Aetna HDHP HSA $4,500

The Aetna HDHP HSA $4,500 plan includes routine preventive generic prescription benefits paid at 100% (not subject to the deductible). Benefit Tip: Coinsurance is slightly higher with the Aetna HDHP HSA $4,500 plan, but you will enjoy the lowest per-paycheck contributions.

HDHP HSA $4,500
	IN-NETWORK	OUT-OF-NETWORK
CALENDAR YEAR DEDUCTIBLE
Individual	$4,500	$9,000
Family	$9,000	$18,000
CALENDAR YEAR OUT OF POCKET MAXIMUM (INCLUDES DEDUCIBLE)
Individual	$6,000	$12,000
Family	$12,000	$24,000
COINSURANCE	YOU PAY	YOU PAY
Preventive Care	$0	50%**
Virtual Visits	30%**	Not Covered
Primary Care Physician	30%**	50%**
Specialist	30%**	50%**
Urgent Care	30%**	50%**
Emergency Room	30%**	50%**
PHARMACY
RETAIL RX (UP TO 30-DAY SUPPLY)
Generic	30%**up to a $250 maximum	30%**up to a $250 maximum
Preferred	30%**up to a $250 maximum	30%**up to a $250 maximum
Non-Preferred	30%**up to a $250 maximum	30%**up to a $250 maximum
Specialty	30%**up to a $250 maximum	30%**up to a $250 maximum
MAIL ORDER RX (UP TO 90-DAY SUPPLY)
Generic	30%**up to a $750 maximum	30%**up to a $750 maximum
Preferred	30%**up to a $750 maximum	30%**up to a $750 maximum
Non-Preferred	30%**up to a $750 maximum	30%**up to a $750 maximum
Specialty	30%**up to a $750 maximum	30%**up to a $750 maximum

** After deductible.
*** Routine Preventive Generic Rx paid at 100%with no deductible.