Medical Plans Available Outside California and Pennsylvania
|Plan Features||Aetna Open Access Managed Choice 90/60 (All Locations)||Aetna Open Access Managed Choice – HDHP with HSA (All Locations)|
|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|
|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|
|Lifetime Plan Maximum||Unlimited||Unlimited|
|Primary Care Physician Election||Optional||N/A||Optional||N/A|
|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.|
|Well-Child Care||100% deductible waived||60%* after deductible||100% deductible waived||
60%* after deductible
|Adult Periodic Exams||100% deductible waived||60%* after deductible||100% deductible waived||60%* after deductible|
|Office Visit||$20 co-pay, deductible waived||60%* after deductible||80% after deductible||60%* after deductible|
|Inpatient Hospital Services|
|Semiprivate Room & Board||90% after deductible||60%* after $500 co-pay and deductible||80% after deductible||60%* after deductible|
|Emergency Room (co-pay waived if admitted as an inpatient)||90% after $100 co-pay, deductible waived||80% after $100 co-pay||80% after deductible||80% after deductible|
|Retail Pharmacy—Generic / Brand Name / Non-formulary||$0 co-pay / $30 co-pay / $50 co-pay||Partial reimbursement based on fee schedules||
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|
|Retail Pharmacy Maximum Supply||30 days||N/A||30 days||N/A|
|Mail Order Prescription Drugs||2x retail pharmacy co-pay||Not covered||2x retail pharmacy co-pay after deductible||Not covered|
|Mail Order Pharmacy Maximum Supply||90 days||N/A||90 days||N/A|
*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 a network doctor of facility?
You can find a network doctor or facility in your area by following these simple instructions: