Aetna Medical Coverage
EAB partners with Aetna as our medical carrier. EAB offers competitive medical plan options through Aetna, including two HSA-qualified Consumer Driven Health Plans (CDHP) and a traditional lower deductible PPO plan.
Enrolled team members and their enrolled dependents have access to:
- Aetna Concierge Services for EAB Global
- Personal Health Advocates including specialties in Neonatal Intensive Care Unit (NICU) and transgender advocates Digital and personalized, one-on-one clinical and nurse support
- Telehealth offering through CVS Virtual Care to CVS MinuteClinic at no cost to those enrolled in the PPO plan and nominal cost to those enrolled in the CHDP plan
- Meru Health – access to mental health therapy from your smartphone
Our plans allow domestic partners on eligible Medical, Dental, Vision, Life Insurance and Supplemental Health benefits. Review our Qualifying Life Events page to download the required affidavit that should be submitted to benefits@eab.com.
In-Network Provider Directory
To search for in-network providers, visit this link. Enter your zip code and select “Aetna Choice POS II” network
Transition of Care / Continuity of Care
Aetna offers transition of care, or continuity of care, which allows you to continue to receive services for specified medical conditions (e.g. high risk pregnancy, pregnancy within the third trimester, or cancer treatments) with health care providers who are not in the Aetna network, at in-network coverage levels. To learn more about this program, call Aetna at 1-800-930-2015 or fill out the linked form.
Medical coverage provided by Aetna
Aetna Premium and Value Consumer Driven Health Plans (CDHP)
With the Aetna Premium CDHP, you have an annual deductible and you pay first-dollar costs for all physicians’ visits, medical services and prescriptions until you meet your annual deductible. Once you meet the appropriate in-network or out-of-network deductible, coverage is shared with the carrier in a coinsurance arrangement until an out-of-pocket maximum is met.
Pharmacy Benefits are offered through CapitalRx. Preventative Prescriptions are covered at 100%.
The Aetna CDHP comes with a Health Savings Account (HSA) through Aetna and Inspira Financial (formerly Payflex). To find out more about Health Savings Accounts and how they work in combination with a plan like the Aetna CDHP, click here.
If you are enrolled a CDHP plan, you are not eligible to contribute to a Healthcare Flexible Spending Account Plan, but you may contribute to a Limited Purpose FSA plan for dental and vision expenses only.
Aetna PPO Plan
With the Aetna PPO Plan, services that are subject to a copay, such as office visits and prescriptions, are not subject to the deductible. Most other services are, and once you meet the appropriate in-network or out-of-network deductible, coverage is shared with the carrier in a coinsurance arrangement until an out-of-pocket maximum is met.
Pharmacy Benefits are offered through CapitalRx. Preventative Prescriptions are covered at 100%.
If you enroll on the Aetna PPO Plan, you are eligible to contribute to a Healthcare Flexible Spending Account (FSA) through Chard Snyder. To find out more about FSAs and how they work, click here.
Medical Plans Overview
| Aetna Value CDHP Plan | Aetna Premium CDHP Plan | Aetna PPO Plan | ||||
|---|---|---|---|---|---|---|
| In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network | Out-of-Network | |
| Annual Deductible | ||||||
| Individual | $6,000 | $12,000 | $2,000 | $4,000 | $750 | $1,500 |
| Family | $12,000 | $24,000 | $4,000 | $8,000 | $1,500 | $3,000 |
| Annual Out-of-Pocket Maximum (includes deductibles) | ||||||
| Individual | $6,000 | $12,000 | $4,000 | $8,000 | $3,000 | $6,000 |
| Individual in a Family | $6,000 | $12,000 | $7,500 | $13,700 | N/A | N/A |
| Family | $12,000 | $24,000 | $8,000 | $16,000 | $6,000 | $12,000 |
| Lifetime Maximum Benefit | Unlimited | Unlimited | Unlimited | |||
| Preventive Care | ||||||
| Preventive Care Office Visit / Routine Exams | No charge | 20% coinsurance* | No charge | 40% coinsurance* | No charge | 40% coinsurance* |
| Pre-Natal Maternity Office Visits | No charge | 20% coinsurance* | No charge | 40% coinsurance* | No charge | 40% coinsurance* |
| Immunizations | No charge | 20% coinsurance* | No charge | 40% coinsurance* | No charge | 40% coinsurance* |
| Professional Care | ||||||
| Office Visit (Non-Specialist/Specialist) | 0% coinsurance* | 20% coinsurance* | 20% coinsurance* | 40% coinsurance* | $25 (ded. does not apply) / $40 copay (ded. does not apply) | 40% coinsurance* |
| Outpatient Diagnostic Imaging & Laboratory Services | 0% coinsurance* | 20% coinsurance* | 20% coinsurance* | 40% coinsurance* | 20% coinsurance* | 40% coinsurance* |
| Diagnostic Mammography | 0% coinsurance* | 20% coinsurance* | No charge (ded. does not apply) | 40% coinsurance* | No charge (ded. does not apply) | 40% coinsurance* |
| Inpatient Professional Services | 0% coinsurance* | 20% coinsurance* | 20% coinsurance* | 40% coinsurance* | 20% coinsurance* | 40% coinsurance* |
| Facility Care | ||||||
| Inpatient Care | 0% coinsurance* | 20% coinsurance* | 20% coinsurance* | 40% coinsurance* | 20% coinsurance* | 40% coinsurance* |
| Outpatient Surgery | 0% coinsurance* | 20% coinsurance* | 20% coinsurance* | 40% coinsurance* | 20% coinsurance* | 40% coinsurance* |
| Emergency Care | ||||||
| Outpatient Emergency Care | 0% coinsurance* | 20% coinsurance* | $150 copay/visit (ded. does not apply) | |||
| Other Services | ||||||
| Mental Health Care/Chemical Dependency - Outpatient Physician's Office | 0% coinsurance* | 20% coinsurance* | 20% coinsurance* | 40% coinsurance* | $40 copay/visit (ded. does not apply) | 40% coinsurance* |
| Mental Health Care/Chemical Dependency - Inpatient Services | 0% coinsurance* | 20% coinsurance* | 20% coinsurance* | 40% coinsurance* | 20% coinsurance* | 40% coinsurance* |
| Spinal & Other Manipulations (20 visits/year) | 0% coinsurance* | 20% coinsurance* | 20% coinsurance* | 40% coinsurance* | $40 copay/visit (ded. does not apply) | 40% coinsurance* |
| Speech/Hearing, Cognitive, Physical & Occupational Therapy - Physician's Office (60 visits/year) | 0% coinsurance* | 20% coinsurance* | 20% coinsurance* | 40% coinsurance* | $40 copay/visit (ded. does not apply)** | 40% coinsurance* |
| Prescription Drugs (Offered through CapitalRx) | ||||||
| Retail, 30-Day Supply | ||||||
| Generic | 0% coinsurance* | Not Covered | 20% coinsurance* | Not Covered | $15 Copay | Not Covered |
| Preferred Brand | $35 Copay | |||||
| Non-Preferred Brand | $70 Copay | |||||
| Specialty | 10% coinsurance (ded. does not apply) | |||||
| Retail, 90-day supply | ||||||
| Generic | 0% coinsurance* | Not Covered | 20% coinsurance* | Not Covered | $45 Copay | Not Covered |
| Preferred Brand | $105 Copay | |||||
| Non-Preferred Brand | $210 Copay | |||||
| Specialty | Not Covered | |||||
| Mail Order, 90-day supply | ||||||
| Generic | 0% coinsurance* | Not Covered | 20% coinsurance* | N/A | $30 Copay | Not Covered |
| Preferred Brand | $70 Copay | |||||
| Non-Preferred Brand | $140 Copay | |||||
| Specialty | 10% up to $200 max | |||||
| * indicates after deductible ** these services performed in outpatient facilities will be subject to deductible and coinsurance |
||||||
Medical Plan Contributions
| 2026 Semi-monthly Employee Contributions | PPO Plan | Premium CDHP Plan | Value CDHP Plan |
|---|---|---|---|
| Employee Only | $122.71 | $68.60 | $28.54 |
| Employee + Spouse/DP* | $273.63 | $162.02 | $107.13 |
| Employee + Child(ren) | $258.38 | $151.07 | $72.94 |
| Family* | $402.44 | $220.40 | $122.29 |
| * For domestic partners and their children that do not qualify as dependents under Section 152 of the Internal Revenue Code, premiums associated with domestic partner coverage will be paid by the employee with after-tax dollars and the fair market value of any EAB contributions made on behalf of your domestic partner will be imputed as income to the employees. | |||
Frequently Asked Questions – Consumer Driven Health Plans (CDHPs)
What is a Consumer Driven Health Plan (CDHP)?
A CDHP is essentially a PPO plan with higher deductibles and out-of-pocket maximums. Like a traditional PPO, you do not have to designate a Primary Care Physician and you can choose to go in-network or out-of-network.
What happens to my Health Savings Account(HSA) if I change from a CDHP plan to a PPO?
Those who enroll in the PPO medical plan are no longer eligible to contribute to their HSA, however you WILL be eligible to participate in the Healthcare FSA account option. Any existing balance in your HSA can still be used to cover qualifying medical, dental, and vision expenses.
How do the deductibles work?
The amount you pay for covered services will count toward both your in-network and out-of-network deductible.
How do the out-of-pocket maximums work?
The amount you pay for covered services will count toward both your in-network and out-of-network deductible.
What preventive care services are covered 100% and are not subject to the deductible?
The Patient Protection and Affordable Care Act (PPACA), also known as Health Care Reform, has designated certain services as “preventive”. In general, this includes periodic well visits, routine immunizations and certain designated screenings for symptom-free or disease-free individuals. You can find more information at on www.healthcare.gov.
Additionally, there are over 300 prescriptions that are considered preventive and may be obtained at no cost to you. You can find a list here.
Cost of Medical Coverage
View the costs for coverage under EAB's Employee Benefits.
Need an In-Network Doctor?
Use the Aetna site, or mobile app, to search for participating providers in your area.
Go Mobile with Aetna
Introducing the simple, personalized Aetna Mobile App. Download it today! Available on the App Store for iOS devices, or on Google Play for Android Devices.
Coverage End Date
Health care insurance coverage will end on the last day of the month in which you leave the company.
Continuing Coverage
- COBRA – You have the option to continue medical, dental and/or vision insurance plans on a month-to-month basis as a COBRA participant.
- Heath Insurance Marketplace –There may be other coverage options available to you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan). Some of these options may cost less than COBRA continuation coverage. You can learn more about these options at HealthCare.gov.
COBRA
- Election Period – You will have 60 days from the last day of your departure month to choose to continue coverage under EAB's plans through COBRA.
- Coverage – If you elect to continue coverage for one or more plans, your coverage will be reinstated.
- Duration – In most cases you can participate for up to 18 months following your departure.
- Enrollment – If you would like to enroll in COBRA, registration materials will be sent to you in the mail by Chard Snyder.