DECIDE

Take some time and review the many new choices, programs and resources available to help keep you and your family healthy. 

In-Network Medical Services

Benefits Basic Managed Choice Managed Choice HCRA (Aetna Healthfund)
You Pay You Pay You Pay
Preventative Services $0 $0 $0
Office Visits
Primary Care Physician (PCP) Specialist 		$30 PCP copay (after deductible)
$45 Specialist copay (after deductible) 		$30 PCP copay
$40 Specialist copay 		Deductible and Coinsurance
Emergency $100 copay
(after deductible) 		$100 copay Deductible and Coinsurance
Urgent Care Facility $45 copay
(after deductible) 		$40 copay Deductible and Coinsurance
Deductible $2,500 single
$5,000 family 		$1,250 single
$2,500 family 		$2,000 single
$4,000 family
HCRA Fund N/A N/A $1,000 single
$2,000 family
Deductible after HCRA Fund N/A N/A $1,000 single
$2,000 family
Coinsurance 35% 35% 30%
Annual Out-of-Pocket Maximum $6,000 single
$12,000 family 		$4,750 single
$9,500 family 		$5,600 single
$11,200 family

Note: Prescription drug coverage is included in the medical plan. Prescription drug expenses are not subject to the medical plan deductible

Out-of-Network Medical Services

Benefits Basic Managed Choice Managed Choice HCRA (Aetna Healthfund)
You Pay You Pay You Pay
Office Visits and Preventative Care
 Deductible and Coinsurance Deductible and Coinsurance Deductible and Coinsurance
Emergency $100 copay
(after deductible) 		$100 copay Deductible and Coinsurance
Deductible $7,000 single
$14,000 family 		$3,000 single
$6,000 family 		$6,000 single
$12,000 family
Coinsurance* 50% 50% 50%
Annual Out-of-Pocket Maximum $12,000 single
$24,000 family 		$10,000 single
$20,000 family 		$10,000 single
$20,000 family

* The plan pays out-of-network benefits based on Medicare reimbursement levels (up to 110% of Medicare for professional services and 140% for facility charges). In addition to your coinsurance, you are responsible for amounts that exceed these levels.

Prescription Drugs: Managed Care Plan and HCRA Plan*

Type of Drug Definition Retail Pharmacy
(Non-ShopRite) 		ShopRite Pharmacies or
Spotswood Mail-Order
For a 30-day Supply For a 90-day Supply
Generic Drug with same active ingredients as brand name, with lower cost $15 $15
Preferred Brand** Drug marketed under a specific trademark or name by specific drug manufacturer and included on Aetna's drug list. $40 $40
Non Preferred Brand**
(No generic available) 		Drug marketed under a specific trademark or name by specific drug manufacturer and NOT included on Aetna's drug list. $60 $60
Specialty Brand High-cost prescription medications used to treat complex, chronic conditions $60 Contact your local pharmacy for more information.

* The cost of prescriptions under the Basic Managed Care Plan uses coinsurance. You pay 30% of the cost for Generic and Preferred Brand and 50% of the Non-Preferred Brand (not subject to the medical plan deductible). 
** If you or your physician requests a brand-name medication when a generic is available, you will pay the applicable copay plus the difference between the cost of the generic and brand-name drug.

Vision Plans

Benefit EyeMed Option 1
In-Network Member Cost 		EyeMed Option 1
Out-of-Network Member Cost 		EyeMed Option 2
In-Network Member Cost 		EyeMed Option 2
Out-of-Network
Member Cost
Exam (one every 12 months) $10 copay Up to $35 No copay Up to $28
Frames (one every 24 months) No copay; $120 allowance + 20% off balance over $120 Up to $48 No copay; $180 allowance + 20% off balance over $180 $90
Lenses (one every 12 months)
Single
Bifocal
Trifocal
$25 copay
$25 copay
$25 copay
Up to $25
Up to $40
Up to $60
No copay
No copay
No copay
Up to $25
Up to $39
Up to $63
Contact Lenses
(one order every 12 months)
Conventional No copay; $135 allowance + 15% off balance over $135 Up to $95 No copay; $180 allowance + 15% off balance over $180 Up to $144
Disposable No copay; $135 allowance Up to $95 No copay; $180 allowance Up to $144
Medically Necessary No copy; Paid in Full Up to $200 No copay; Paid in Full Up to $200