Group #	108436
Website:	www.aetna.com
Member Services:	(866) 290 - 8039
24 Hour Nurse Line:	(800) 556 - 1555
PLAN YEAR: July 1 - June 30
Deductibles are on a plan year basis.
Dependent age limit: 26

AETNA HEALTH INSURANCE PLAN Plan Year July 1, 2022 – June 30, 2023
	Premium Open Choice PPO 750 Plan	Base Open Choice PPO 1500 Plan	High Deductible Health Plan(HDHP 2900) with HSA
Employee(district paid)	$814.00	$719.00	$662.00
Spouse(employee paid)	$931.00	$728.00	$755.00
Child(ren)(employee paid)	$764.00	$580.00	$622.00
Family(employee paid)	$1,595.00	$1,314.00	$1,299.00
Rates are listed above on a per month basis.
Regular Board and employee paid benefit deductions will not be paid/deducted out of the 3rd paycheck of a month for 12 month employees Aetna Health, Aetna Dental, VBA Vision, Dearborn Life Insurance, American Fidelity and H.S.A contributions. The monthly premium paid for these benefits (employer & employee paid) is divided between the first two paychecks of each month for the next month's coverage.
9 and 10 month employees will use the 3rd paycheck of a month to catch up on benefits if needed and to help cover summer months.
Employees enrolled in the Qualified High Deductible /HSA Plan will receive a bi-monthly contribution paid by the district into the employee's HSA. The contribution is equal to the premium difference of the employee only rate of the PPO plan and the HDHP plan.

	Premium Open Choice PPO 750 Plan Summary In-Network	Base Open Choice PPO 1500 Plan Summary In-Network	High Deductible 2900 Health Plan Summary In-Network
Member Coinsurance	100%	80%	100%
Preventive Care	100%; deductible waived	100%; deductible waived	100%; deductible waived
Office Visit (non-Specialist)	$30 copay	$35 copay	100% after deductible
Specialist	$50 copay	$50 copay	100% after deductible
Urgent	$75 copay	$100 copay	100% after deductible
Emergency Room	$200 copay	$200 copay	100% after deductible
Deductible (individual/family)	$750 / $1,500	$1,500 / $3,000	$2,900 / $5,800

Orchard FarmSchool District

Employee Benefits 2022-23