Medical – Arizona

Plan Features Aetna Choice POS II – HDHP Banner + Aetna Open Access Select Aetna Choice POS II – $100
In-Network Out-of-Network In-Network Only In-Network Out-of-Network
Calendar Year Deductible
Individual/Family		 $2,000/$4,000 $4,000/$8,000 None $100/$200 $500/$1,000
Calendar Year Out-of-Pocket Maximum
Individual/Family		 $3,000/$6,000 $6,000/$12,000 $2,500/$5,000 $2,500/$5,000 $5,000/$10,000
HSA Employer Contribution Individual/Family $1,000/$2,000* N/A N/A
Primary/Specialist Office Visit 20%** 40%** $20 copay/
$40 copay		 $20 copay/
$40 copay		 40%**
Preventive Services No charge 40%** No charge No charge 40%**
Emergency Room 20%** $100 copay (copay waived if admitted) $100 copay + 20% (copay waived if admitted)
Inpatient Hospitalization 20%** 40%** $500 copay 20%** 40%**
Prescription Drugs
Rx (30-Day Retail)
Generic
Preferred
Non-Preferred 		$10 copay**
$30 copay**
$50 copay**		 Not Covered $10 copay
$30 copay
$50 copay		 $10 copay
$30 copay
$50 copay		 Not covered
Rx (90-Day Mail Order)
Generic
Preferred
Non-Preferred 		$20 copay**
$60 copay**
$100 copay**		 Not Covered $20 copay
$60 copay
$100 copay		 $20 copay
$60 copay
$100 copay		 Not covered

*Prorated for new hires.
**After deductible.

The Aetna Choice POS II-HDHP offers a variety of benefits, but it’s important to understand how the plan works to see if it’s the right choice for you.

  • In-network preventive care is always covered at 100%.
  • You pay 100% of your medical care until you meet the deductible.
  • You and Lucid share the cost for care. Lucid pays the cost of your monthly premium, while your costs include the deductible, coinsurance, and copays.
  • If you reach the out-of-pocket max, the plan pays 100%.
Aetna Choice POS II – HDHP
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/Specialist 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 Banner + Aetna Open Access Select plan offers comprehensive healthcare coverage through a network of trusted providers. Here are the plan’s key features:

  • You can visit any doctor or specialist within the network without needing referrals or choosing a primary care physician (PCP).
  • The plan only covers in-network care, except for emergencies, so it’s important to stay within the network for non-emergency services.
  • There’s no annual deductible—coverage starts right away for eligible services.
  • You’ll pay copayments or coinsurance for certain services.
  • Use in-network providers for all non-emergency services to receive benefits through this plan.
Banner + Aetna Open Access Select Plan
Benefit Level In-Network Only
Network Name Banner Joint Venture Open Access
Calendar Year Deductible
Individual
Individual in a family
Family		 None
Calendar Year Out-of-Pocket Maximum
Individual
Individual in a family
Family		 $2,500
$2,500
$5,000
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 Aetna Choice POS II – $100 plan offers flexibility and cost savings. Here are the plan’s key features:

  • You can 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, you’ll pay a portion of the costs through coinsurance and copayments.
  • Lower out-of-pocket costs when you use in-network providers.
Aetna Choice POS II – $100
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.

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.

 

Bi-Weekly Payroll Deductions

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.

Coverage Tier  Aetna
Choice POS II 
HDHP 		 Banner + Aetna Open Access Select Aetna
Choice POS II –
$100
Employee Only $0.00 $23.29 $35.68
Employee + Spouse $0.00 $60.04 $92.01
Employee + Children $0.00 $47.91 $73.42
Employee + Family $0.00 $82.19 $125.94

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Documents

Aetna