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retiree-aetna-options

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Retiree Medical Plan

Below is a high-level summary of the 2019 Retiree Medical Plan, provided through Aetna, for non-Medicare eligible participants. See the summary plan description for details.

Plan Features

  Network Non-Network
Annual Deductible1    

Retiree Only

$400

$800

Retiree + One/Family

$800

$1,600
Out-of-Pocket (OOP) Maximum    

Retiree Only

$2,500

$5,000

Retiree + One/Family

$4,500

$9,000

1 If you were eligible for Medicare prior to January 1, 2000, refer to the Retiree Medical SPD for additional information

Covered Services

  What You Pay*
Office Visits Network Non-Network
  • Primary care physician
  • Specialist

20%

30%

Preventive Care    
  • Adult Routine Physical
  • Well Child Care (up to age 18)
  • Mammography
  • PSA Test
  • Cervical Cancer Screening
  • Colorectal Cancer Screening

100% covered,
no deductible

30%

Other Outpatient Services    
  • Acupuncture Therapy
    Max: 26 visits/year

20%

30%

  • Chiropractic Care
    Max: 26 visits/year

20%

30%

  • Hearing Aids
    Max: $2,500 every 3 years

20%

30%

  • Infertility
    Lifetime limit: $20,000 medical; $10,000 prescription

20%

30%

  • Physical therapy

20%

30%

  • Physician home visit

20%

30%

  • X-rays and lab

20%

30%

Vision Care    
  • Routine Exam
    (one/calendar year)

100% covered,
no deductible

30%

  • Eyeglasses

Aetna Discount Program

Aetna Discount Program

Inpatient Hospital    
  • Room and board
  • Ancillary charges
  • Special duty nursing
  • Intensive care, cardiac care units

10%

30%

Skilled Nursing Facility    
  • Room and board
  • Ancillary charges

(Limited to 120 days/calendar year)

10% 30%
Surgery    
  • Inpatient/Outpatient

10%

30%

  • Cosmetic

Not covered unless
medically necessary

Not covered unless
medically necessary

Mental Health / Substance Abuse    
  • Inpatient
    (treatment must be certified)

10%

30%

  • Outpatient

20%

30%

Emergency Room    

No benefits for non-emergency use of emergency room

10%

10%

Other Services    
  • Ambulance
  • Hospice care
  • Home health care
  • Durable medical equipment
  • Prosthetic devices

20%

30%

*All benefit levels (what you pay) are after the deductible, except where noted.

Prescription Drugs (through Express Scripts)

Benefit What You Pay

Deductible

No deductible

Out-of-Pocket (OOP) Drug Limit

$1,500

Retail (up to 30-day supply)

Generic

$10

Preferred Brand

25%, Min $10/ Max $50

Non-Preferred Brand

25%, Min $25/Max $100

Mail Order (up to 90-day supply)

Generic

$20

Preferred Brand

25%, Min $20/Max $100

Non-Preferred Brand

25%, Min $50/Max $200

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