Medical Coverage

Policy Year Maximum: Unlimited

Deductible

Preferred Care

Non-Preferred Care

The policy year deductible is waived for all of the following eligible medical services: 

  • In-network care for preventive care and wellness 
  • In-network care for pediatric dental care 
  • In-network care and out-of-network care for pediatric vision care 
  • In-network care and out-of-network care for outpatient prescription drugs

Students: $400 per Policy Year
Family: $1,200 per Policy Year

Students: $750 per Policy Year
Family: $2,250 Per Policy Year

Coinsurance: Coinsurance is both the percentage of covered medical expenses that the plan pays, and the percentage of covered medical expenses that you pay.  The percentage that the plan pays is referred to as “plan coinsurance” or the “payment percentage,” and varies by the type of expense. Please refer to the Schedule of Benefits for specific information on coinsurance amounts.

Out of Pocket Maximums

Preferred Care

Non-Preferred Care

Once the Individual or Family Out-of-Pocket Limit has been satisfied, Covered Medical Expenses will be payable at 100% for the remainder of the Policy Year.

The following expenses do not apply toward meeting the plan’s out-of-pocket limits:

  • Non-covered medical expenses; and
  • Expenses that are not paid or precertification benefit reductions or penalties because a required precertification for the service(s) or supply was not obtained from Aetna.

Individual Out-of-Pocket: 
$7,900 per Policy Year

Family Out-of-Pocket: 

$15,800 per Policy Year

Individual Out-of-Pocket: 
$15,000 per Policy Year

Family Out-of-Pocket:   

$20,000 per Policy Year