Medical Benefits

Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.aetna.com/asa.

	In-Network
Deductible (Individual/Family)	$1,000 / $2,000
Member Coinsurance	20%
Out-of-Pocket Max (Individual/Family)	$2,500 / $5,000
Physician Visits
Vibrant Provider with Copay Waiver Approval	$0 Copay
Primary Care Visit	$40 Copay
Preventive Care	Covered 100%
Specialist Visit	$40 Copay
Telehealth	$10 Copay
Hospital Services
Physician Services	Deductible, then 20%
Inpatient Hospitalization	Deductible, then 20%
Outpatient Surgery	Deductible, then 20%
Basic Outpatient Diagnostics	Deductible, then 20%
Urgent Care	$40 Copay
Emergency Room	$100 Copay + Deductible, then 20%

Vibrant Health Pharmacy Utilization Benefit (Deductible does not apply)*
Tier 1	$0
Tier 2	$20
Tier 3	$50
Tier 4	$200
Retail Prescription Benefits
Tier 1	$15
Tier 2	$70
Tier 3	$110
Tier 4	$200


*prescriptions that are eligible to be filled at Vibrant Health’s 340b Pharmacy

	Per Pay Period Cost
Employee Only	$87.51
Employee + Spouse	$578.08
Employee + Child(ren)	$457.68
Employee + Family	$995.40

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	In-Network
Deductible (Individual/Family)	$3,400 / $6,800
Member Coinsurance	0%
Out-of-Pocket Max (Individual/Family)	$3,400 / $6,800
Physician Visits
Vibrant Provider with Copay Waiver Approval	Deductible
Primary Care Visit	Deductible
Preventive Care	Covered 100%
Specialist Visit	Deductible
Telehealth	Deductible
Hospital Services
Physician Services	Deductible
Inpatient Hospitalization	Deductible
Outpatient Surgery	Deductible
Basic Outpatient Diagnostics	Deductible
Urgent Care	Deductible
Emergency Room	Deductible

Vibrant Health Pharmacy Utilization Benefit (Deductibe does not apply)*
Tier 1	Deductible
Tier 2	Deductible
Tier 3	Deductible
Tier 4	Deductible
Retail Prescription Benefits
Tier 1	Deductible
Tier 2	Deductible
Tier 3	Deductible
Tier 4	Deductible