Medical
Medical coverage offers healthcare protection for you and your family. With the Aetna HDHP, you may visit any medical provider you choose, but in-network providers offer the highest level of benefits and lower out-of-pocket costs. Network providers charge members reduced, contracted fees instead of their typical fees. Providers outside the plan’s network set their own rates, so you may be responsible for the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits. With the Aetna EPO plan and the three HMO plans, you must visit an in-network provider in order to obtain coverage, unless it is for a true medical emergency.
Preventive Care – like physical exams, flu shots, and screenings – is always covered 100% when you use in-network providers. The main difference between the plans is the amount you’ll pay in premiums each pay period and the cost of care when you need it.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums – the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the calendar.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Aetna HDHP
Plan Information
Plan Name: Aetna HDHP
Policy Number: ASC-0621535
Effective Date: 03/01/2025
Provider Network: Aetna
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,250/$5,000
Out-of-Pocket Max (Individual/Family)
$4,500/$6,750
Preventive Care
$0
Primary Care Visit
20% after deductible
Specialist Visit
20% after deductible
Urgent Care
20% after deductible
Emergency Room
20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 after deductible
Preferred Brand
$40 after deductible
Non-Preferred Brand
$70 after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 after deductible
Preferred Brand
$80 after deductible
Non-Preferred Brand
$140 after deductible
Out-of-Network
Deductible (Individual/Family)
$4,000/$8,000
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
50% after deductible
Primary Care Visit
50% after deductible
Specialist Visit
50% after deductible
Urgent Care
50% after deductible
Emergency Room
20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Plan Documents
Contact Information
Aetna EPO
Plan Information
Plan Name: Aetna EPO
Policy Number: ASC-0621535
Effective Date: 03/01/2025
Provider Network: Aetna
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$750/$1,500
Out-of-Pocket Max (Individual/Family)
$3,250/$6,500
Preventive Care
$0
Primary Care Visit
$25 copay
Specialist Visit
$40 copay
Urgent Care
$50 copay
Emergency Room
$250 copay
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$40 copay
Non-Preferred Brand
$70 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$80 copay
Non-Preferred Brand
$140 copay
Plan Documents
Contact Information
Kaiser HMO (California)
Plan Information
Plan Name: Kaiser HMO (California)
Policy Number: 600771 (No. Cal); 226242 (So. Cal)
Effective Date: 03/01/2025
Provider Network: Kaiser
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$1,500/$3,000
Preventive Care
$0
Primary Care Visit
$25 copay
Specialist Visit
$25 copay
Urgent Care
$25 copay
Emergency Room
$100 copay
Retail Rx (Up to 30-Day Supply)
Generic
$15 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$30 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$60 copay
Plan Documents
Contact Information
Kaiser HMO (Washington, DC)
Plan Information
Plan Name: Kaiser HMO (Washington, DC)
Policy Number: 14880
Effective Date: 03/01/2025
Provider Network: Kaiser
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$2,000/$4,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$30 copay
Urgent Care
$30 copay
Emergency Room
$200 copay
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$120 copay
Plan Documents
Contact Information
CDPHP HMO (Albany)
Plan Information
Plan Name: CDPHP HMO (Albany)
Policy Number: 10005140
Effective Date: 12/01/2024
Provider Network: CDPHP
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$7,350/$14,700
Preventive Care
$0
Primary Care Visit
$30 copay
Specialist Visit
$50 copay
Urgent Care
$35 copay
Emergency Room
$100 copay
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$25 copay
Preferred Brand
$75 copay
Non-Preferred Brand
$125 copay