Other Highlights of the Medical Plan

Allergy Treatment for Adults and Children—Premium Plan

• There is no co-pay for adult or children, respectively, when receiving allergy treatments.

Alternative Care Benefit

90 visits per year combined for the three following areas:

• Physical Therapy
• Occupational Therapy
• Speech Therapy

20 visits per year for:

• Chiropractic Care
• Massage Therapy
• Registered Dietitian (first 5 visits $0 co-pay for all plans -- not covered at out-of-network providers)
• Acupuncture (not covered at out-of network providers)

Behavioral Health Benefits

• Eliminated Deductible and Coinsurance: Inpatient stays related to substance abuse are covered at 100% just as mental health inpatient stays are covered.
• Intensive Outpatient Program allows a maximum of 30 days per plan year.
• Reduced Deductible: The deductible for Intensive Outpatient Programs at out of network providers is $300 per day.

Child Dental Preventive Care Benefits

• A benefit offered to all children under the medical plan up to age 19.
• The Plan allows 2 oral exams and 2 cleanings per year, covered at 100% at Network Dentists.
• Sealants for children's preventative dental care (under the medical plan) will be covered at 100% - 1 treatment every 3 rolling years on permanent molars only for children to age 13.

Durable Medical Equipment

• Reduced Member Coinsurance: Repairs for Durable Medical Equipment (wheelchairs, canes, etc) only require a 10% coinsurance for Premium Plan and 20% coinsurance for Standard Plan.

Emergency Room Out-of-Network

• Reduced Out of Pocket Expense (All Plan Levels): Emergency Room care at an out of network facility is covered the same as in-network emergency room care.

Orthotics

• Reduced Member Coinsurance: Custom molded foot orthotics and oral sleep apnea appliances only require a 10% coinsurance for Premium Plan, 20% coinsurance for Standard Plan (deductible applies for the Standard plan level).

Physical Therapy

• Members on the Premium Plan level receive up to 90 physical therapy visits each year (combined benefit with occupational therapy and speech therapy), with the first 5 having no copay and no coinsurance.
• Hospital-owned/hospital-affiliated physical therapy facilities are limited to 5 visits annually. Be sure to ask the facility if they are a freestanding (not hospital-owned) facility and if they are an Aetna provider, or call Aetna Member Services (1-877-580-5019) for help in finding a freestanding physical therapy facility.

Routine Eye Exams under Medical Plan

• Routine Eye exams for members are covered annually.
• Refractions are covered as part of the Routine Eye Exam for contact lenses or glasses. However, the co-pay or coinsurance for the exam still applies.