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.
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.
Reduce your out-of-pocket costs when you need care through a lower deductible and higher premiums.
Receive coverage for in-network care only, coordinated by your primary care provider (PCP); available in California only
Receive coverage for in-network care only, coordinated by your primary care provider (PCP); available in Colorado only
All our medical plans provide:
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.
with services such as annual physicals, recommended immunizations, and routine cancer screenings covered at 100%. See more covered preventive services.
included with each medical plan.
through annual out-of-pocket maximums that limit the amount you will pay each year.
For help selecting a medical plan, use the PLANselect Benefits Decision Support Tool.
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.
|
$750/$1,500 | $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 |
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 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.
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.
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.*
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:
* 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.
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.
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.
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.
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.
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.
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.
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.
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.)
See how medications are covered through Aetna and Kaiser
The cost of prescription drugs is rising faster than many other health care services and supplies. But, there are ways for you to save.
Generic medications are generally just as effective as brand-name medications, but they typically cost between 80% and 85% less.
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.
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):
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.
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:
Telemedicine | Doctor’s office | Urgent care clinic | Emergency room |
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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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