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EMPLOYEE BENEFITS

The Benefits Section of Human Resources & Risk Management is a customer service and benefits processing operation. We handle the daily activities of managing your benefits, design communications to keep you apprised of changes, prepare you for retirement, conduct data analysis, provide training on our technology-based benefits and new employee orientation. Our staff continuously strives to provide comprehensive benefits to employees, dependents and retirees while maintaining reasonable costs and a high level of service.   
 
We recognize each employee has different needs and since time is of the essence, technology and convenience are the key factors in conducting business. Plan participants may log on to
http://www.aetna.com/ to check claims payment status, eligibility, order an ID card, Price A Procedure, Price A Drug, print your Explanation of Benefits (EOB) statements, check out the Clinical Policy Bulletins, refill mail order prescriptions, monitor Flexible Spending Account (FSA) balances, query for medical information or just search for a provider anywhere in the country. Utilizing the Aetna tools enables you to get the most value out of your plan and saves time!

Those who prefer personal contact may call Aetna’s Harris County dedicated customer service line at (800) 279-2401 or the Harris County Benefits staff at (713) 274-5500, toll free (866) 474-7475.

Benefits Comparison for Plan Year 3/1/14 – 2/28/15

                                 Aetna Choice POS II Plan Design - Plan Highlights

 

BASE PLAN
In-Network

BASE PLAN
Out-of-Network

Annual Deductible
(per calendar year)

$   500 Individual
$1,500 Family

$1,000 Individual
$3,000 Family

Maximum Out-of-Pocket-includes deductible, coinsurance and medical copays

(Per Individual/Family Per Calendar Year)

$4,000 Individual 

$10,000 Family

$9,000 Individual 
$27,000 Family

Lifetime Maximum Benefit

Unlimited except where otherwise indicated

$1,000,000

Physician's Office Copay
Primary Care
Specialist (Aexcel provider)
Specialist (non-Aexcel prov)


100% after $25 copay
100% after $40 copay
100% after $50 copay



50% after deductible

Preventive Care

100% coverage

50% after deductible

Allergy Services (includes testing, serum and injections)

100% after $40  copay

50% after deductible

Maternity Care
  Physician's Office
   (prenatal & post natal)
 
 In the Hospital
   (for mother & newborn)


$40 for first visit only


80% after deductible


50% after deductible


50% after deductible

Diagnostic Laboratory & Radiology Services

100% coverage

50% after deductible

Complex Imaging/High Tech Radiology

90% after deductible
(requires precertification)

50% after deductiible

Rehabilitation, Speech, Occupational and Physical Therapy

100% after a $25 copay,
up to 60 visits per calendar year*

50% after deductible,
up to 60 visits per calendar year*

Walk-In Clinic

100% after a $25 copay

50% after deductible

Urgent Care Facility

100% after a $50 copay

50% after deductible

Emergency Room

$300 copay; waived if confined,
80% after deductible if admitted

$300 copay; waived if confined,
50% after deductible if admitted

Outpatient Surgery

80% after deductible

50% after deductible

Inpatient Services

80% after deductible

50% after deductible

Home Health Care

90% after deductible,
up to 100 visits per calendar year*

50% after deductible,
up 100 visits per calendar year*

International care

n/a

50% after deductible

Mental Health
   Outpatient Visits
   Inpatient Services


100% after $30 copay
80% after deductible


50% after deductible
50% after deductible

Chemical Dependency
 
   Outpatient Visits
    Inpatient Services


100% after $30 copay
80% after deductible


50% after deductible
50% after deductible

 

BASE PLUS PLAN
In-Network

BASE PLUS PLAN
Out-of-Network

Annual Deductible
(per calendar year)

None

$1,000 Individual
$3,000 Family

Maximum Out -of-Pocket-includes deductible, coinsurance and medical copays

(Per Individual/Family Per Calendar Year)

$3,000 Individual

$7,500 Family

$9,000 Individual

$27,000 Family

Lifetime Maximum Benefit

Unlimited except where otherwise indicated

$1,000,000

Physician's Office Copay
Primary Care
Specialist (Aexcel provider)
Specialist (non-Aexcel prov)


100% after $20 copay
100% after $30 copay
100% after $40 copay



60% after deductible

Preventive Care

100% coverage

60% after deductible

Allergy Services (includes testing, serum and injections)

100% after $40 copay

60% after deductible

Maternity Care
  Physician's Office
   (prenatal & post natal)
 
 In the Hospital
   (for mother & newborn)


$30 for first visit only


$500 per confinement copay for mother
$500 copay for each newborn


60% after deductible


60% after deductible

Diagnostic Laboratory & Radiology Services

100% coverage

60% after deductible

Complex Imaging/High Tech Radiology

100% copay 
(requires precertification)

60% after deductiible

Rehabilitation, Speech, Occupational and Physical Therapy

100% after a $20 copay,
up to 60 visits per calendar year*

60% after deductible,
up to 60 visits per calendar year*

Walk-In Clinic

100% after a $20 copay

60% after deductible

Urgent Care Facility

100% after a $50 copay

60% after deductible

Emergency Room

$300 copay; waived if confined,
80% after deductible if admitted

$300 copay; waived if confined,
60% after deductible if admitted

Outpatient Surgery

100% after $300 copay for surgical procedures, 100% coverage for non-surgical

60% after deductible

Inpatient Services

$500 per confinement copay*

60% after deductible

Home Health Care

100% coverage,
up to 100 visits per calendar year*

60% after deductible,
up 100 visits per calendar year*

International care

n/a

60% after deductible

Mental Health
   Outpatient Visits
   Inpatient Services


100% after $30 copay
$500 per confinement copay*


60% after deductible
60% after deductible

Chemical Dependency
 
   Outpatient Visits
    Inpatient Services


100% after $30 copay
$500 per confinement copay*


60% after deductible
60% after deductible

* Maximums are a combined limit for in-network and out-of-network services.

 

PRESCRIPTION BENEFIT IN-NETWORK FOR BOTH PLANS  

 

% You Pay

Minimum Copay

Maximum Copay

RETAIL (30 day supply)

Generic

25%

$5

$35

Brand

30%

$25

$200

Specialty

30%

$50

$200

MAIL ORDER (61-90 days supply)

Generic

25%

$10

$70

Brand

30%

$50

$200

PRESCRIPTION BENEFIT OUT-OF-NETWORK FOR BOTH PLANS
60% of the recognized charge at non-participating pharmacies

 

Go to http://www.hctx.net/HRRM/medicalplan.aspx for a description of your employee benefit plans and options.

Mid Year Budget Update and Review 2014-2015

Mid-Year Budget Update and Review    

 
 
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Contact Human Resources and Risk Management at hrrm_email@hctx.net.
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