Medical Plan

For 2017-2018, you have one medical plan option: the POS Plan.



THE POS PLAN

The POS Plan is a conventional medical plan where members pay co-pays for some services (co-pays are fixed fee amounts that you pay at the time you receive services). The POS Plan also uses co-insurance for some services (co-insurance is the portion of expense you must pay for care, in most cases, after meeting your deductible). The deductible is a set amount that typically you must pay before co-insurance starts. Refer to the Quick Guide for deductible amounts.

The POS Plan also has an out-of-pocket maximum to protect you in the event you have significant medical expenses during the year.

The POS Plan allows members to receive services from a national network of providers and facilities. It is an open access plan that:

The POS Plan has three Network options:

EHN and In-Network preventive care is covered at 100% and is not subject to the deductible. For all other medical services, the plan pays a portion of your covered expenses: 90% for Emory Healthcare Network (EHN), 80% In-Network (Aetna National) and 60% percent Out-of-Network after you pay the annual deductible. Office visits are covered with a co-payment. Prescription drugs are covered through co-insurance.

To locate an EHN or In-Network physician or facility, go to www.aetna.com/docfind/custom/emory or call Aetna at 800-847-9026.


 

arrow RATES

medical rates

Tobacco-Use Surcharge - $50 per person

To support the health and wellness of our Medical House Staff Members, Emory has implemented a $50 per person monthly tobacco-use surcharge on medical contributions for employees and their spouses/SSDPs who use tobacco products. You must certify online in Self-Service whether or not you and your spouse/SSDP have used tobacco within the last 60 days. The per person tobacco-use surcharge will be waived if:


arrow  PREVENTIVE CARE

Routine preventive care is covered at 100% under the POS Plan. Preventive care can help you identify potential health risks before they become real health problems. Services include annual physicals, well-child visits, immunizations, health screenings and more. View preventive care list.



arrow  PRESCRIPTION DRUGS

Prescription drug coverage is part of your medical plan and you pay a percentage of the cost though co-insurance. There is also a retail minimum and a retail maximum within a five-tier structure (see chart below). You will pay the co-insurance amount subject to the retail minimum and maximum cost. You do not have to meet your deductible first. Prescription drug coverage is administered through CVS/caremark. To determine your coverage tier or cost, call 866-601-6935  or visit online at: www.caremark.com.

prescription drug chart

Tier Zero

The POS Plan offers Tier Zero for prescription drugs. With Tier Zero, generic prescription medications used to treat chronic health conditions such as congestive heart failure (CHF), diabetes, high blood pressure, high cholesterol, tobacco addiction and more, are covered at 100%. For Tier Zero medications you pay $0 for a 30- or 90-day supply.

For a complete list of Tier Zero medications, see page 22. Please note that from time to time this list will change as medications will be moved off patent protection (brand) and placed in a generic status. It is also possible for generic medications to fall off the list as they become available over-the-counter. For the most up-to-date information or to request an updated listing, please contact CVS/caremark at 866-601-6935 or visit online at: www.caremark.com.

View list of Tier Zero medications.

Requirement for Maintenance Drugs

A maintenance drug is one that is commonly used to treat a chronic or long-term condition and requires regular, daily use. Examples include drugs used to treat high blood pressure, heart disease, asthma and diabetes. Birth control is also considered a maintenance drug. Click here for a list of maintenance drugs. Maintenance drugs now require that you have a prescription for a 90-day supply (not a 30-day supply).

You must also fill your prescription in one of three ways:

IMPORTANT: If you don’t use a 90-day prescription and try to get a 30-day prescription filled at a retail location other than one of the methods above, you will be charged the full retail cost (not the co-pay amount).