 100% after deductible
20% after deductible
Covered 100% after deductible
20% after deductible
Covered 100% after deductible
Unlimited
Unlimited
$20; after deductible Generic (Tier 1) $35; after deductible Brand (Tier 2) $50; after deductible Non-preferred Brand (Tier 3)
20% of submitted cost; after applicable copay
$40 / $70 / $100; after deductible
N/A
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2022 BENEFITS GUIDE
Please refer to full Summary of Benefits enclosure for fee schedule for more services.
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Minimum Value Base Plan
Regardless of what services are rendered under the Minimum Value plan, you are responsible for the full cost of Aetna’s negotiated contracted rate except for your annual well exams.
Once you spend $6,000 out of pocket on medical expenses in 2022, Aetna will pick up 100% of your charges except for prescription drugs (copayments are still required).
When you have hit the Out Of Pocket maximum and have spent in total $6,450 for medical services in 2022, Aetna is responsible for paying 100% of your medical expenses for the remainder of the year.
Please note that on top of the substantial upfront cost sharing at time of service, you are still responsible for paying monthly premiums.