2019 Medical Plan Options-AE
In 2019 you continue to have the same three medical plan options available to you through Aetna. Need help deciding which one is best for you? Contact the Health Advocate to discuss your options at 1-866-695-8622.
Please click here if you want to view a recording of an Annual Enrollment Overview session.
The Aetna Consumer Choice (HSA) Plan 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).
The Aetna Whole Health (ACO) Plan 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. When obtaining care from a Tier 2 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.
The Aetna PPO Plan is the most expensive plan, but you have the same access to Aetna’s full network similar to the HSA Plan. You will incur a flat copay for most services outside of the hospital. This plan does not require the selection of a PCP or referrals.
See the plan summaries for each of the plans for more details on costs and coverage.
Prescription Drug Coverage: All three plans use the same prescription drug formulary. Note this formulary has changed to the Aetna Standard Formulary in 2019. Coverage for some drugs where there are lower cost options will be discontinued. If a doctor shows there is 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 1-855-586-6963 or the Health Advocate service at 1-866-695-8622.
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 or $200 a day in the ICU. 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 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.
Monthly premiums are as follows:
$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 plan for based on your estimated use of healthcare services. This tool provides examples only and actual cost will be based on the actual services used.
Annual Enrollment will take place beginning Monday, November 5th and ending at midnight on Tuesday, November 20th. Between now and when annual enrollment begins we will have several opportunities for you to learn more about the medical options .
Medical Plan Summaries:
- Aetna PPO Plan Summary
- Aetna Whole Health (ACO) Plan Summary
- Aetna Whole Health Member brochure
- Aetna Consumer Choice (HSA) Plan Summary
- Side by side quick plan comparison
- Hospital Indemnity Plan Summary
- Aetna Preventive Medicine List for the Aetna Consumer Choice (HSA) Plan
(paid at 100% – not subject to the deductible)
Other Aetna Medical Plan Information
- Whole Health Provider Summary
- Whole Health FAQs
- Whole Health Full Provider Directory (pdf) most current listing is found online
- Instructions on how to find if a doctor is in Aetna’s PPO/HSA or Whole Health (ACO) network
- Rx Pre-certification and Step Therapy Overview
- RX listing needing Pre-cert or Step Therapy
- RX Excluded Drugs
- Your personalized Aetna Navigator Account
- Aetna Required Information on your Medical Plan
- Aetna Concierge Service
- Aetna’s Mobile App
- Aetna’s Discount Program
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:
- Health Savings Account Quick Reference Guide
- Health Savings Accounts Frequently Asked Questions (4 Pages)
- Health Savings Account 2019 Employee Guide (19 pages)
- HSA Account Fee Schedule
- Health Savings Account Payroll Deduction Form
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 (minimum balance of $1,000 in your Health Savings Account is required before you can invest in Mutual funds). There is no monthly Investment Account Maintenance fee.
With an investment account you have:
- Investing with your HSA
- HSA Investment Fund Performance as of 09-30-18
- integration with Morningstar research data
- 403(b)-like investment capabilities with no transaction fees for trading
- Tax-free growth
Tour the “Financial Center” section of your Health Savings Account with PayFlex for more information.