2025 benefit highlights
| Traditional Aetna Choice POS II | In-network | Out-of-network**** |
|---|---|---|
| Deductible | In-Network: EE Only $1,600; EE+ Family: Individual $1,600/ Family $3,200. | Out-of-Network: EE Only $3,200; EE+ Family: Individual $3,200/ Family $6,400. |
| Annual out-of-pocket maximum | In-Network: EE Only $4,200; EE+ Family: Individual $4,200/ Family $8,400. | Out-of-Network: EE Only $8,400; EE+ Family: Individual $8,400/ Family $16,800. |
| Office Visits |
50 copay/visit, deductible doesn't apply PCP
$75 copay/visit, deductible doesn't apply SPC |
50% coinsurance |
| Preventive Care | 100% covered, deductible waived | 50% coinsurance |
| Inpatient Hospital | 30% coinsurance | 50% coinsurance |
| Urgent Care | $75 copay | 50% coinsurance |
| Emergency Room | 30% coinsurance | 30% coinsurance |
| Ambulance | 30% coinsurance | 30% coinsurance |
| Chiropractor | $75 copay | 50% coinsurance, after deductible |
| Short-Term Rehabilitation (60 visits/calendar year for Physical, Occupational & Speech Therapy combined, including outpatient hospital services. Includes treatment of Autism & habilitation services) |
$75 copay | 50% coinsurance |
*Deductible: The amount you pay for covered services before your health plan begins to pay.
**Copay: This is the dollar amount you pay for health care expenses after you meet your deductible limit.
***Coinsurance: This is the percentage of health care expenses you pay after your deductible. Your health plan pays the rest up to any benefit or lifetime maximum.
****Note: The plan pays benefits for out-of-network services based on the allowable charge for a service. If your out-of-network provider charges more than the allowable charge, you will be responsible for any expenses incurred that are above this amount, in addition to your out-of-network deductible and coinsurance/copay. Any amount that you pay above the allowable charge will not apply to your out-of-pocket maximum.
