Health Care Benefits
MEDICAL INSURANCE
Aetna is one of the nation’s leading providers of health care, pharmacy, and vision-care products serving approximately 13.7 million medical members as of December 31, 2002. The company has expansive nationwide networks of more than 552,000 health care service providers, including over 332,000 primary care and specialist physicians and 3,373 hospitals. Wahlco, in partnership with Aetna, offers a choice of medical plans so employees can select the coverage that is right for them. Employees and their dependents are covered on a cost sharing basis, with Wahlco contributing a generous portion of the medical premiums. We offer both an HMO and a PPO plan.
AETNA HMO
Under this plan, employees must choose a Primary Care Physician (PCP). All non-emergency care is directed through the PCP. Participants will receive benefits only if they use the doctors, clinics and hospitals that belong to the medical group in which they enroll. Emergency care is provided 24 hours a day, 7 days a week anywhere in the world.
AETNA PPO
Under the PPO plan employees have the freedom to go in and out-of-network for care. PPO providers have negotiated rates and provide richer levels of benefits with claim forms filed by the providers. Services outside the PPO network are also available at higher out-of-pocket cost.
MEDICAL BENEFITS SUMMARY
| FEATURE | AETNA HMO (Network only) |
AETNA PPO (Preferred) |
AETNA PPO (Non-Preferred) |
|---|---|---|---|
| Lifetime Maximum |
Unlimited | Unlimited | Unlimited |
| Deductible Annual |
- | - | - |
| Individual | $1,500 | $1,000 | $2,000 |
| Family | $3,000 | $2,000 | $4,000 |
| Hospitalization | 100% | 90% | $250, 70% |
| Emergency Services |
$100 co-pay | 90% co-pay | 70% co-pay |
| Wellness Exams | - | - | - |
| Adult | $15 co-pay | $10 co-pay (1 per 24 mo.) |
70% (1 per 24 mo.) |
| Children | $15 co-pay | $10 co-pay | 70% co-ins |
| Chiropractic | $15 co-pay (Max 20 visits/yr) |
90% (Max $1,000/yr) |
70% (Max $1,000/yr) |
| Mental Health (non-severe) |
- | - | - |
| Inpatient | 100% (Max 30 days/yr) |
90% | $250, 70% |
| Outpatient | $25 co-pay (Max 20 visits/yr) |
$10 co-pay | 70% |
VISION
The Vision One Discount Program is available to all Aetna members through EyeMed Vision Care. Participants receive discounts on eyeglasses, contact lenses, non-prescription sunglasses, contact lens solution and Lasik surgery.
PRESCRIPTION
To help provide access to quality, cost-effective medications, Wahlco uses Aetna’s formulary* prescription drug benefit plan. Aetna’s Medication Formulary Guide AETNA Navigator provides information regarding medications covered under these benefit plans.
HEALTH CARE REIMBURSEMENT
Employees may defer up to $2,500 pre-tax, per year, to be reimbursed for prescriptions, over-the-counter drugs, insurance deductibles, co-payments, glasses and contact lenses, orthodontia and other health care related expenses not covered by insurance.
The benefit is at 100% after employee co-payment as follows:
| Prescription Drugs Co-Pay: |
AETNA HMO | AETNA PPO |
|---|---|---|
| Generic Formulary | $10 | $10 |
| Brand Name Formulary | $15 | $20 |
| Non-Formulary | $30 | $35 |
| Mail Order | $20 / $30 / $60 (90 day supply) |
$20 / $30 / $60 (60 day supply) |
*Formulary is an approved list of medications which HMO/PPO network physicians may prescribe.
All information contained in this website is a summary and brief description of your coverage only and is not a contract. Please see your plan documents for a complete description of your benefits and the governing terms and conditions.
