Medical Plan Options and Health Savings Account
• Because we know choosing the right plans can be difficult, we hope you will visit ALEX, the Bates virtual benefits counselor to help you through enrollment decisions. ALEX can help assist you throughout the year. We hope you take advantage of this fun, engaging, and confidential tool to help you learn more about the benefits that Bates is pleased to offer.
• Learn about your benefits and make the best choices for you and your family
• Help you choose the right benefits for your personal situation
• Learn more about the High Deductible Health Plan (HDHP) and see how much money it could save you.
• See everything that is available to you and your family. Benefits are more than just health insurance!
Click Here anytime and anywhere from your smartphone, tablet, or computer to talk to ALEX.
• The Aetna Consumer Choice (HSA) Plan(Click here for summary) is a qualified high deductible health plan and is the only plan that allows you to contribute to a Health Savings Account (HSA).
• An HSA allows you and the college to set aside funds on a pre-tax basis to pay for qualified medical care (including deductibles and coinsurance). It also requires the lowest amount of employee payroll contribution towards the cost of the premium.
• The plan pays for preventive medical care at 100% and also certain preventive drugs at 100%. All other services and prescription drugs are subject to a deductible before the plan begins to pay for in-network services at 80% up to the out-of-pocket limit.
• With this plan, all providers in the Aetna network are covered at the same level. If you enroll in the HSA Plan you will automatically be enrolled in the Hospital Indemnity Plan (HIP) and Bates will cover the cost. The HIP provides a $1,000 benefit if a covered member is admitted for an inpatient hospital stay, as well as other daily benefits for extended hospital stays (see HIP Plan for more information including the definition of being admitted).
(paid at 100% – not subject to the deductible)
A Health Savings Account, or HSA for short, is a tax-advantaged account that both Bates and you can contribute to and it is owned by you. You can use funds from your HSA to pay for current medical expenses (including dental and vision) for yourself and your tax dependents or save for future healthcare expenses.
Unlike our current Healthcare Reimbursement Account, any contributions remaining in your HSA roll over from year to year and the account is yours when you leave bates. Watch this short video for an introduction to an HSA.
Health Savings Accounts Reference Materials:
Investing funds in your Health Savings Account
Once you feel you have enough funds in your Health Savings Account to cover your medical needs you can begin investing in Mutual Funds for longer-term growth (a minimum balance of $1,000 in your Health Savings Account is required before you can invest in Mutual funds). There is a .02% fee of your investment account balance charged to your account each month.
With an investment account you have:
Tour the “Investments” section of your Health Savings Account with PayFlex for more information.
• The Aetna Whole Health (ACO) Plan (Click here for summary) is a unique plan that features varying levels of coverage based on three provider networks. Members incur the lowest annual deductible and out-of-pocket expenses when receiving care from providers in the Aetna Whole Health Tier 1 network (Maximum Savings).
• When obtaining care from a Tier 2 (Standard Savings) network provider or a non-participating provider, you will incur a higher deductible and additional out-of-pocket costs. To receive the highest level of benefit under this plan, you are required to select a PCP from the Tier 1 network, but you do not need referrals for specialist services.
Prescription Drug Coverage
• All three plans use the same Aetna Standard prescription drug formulary.
• If a doctor shows there is a medical necessity for continuing on an excluded drug, coverage may be continued with an override. Some prescription drugs will switch from Tier 2 to Tier 3 and vice versa.
• There are two cost management programs for certain drugs (see listings below). Questions for Aetna?
• Call the concierge services line listed on the back of your card at 1-855-586-6963 or the NFP Benefit Support Team at 1-844-348-1463.
Hospital Indemnity Plan
• If you elect the [HSA] Aetna Consumer Choice Plan then the college will cover the cost and automatically enroll you in this plan.
• You may also elect the HIP if you are covered under the ACO or PPO or even if you opt-out of the Bates medical plan. The premium will be deducted from your check on an after-tax basis.
• The HIP plan provides a $1,000 benefit should any covered member of your family be admitted* to the hospital for an overnight stay. You will receive an additional $100 for any additional day spent in the hospital, $200 a day in the ICU, or $50 a day in a rehabilitation unit following a hospital stay. If you do not want to enroll in the HIP we ask that you elect to Opt Out of the HIP.
* See Hospital Indemnity Plan brochure for the definition of Admission, there are times you may be in a hospital overnight and not be “admitted”. For example, some outpatient procedures such as joint replacements may require you to stay in the hospital overnight but this is not an admission to the hospital. You must be admitted to receive the $1,000 benefit.
$10.96 – You Only
$24.43 – You + Spouse/Partner
$18.78 – You + Child(ren)
$31.04 – You, Spouse/Partner + Child(ren)
A cost comparison tool (excel spreadsheet) has been developed for you to compare your total out-of-pocket costs by the plan based on your estimated use of healthcare services. This tool provides examples only and the actual cost will be based on the actual services used.
Additional Aetna Medical Plan Information
- Whole Health Provider Summary
- Whole Health FAQs
- Instructions on how to find if a doctor is in Aetna’s PPO/HSA or Whole Health (ACO) network
- Aetna Standard Rx Formulary
- Rx Pre-certification and Step Therapy Overview
- RX listing needing Pre-cert or Step Therapy
- RX Excluded Drugs
- Your personalized Aetna Navigator Account
- Aetna Concierge Service
- Aetna’s Mobile App
- Aetna’s Discount Program