Medical Coverage

Policy Year Maximum: Unlimited

Deductible Preferred Care Non-Preferred Care
The policy year deductible is waived for preferred care covered medical expenses that apply to Preventive Care Expense benefits.

In addition to state and federal requirements for waiver of the Policy Year Deductible, this Plan will waive the Deductible for: Preferred Care and Non Preferred care Deductible-waived for Pediatric Vision Services, Preferred Care Deductible (only) is Waived for Pediatric Preventive Dental.     

Per visit or admission Deductibles do not apply towards satisfying the Policy Year Deductible.

Students: $250 per Policy Year
Family: $750 per Policy Year

Students: $400 per Policy Year
Family: $1,200 Per Policy Year

Coinsurance: Coinsurance is both the percentage of covered medical expenses that the plan pays, and the percentage of covered medical expenses that you pay.  The percentage that the plan pays is referred to as “plan coinsurance” or the “payment percentage,” and varies by the type of expense. Please refer to the Schedule of Benefits for specific information on coinsurance amounts.

Out of Pocket Maximums Preferred Care Non-Preferred Care
Once the Individual or Family Out-of-Pocket Limit has been satisfied, Covered Medical Expenses will be payable at 100% for the remainder of the Policy Year.
The following expenses do not apply toward meeting the plan’s out-of-pocket limits:
  • Non-covered medical expenses; and
  • Expenses that are not paid or precertification benefit reductions or penalties because a required precertification for the service(s) or supply was not obtained from Aetna.

Individual Out-of-Pocket:
$6,850 per Policy Year

Family Out-of-Pocket:
$13,700 per Policy Year

Individual Out-of-Pocket:
$15,000 per Policy Year

Family Out-of-Pocket:  
$20,000 per Policy Year