Aetna HDHP HSA $2,500

You may visit in-network or out-of-network providers, but consider the cost difference before visiting the doctor. Benefit Tip: The two Aetna HDHP HSA plans both feature routine preventive generic prescription drugs paid at 100% with no deductible.

HDHP HSA $2,500
	IN-NETWORK	OUT-OF-NETWORK
CALENDAR YEAR DEDUCTIBLE
Individual	$2,500	$3,500
Family	$3,500*	$4,500
CALENDAR YEAR OUT OF POCKET MAXIMUM (INCLUDES DEDUCIBLE)
Individual	$5,000	$7,000
Family	$7,000	$9,000
COINSURANCE	YOU PAY	YOU PAY
Preventive Care	$0	50%**
Virtual Visits	20%**	Not Covered
Primary Care Physician	20%**	50%**
Specialist	20%**	50%**
Urgent Care	20%**	50%**
Emergency Room	20%**	50%**
PHARMACY
RETAIL RX (UP TO 30-DAY SUPPLY)
Generic	20%** up to a $250 maximum	20%** up to a $250 maximum
Preferred	20%** up to a $250 maximum	20%** up to a $250 maximum
Non-Preferred	20%** up to a $250 maximum	20%** up to a $250 maximum
Specialty	20%** up to a $250 maximum	20%** up to a $250 maximum
MAIL ORDER RX (UP TO 90-DAY SUPPLY)
Generic	20%** up to a $750 maximum	20%** up to a $750 maximum
Preferred	20%** up to a $750 maximum	20%** up to a $750 maximum
Non-Preferred	20%** up to a $750 maximum	20%** up to a $750 maximum
Specialty	20%** up to a $750 maximum	20%** up to a $750 maximum

* $2,800 per individual, not to exceed the family deductible
** After deductible
*** Routine Preventive Generic Rx paid at 100% with no deductible