Aetna POS Plan

About the POS Plan

With the POS Plan, you pay with copays for some services (copays are fixed fee amounts that you pay at the time you receive services).

The Plan also uses coinsurance for some services (coinsurance is the portion of expense you must pay for care, in most cases, after meeting your deductible). The deductible is a set amount that typically you must pay before co-insurance starts.

The POS Plan allows you to receive services from a national network of providers and facilities. It is an open access plan that:

• Provides the flexibility to choose any provider
• Does not require that a Primary Care Physician (PCP) be identified or selected
• Does not require a PCP referral to see a specialist

You cannot open a Health Savings Account (HSA) or receive HSA contributions from Emory, but you have the option of enrolling in a Healthcare Flexible Spending Account (FSA) which allows you to set aside up to $3,050 pre-tax dollars to help pay for medical expenses.

Incentives

You can earn incentives by completing various healthy activities to help offset your medical costs. Your spouse may also be eligible for some of the incentives.

Networks

The POS Plan has three network options:

• Tier 1: The Tier 1 Network includes the Emory Healthcare Network (EHN) along with new Emory facilities: Emory Decatur, Emory Hillandale and Emory Long Term Acute Care facilities. Tier 1 also includes all EHN and DeKalb Physician Hospital Organization (DPHO) providers. This network’s facilities and providers offer the lowest copays, coinsurance and deductibles.
• Tier 2: The Tier 2 Network includes providers and facilities contracted through Aetna’s national network. Copays, coinsurance and deductibles are higher than Tier 1 providers.
• Tier 3: The Tier 3 Network includes providers and facilities not participating in Aetna and has the highest costs associated with it.

To locate a physician or facility in the Tier 1 or Tier 2 or Network, use Aetna's DocFind:

Deductible

All eligible expenses incurred by you or your covered dependents throughout the plan year apply towards meeting the annual deductible.

• The Tier 1 deductible is $850 (Employee Only) or $2,550 (Employee + Spouse, Employee + Children, or Family).
• The Tier 2 deductible is $1,000 (Employee Only) or $3,000 (Employee + Spouse, Employee + Children, or Family).
• The Tier 3 deductible is $2,000 (Employee Only) or $6,000 (Employee + Spouse, Employee + Children, or Family).

The annual deductible must be satisfied before any plan expenses are paid by coinsurance, with the exception of preventive care and Tier Zero prescriptions which are covered at 100%.

The deductible for the POS Plan typically applies to medical services other than office visits, and does not apply to prescriptions.  

Coinsurance

Tier 1 and Tier 2 preventive care is covered at 100% and is not subject to the deductible. For all other medical services, the POS Plan pays a portion of your covered expenses after you pay the annual deductible:

• Tier 1 care is covered at 85% (you pay 15%)
• Tier 2 care is covered at 75% (you pay 25%) 
• Tier 3 care is covered at 50% (you pay 50%)

Office visits are covered with a copayment. Prescription drugs are covered through coinsurance.

Out-of-Pocket Maximum

The POS Plan has an out-of-pocket maximum to protect you in the event you have significant medical expenses during the year. The out-of-pocket maximum includes all copays, as well as deductible and coinsurances, such as prescription drug costs and office visit copays.

• The Tier 1 out-of-pocket maximum is $3,000 (Employee Only) or $6,000 (Employee + Spouse, Employee + Children, or Family).
• The Tier 2 out-of-pocket maximum is $4,500 (Employee Only) or $9,000 (Employee + Spouse, Employee + Children, or Family).
• The Tier 3 out-of-pocket maximum is $11,250 (Employee Only) or $22,500 (Employee + Spouse, Employee + Children, or Family).

Prescription Drugs

Prescription drug coverage is part of your medical plan and is administered through CVS Caremark.

Behavioral Mental Health

Behavioral Mental Health is covered as part of your Emory medical plan. Aetna provides a network of experienced psychiatrists, psychologists, clinical nurse specialists and licensed counselors with broad expertise in treating children, adolescents, adults and families.

To make it easier and more cost-effective to access behavioral mental health services, out-of-network behavioral health providers will now be covered at the in-network benefit level for the Aetna POS and HSA Plans. This includes psychiatry, psychology and other licensed behavioral health providers.

For a listing of providers, contact Aetna at 800-847-9026 or use Aetna DocFind: