Non-Arizona Medical

Non-Arizona Medical

Medical Plan Comparison

Plan Features Aetna Choice Plus HDHP PPO Aetna Open Access Select $500 EPO Aetna Choice Plus $100 PPO Aetna Open Access Select $0 EPO Kaiser Traditional HMO
(CA only)
In-Network In-Network Only In-Network  In-Network Only In-Network Only
Calendar Year Deductible
Individual/Family
$2,000/$4,000 $500/$1,000 $100/$200 None None
Calendar Year Out-of-Pocket Maximum
Individual/Family
$3,000/$6,000 $1,500/$4,500 $2,500/$5,000 $1,500/$4,500 $1,500/$3,000
HSA Employer Contribution Individual/Family $1,000/$2,000* N/A N/A N/A N/A
Primary/Specialist Office Visit 20%** $20 copay/
$40 copay
$20 copay/
$40 copay
$20 copay/
$40 copay
$15 copay
Preventive Services No charge No charge No charge No charge No charge
Emergency Room 20%** $100 copay (waived if admitted) $100 copay + 20% 
(copay waived if admitted)
$100 copay (waived if admitted) $100 copay (waived if admitted)
Inpatient Hospitalization 20%** $500 copay 20%** $500 copay $250 copay
Prescription Drugs
Retail
30-Day Supply

Generic
Preferred
Non-Preferred
$10 copay**
$30 copay**
$50 copay**
$10 copay
$30 copay
$50 copay
$10 copay
$30 copay
$50 copay
$10 copay
$30 copay
$50 copay
$10 copay
$30 copay
Up to $150 copay
Mail Order 
90-Day Supply

Generic
Preferred
Non-Preferred
$20 copay**
$60 copay**
$100 copay**
$20 copay
$60 copay
$100 copay
$20 copay
$60 copay
$100 copay
$20 copay
$60 copay
$100 copay
$20 copay
$60 copay
Not covered

*Prorated for new hires.
**After deductible.

Free In-Network Preventive Care

Annual checkups help you stay healthy. Take care of yourself and your family by using your FREE in-network preventive care benefits each year! Preventive care visits allow you to take action early and keep treatable health issues from becoming chronic conditions.
The total amount that you pay for your benefits coverage depends on the plans you choose, how many dependents you cover, and for medical coverage, how much you earn. Your healthcare costs are deducted from your pay on a pre-tax basis—before federal, state, and social security taxes are calculated—so you pay less in taxes.

Bi-Weekly Payroll Deductions

  Aetna Choice Plus
HDHP PPO
Aetna Open Access Select $500 EPO Aetna Choice Plus
$100 PPO
Aetna Open Access Select $0 EPO Kaiser Traditional HMO
(CA only)
Employee Only $0.00 $31.00 $67.60 $69.90 $80.54
Employee + Spouse $0.00 $102.24 $148.66 $153.68 $177.19
Employee + Children $0.00 $88.35 $128.45 $132.79 $161.08
Employee + Family $0.00 $141.54 $205.78 $212.75 $241.62

New York Weekly Payroll Deductions

  Aetna Choice Plus
HDHP PPO
Aetna Open Access Select $500 EPO Aetna Choice Plus
$100 PPO
Aetna Open Access Select $0 EPO
Employee Only $0.00 $15.50 $33.80 $34.95
Employee + Spouse $0.00 $51.12 $74.33 $76.84
Employee + Children $0.00 $44.17 $64.22 $66.40
Employee + Family $0.00 $70.77 $102.89 $106.38

The Aetna Choice Plus HDHP PPO gives you flexibility in how you manage your healthcare costs. It pairs a large network of doctors and hospitals (PPO) with the option to save money in a Health Savings Account (HSA). You pay for all medical costs upfront until you reach your deductible, but your HSA can help you cover these expenses with pre-tax savings. After you meet the deductible, the plan starts sharing costs with you until you hit your out-of-pocket maximum, after which it pays for everything covered by the plan. Choosing in-network doctors will save you money, but you can also see out-of-network providers at a higher cost. This plan helps you make smart choices about your healthcare while keeping costs under control.

Aetna Choice Plus HDHP PPO
Benefit Level In-Network Out-of-Network
Network Name Aetna Choice POS II
(Open Access)
N/A
Calendar Year Deductible
Individual
Individual in a family
Family
$2,000
$2,000
$4,000
$4,000
$4,000
$8,000
Calendar Year Out-of-Pocket Maximum
Individual
Individual in a family
Family
$3,000
$3,000
$6,000
$6,000
$6,000
$12,000
Primary Office Visit 20%* 40%*
Emergency Room 20%*
Hospitalization 20%* 40%*
Rx Generic/Preferred/Non-Preferred
30-Day Retail
$10/$30/$50 Not Covered
Rx Generic/Preferred/Non-Preferred
90-Day Mail Order
$20/$60/$100 Not Covered

*After deductible.

The Aetna Open Access Select $500 EPO plan provides comprehensive coverage through a network of selected providers. With this plan, you can visit any in-network doctor or specialist without needing a referral or choosing a primary care physician (PCP). The plan includes a $500 annual deductible, meaning you are responsible for the first $500 of covered medical expenses each year before the plan starts to share costs. After meeting the deductible, the plan covers a portion of your expenses through coinsurance or copays. Using in-network providers will give you the highest level of benefits and help you keep out-of-pocket costs lower.

Aetna Open Access Select $500 EPO
Benefit Level In-Network Only
Network Name Aetna Select (Open Access)
Calendar Year Deductible
Individual
Individual in a family
Family
$500
$500
$1,000
Calendar Year Out-of-Pocket Maximum
Individual
Individual in a family
Family
$1,500
$1,500
$4,500
Primary/Specialist Office Visit $20 copay/$40 copay
Emergency Room $100 copay (copay waived if admitted)
Hospitalization $500 copay*
Rx Generic/Preferred/Non-Preferred
30-Day Retail
$10/$30/$50
Rx Generic/Preferred/Non-Preferred
90-Day Mail Order
$20/$60/$100

*After deductible.

The Aetna Choice Plus $100 PPO plan offers flexibility and cost savings by allowing you to see any doctor or specialist, with the best savings coming from in-network providers. This plan includes a $100 annual deductible, meaning you are responsible for the first $100 of covered medical expenses each year before the plan starts to share costs. After meeting the deductible, the plan covers a portion of your expenses through coinsurance or copays. Using in-network providers will give you the highest level of benefits and help you keep out-of-pocket costs lower.

Aetna Choice Plus $100 PPO
Benefit Level In-Network Out-of-Network
Network Name Aetna Choice POS II
(Open Access)
N/A
Calendar Year Deductible
Individual
Individual in a family
Family
$100
$100
$200
$500
$500
$1,000
Calendar Year Out-of-Pocket Maximum
Individual
Individual in a family
Family
$2,500
$2,500
$5,000
$5,000
$5,000
$10,000
Primary/Specialist Office Visit $20 copay/$40 copay 40%*
Emergency Room $100 copay + 20% (copay waived if admitted)
Hospitalization 20%* 40%*
Rx Generic/Preferred/Non-Preferred
30-Day Retail
$10/$30/$50 Not Covered
Rx Generic/Preferred/Non-Preferred
90-Day Mail Order
$20/$60/$100 Not Covered

*After deductible.

The Aetna Open Access Select $0 EPO plan provides comprehensive coverage through a network of selected providers. With this plan, you can visit any in-network doctor or specialist without needing a referral or choosing a primary care physician (PCP). The plan has no annual deductible, meaning it starts covering eligible services right away. However, copays or coinsurance may apply for certain services. Using in-network providers will give you the highest level of benefits and help you keep out-of-pocket costs lower. Note that out-of-network services are not covered, except in emergencies.

Aetna Open Access Select $0 EPO
Benefit Level In-Network Only
Network Name Aetna Select (Open Access)
Calendar Year Deductible
Individual
Individual in a family
Family
None
Calendar Year Out-of-Pocket Maximum
Individual
Individual in a family
Family
$1,500
$1,500
$4,500
Primary/Specialist Office Visit $20 copay/$40 copay
Emergency Room $100 copay (copay waived if admitted)
Hospitalization $500 copay
Rx Generic/Preferred/Non-Preferred
30-Day Retail
$10/$30/$50
Rx Generic/Preferred/Non-Preferred
90-Day Mail Order
$20/$60/$100

The Kaiser Traditional HMO plan (CA only) provides comprehensive coverage through Kaiser Permanente’s network of providers and facilities. You’ll select a primary care physician (PCP) to coordinate your care, including referrals to in-network specialists when needed. With no deductibles and fixed copayments for most services, this plan makes managing healthcare costs simple. Services outside the Kaiser network are generally not covered, except in emergencies. Staying within the Kaiser system ensures the best value and minimal out-of-pocket costs.

Kaiser Traditional HMO
Benefit Level In-Network Only
Network Name Kaiser
Calendar Year Deductible
Individual
Individual in a family
Family
None
Calendar Year Out-of-Pocket Maximum
Individual
Individual in a family
Family
$1,500
$1,500
$3,000
Primary/Specialist Office Visit $15 copay
Emergency Room $100 copay (copay waived if admitted)
Hospitalization $250 copay
Rx Generic/Preferred/Non-Preferred
30-Day Retail
$10/$30/10% up to $150 maximum
Rx Generic/Preferred/Non-Preferred
90-Day Mail Order
$20/$60/Not Covered