MEDICAL PLAN UPDATES
Updates Due to Health Care Reform
Effective October 1st, Aetna Small Group plans are updated to include the following mandated requirements:
Lifetime Maximums – Removed on all plans
Dependent age to 26 – Both medical & dental
No pre-existing condition exclusion for children <19
Preventive Care – 100% no copay
Eliminated HMO Plans
Vitalidad HMO 5 migrates to Vitalidad HMO 10
Vitalidad Plus HMO 20/5 migrates to Vitalidad Plus HMO 10/5
Vitalidad Plus HMO 40/10 migrates to Vitalidad Plus HMO 30/10
Eliminated MC/PPO Plans
EPO 500 80 (migrates to MC 750 80/50/50)
MC HSA 3300 80/50 (migrates to MC HSA 3500 80/50)
PPO 750 80/60 (migrates to PPO 500 90/70)
Other Benefit Modifications
MC 10,000 100/50
PCP copay $20 (was $15)
Lab/xray changed to 1st $300 covered at 100%, then ded/coins (was $15 copay)
MC HSA 2000 80/50
Increased In-network OOP Maximum to $3500/$7000
OP Surgery at Hospital is 20% (was $150 + 30%)
MC HSA 3000 90/50 (previously 100/50)
Increased In-network OOP Maximum to $2500/$5000
Change to True Integrated Family (TIF) accumulation for Ded/OOP max
The entire Family Deductible must be met before any benefits are payable. A Single Deductible only applies to an individual enrolled as a single subscriber.
Any combination of family members can meet deductible
One member of family can meet deductible for entire family
Out of Pocket Max works the same way
MC HSA 3500 80/50 (formerly MC HSA $3300 80/50)
Increase In Network deductible to $3500/$7000
Change to TIF accumulation for Ded/OOP Max
Increase In Network OOP Max to $2000/$4000
OP Surgery at Hospital – 20% coins (rather than $150 copay + 30%)
