Group Number
15784
Provided By
Meritain
Provider Website
Customer Service
Resources
Frequently Asked QuestionsMedical 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 these plans do not offer out-of-network coverage. To find participating provider, please visit www.aetna.com.
In-Network |
|
|---|---|
Annual Deductible |
$5,000/ $10,000 |
Out-of-Pocket Max |
$7,900/ $15,800 |
Member Coinsurance |
70% |
Physician Visits |
|
Primary Care Visit |
$50 Copay |
Teladoc |
$25 Copay |
X-Rays |
Covered at 100% |
Preventive Care |
100% |
Specialist Visit |
$75 Copay |
Hospital Services |
|
Physician Services |
70% after Deductible |
Inpatient Hospitalization |
70% after Deductible |
Outpatient Surgery |
70% after Deductible |
Basic Outpatient Diagnostics |
70% after Deductible |
Urgent Care |
$100 Copay |
Emergency Room |
$500 Copay- waived if admitted |
Prescription Drugs |
|
|---|---|
Retail Prescriptions |
|
Tier 1 |
$15 |
Tier 2 |
$35 |
Tier 3 |
$65 |
Tier 4 |
20% up to $250 |
Mail Order Prescriptions |
|
Tier 1 |
$30 |
Tier 2 |
$70 |
Tier 3 |
$130 |
Bi-Weekly Cost |
Employee Annual Cost |
SCC Annual Contribution |
|
|---|---|---|---|
Employee Only |
$0.00 |
$0.00 |
$8,992.96 |
Employee + Spouse |
$333.67 |
$8,008.08 |
$12,000.00 |
Employee + Child(ren) |
$180.23 |
$4,325.52 |
$12,000.00 |
Employee + Family |
$559.70 |
$13,432.92 |
$12,000.00 |
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 these plans do not offer out-of-network coverage. To find participating provider, please visit www.aetna.com.
In-Network |
|
|---|---|
Annual Deductible |
$2,000/ $4,000 |
Out-of-Pocket Max |
$6,000/ $12,000 |
Member Coinsurance |
70% |
Physician Visits |
|
Primary Care Visit |
$25 Copay |
Teladoc |
$25 Copay |
X-Rays |
$25 Copay |
Preventive Care |
100% |
Specialist Visit |
$50 Copay |
Hospital Services |
|
Physician Services |
70% after Deductible |
Inpatient Hospital |
70% after Deductible |
Outpatient Hospital |
70% after Deductible |
Basic Outpatient Diagnostics |
70% after Deductible |
Urgent Care |
$75 Copay |
Emergency Room |
$400 Copay- waived if admitted |
Prescription Drugs |
|
|---|---|
Retail Prescriptions |
|
Tier 1 |
$10 |
Tier 2 |
$50 |
Tier 3 |
$100 |
Tier 4 |
20% up to $400 |
Mail Order Prescriptions |
|
Tier 1 |
$20 |
Tier 2 |
$100 |
Tier 3 |
$200 |
Bi-Weekly Cost |
Employee Annual Cost |
SCC Annual Contribution |
|
|---|---|---|---|
Employee Only |
$39.29 |
$942.96 |
$10,138.32 |
Employee + Spouse |
$447.24 |
$10,733.76 |
$12,000.00 |
Employee + Child(ren) |
$272.88 |
$6,549.12 |
$12,000.00 |
Employee + Family |
$704.07 |
$16,897.68 |
$12,000.00 |
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 these plans do not offer out-of-network coverage. To find participating provider, please visit www.aetna.com.
In-Network |
|
|---|---|
Annual Deductible |
$1,000/ $2,000 |
Out-of-Pocket Max |
$4,000/ $8,000 |
Member Coinsurance |
80% |
Physician Visits |
|
Primary Care Visit |
$25 Copay |
Teladoc |
$25 Copay |
X-Rays |
$25 Copay |
Preventive Care |
100% |
Specialist Visit |
$50 Copay |
Hospital Services |
|
Physician Services |
80% after Deductible |
Inpatient Hospitalization |
80% after Deductible |
Outpatient Surgery |
80% after Deductible |
Basic Outpatient Diagnostics |
80% after Deductible |
Urgent Care |
$75 Copay |
Emergency Room |
$300 Copay- waived if admitted |
Prescription Drugs |
|
|---|---|
Retail Prescriptions |
|
Tier 1 |
$10 |
Tier 2 |
$50 |
Tier 3 |
$100 |
Tier 4 |
20% up to $400 |
Mail Order Prescriptions |
|
Tier 1 |
$20 |
Tier 2 |
$100 |
Tier 3 |
$200 |
Bi-Weekly Cost |
Employee Annual Cost |
SCC Annual Contribution |
|
|---|---|---|---|
Employee Only |
$88.84 |
$2,132.16 |
$11,416.92 |
Employee + Spouse |
$566.70 |
$13,600.80 |
$12,000.00 |
Employee + Child(ren) |
$370.37 |
$8,888.88 |
$12,000.00 |
Employee + Family |
$855.91 |
$20,541.84 |
$12,000.00 |
Group Number
15784
Provided By
Meritain
Provider Website
Customer Service
Resources
Frequently Asked Questions