Aetna HDHP
Take charge of your spending through lower premiums, higher deductibles, and a tax-free Health Savings Account (HSA) with contributions from Conga that you own for life.
Our benefits program includes medical plan options with a range of coverage levels and costs, so you can choose the one that’s best for you. You can enroll as a new hire, during Open Enrollment, or if you have a qualifying life event. To enroll, log in to Workday. If you have questions about your medical coverage, visit TouchCare Advocacy or call 866-486-8242.
For help selecting a medical plan, use the PLANselect Benefits Decision Support Tool.
Medical plan options
Aetna PPO 750
Reduce your out-of-pocket costs when you need care through a lower deductible and higher premiums.
Kaiser HMO (CA)
Receive coverage for in-network care only, coordinated by your primary care provider (PCP); available in California only
Kaiser HMO (CO)
Receive coverage for in-network care only, coordinated by your primary care provider (PCP); available in Colorado only
Key features at a glance
All our medical plans provide:
Comprehensive, affordable coverage
for a wide range of health care services. Tip: If you need extra protection from large or unexpected medical expenses, you may also choose to enroll in supplemental coverage.
Free in-network preventive care,
with services such as annual physicals, recommended immunizations, and routine cancer screenings covered at 100%. See more covered preventive services.
Prescription drug coverage
included with each medical plan.
Financial protection
through annual out-of-pocket maximums that limit the amount you will pay each year.
Get to know your plan
Save money
Access health resources
For help selecting a medical plan, use the PLANselect Benefits Decision Support Tool.
Aetna Plans
| Aetna HDHP | Aetna PPO 750 | |||
|---|---|---|---|---|
| In-Network | Out-of-Network | In-Network | Out-of-Network | |
| HSA-eligible | Yes | No | ||
|
Conga contribution to HSA
(individual/family)
|
$500/$1,000 | N/A | ||
|
Annual deductible
(individual/family)
|
$2,000/$4,000*
* Limited to $3,000 for individuals within a family. See an example
|
$4,000/$8,000*
* Limited to $5,600 for individuals within a family.
See an example.
|
$500/$1,000 | $1,000/$2,000 |
|
Annual out-of-pocket maximum
(individual/family)
|
$3,500/$7,000 | $7,000/$14,000 | $3,500/$7,000 | $7,000/$14,000 |
| Medical care: Your costs | ||||
| Preventive care | Covered at 100% in-network; no deductible | |||
| Office visit (primary care) | You pay 20% after deductible | You pay 40% after deductible | You pay $20 copay; no deductible | You pay 40% after deductible |
| Office visit (specialist) | You pay 20% after deductible | You pay 40% after deductible | You pay $20 copay; no deductible | You pay 40% after deductible |
| Telemedicine visit | You pay 20% after deductible | You pay 40% after deductible | You pay $20 copay; no deductible | You pay 40% after deductible |
| Walk-in clinic | You pay 20% after deductible | You pay 40% after deductible | You pay $20 copay; no deductible | You pay 40% after deductible |
| Urgent care | You pay 20% after deductible | You pay 40% after deductible | You pay $20 copay; no deductible | You pay 40% after deductible |
| Emergency room | You pay 20% after deductible | You pay 20% after $150 copay; no deductible | ||
| Hospital stay | You pay 20% after deductible | You pay 40% after deductible | You pay 20% after deductible | You pay 40% after deductible |
| Fertility treatment | Plan pays up to $10,000/member/lifetime | Plan pays up to $10,000/member/lifetime | ||
| Mental health office visit | You pay 20% after deductible | You pay 40% after deductible | You pay $20 copay; no deductible | You pay 40% after deductible |
| Chiropractor | You pay 20% after deductible | You pay 40% after deductible | You pay $20 copay; no deductible (up to 30 visits per year) | You pay 40% after deductible (up to 30 visits per year) |
| Acupuncture (up to 20 visits per year) | You pay 20% after deductible | You pay 40% after deductible | You pay $20 copay; no deductible | You pay 40% after deductible |
| Physical Therapy | You pay 20% after deductible | You pay 40% after deductible | You pay $20 copay; no deductible | You pay 40% after deductible |
| Prescriptions: Your costs | ||||
| Retail Pharmacy: 30-day supply | ||||
| Generic | You pay $10 after deductible | You pay 20% after deductible, up to $250 | You pay $5 copay | You pay 20%, up to $250 |
| Preferred Brand | You pay $30 after deductible | You pay 20% after deductible, up to $250 | You pay $25 copay | You pay 20%, up to $250 |
| Non-Preferred Brand | You pay $50 after deductible | You pay 20% after deductible, up to $250 | You pay $40 copay | You pay 20%, up to $250 |
| Specialty | Varies based on type of drug | Not covered | You pay $45 copay | Not covered |
| Mail Order: 90-day supply (or 30-day supply if using an out-of-network pharmacy) | ||||
| Generic | You pay $20 after deductible | You pay 20% after deductible, up to $250 | You pay $5 copay | You pay 20%, up to $250 |
| Preferred Brand | You pay $60 after deductible | You pay 20% after deductible, up to $250 | You pay $50 copay | You pay 20%, up to $250 |
| Non-Preferred Brand | You pay $100 after deductible | You pay 20% after deductible, up to $250 | You pay $80 copay | You pay 20%, up to $250 |
| Specialty | Not available | Not available | Not available | Not available |
Embedded deductible
An embedded deductible means one person on a plan with two or more members can meet the individual deductible and start receiving covered benefits.
Example:
Let’s say you have a plan with four family members, John, Jane, Billy and Katie. Each family member has a $500 individual deductible OR $1,000 for the family. John meets his $500 individual deductible; therefore, he can start receiving covered plan benefits. The remaining three family members can contribute any portion to satisfy the $1,000 family deductible. Jane can contribute $125, Billy can contribute $275 and Katie can contribute the final $100. Or Jane can contribute the entire $500. Then the family deductible is met.
Note: This is an example for illustrative purposes only. The amounts above don’t reflect an actual plan deductible.
Kaiser Plans
| Kaiser HMO (CA) | Kaiser HMO (CO) | |||
|---|---|---|---|---|
|
Annual deductible
(individual/family)
|
None | None | ||
|
Annual out-of-pocket maximum
(individual/family)
|
$1,500/$3,000 | $1,500/$3,000 | ||
| Medical care: Your costs | ||||
| Preventive care | Covered at 100% in-network, so you pay nothing | |||
| Office visit (primary care) | You pay $20 copay | You pay $20 copay | ||
| Office visit (specialist) | You pay $35 copay | You pay $35 copay | ||
| Telemedicine visit | You pay $0 | You pay $0 | ||
| Walk-in clinic | You pay $20 copay | You pay $20 copay | ||
| Urgent care | You pay $20 copay | You pay $20 copay | ||
| Emergency room | You pay $100 copay | You pay $250 copay | ||
| Hospital stay | You pay $250/admission | You pay $250/admission | ||
| Fertility | You pay 50% of cost for diagnosis, treatment of infertility, and artificial insemination (see Evidence of Coverage for details) | You pay 50% of cost for diagnosis, treatment of infertility, and artificial insemination (see Evidence of Coverage for details) | ||
| Mental health office visit | You pay $20 copay ($10 copay for group treatment) | You pay $20 copay ($10 copay for group treatment) | ||
| Chiropractor | You pay $15 copay (up to 20 visits) | You pay $20 copay (up to 20 visits) | ||
| Acupuncture | You pay $20 copay (up to 20 visits) | Not covered | ||
| Physical Therapy | You pay $20 copay | You pay $20 copay | ||
| Prescriptions: Your costs | ||||
| 30-day supply (retail pharmacy) | ||||
| Retail pharmacy | 30-day supply | 30-day supply | ||
| Generic | You pay $10 copay | You pay $10 copay | ||
| Brand | You pay $35 copay ($35 copay for non-preferred brand drugs) | You pay $20 copay ($35 copay for non-preferred brand drugs) | ||
| Specialty | You pay $35 copay | You pay 20%, up to $250 | ||
| Mail order | 100-day supply | 90-day supply | ||
| Generic | You pay $20 copay | You pay $20 copay | ||
| Brand-Name | You pay $70 copay | You pay $40 copay ($70 copay for non-preferred brand drugs) | ||
| Specialty | Not available | Not available | ||
The Aetna HDHP is a high-deductible coverage with a tax-free Health Savings Account (HSA) that helps you save money and plan ahead for future medical expenses. This combination gives you more control over your money and rewards you for making healthy, cost-conscious choices.
As an added bonus, Conga will contribute to your HSA: $500 for employee-only coverage or $1,000 if you cover dependents. With the Aetna HDHP plan, you can see any provider you wish, but you’ll pay less when you stay in network.
The Aetna HDHP covers a wide range of range of health care services, including doctors' services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, fertility services, mental health services, and more.
Transition of Care
If you enroll in the Aetna HDHP and you are in the midst of medical treatment when coverage begins (such as for pregnancy or cancer treatment), and your provider is not part of the Aetna network, you may qualify for transition of care benefits. Contact Aetna at 877-204-9186 for more details about the transition of care process.
How the Aetna HDHP Works
You pay the plan premium from your paycheck (pre-tax) to have coverage.
HSA
You can set aside tax-free money from your paycheck and receive Conga contributions to help cover your costs — now, or in the future.
Deductible
You pay 100% of your medical and prescription costs until you meet the annual deductible.*
Covered Medical Care
After meeting the deductible, the plan pays a percentage of the cost of covered medical care and prescriptions when you use in-network providers. You pay the remaining amount.
Out-of-Pocket Maximum
You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.*
Use your HSA to save money and plan ahead!
Contributing to your HSA is a great way to budget for deductibles and other out-of-pocket expenses while also saving money — your HSA contributions are tax-free! *
Keep in mind:
- The Aetna HDHP costs you less from your paycheck, so you may have extra money available to put in your HSA.
- You can only spend HSA money that’s actually been deposited into your account. If you don’t have enough money in your HSA when you need it, you can pay another way and reimburse yourself later, so you take full advantage of your HSA’s tax savings.
- You never forfeit any money left in your HSA — it rolls over year after year. If you know about future expenses or want to save for your health care costs in retirement, set aside a little extra each paycheck so your balance can grow over time.
- You can change your HSA contribution amount throughout the year as needed to keep up with any changes in your situation.
* Contributions are not subject to federal tax. Exceptions include CA and NJ, where you’ll pay state tax on HSA contributions, and NH and TN where state taxes apply to tax dividend and interest earnings after a certain dollar amount. Consult with your tax advisor to understand the potential tax consequences of enrolling in an HSA. Money in an HSA can be withdrawn tax-free as long as it is used to pay for qualified health-related expenses. If money is used for ineligible expenses, you’ll pay ordinary income tax on the amount withdrawn, plus a 20% penalty tax if you withdraw the money before age 65.
The Aetna PPO 750 offers slightly lower out-of-pocket costs in exchange for higher premiums. With this plan, your costs are more predictable, but you’ll likely still have out-of-pocket expenses. You can see any provider you wish, but you will pay less when you stay in network.
The Aetna PPO 750 covers a wide range of range of health care services, including doctors' services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, fertility services, mental health services, and more.
Transition of Care
If you enroll in the Aetna PPO 750 and you are in the midst of medical treatment when coverage begins (such as for pregnancy or cancer treatment), and your provider is not part of the Aetna network, you may qualify for transition of care benefits. Contact Aetna at 877-204-9186 for more details about the transition of care process.
How the Aetna PPO 750 Works
You pay the plan premium from your paycheck (pre-tax) to have coverage.
Copays
You pay copays for most services including office visits and prescriptions.
Deductible
For some services, like hospital admissions, you must pay 100% of the cost until you meet the annual deductible.*
Coinsurance
For some services, like hospital admissions, after meeting the deductible, the plan pays a percentage of the cost of covered medical care and prescriptions when you use in-network providers. You pay the remaining amount.
Out-of-Pocket Maximum
You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.
Save money with an FSA!
A Health Care Flexible Spending Account (FSA) lets you take advantage of tax-free savings when paying for health care. But, be sure to plan your FSA contributions carefully. The FSA is a “use it or lose it” plan, but you can carry over up to $610 of unused money in your FSA to the next year; you will forfeit any remaining amount above $610.
The Kaiser HMO (CA) and Kaiser HMO (CO) plans provide coverage only when you receive care from providers within the Kaiser network. Your primary care provider (PCP) will coordinate your care.
How the Kaiser HMO (CA) and Kaiser HMO (CO) Works
You pay the plan premium from your paycheck to have coverage.
Copay
You pay a small fee at the time of service for doctor visits and prescriptions.
Out-of-Pocket Maximum
You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.
Do you have a primary care provider (PCP)?
With an HMO, you’re required to select a primary care provider (PCP) who will manage your care and provide referrals if you need to see a specialist.
Save money with an FSA!
A Health Care Flexible Spending Account (FSA) lets you take advantage of tax-free savings when paying for health care. But, be sure to plan your FSA contributions carefully.
The FSA is a “use it or lose it” plan, but you can carry over up to $610 of unused money in your FSA to the next year; you will forfeit any remaining amount above $610.
When you enroll in a Conga medical plan, you automatically receive prescription drug coverage.
Drug Tiers
The cost of prescription drugs under each medical plan depends on the type of medication — generic, preferred, or non-preferred. All prescription carriers have a formulary, which is their list of preferred drugs based on effectiveness and cost.
You pay the plan premium from your paycheck (pre-tax) to have coverage.
Generic drugs
Same active ingredients as brand-name equivalents and meet the same standards for quality and effectiveness, but usually cost much less.
Specialty drugs
Medication used to treat complex conditions like rheumatoid arthritis, multiple sclerosis, or psoriasis.
Brand-name drugs
Drugs with no generic equivalent. On a formulary, there are brand-name drugs which are favored by the plan. (In the Aetna plans, these are called Preferred Brand.) Brand-name drugs not included on the formulary are still covered, but may cost more. (In the Aetna plans, these are called Non-Preferred Brand.)
Check the Formulary
See how medications are covered through Aetna and Kaiser
Save Money on Your Prescriptions!
The cost of prescription drugs is rising faster than many other health care services and supplies. But, there are ways for you to save.
Ask your doctor about generic medications.
Generic medications are generally just as effective as brand-name medications, but they typically cost between 80% and 85% less.
Use the mail order program.
If you take maintenance medication to treat a chronic condition — such as an allergy, heart disease, high blood pressure, or diabetes — the convenience and cost savings of the home delivery prescription programs through Aetna and Kaiser will save you time and money.
Why Use the Mail Order Program?
- Prescriptions are shipped to you for free — no waiting in line at the pharmacy.
- You can set up automatic refills.
Prescription Management Programs
Your Aetna pharmacy benefits include several programs aimed at ensuring your safety and making sure you receive the most clinically appropriate and cost-effective medication.
Dispense as Written: When available, your prescription will be filled with a generic alternative to a brand-name medication. Generic drugs have the same primary medication ingredient, are equally safe and effective, and are taken at the same dose, but cost significantly less than brand-name medications. If you request a brand-name drug when there is a generic equivalent available, you will pay the brand copay or coinsurance, plus the cost difference between the brand and generic drug. However, if your doctor indicates “Dispense as Written/DAW” on the prescription, you will not pay the cost difference, and will pay only the brand copay or coinsurance.
Prior Authorization: Some medications may require prior authorization. This means that Aetna needs more information from your doctor to determine if the medication is the best option for you and will be approved for coverage. You can find medications that require prior authorization on Aetna website.
Step Therapy: Step Therapy encourages you to try the most cost-effective and appropriate medications available to treat your condition. Typically, these medications are generics or lower-cost brand-name medications. You need to try these first, before more expensive medications are approved for coverage. At any time, if your provider feels a first-line medication isn’t right for you due to medical reasons, he or she can request authorization for coverage of a different medication.
As a TouchCare member, you have a personal Health Assistant in your pocket. We’re here to help answer any and all of your health care and benefit questions…all at no cost to you.
Here are just a few examples of what we can help with (at no cost to you):
- Benefit Navigation: We can explain the medical plan choices available to you, including associated tax-savings accounts.
- Bill Negotiation: Send us your bill, tell us what you think is wrong, and ask questions — we’ll work on your behalf to fix any errors.
- Cost Comparison: We’ll help you research your options and costs to ensure you never overpay for care
- Provider Search: We can help find highly-rated providers that are in-network and conveniently located
- RxCare: Let us help you find the lowest cost option for all your prescriptions.
- Answers: We can answer your benefit questions in plain language
Get personalized assistance to help you navigate the health care system, while saving time and money. TouchCare is available to you and your family members. Visit TouchCare Advocacy, call 866-486-8242, or email assist@touchcare.com. You can also download the TouchCare mobile app.
Consider using your carrier’s telehealth programs where you can see a doctor on your computer or mobile device and get answers 24/7.
- Aetna: You have access to medical advice from board-certified physicians 24/7, 365 days a year through your Aetna’ telemedicine service. Teladoc offers you fast, convenient diagnosis and treatment for many common conditions through video consult on your smartphone or computer. Visit Teladoc to enroll or learn more. You can also call 855-835-2362.
- Kaiser: Schedule an appointment with your doctor, meet with a specialist, or have an on-demand video visit with an on-call physician. Ask your doctor about availability.
When you think about the financial impact of your health care choices, you can help lower costs for yourself and the entire company. Get the most from your medical benefits by following these tips to be well and buy smart:
- Use in-network providers. They’ve agreed to charge only up to negotiated rates and bill your insurance company directly, which saves you money and time. Also, check with your insurance company to ensure that a service is covered before you receive care. Note: If you’re enrolling in an HMO plan (if available in your area), the plan only pays benefits for care received in network, unless you have an emergency or need urgent care.
- Keep up with preventive care. It’s covered in full by all of our medical plans and can help detect and prevent potentially serious and costly health issues early. You pay nothing for annual physicals, recommended immunizations, routine cancer screenings, and more when you see in-network providers.
-
Use tax-free money to pay for eligible health expenses. If you’re enrolled in the Aetna HDHP, you
can contribute to a
Health Savings Account (HSA). If you’re enrolled
in the Aetna PPO 750 or a Kaiser HMO, you can contribute to a
Flexible Spending Account (FSA). (You can also contribute to an FSA if you don't elect medical coverage through Conga.) HSAs and
FSAs are easy to use and save you money. You can set aside pre-tax dollars from your paycheck to use for your
out-of-pocket costs.
Keep in mind that with an HSA, you can only spend contributions that have actually been deposited into your account. And with an FSA, you can only carry over up to $610 of unused money in your FSA to the next year; you will forfeit amounts above $610. - Shop smart for prescriptions. Using generic alternatives will almost always save you money — and they’re just as effective as brand-name prescriptions. Also, try calling a few local pharmacies to compare prices before deciding where to fill a prescription. For your ongoing prescriptions, use the mail-order program to save money and time.
- Choose the right place to get care. Facilities charge different amounts for the same services, so think about your options when you or a family member needs medical attention. Use the guide below to help you save money and choose the most appropriate care for your situation.
| Telemedicine | Doctor’s office | Urgent care clinic | Emergency room |
|---|---|---|---|
| Use it for | |||
| A common, non-emergency medical issue that can be diagnosed by phone or online | A condition that doesn’t need immediate attention and can wait until the next day | A condition that needs immediate care but is not life- or limb-threatening | A life-threatening or potentially crippling condition that needs immediate attention |
| Examples | |||
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