Our benefits program includes medical plan options with a range of coverage levels and costs, so you can choose the one that’s best for you. These plans are administered by Aetna. You can enroll as a new hire, during Open Enrollment, or if you have a qualifying life event. To see your premiums and enroll, log in to the Employee Central website.
Carrier: Aetna
Southern California employees only
Provides in-network care only, coordinated by your primary care provider (PCP). This plan provides a small network of providers and medical groups in the Southern CA area only.
Carrier: Aetna
California employees only
Provides in-network care only, coordinated by your primary care provider (PCP). This plan provides a limited network of providers and medical groups throughout California.
Carrier: Aetna
California employees only
Provides in-network care only, coordinated by your primary care provider (PCP). This plan offers a broad network of providers throughout California.
Carrier: Aetna
Offered in all states
This plan provides nationwide coverage for in- and out-of-network providers. Aside from preventive services, your deductible must be met before receiving first-dollar coverage. This is an HSA-eligible plan.
for a wide range of health care services.
Tip: If you need extra protection from large or unexpected medical expenses, you may also choose to enroll in supplemental medical coverage.
such as annual physicals, recommended immunizations, and routine cancer screenings covered at 100%. See more covered preventive services.
included with each medical plan. Prescription benefits are provided by Aetna.
through annual out-of-pocket maximums that limit the amount you’ll pay each year.
| Aetna Whole Health HMO | Aetna Value HMO | Aetna HMO | Aetna Open Access Managed Choice HDHP | |||||
|---|---|---|---|---|---|---|---|---|
| In-Network (Only) | Out-of-Network | In-Network (Only) | Out-of-Network | In-Network (Only) | Out-of-Network | In-Network | Out-of-Network | |
| Annual Deductible (calendar year) | None | N/A | None | N/A | None | N/A | $1,600 Individual/ $3,200 Per Member/ $3,200 Family | $4,500 Individual/ $4,500 Per Member/ $9,000 Family |
| Coinsurance | N/A | N/A | N/A | N/A | N/A | N/A | 80% | 80% |
| Annual Out-of-Pocket Maximum (calendar year) | $2,000 Individual $4,000 Family | N/A | $2,000 Individual $4,000 Family | N/A | $3,500 Individual $7,000 Family | N/A | $3,200 Individual/ $3,200 Per Member/ $6,400 Family | $9,000 Individual/ $9,000 Per Member/ $18,000 Family |
| SCAN Contribution to Health Savings Account (HSA) | N/A | N/A | N/A | N/A | N/A | N/A |
CA Employees Non-CA Employees |
|
| Physician Services: Your Costs | ||||||||
| Preventive care | Covered 100% | N/A | Covered 100% | N/A | Covered 100% | N/A | Covered 100%* | You pay 40% after deductible |
| Primary Care Office Visit | $10 copay | N/A | $20 copay | N/A | $10 copay | N/A | You pay 20% after deductible | You pay 40% after deductible |
| Specialist Office Visit | $30 copay | N/A | $40 copay | N/A | $30 copay | N/A | You pay 20% after deductible | You pay 40% after deductible |
| Lab/X-ray | No copay | N/A | No copay | N/A | No copay | N/A | You pay 20% after deductible | You pay 40% after deductible |
| Imaging (CT/MRIs) | $100 copay per type of scan | N/A | $100 copay per type of scan | $100 copay per type of scan | 20% coinsurance per scan | N/A | You pay 20% after deductible | You pay 40% after deductible |
| Physical Therapy – up to 20 visits (calendar year) | $10 copay | N/A | $20 copay | N/A | $10 copay | N/A | You pay 20% after deductible | You pay 40% after deductible |
| Durable medical equipment | 50% | N/A | 20% | N/A | 50% | N/A | 50% | 50% |
| Hospital Services: Your Costs | ||||||||
| Inpatient** | $250 copay per admission | N/A | $250 copay per admission | N/A | 20% per admission | N/A | You pay 20% after deductible | You pay 40% after deductible |
| Outpatient | $125 copay per visit | N/A | $125 copay per visit | N/A | 20% per visit | N/A | You pay 20% after deductible | You pay 40% after deductible |
| Emergency Room | $100 copay (waived if admitted) | N/A | $100 copay (waived if admitted) | N/A | $150 copay (waived if admitted) | N/A | You pay 20% after deductible | You pay 20% after deductible |
| Ambulance | $100 copay | N/A | $100 copay | N/A | $100 copay | N/A | You pay 20% after deductible | You pay 20% after deductible |
| Urgent Care | $10 copay | N/A | $20 copay | N/A | $10 copay | N/A | You pay 20% after deductible | You pay 40% after deductible |
| Mental Health Care: Your Costs | ||||||||
| Inpatient | $250 copay per admission | N/A | $250 copay per admission | N/A | 20% copay per admission | N/A | You pay 20% after deductible | You pay 40% after deductible |
| Outpatient | $10 copay | N/A | $20 copay | N/A | $10 copay | N/A | You pay 20% after deductible | You pay 40% after deductible |
| Prescription drugs: Your costs | ||||||||
| Retail Pharmacy (30-day supply) | ||||||||
| Tier 1 | $15 | N/A | $15 | N/A | $15 | N/A | $10 | 40% up to $250 |
| Tier 2 | $30 | N/A | $30 | N/A | $30 | N/A | $30 | 40% up to $250 |
| Tier 3 | $50 | N/A | $50 | N/A | $50 | N/A | $50 | 40% up to $250 |
| Tier 4 | 30% up to $250 per fill | N/A | 30% up to $250 per fill | N/A | 30% up to $250 per fill | N/A | 30% up to $250 per fill | See Benefit Summary for OON |
| Mail Order (90-day supply) | ||||||||
| Tier 1 | $37.50 | N/A | $37.50 | N/A | $37.50 | N/A | $25 | See Benefit Summary for OON |
| Tier 2 | $90 | N/A | $90 | N/A | $90 | N/A | $90 | See Benefit Summary for OON |
| Tier 3 | $150 | N/A | $150 | N/A | $150 | N/A | $100 | See Benefit Summary for OON |
| Tier 4 | 30% up to $250 per fill | N/A | 30% up to $250 per fill | N/A | 30% up to $250 per fill | N/A | 30% up to $250 per fill | See Benefit Summary for OON |
*Deductible does not apply
**Semi-private room
You pay the plan premium from your paycheck to have coverage.
Copay
You pay a small fee at the time of service for doctor visits and prescriptions.
Coinsurance
You and the plan share the cost of certain services, with the plan paying the majority.
Out-of-Pocket Maximum
You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.
You are required to designate a primary care provider (PCP) upon enrollment in Employee Central. You must click here to find your doctor. Do not use another site.
A PCP is critical to your health, providing preventive care, regular checkups, treatment for illness and injury, and help with managing chronic conditions.
Please note that each plan has a different network of doctors. This will impact the plan that you enroll in. If you cannot find your doctor in one plan, try searching under another plan.
You pay the plan premium from your paycheck to have coverage.
Deductible
You pay 100% of your medical costs until you meet the annual deductible. (The deductible also applies to prescriptions except for maintenance medications.)
Coinsurance
After meeting the deductible, you and the plan share the cost of covered services, with the plan paying the majority.
Out-of-Pocket Maximum
You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.
The cost of your prescription drugs under each medical plan depends on the tier of the medication — generic, preferred, or non-preferred. All prescription carriers have a list of preferred drugs based on effectiveness and cost. Check Aetna’s website for a list of covered drugs.
Generic drugs
Same active ingredients as brand-name equivalents and meet the same standards for quality and effectiveness, but usually cost much less.
You pay: $
Preferred Drugs
Brand-name medications included on the formulary and favored by your prescription carrier.
You pay: $$
Non-Preferred drugs
Brand-name medications not preferred by your carrier. They may still be covered, but may require prior authorization and cost more.
You pay: $$$
The cost of prescription drugs is rising faster than many other health care services and supplies. But, there are ways for you to save.
Generic medications are generally just as effective as brand-name medications, but they typically cost between 80% and 85% less.
If you take maintenance medication to treat a chronic condition — such as an allergy, heart disease, high blood pressure, or diabetes — the convenience and cost savings of the home delivery prescription program through Aetna will save you time and money.
When you carefully consider the financial impact of your health care choices, you can help lower costs for yourself and the entire company. Get the most from your medical benefits by following these tips to be well and buy smart:
| Telemedicine | Doctor’s Office | Urgent Care Clinic | Emergency Room |
|---|---|---|---|
| Use it for | |||
| A common, non-emergency medical issue that can be diagnosed by phone or online | A condition that doesn’t need immediate attention and can wait until the next day | A condition that needs immediate care but is not life- or limb-threatening | A life-threatening or potentially crippling condition that needs immediate attention |
| Examples | |||
|
|
|
|
| Cost | |||
| You pay: $ | You pay: $ | You pay: $$ | You pay: $$$ |
| Find it | |||
| Visit the Teladoc.com/Aetna website to get started | Call your regular doctor or search for an in-network provider on your medical plan carrier’s website | Search for urgent care clinics near you at aetnaresource.com/m/SCAN | Call 911 or search online for the nearest hospital |
