Medical Benefits

Provided by: Meritain - Aetna Choice POS II Network
BENEFIT MED 1 EPO HSA PLAN (IN-NETWORK ONLY) MED 2 EPO PLAN (IN-NETWORK ONLY) MED 3 PPO PLAN (IN-NETWORK) MED 3 PPO PLAN (OUT-OF-NETWORK)
Deductible Individual/Family $2,000/$4,000* $1,500/$3,000 $500/$1,000 $1,500/$3,000
Out-of-Pocket Maximum Individual/Family $4,000/$6,750** $4,000/$8,000 $3,000/$6,000 $6,000/$12,000
Preventive Care Services Plan pays 100% no deductible Plan pays 100% no deductible Plan pays 100% no deductible Plan pays 60% after deductible
Primary Care Physician (PCP) Required? No No No No
PCP Office Visit Plan pays 90% after deductible $20 copay $20 copay Plan pays 60% after deductible
Specialist Office Visit Plan pays 90% after deductible $40 copay $40 copay Plan pays 60% after deductible
Diagnostic Laboratory (Lab/X-Ray) — Office Based Plan pays 90% after deductible $20 (PCP) / $40 (Specialist) - no deductible Plan pays 100% after deductible Plan pays 60% after deductible
Diagnostic Laboratory (Lab/X-Ray) — Hospital Based Plan pays 70% after deductible Plan pays 70% after deductible Plan pays 100% after deductible Plan pays 60% after deductible
Advanced Imaging (MRI/CT-Scan) — Freestanding Plan pays 100% after deductible $20 (PCP) / $40 (Specialist) - no deductible Plan pays 100% after deductible Plan pays 60% after deductible
Advanced Imaging (MRI/CT-Scan) — Hospital Based Plan pays 70% after deductible Plan pays 70% after deductible Plan pays 100% after deductible Plan pays 60% after deductible
Emergency Room Plan pays 70% after deductible $100 copay; Plan pays 70% after deductible Plan pays 100% after deductible Plan pays 100% after deductible
Inpatient Hospital Plan pays 70% after deductible Plan pays 70% after deductible Plan pays 100% after deductible Plan pays 60% after deductible
Urgent Care Center Plan pays 90% after deductible $40 copay $40 copay Plan pays 60% after deductible
Outpatient Surgery — Ambulatory Surgical Center Plan pays 70% after deductible Plan pays 70% after deductible Plan pays 100% after deductible Plan pays 60% after deductible
Outpatient Surgery — Hospital Setting Plan pays 70% after deductible $100 copay; Plan pays 70% after deductible Plan pays 100% after deductible Plan pays 60% after deductible
Teladoc $56 copay per consult $0 copay $0 copay —
Vision Care — Maximum Benefit Per Year (exam, refractions, lenses, frames, contacts) $100 $100 $100 $100

* The entire family deductible must be satisfied if you or any dependent child(ren) or spouse before the plan begins to pay.
** The entire family out-of-pocket maximum must be met (by any combination of one or more family members) before the plan will pay 100% of covered services.

Find a Provider

  • Visit www.aetna.com/docfind
  • Enter your ZIP code, city, county, or state.
  • Enter in Aetna Choice POS II (Open Access) under “Select a Plan.” Or you can select Aetna Choice POS II (Open Access) from the list of plans.
  • Next, you can either click on one of the categories under “Find what you need by category,” or you can use the search box and choose your provider from the list of providers displayed.

Prescription Drug Plan:

Express Scripts

The prescription drug plan is administered by Express Scripts. When you enroll in one of the medical plans you are automatically enrolled in the corresponding prescription drug plan. Your medical plan ID card will include information related to your prescription drug plan (one ID card for Medical/Rx).

EPO HSA Plan EPO Plan PPO Plan
Retail (Up to a 30-Day Supply)
Generic Plan pays 70% after deductible $15 copay $15 copay
Preferred Brand Plan pays 70% after deductible $35 copay $35 copay
Non-Preferred Brand Plan pays 70% after deductible $70 copay $70 copay
Specialty Plan pays 70% after deductible Plan pays 80% no deductible Plan pays 80% no deductible
Mail Order (Up to a 90-Day Supply)
Generic Plan pays 70% after deductible $30 copay $30 copay
Preferred Brand Plan pays 70% after deductible $70 copay $70 copay
Non-Preferred Brand Plan pays 70% after deductible $140 copay $140 copay

Express Scripts Pharmacy

Express Scripts has a network of nearly 60,000 independent and chain pharmacies nationwide. When you visit a participating pharmacy, you will receive up to a 30-day supply after paying the applicable cost share (or a 90-day supply of maintenance medications through the Smart90 Program). Remember to take your Medical/Rx ID card with you.

Sign up online at www.express-scripts.com/rx or download the Express Scripts mobile app. You can easily manage your prescriptions, make payments, request refills, and check the status of your order all through your member portal.

Need assistance getting started?
Call 800.669.3612 and speak with a representative today!

Specialty Medications

Specialty drugs are medications that require special handling, administration, or monitoring. These are generally administered by injection. Your provider will be able to indicate if the medication you are being prescribed is considered a specialty medication. Specialty medications must be filled by the Express Scripts specialty pharmacy, Accredo.

Visit www.accredo.com and click “Find a Medication” to get started.

Please note, that if you take a specialty medication, you are not automatically enrolled with Accredo Specialty Pharmacy.

Price Assure

Express Scripts has partnered with GoodRx to help you and your family manage prescription costs. With the Price Assure program, your prescription prices are automatically discounted. Just show your Medical/Rx ID card at a participating GoodRx pharmacy, and if GoodRx offers the lowest price, that’s all you’ll pay!

  • Discounts apply to generic medications that are covered by the plan, excluding specialty generics.
  • Out-of-pocket costs count toward your medical/prescription drug deductible and out-of-pocket maximum.

Visit www.goodrx.com to find a GoodRx participating pharmacy close to you.
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