Medical Plans Available in California and Pennsylvania

Plan Features Aetna Open Access Managed Choice 90/60 Aetna Open Access Managed Choice – HDHP with HSA Kaiser HMO CA
(available in CA only)
Aetna HMO CA & Aetna HMO PA
General Plan Information In-Network Out-of-Network In-Network Out-of-Network
Annual Deductible—Individual/Family $500 / $1,000 $750 / $1,500 $1,800 / $3,600 $4,000 / $8,000 None None
Co-insurance 90% 60%* 80% 60%* 100% 100%
Annual Out-of-Pocket Limit $1,500 individual, $4,500 family $3,000 individual, $9,000 family $4,000 individual, $8,000 family $8,000 individual, $16,000 family $1,500 / $3,000 $1,500 / $3,000
Lifetime Plan Maximum Unlimited Unlimited Unlimited Unlimited
Primary Care Physician Election Optional N/A Optional N/A Suggested Yes
Health Savings Account (HSA) N/A If you contribute to your HSA (minimum annual contribution of $100), Omnicell will contribute to your HSA ($750 per year for individual coverage and $1,500 per year for family coverage; prorated for employees starting during the calendar year). The 2019 HSA limit (Omnicell's and your contributions combined) is $3,500 pre-tax for employee only coverage or $7,000 pre-tax if you cover one or more eligible family members. Participants who will be 55 or older in 2019 can contribute an additional $1,000. N/A N/A
Preventive Services
Well-Child Care 100% deductible waived 60%* after deductible 100% deductible waived 60%* after deductible 100% covered 100% covered
Adult Periodic Exams 100% deductible waived 60%* after deductible 100% deductible waived 60%* after deductible 100% covered 100% covered
Physician Services
Office Visit $20 co-pay deductible waived 60%* after deductible 80% after deductible 60%* after deductible $20 co-pay $20 co-pay (office hours), $25 co-pay (after office hours/home visit)
Inpatient Hospital Services
Preauthorization Required Yes Yes Yes Yes
Semiprivate Room & Board 90% after deductible 60%* after $500 co-pay and deductible 80% after deductible 60%* after deductible 100% 100%
Emergency Services
Emergency Room (co-pay waived if admitted as an inpatient) 90% after $100 co-pay, deductible waived 90%* after $100 co-pay

80%* after deductible

80%* after deductible

$50 co-pay $100 co-pay
Prescription Drugs
Retail Pharmacy—Generic / Brand Name / Non-formulary $0 co-pay /$30 co-pay / $50 co-pay Partial reimbursement based on fee schedules Before deductible:
Generic preventive/certain maintenance drugs** covered at $0
After deductible:
$0 co-pay /$30 co-pay / $50 co-pay.
Partial reimbursement based on fee schedules Kaiser pharmacy:$10 copay / $15 copay / Not applicable $0 co-pay /$20 co-pay /$40 co-pay
Retail Pharmacy Maximum Supply 30 days N/A 30 days N/A 100 days 30 days
Mail Order Prescription Drugs 2x retail pharmacy co-pay Not covered 2x retail pharmacy co-pay after deductible Not covered Same co-pay as above using Kaiser mail order pharmacy 2x retail pharmacy co-pay
Mail Order Pharmacy Maximum Supply 90 days N/A 90 days N/A 100 days 90 days

*Reimbursement will be based on a negotiated rate rather than the usual and customary rate.

**To access the list of qualified preventive drugs, go to the Aetna website.

How do I find an Aetna network doctor of facility?

If you enroll in one of the Aetna plans, you can find a network doctor or facility in your area by following these simple instructions: