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
Co-insurance 90% 60%* 80% 60%*
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.
Preventive Services
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
Physician Services
Office Visit $20 co-pay, deductible waived 60%* after deductible 80% after deductible 60%* after deductible
Inpatient Hospital Services
Preauthorization Required Yes Yes
Semiprivate Room & Board 90% after deductible 60%* after $500 co-pay and deductible 80% after deductible 60%* after deductible
Emergency Services
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
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
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: