Medical Services

In-network preventive care is covered 100%, no deductible. For most other services, you pay the full cost until you meet the deductible. Then you pay coinsurance until you meet the annual out-of-pocket maximum.

At-A-Glance

Here’s a quick look at the Stimson medical plan. For plan details, review the Aetna Medical Plan Design and Benefits.

In-Network* Out-of-Network
Health Savings Account (HSA) You are eligible to set up a Health Savings Account (HSA) when you enroll in the Stimson medical plan.
WHAT YOU PAY
Premiums Your per pay period contribution for medical coverage.
Annual Deductible

Single: $1,500

Family: $3,000

Single: $3,000

Family: $6,000

Out-of-Pocket Maximum

Single: $2,500

Family: $5,000

Single: $5,000

Family: $10,000

COVERED SERVICES

Preventive Services
Well-Child Care, Routine Adult Physicals, Immunizations, Prenatal and Postnatal Care, Women’s Health
$0; no deductible 30% after deductible
Office Visits
Primary Provider/Specialist
10% after deductible 30% after deductible
Inpatient Care 10% after deductible 30% after deductible (UCR)
Outpatient Care 10% after deductible 30% after deductible (UCR)
Urgent Care 10% after deductible 30% after deductible (UCR)
Other Services
Ambulance Services, Chiropractic Services, Diagnostic Laboratory, Durable Medical Equipment, Home Health Care, Naturopathic Services, Skilled Nursing Care, X-ray & Imaging
10% after deductible 30% after deductible (UCR)
Acupuncture
25 visits per calendar year for treatments of headaches and acute pain
10% after deductible 30% after deductible (UCR)
Hearing Exam
One exam per 24 months
10% after deductible 30% after deductible (UCR)
Private-duty nursing
70, eight-hour shifts per plan year
10% after deductible 30% after deductible (UCR)
Emergency Room

Emergencies: 10% after deductible

Non-Emergencies: 50% after deductible

Emergencies: Same as in-network providers

Non-Emergencies: 50% after deductible (UCR)

Mental Health and Substance Abuse
Inpatient/Outpatient Care
10% after deductible 30% after deductible (UCR)
Prescription Drugs The medical plan includes prescription drug coverage through Aetna. Most prescription drugs are subject to the medical plan deductible, then you pay the applicable copays. Learn More

*In some circumstances, you may go to an in-network provider, but receive services from an out-of-network provider. If that’s the case, generally you’ll pay 20% after the deductible for the out-of-network provider after you meet the in-network provider deductible.

KEY TERM

UCR: Usual and customary rates

The amount paid for medical services in a geographic area based on what providers in the area usually charge for the same or similar service.

Price Transparency

The Transparency in Coverage rule requires group health plans to disclose the costs of covered health care items and services beginning July 1. LEARN MORE