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Aetna Health Insurance Comparison
INFORMATION CONCERNING THE AETNA MEDICAL PLANS YOU MAY SELECT
The Aetna plans and premiums described below are in effect thru November 30, 2011; the plans and premiums offered at the time you apply may differ. A complete listing of services, limitations, exclusions, terms and conditions are contained in the group policy and booklet-certificate. The following table compares the provisions of the Emblem Health medical plans and the proposed Aetna plans.
Plan Feature |
Gold Plan |
Health Savings Account Plan |
|
Maximum Age for Dependent Child |
26 |
26 |
In-Network Services |
||
|
Annual Deductible |
|
|
|
Individual |
$1,500 |
$2,500 |
|
Family |
$4,500 |
$5,000 |
|
Coinsurance (amount carrier pays after you satisfy the deductible) |
90% |
90% |
|
Annual Out-of-Pocket Maximum |
|
|
|
Individual |
$3,000 |
$5,000 |
|
Family |
$9,000 |
$10,000 |
|
Preventive /routine care (see plan for limits) Well child care to age 19 Adult physical exams Routine gynecology exams Mammograms & routine Digital rectal exam/prostate-specific antigen test Flu shots Colorectal cancer screening Eye exams |
No Charge No Charge No Charge No Charge No Charge No Charge
No Charge No Charge |
No Charge No Charge No Charge No Charge No Charge No Charge
No Charge No Charge |
|
Office Visit Copay |
$25 |
Subject to Deductible & Coinsurance |
|
Specialist Copay |
$25 |
Subject to Deductible & Coinsurance |
|
Hospital Admission, Surgical Copay and Diagnostic Tests |
90% after Deductible |
Subject to Deductible & Coinsurance |
|
Lifetime Maximum Benefit |
Unlimited |
Unlimited |
|
Out-of-Network Services |
||
|
Annual Deductible |
|
|
|
Individual |
$3,000 |
Not Applicable |
|
Family |
$9,000 |
Not Applicable |
|
Annual Out-of-Pocket Maximum |
|
|
|
Individual |
$6,000 |
Not Applicable |
|
Family |
$18,000 |
Not Applicable |
|
Coinsurance (amount carrier pays after you satisfy the deductible) |
70% After Deductible |
Not Applicable |
|
Lifetime Maximum Benefit |
Unlimited |
Not Applicable |
|
Prescription Drug Program |
||
|
In-Network Copay: Generic/Preferred/Non-Preferred |
$15/$35/$70 |
Not Applicable |
|
Prescription Drug Deductible |
None |
100% after deductible |
Your take-home pay may differ from our illustrations. We assumed we would withhold from your pay 5% for federal and state income taxes, 7.65% in FICA taxes, and 75% of the cost of the medical insurance premium with pre-tax dollars. Your check is directly deposited into your bank account on the 15th and last day of the month. Each check is ½ your monthly pay. We send your paystub to your e-mail account so that you can see how we arrived at your take-home pay.
You'll pay us a monthly PEO fee, which will be deducted from your bank account around the 13th of each month. The PEO fee covers the salary we pay you, our share of your FICA tax, medical, disability and life insurance coverage, our cost to provide workers' compensation and unemployment insurance, our regulatory expenses (such as state licensing fees), and direct operating costs for such items as payroll processing and overhead. In the event there are insufficient funds in your bank account when we withdraw our PEO fees, we charge a $50 fee. If we do not receive payment by the end of the month, we immediately terminate your medical insurance and terminate you from our program.
We also charge a one-time set up fee of $200 per employee to establish each employee's record on our system, and an annual calendar year renewal fee of $120 per employee. The set-up and renewal fees offset our direct expenses for operating our company. In Connecticut, we also pass on the sales tax charged by the State which ranges from $9 - $17 a month depending on the medical plan and coverage selected.