2016 Health Plan Highlights for Federal Employees

2016 Health Plan
Highlights for
Federal Employees
High Option HMO plan
Standard Option HMO plan
High-deductible health plan
(HDHP)
www.aetnafeds.com/altius
19.02.324.1-FED (9/15)
• No deductibles plus predictable costs with
the HMO plans
•Built-in dental on the High Option HMO plan
•Extras to make the most of your plan
Earn healthy-living
incentives
Earn up to $50 for yourself or $100 per family for
completing specific wellness activities.
Just log in to your member website and complete:
•An online health assessment
•One online wellness program
•A post-program survey
Your health plan comes with more
It all starts with your member website
Same networks you’re used to
Altius is now an Aetna company. So that means you can take
advantage of some great new perks.
You can feel good that you get access to the same doctor
and hospital networks you’ve been using. Chances are
your doctor is in network.
All your plan information and extras are in one place — your
secure member website. You just need to sign up.
Register at www.aetnafeds.com/altius. Then log in anytime.
When you do, you can find ways to save on healthy-living
favorites like:
•Jawbone® wearable fitness devices
•Gym memberships and weight-loss programs
•Chiropractic care, acupuncture and massage therapy
Plus, your member website has tools that help you:
•Find a doctor, hospital or walk-in clinic, close to home or
out of state
•Create your own personal health record and review claims
•Save money by comparing costs, using the Member
Payment Estimator and Price-A-DrugSM tool … and more
To make sure, check our directory before signing up. Go
to www.aetnafeds.com/altius and click on “Find Your
Doctor Now.”
Want to test drive the tools now?
Log in at
www.aetnafeds.com/altius.
Use“federal3” as your user name
and password.
We’re now an Aetna company. So check your Altius federal brochure at
High Option HMO — Predictible costs with built-in dental
Key benefits
What you pay
Medical services provided by physicians
Preventive care services
$0
Diagnostic and treatment services provided in the office
$20 primary care; $30 specialist
In a hospital, surgical center or other facility
10% coinsurance
Hospital services
Inpatient
$200 per day, up to $600 per admission
Outpatient
10% coinsurance
Maternity
Physician care
$0 for prenatal care
Hospital care
$200 per day, up to $600 per admission
Emergency benefits
In and out of area
$200 for emergency room services
Mental health and substance abuse treatment
Office visits
$20 copay
Inpatient services
$200 per day, up to $600 per admission
Prescription drugs
Retail pharmacy — 30-day supply
$7 preferred generic; $25 preferred brand name;
40% up to $240 max copay nonpreferred
Mail order — 31- to 90-day supply
$7 preferred generic; $50 preferred brand name;
40% up to $720 max copay nonpreferred
Injectable and intravenous therapy drugs
20% preferred; 30% nonpreferred
Vision care
Annual routine eye exam
$0
Plus, you’ll get $100 every 24 months for eyewear
reimbursement
Dental care
Coverage for preventive, restorative, periodontics,
endodontics, oral surgery and crowns
Cost sharing per procedure; no deductible, annual limits or
waiting periods — see plan brochure for details
2016 High Option HMO rates (what you pay every other week)
Code
Non-postal
Postal 1
Self only
9K1
$101.42
$89.56
Self + one
9K3
$228.23
$202.62
Self + family
9K2
$207.64
$180.50
www.aetnafeds.com/altius for full plan details, service areas and rates.
Standard Option HMO — Lower biweekly rates
Key benefits
What you pay
Medical services provided by physicians
Preventive care services
$0
Diagnostic and treatment services provided in the office
$20 primary care; $40 specialist
In a hospital, surgical center or other facility
15% coinsurance
Hospital services
Inpatient
15% coinsurance
Outpatient
15% coinsurance
Maternity
Physician care
$0 for prenatal care
Hospital care
Nothing after $200 per admission copay
Emergency benefits
In and out of area
$250 for emergency room services
Mental health and substance abuse treatment
Office visits
$20 copay
Inpatient services
15% coinsurance
Prescription drugs
Retail pharmacy — 30-day supply
$7 preferred generic; $35 preferred brand name;
50% up to $240 max copay nonpreferred
Mail order — 31- to 90-day supply
$7 preferred generic; $70 preferred brand name;
50% up to $720 max copay nonpreferred
Injectable and intravenous therapy drugs
20% preferred; 30% nonpreferred
Vision care
Annual routine eye exam
$0
Plus, you’ll get $100 every 24 months for eyewear
reimbursement
2016 Standard Option HMO rates (what you pay every other week)
Code
Non-postal
Postal 1
Self only
DK4
$57.49
$47.72
Self + one
DK6
$125.71
$104.34
Self + family
DK5
$126.96
$105.38
HDHP — With a tax-free savings account
Key benefits
What you pay
Deductible
$1,300 for self only; $2,600 for self + one or self + family
HSA deposits — We’ll contribute $54.16 per month for self only or $108.33 per month for self + one or self + family.
You can use your HSA to help pay for your health care. Or save it — even if you leave the plan.
Medical services provided by physicians
Preventive care services
$0
Diagnostic and treatment services provided in the office
$20 primary care after deductible;
$30 specialist after deductible
In a hospital, surgical center or other facility
10% after deductible
Hospital services
Inpatient
10% after deductible
Outpatient
10% after deductible
Maternity
Physician care
10% after deductible
Hospital care
10% after deductible
Emergency benefits
In area
$200 for emergency room services
Out of area
$200 for emergency room services
Mental health and substance abuse treatment
Office visits
$20 copay after deductible
Inpatient services
10% after deductible
Prescription drugs
Retail pharmacy — 30-day supply
No deductible for preventive medicine
$7 preferred generic after deductible; $25 preferred brand
name after deductible; $50 nonpreferred after deductible
Mail order — 31- to 90-day supply
No deductible for preventive medicine
$21 preferred generic after deductible; $75 preferred brand
name after deductible; $150 nonpreferred after deductible
Injectable and intravenous therapy drugs
10% preferred; 20% nonpreferred after deductible
Vision care
Annual routine eye exam
$0
Plus, you’ll get $100 every 24 months for eyewear
reimbursement
2016 HDHP rates (what you pay every other week)
Code
Non-postal
Postal 1
Self only
9K4
$42.57
$35.33
Self + one
9K6
$87.22
$72.40
Self + family
9K5
$88.97
$73.85
Instead of an office visit
Does someone in the family have flu symptoms? Maybe an
ear infection? Use the Teladoc® network of doctors,
including pediatricians, to find out.
Teladoc lets you talk to a doctor over the phone or through
online video, 24/7. These board-certified physicians can also
write a prescription if medically necessary.
Learn more at www.teladoc.com/aetna.
Ready to enroll in your Altius health plan?
Sign-up is 1-2-3 easy
Step 1: Choose a plan
Review the brochure and
find a plan that fits your
needs.
Need help? Call us at
1-800-837-0977.
Step 2: Find your plan’s
enrollment code
They’re listed in the rate
charts in this brochure. You
can also find them at
www.aetnafeds.com/altius.
And remember: Self + one is
new for 2016. You can enroll
yourself plus just one
eligible family member.
Step 3: Fill out the form
Check with your HR
department to see if you can
enroll online, using an
agency system like MyPay,
Employee Express or
PostalEASE. Or you may
need to submit a paper 2809
form.
Need a form? Go to
www.aetnafeds.com/
enroll-now.php.
Health benefits and insurance plans are offered, underwritten and/or administered by Aetna Health Inc., Aetna Health of
California Inc. and/or Aetna Life Insurance Company (Aetna).
This is a brief description of the features of this Aetna health benefits plan. Before making a decision, please read the plan’s
applicable federal brochure(s). All benefits are subject to the definitions, limitations and exclusions set forth in the federal brochure.
Plan features and availability may vary by location and are subject to change. Pharmacy clinical programs such as precertification,
step therapy and quantity limits may apply to your prescription drug coverage. Providers are independent contractors and are not
agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health
services. Trademarks and logos displayed are the property of their respective owners. Discounts are not guaranteed under our
contract with the FEHB program. Please see www.aetnafeds.com/altius for details. HealthEquity Inc. is an IRS-approved nonbank
custodian of health savings accounts. Teladoc and Teladoc physicians are independent contractors and are neither agents nor
employees of Aetna. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be
written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe
DEA-controlled substances, nontherapeutic drugs and certain other drugs that may be harmful because of their potential for abuse.
Teladoc physicians reserve the right to deny care for potential misuse of services.
Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna
plans, refer to www.aetnafeds.com/altius.
www.aetnafeds.com/altius
©2015 Aetna Inc.
19.02.324.1-FED (9/15)