Decide

Take some time and review the many new choices, programs and resources available to help keep you and your family healthy.

In-Network Medical Services

Benefits	Basic Managed Choice	Managed Choice	HCRA (Aetna Healthfund)
	You Pay	You Pay	You Pay
Preventative Services	$0	$0	$0
Office Visits Primary Care Physician (PCP) Specialist	$30 PCP copay (after deductible) $45 Specialist copay (after deductible)	$30 PCP copay $40 Specialist copay	Deductible and Coinsurance
Emergency	$100 copay (after deductible)	$100 copay	Deductible and Coinsurance
Urgent Care Facility	$45 copay (after deductible)	$40 copay	Deductible and Coinsurance
Deductible	$2,500 single $5,000 family	$1,250 single $2,500 family	$2,000 single $4,000 family
HCRA Fund	N/A	N/A	$1,000 single $2,000 family
Deductible after HCRA Fund	N/A	N/A	$1,000 single $2,000 family
Coinsurance	35%	35%	30%
Annual Out-of-Pocket Maximum	$6,000 single $12,000 family	$4,750 single $9,500 family	$5,600 single $11,200 family

Note: Prescription drug coverage is included in the medical plan. Prescription drug expenses are not subject to the medical plan deductible

Out-of-Network Medical Services

Benefits	Basic Managed Choice	Managed Choice	HCRA (Aetna Healthfund)
	You Pay	You Pay	You Pay
Office Visits and Preventative Care	Deductible and Coinsurance	Deductible and Coinsurance	Deductible and Coinsurance
Emergency	$100 copay (after deductible)	$100 copay	Deductible and Coinsurance
Deductible	$7,000 single $14,000 family	$3,000 single $6,000 family	$6,000 single $12,000 family
Coinsurance*	50%	50%	50%
Annual Out-of-Pocket Maximum	$12,000 single $24,000 family	$10,000 single $20,000 family	$10,000 single $20,000 family

* The plan pays out-of-network benefits based on Medicare reimbursement levels (up to 110% of Medicare for professional services and 140% for facility charges). In addition to your coinsurance, you are responsible for amounts that exceed these levels.

Prescription Drugs: Managed Care Plan and HCRA Plan*

Type of Drug	Definition	Retail Pharmacy (Non-ShopRite)	ShopRite Pharmacies or Spotswood Mail-Order
		For a 30-day Supply	For a 90-day Supply
Generic	Drug with same active ingredients as brand name, with lower cost	$15	$15
Preferred Brand**	Drug marketed under a specific trademark or name by specific drug manufacturer and included on Aetna's drug list.	$40	$40
Non Preferred Brand** (No generic available)	Drug marketed under a specific trademark or name by specific drug manufacturer and NOT included on Aetna's drug list.	$60	$60
Specialty Brand	High-cost prescription medications used to treat complex, chronic conditions	$60	Contact your local pharmacy for more information.

* The cost of prescriptions under the Basic Managed Care Plan uses coinsurance. You pay 30% of the cost for Generic and Preferred Brand and 50% of the Non-Preferred Brand (not subject to the medical plan deductible).
** If you or your physician requests a brand-name medication when a generic is available, you will pay the applicable copay plus the difference between the cost of the generic and brand-name drug.

Dental Plans

Active PPO with PPOII and Extend(SM) Networks	In-Network You Pay	Out-of-Network You Pay
Annual Deductible - Individual*	$25	$25
Annual Deductible - Family*	$75	$75
Preventative Services	100%	100%
Basic Services	85%	80%
Major Services	65%	60%
Annual Benefit Maximum	$2,000	$2,000
Office Visit Copay	N/A	N/A
Orthodonic Services**	50%	50%
Orthodonic Deductible	None	None
Orthodonic Lifetime Maximum	$1,500	$1,500

*The deductible applies to Basic and Major Services only.
**Orthodontia is covered only for children (appliance must be placed prior to age 20).

Vision Plans

Benefit	EyeMed Option 1 In-Network Member Cost	EyeMed Option 1 Out-of-Network Member Cost	EyeMed Option 2 In-Network Member Cost	EyeMed Option 2 Out-of-Network Member Cost
Exam (one every 12 months)	$10 copay	Up to $35	No copay	Up to $28
Lenses (one every 12 months)
Single Bifocal Trifocal	$25 copay $25 copay $25 copay	Up to $25 Up to $40 Up to $60	No copay No copay No copay	Up to $25 Up to $39 Up to $63
Contact Lenses (one order every 12 months)
Conventional	No copay; $135 allowance + 15% off balance over $135	Up to $95	No copay; $180 allowance + 15% off balance over $180	Up to $144
Disposable	No copay; $135 allowance	Up to $95	No copay; $180 allowance	Up to $144
Medically Necessary	No copy; Paid in Full	Up to $200	No copay; Paid in Full	Up to $200