Page 5 - Benefits Guide
P. 5
Health Care
Medical Coverage
Corizon Health provides three medical plan options to meet your individual and family needs.
You have a choice of three medical options provided through Aetna:
SMART Value High Deductible Health Plan (HDHP) with a Health Savings Account (HSA)
SMART Choice HDHP with an HSA (Note this plan includes a Corizon Health contribution to your HSA of $250 for employee only or $500 for all other tiers)
SMART Premium PPO Plan
Corizon Health’s medical plan options are administered by Aetna. All plans pay 100% of the cost for in-network preventive care, per the ACA guidelines. As always, you are encouraged to use in-network providers in order to receive the most value for your health care dollar. In-network providers agree to charge you negotiated rates and take part in quality assurance programs. You can find a provider online at www.aetna.com or by calling 1-800-938-0508.
Health Care
SMART Value HDHP with HSA*
SMART Choice HDHP with HSA*1
SMART Premium PPO Plan
In-Network
Out-of-Network
In-Network
Out-of-Network
In-Network
Out-of-Network
Deductible
(individual/family)
$5,000/$10,000
$10,000/$20,000
$2,700/$5,400
$5,400/$10,800
$1,250/$2,500
$2,500/$5,000
Out-of-Pocket Maximum (individual/family)
$6,650/$13,200
$13,200/$23,600
$5,000/$10,000
$10,000/$20,000
$4,000/$8,000
$8,000/$16,000
Coinsurance
70%
50%
80%
50%
80%
50%
Preventive Care
100% covered
50%**
100% covered
50%**
100% covered
50%**
PCP Office Visit
70%**
50%**
80%**
50%**
$25 copay
50%**
Specialist Office Visit
70%**
50%**
80%**
50%**
$50 copay
50%**
Diagnostic Test & Imaging - Free Standing
70%**
50%**
80%**
50%**
80%**
50%**
Diagnostic Test & Imaging - Inpatient/ Outpatient
60%**
50%**
70%**
50%**
70%**
50%**
Inpatient Hospital
70%**
50%**
Deductible then $250 copay per admit and 80%
Deductible then $500 copay per admit and 70%
$250 copay per admit, then 80%**
$500 copay per admit, then 50%**
Emergency Room
70%**
70%**
80%**
80%**
$250 copay per admit, then 80%**
$250 copay per admit, then 80%**
Urgent Care
70%**
50%**
80%**
50%**
$50 copay
50%**
*Medical and prescription drug deductible combined
**After deductible is met
1Includes HSA contribution of $250 for employee only or $500 for all other tiers
Going Out of Network?
Keep in mind: Out-of-network charges will not count toward your in-network annual deductible or out-of-pocket maximum. The same goes for in-network charges—they
will not count toward your out-of-network annual deductible or out-of-pocket maximum.
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