Medical Benefits

Apple Bank gives you the option to choose between one of two medical plan options with Aetna.

Our Aetna High Deductible Health Plan (HDHP) option offers you a degree of flexibility when selecting the type of care that is best for you and your dependents. The plan is designed to provide you with the option to use a health savings account (HSA).

The Aetna Point of Service Plan (POS) option is a more traditional program. You will still share the cost of services with a deductible and coinsurance, but routine office visits will have predictable $25 or $50 copays.

Both of our medical plans are Open Access (search the Aetna Choice POS II network), which means that you do not need a referral to visit a specialist.

When you enroll in the HDHP and open an HSA, Apple Bank will contribute to your HSA. Please see the HSA Overview page for more information. Those without an HSA may enroll in the FSA plan.

Note: Employees over age 65 who have enrolled in Medicare, who are claimed as a dependent on someone else’s tax return, or whose spouse contributes to an FSA are not eligible to contribute to a Health Savings Account (HSA).

No-Cost Preventive Drug List

Certain maintenance drugs can be filled at no charge. These include medications for cholesterol, diabetes, high blood pressure and others. Refer to Aetna’s 2024 Health Care Reform Preventive Drug List to see if your maintenance medication qualifies for this program.

Forget your deductible, just pay your copay or coinsurance when buying certain medication. Refer to Aetna’s 2024 Preventive Medicine List to help reduce your out-of-pocket costs for the medicines you need.

Both of the Aetna medical plan options include coverage for prescription drugs. Medications are classified by tier on the Aetna formulary. This is simply a drug list which is reviewed periodically. You may be subject to step therapy, quantities limits, or your prescription drug may not be covered under the new formulary.

To check your prescriptions:

  1. Visit the Aetna website at www.aetna.com/individuals-families/find-a-medication.html
  2. Select “Choose your Plan”.
  3. Choose a Plan year
  4. Select Plan “Aetna Standard Plans”.
  5. Click on “View pharmacy plans”

No one wants to spend any more than necessary on healthcare.

The most important factor in the increase of healthcare costs is how you use healthcare services. In order for our health plans to continue to provide high-quality care in the most cost-effective way, we all must take greater responsibility for making healthier lifestyle choices and more informed healthcare decisions.

Use in-network providers and generic drugs whenever possible and pursue treatments at the appropriate level (for example, not using an emergency room when an urgent care or primary care office visit may be more appropriate). Being a conscientious health care consumer will make a positive impact on your out-of-pocket health care costs and help limit our cost increases in the future.

Below are eight ways to be a smart healthcare consumer and save money.

  1. Use the Aetna Network. Using doctors, hospitals, and facilities that participate in the Aetna Choice POS II network can save you a lot of money. “In-Network” services apply to all health care services, including doctors and hospitals, as well as outpatient testing, treatment and surgery centers that are participating in the Aetna network. To verify that a doctor or facility is in the network, visit www.aetna.com or call the number on the back of your Aetna ID card.
  2. Use convenience care clinics. For minor illnesses and injuries, convenience care clinics located in pharmacies, grocery stores and other retail stores provide quick, affordable care.
  3. Use the emergency room only for true emergencies. For non-life-threatening emergencies, visit an urgent care center instead of the emergency room. You’ll get treated more quickly and pay less. Emergency Rooms (ER) provide immediate specialized care to people with serious, often life-threatening issues. Treatment for non-emergency conditions in an ER costs hundreds of dollars more than treatment at an urgent care center or your doctor’s office.
  4. Visit a doctor online. All plans offer this service; you can consult with a doctor about minor illnesses or injuries virtually by phone or online.
  5. Ask for generic drugs. You can save up to 80% compared to brand-name drugs.
  6. Use cost-saving tools. Compare the costs of medical tests, services, and procedures online at www.aetna.com. Once you log in, you will have access to the cost comparison tool.
  7. Avoid the hospital. Many procedures like MRIs and colonoscopies cost less when done at independent outpatient centers instead of a hospital. Outpatient surgery is also less expensive than hospitalization.
  8. Get regular preventive care. Doctor’s visits are for healthy people too. Getting checkups, immunizations and other health screenings can help detect health problems early when they are less expensive to treat. Each of our plans covers in-network preventive care at no cost.

Medical Plans Overview

Aetna HDHP with HSA
Benefits In-Network Out-of-Network
 Calendar Year Deductible
(Individual / Family)		 $2,000 / $4,000 $4,000 / $8,000
 Apple Bank HSA Contribution
(Individual /Family)		 $600 / $1,200
Out-of-pocket Maximum
(Individual /Family)		 $3,000 / $6,000 $10,000 / $20,000
Coinsurance (you pay) 10% 30%
Preventive Care No Charge 30% after deductible
PCP/Specialist
 10% after deductible 30% after deductible
Urgent Care 10% after deductible 30% after deductible
Emergency Room 10% after deductible 10% after deductible
Inpatient Hospital 10% after deductible 30% after deductible
Outpatient Hospital 10% after deductible 30% after deductible
Prescription Drug Coverage
Deductible Medical deductible applies N/A
Retail Prescriptions (30-day supply) Generic / Preferred Brands / Non-Preferred Brands Deductible, then $5/ $30 / $60 Not covered
Mail Order (90-day supply)
Generic / Preferred Brands / Non-Preferred Brands		 Deductible, then $10 / $60 / $120 Not covered
Aetna POS
Benefits In-Network Out-of-Network
 Calendar Year Deductible
(Individual /Family)		 $500 / $1,000 $4,000 / $8,000
 Apple Bank HSA Contribution
(Individual /Family)		 N/A
Out-of-pocket Maximum
(Individual /Family)		 $3,000 / $6,000 $10,000 / $20,000
Coinsurance (you pay) 20% 30%
Preventive Care No Charge 30% after deductible
PCP/Specialist
 $25 / $50 copay 30% after deductible
Urgent Care $75 copay 30% after deductible
Emergency Room $250 copay $250 copay
Inpatient Hospital 20% after deductible 30% after deductible
Outpatient Hospital 20% after deductible 30% after deductible
Prescription Drug Coverage
Deductible $50 / $100 N/A
Retail Prescriptions (30-day supply) Generic / Preferred Brands / Non-Preferred Brands Deductible, then $5/ $30 / $60 Not covered
Mail Order (90-day supply)
Generic / Preferred Brands/Non-Preferred Brands		 Deductible, then $10 / $60 / $120 Not covered
This is only a summary of benefits. Any discrepancy between the above and the insurance contracts, summary plan descriptions (SPDs) or any other legal documents that govern the plans of benefits described above will be resolved according to those documents.
24/7 TELADOC
If you have cold or flu symptoms, a sore throat, a sinus infection, allergies, a rash or another minor illness, you can skip the doctor’s office and receive medical care from the comfort of your home through Teladoc.
This benefit allows you to consult with a doctor through videoconference using your smartphone, tablet or computer. Board-certified doctors diagnose your condition, recommend treatment and send a prescription directly to your pharmacy, if needed.
  • It’s an easy alternative to an office visit.
  • You can see a doctor seven days a week, including evenings and weekends when your doctor’s office is closed.
  • No appointment is necessary.
  • Call 800-835-2362 or register at www.teladoc.com/aetna so you are ready when you need it.
STAY IN-NETWORK TO GET THE MOST FROM YOUR BENEFITS
Both plans offer access to a large national network of providers and healthcare facilities. Visit www.aetna.com to find an in-network provider.
Once on the website, follow these simple steps:
  1. Select ‘Find a Doctor’ from menu across top of page
  2. Select ‘Aetna Plans’ then ‘Plan from an employer’
  3. Enter your search parameters and zip code and click ‘Search’
  4. Review your choices in the ‘Aetna Choice POS II (Open Access)’ network.
Aetna Mobile App
Download the Aetna mobile app to have instant access to your ID card, coverage details, and claims. You can also find in-network providers that are near you.

Button - click here to download app from Google Play     Button - click here to download app from Apple App store

NOT SURE WHERE TO GO FOR CARE?
Watch this quick video from Aetna.

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WHAT DO ALL THESE HEALTH CARE TERMS MEAN?
Get answers by watching this 60-second video.

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