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The Aetna Health Concierge can help you understand your benefits and provide tools to make more informed decisions about your health care. Call (800) 374-3985 or visit aetna.com to send a message.
Your Aetna Health Concierge can help you:

• Locate in-network providers near you
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• Get second opinions if your doctor recommends surgery
• Review and resolve health care claim issues
• Put together questions for your next doctor visit
• Answers questions about counseling services, treatments and medications

Go to aetna.com for more information about what
your Aetna Health Concierge can do for you.

Adam

Meet Adam

Adam is single and in good health. He uses in-network doctors and pharmacies. Adam has a pretty smooth year.

Let's take a look…

He gets his free annual physical.

$300

100% paid by the Company!
He goes to the doctor once for strep. The doctor prescribes Adam two generic medications.

$150 visit
$15 generic x 2

He goes to an urgent care clinic after a sports injury and gets an X-ray.

$250 visit
$400 X-ray

Adam sees a specialist twice during his recovery.

$225 visit x 2

Adam has incurred a total of $1,570 in expenses. Now let's see which plan would have been better for Adam!

$1,570

in total expenses

Wait!

We also need to remember that Adam has been paying for medical coverage from his paycheck. He gets his biometric screening and doesn't use tobacco, so he gets the full wellness incentives. We'll add that in too!

Remember, Adam incurred $1,570 in expenses.

In the Value Plan, he pays most of the cost out-of-pocket, but he pays copays for Preventive Drug List prescriptions. In the Classic Plan, he pays some through copays.

Value Plan Classic Plan
Costs paid by Adam $1,270 $600
Adam's paycheck deductions $702 $2,574
Company-provided contributions $0 $0
And the winner is...

The Value Plan is the winner for Adam!

Value Plan* Classic Plan
Costs paid by Adam $1,270 $600
Adam's paycheck deductions $702 $2,574
Company-provided contributions $0 $0
Adam's Total Cost $1,972 $3,174
*Team member contributions to the optional HSA can further reduce the Value Plan total.
To see a more detailed calculation of Adam's care click here.

Carlos

Meet Carlos

Carlos is single and in pretty good health. He uses in-network doctors and pharmacies. But he's had a bit of a bumpy year.

Let's take a look...

He gets his free annual physical.

$300

100% paid by the Company!
He starts having trouble with a condition that hasn't bothered him in years. He goes to his primary care doctor four times.

$150 visit x 4

His doctor prescribes his several generic medications that he fills at the pharmacy.

$15 generic x 4

His condition worsens and he goes to the ER.

$1,100 visit

After his ER visit he sees a specialist four times.
The doctor orders one round of tests from an outside facility.

$225 visit x 4
$250 labs

The doctor also prescribes a couple of preferred brand  medications. Carlos fills them at the pharmacy and then switches to mail order.

$65 preferred  x 2
$195 preferred mail order  x 2

Since his condition isn't improving, the specialist decides Carlos needs to an MRI.

$1,000 MRI

He sees a physical therapist six times to recover from his surgery.

$130 visit x 6

Carlos has incurred a total of $5,510 in expenses. Now let's see which plan would have been better for Carlos!

$5,510

in total expenses

Wait!

We also need to remember that Carlos has been paying for medical coverage from his paycheck. He gets his biometric screening and doesn't use tobacco, so he gets the full wellness incentives. We'll add that in too!

Remember, Carlos incurred $5,510 in expenses.

In both plans, Carlos met his deductible. When he hit his deductible, both he and the company shared the costs with coinsurance.

Value Plan Classic Plan
Costs paid by Carlos $4,357 $2,642
Carlos's paycheck deductions $702 $2,574
Company-provided contributions $0 $0
And the winner is...

The Classic Plan is the winner for Carlos!

Value Plan* Classic Plan
Costs paid by Carlos $4,357 $2,642
Carlos's paycheck deductions $702 $2,574
Company-provided contributions $0 $0
Carlos's Total Cost $5,059 $5,216
*Team member contributions to the optional HSA can further reduce the Value Plan total.
To see a more detailed calculation of Carlos's care click here.

Sara

Meet Sara

Sara is single. She uses in-network doctors and pharmacies. But, she's had a tough year.

Let's take a look...

She gets her free annual physical.

$300

100% paid by the Company!
She starts feeling bad and goes to the primary doctor several times.

$150 visit x 6

Her doctor prescribes a generic medications and a preferred brand drugs over the course of the visits. Sara fills all of them twice at the pharmacy before switching to mail order.

$15 generic x 2
$65 preferred  x 2
$45 generic mail order x 2
$195 preferred mail order x 2

With her problem getting worse, she starts seeing a specialist every week.

$225 visit x 6

During a few of her visits lab work is ordered. The specialist also changes her medication to a preferred drug that she fills at the pharmacy.

$250 labs x 3
$65 preferred x 3

But her condition gets worse and she goes to the ER twice.

$1,100 visit x 2

Since she wasn't getting better, her specialist orders surgery.

$40,000 surgery & hospital stay

She sees a physical therapist eight times to recover from her surgery and refills her preferred drugs through mail order three more times.

$130 visit x 8
$195 preferred mail order x 3

Sara has incurred a total of $47,960 in expenses. Now let's see which plan would have been better for Sara!

$47,960

in total expenses

Wait!

We also need to remember that Sara has been paying for medical coverage from her paycheck. She gets her biometric screening and doesn't use tobacco, so she gets the full wellness incentives. We'll add that in too!

Remember, Sara incurred $47,960 in expenses.

In both plans Sara pays up to the out-of-pocket max for medical care. 

Value Plan Classic Plan
Costs paid by Sara $6,000 $4,000
Sara's paycheck deductions $702 $2,574
Company-provided contributions $0 $0
And the winner is...

The Classic Plan is the best choice for Sara!

Value Plan* Classic Plan
Costs paid by Sara $6,000 $4,000
Sara's paycheck deductions $702 $2,574
Company-provided contributions $0 $0
Sara's Total Cost $6,702 $6,574
*Team member contributions to the optional HSA can further reduce the Value Plan total.
To see a more detailed calculation of Sara's care click here.

Felicia

Meet Felicia

Felicia is married. She and her husband are in good health. They use in-network doctors and pharmacies. They have a pretty smooth year.

Let's take a look...

They get their free annual physicals.

$300 x 2

100% paid by the Company!
Felicia goes to the doctor once for the flu. The doctor prescribes Felicia two generic medications.

$150 visit
$15 generic x 2

She goes to an urgent care clinic after a fall in her backyard and gets an X-ray.

$250 visit
$400 X-ray

Felicia sees a specialist twice during her recovery.

$225 visit x 2

Felicia's husband has allergies and goes to a specialist. The doctor prescribes him two generic medications he fills through mail order.

$225 visit x 2
$45 generic x 2

Felicia has incurred a total of $2,420 in expenses. Now let's see which plan would have been better for Felicia!

$2,420

in total expenses

Wait!

We also need to remember that Felicia has been paying for medical coverage from her paycheck. She and her husband both get a biometric screening and neither one uses tobacco, so she gets the full wellness incentives. We'll add that in too!

Remember, Felicia incurred $2,420 in expenses. 

In the Value Plan, she pays most of the cost out-of-pocket, but she pays copays for Preventive Drug List prescriptions. In the Classic Plan, she pays some through copays.

Value Plan Classic Plan
Costs paid by Felicia $1,770 $750
Felicia's paycheck deductions $3,562 $7,982
Company-provided contributions $0 $0
And the winner is...

The Value Plan is the winner for Felicia!

Value Plan* Classic Plan
Costs paid by Felicia $1,770 $750
Felicia's paycheck deductions $3,562 $7,982
Company-provided contributions $0 $0
Felicia's Total Cost $5,332 $8,732
*Team member contributions to the optional HSA can further reduce the Value Plan total.
To see a more detailed calculation of Felicia's care click here.

Jason

Meet Jason

Jason is married. He and his wife use in-network doctors and pharmacies. Midyear his wife is diagnosed with a health condition.

Let's take a look...

They get their free annual physicals.

$300 x 2

100% paid by the Company!
Both Jason and his wife take generic allergy medication year-round. They fill their prescriptions through mail order.

$45 generic mail order x 2 x 4

After not feeling well for a few weeks, his wife goes to the primary care doctor. The doctor orders lab work from an outside facility.

$150 visit x 1
$250 labs x 1

She is diagnosed with health condition and prescribed one generic and two preferred brand drugs. She fills them at the pharmacy.

$15 generic x 1
$65 preferred x 2

Her condition worsens and she goes into the hospital for three days.

$7,500 hospital stay

When she leaves the hospital her medication is changed to two ongoing, generic drugs that she fills twice through mail order.

$45 generic mail order  x 2 x 2

Jason has incurred a total of $9,185 in expenses. Now let's see which plan would have been better for Jason!

$9,185

in total expenses

Wait!

We also need to remember that Jason has been paying for medical coverage from his pay check. He and his wife both get a biometric screening and neither one uses tobacco, so he gets the full wellness incentives. We'll add that in too!

Remember, Jason incurred $9,185 in expenses. 

In both plans, Jason met his deductible. When he hit his deductible, both he and the company shared the costs with coinsurance.

Value Plan Classic Plan
Costs paid by Jason $5,442 $3,634
Jason's paycheck deductions $3,562 $7,982
Company-provided contributions $0 $0
And the winner is...

The Value Plan is the winner for Jason!

Value Plan* Classic Plan
Costs paid by Jason $5,442 $3,634
Jason's paycheck deductions $3,562 $7,982
Company-provided contributions $0 $0
Jason's Total Cost $9,004 $11,616
*Team member contributions to the optional HSA can further reduce the Value Plan total.
To see a more detailed calculation of Jason's care click here.

Kelly

Meet Kelly

Kelly is married. She and her husband use in-network doctors and pharmacies. Both Kelly and her husband have a tough year.

Let's take a look...

They get their free annual physicals.

$300 x 2

100% paid by the Company!
Kelly's husband sees the doctor to get help for his allergies. After one round of allergy testing, he begins monthly allergy shots.

$150 visit x 1
$525 testing x 1
$50 allergy shots x 10

Kelly also starts taking a new,  costly preferred brand drug for an ongoing heart condition. She fills it twice at the pharmacy and then once through mail order.

$65 preferred x 2
$195 preferred mail order x 1

One night Kelly's husband has to go to the ER after falling in the garage.

$1,100 visit

Kelly's husband has a two x-rays, lab work and stays in the hospital for monitoring overnight.

$400 scans x 2
$250 labs x 1
$2,500 hospital stay

Kelly is sent to a specialist for her heart condition. The doctor recommends surgery.

$225 visit x 1
$40,000 surgery & hospital stay

After the surgery, Kelly's specialist prescribes two, new preferred drugs. She fills both at the pharmacy twice before switching to mail order in the fall.

$65 preferred x 2 x 2
$195 preferred mail order x 1 x 2

Kelly has incurred a total of $47,625 in expenses. Now let's see which plan would have been better for Kelly!

$47,625

in total expenses

Wait!

Wait! We also need to remember that Kelly has been paying for medical coverage from her paycheck. She and her husband both get a biometric screening and neither one uses tobacco, so she gets the full wellness incentives. We'll add that in too!

Remember, Kelly incurred $47,625 in expenses. 

In both plans Kelly pays up to the out-of-pocket max for medical care. So the only costs she has to pay the rest of the year for the Value Plan are copays forPreventive Therapy Drug List prescriptions. In the Classic Plan she'll still have to pay some copays, including for prescription drugs.

Value Plan Classic Plan
Costs paid by Kelly $10,548 $7,165
Kelly's paycheck deductions $3,562 $7,982
Company-provided contributions $0 $0
And the winner is...

The Value Plan is the winner for Kelly!

Value Plan* Classic Plan
Costs paid by Kelly $10,548 $7,165
Kelly's paycheck deductions $3,562 $7,982
Company-provided contributions $0 $0
Kelly's Total Cost $14,110 $15,147
*Team member contributions to the optional HSA can further reduce the Value Plan total.
To see a more detailed calculation of Kelly's care click here.

David

Meet David

David covers his three kids and everyone is in good health. They use in-network doctors and pharmacies. They have a pretty smooth year.

Let's take a look...

All of the family gets their physicals and the kids get their immunizations.

$300 x  4

100% paid by the Company!
A few of them have go to the doctor when they get the flu. The kids also go to the doctor a few times for sinus infections and rashes that won't go away.

$150 visit x 7

David sees the doctor to renew an allergy prescription for the year. David uses mail order to fill it.

$150 visit x 1
$45 generic mail order x 4

His son is diagnosed with allergies after some testing and begins taking a generic medicine. David fills it once at the pharmacy and then switches to mail order for the rest of the year.

$525 allergy testing x 1
$15 generic x 1
$45 generic mail order x 2

David has incurred a total of $3,060 in expenses. Now let's see which plan would have been better for David!

$3,060

in total expenses

Wait!

We also need to remember that David has been paying for medical coverage from his paycheck. He gets his biometric screening and doesn't use tobacco, so he gets the full wellness incentives. We'll add that in too!

Remember, David incurred $3,060 in expenses. 

In the Value Plan, he pays most of the cost out-of-pocket, but he pays copays for Preventive Drug List prescriptions. In the Classic Plan, he pays some through copays.

Value Plan Classic Plan
Costs paid by David $1,735 $895
David's paycheck deductions $3,614 $7,306
Company-provided contributions $0 $0
And the winner is...

The Value Plan is the winner for David!

Value Plan* Classic Plan
Costs paid by David $1,735 $895
David's paycheck deductions $3,614 $7,306
Company-provided contributions $0 $0
David's Total Cost $5,349 $8,201
*Team member contributions to the optional HSA can further reduce the Value Plan total.
To see a more detailed calculation of David's care click here.

Lisa

Meet Lisa

Lisa covers her two boys and the kids are very active in sports. They use in-network doctors and pharmacies. This is a bumpy year for the family. Both of the kids have serious sports injuries.

Let's take a look...

All of the family gets their physicals and the kids get their immunizations.

$300 x  3

100% paid by the Company!
Lisa sees a specialist twice for an ongoing condition. She receives a new, generic prescription to help her better manage it and fills it at the pharmacy.

$225 visit x 2
$15 generic x 1

One of her sons sees the doctor to renew an allergy prescription for the year. Lisa uses mail order to fill it.

$150 visit x 1
$45 generic mail order x 4

Both kids get sick a few times. Each time they receive a few generic prescriptions to help them get better.

$150 visit x 4
$15 generic  x 4

This is the year of the sports injury at Lisa's house. They rack up three trips to urgent care. After one of her sons has lingering pain, they go to an outside facility for two X-rays and one CT-scan.

$250 visit x 3
$400 X-ray x 2
$1,000 scan x 1

One of her sons needs surgery to repair a badly injured knee, which comes with two generic drugs for recovery. Lisa's son also has to do physical therapy for a few months.

$7,000 surgery
$15 generic x 2
$130 visit x 6

Lisa has incurred a total of $12,715 in expenses. Now let's see which plan would have been better for Lisa!

$12,715

in total expenses

Wait!

We also need to remember that Lisa has been paying for medical coverage from her paycheck. She gets her biometric screening and doesn't use tobacco, so she gets the full wellness incentives. We'll add that in too!

Remember, Lisa incurred $12,715 in expenses. 

In both plans, Lisa met her deductible. When she hit her deductible, both she and the company shared the costs with coinsurance.

Value Plan Classic Plan
Costs paid by Lisa $7,045 $3,686
Lisa's paycheck deductions $3,614 $7,306
Company-provided contributions $0 $0
And the winner is...

The Value Plan is the winner for Lisa!

Value Plan* Classic Plan
Costs paid by Lisa $7,045 $3,686
Lisa's paycheck deductions $3,614 $7,306
Company-provided contributions $0 $0
Lisa's Total Cost $10,659 $10,992
*Team member contributions to the optional HSA can further reduce the Value Plan total.
To see a more detailed calculation of Lisa's care click here.

Michelle

Meet Michelle

Michelle covers her son and daughter and the family is typically in good health. They use in-network doctors and pharmacies. But this is a tough year due to a serious health condition.

Let's take a look...

Everyone gets their physicals and the kids get their immunizations.

$300 x  3 = $900

100% paid by the Company!
Both kids get sick a few times. Each time they receive a few generic prescriptions to help them get better.

$150 visit x 4
$15 generic  x 4

Michelle sees a specialist every month for an ongoing condition. She also fills two generic medications by mail order to help her manage it.

$225 visit x 12
$45 generic mail order x 2 x 4

Midyear Michelle's son's health condition gets very serious and he's rushed to the ER. He's admitted to the hospital after two days of monitoring.

$1,100 visit x 1
$5,000 hospital stay

His specialist schedules for surgery given his condition is getting worse. In addition to his hospital stay, he's in the ICU for one day.

$30,000 surgery
$5,000 ICU

After lingering pain from a sports injury, her daughter starts physical therapy for three months.

$130 visits x 12

Michelle has incurred a total of $47,280 in expenses. Now let's see which plan would have been better for Michelle!

$47,280

in total expenses

Wait!

We also need to remember that Michelle has been paying for medical coverage from her paycheck. She gets her biometric screening and doesn't use tobacco, so she gets the full wellness incentives.  We'll add that in too!

Remember, Michelle incurred $47,280 in expenses. 

In both plans Michelle pays up to the out-of-pocket max for medical care. So the only costs she has to pay the rest of the year for the Value Plan are copays forPreventive Therapy Drug List prescriptions. In the Classic Plan she'll still have to pay some copays, including for prescription drugs.

Value Plan Classic Plan
Costs paid by Michelle $10,780 $6,392
Michelle's paycheck deductions $3,614 $7,306
Company-provided contributions $0 $0
And the winner is...

The Classic Plan is the winner for Michelle!

Value Plan* Classic Plan
Costs paid by Michelle $10,780 $6,392
Michelle's paycheck deductions $3,614 $7,306
Company-provided contributions $0 $0
Michelle's Total Cost $14,394 $13,698
*Team member contributions to the optional HSA can further reduce the Value Plan total.
To see a more detailed calculation of Michelle's care click here.

Sonja

Meet Sonja

Sonja's family is in good health. She and her husband have two kids. They use in-network doctors and pharmacies. They have a pretty smooth year.

Let's take a look...

All of the family gets their physicals and the kids get their immunizations.

$300 x  4 = $1,200

100% paid by the Company!
They have go to the doctor when they get the flu. The kids also go to the doctor a few times for ear infections. The ear infections resulted in a few generic prescriptions.

$150 visit x 8
$15 generic x 4

Sonja's husband has to see a specialist for an ongoing condition. He gets a generic prescription that he fills through mail order twice.

$225 specialist visit
$45 generic mail order x 2

Her son gets allergy testing done and has four allergy shots.

$525 testing x 1
$50 allergy shots x 4

Sonja has incurred a total of $3,500 in expenses. Now let's see which plan would have been better for Sonja!

$3,500

in total expenses

Wait!

We also need to remember that Sonja has been paying for medical coverage from her paycheck. She and her husband both get a biometric screening and neither one uses tobacco, so she gets the full wellness incentives. We'll add that in too!

Remember, Sonja incurred $3,500 in expenses. 

In the Value Plan, she pays most of the cost out-of-pocket, but she pays copays for Preventive Drug List prescriptions. In the Classic Plan, she pays some through copays.

Value Plan Classic Plan
Costs paid by Sonja $2,240 $1,105
Sonja's paycheck deductions $6,318 $12,350
Company-provided contributions $0 $0
And the winner is...

The Value Plan is the winner for Sonja!

Value Plan* Classic Plan
Costs paid by Sonja $2,240 $1,105
Sonja's paycheck deductions $6,318 $12,350
Company-provided contributions $0 $0
Sonja's Total Cost $8,558 $13,455
*Team member contributions to the optional HSA can further reduce the Value Plan total.
To see a more detailed calculation of Sonja's care click here.

Nathan

Meet Nathan

Nathan's family is in good health and his two kids are very active in sports. They use in-network doctors and pharmacies. This is a bumpy year filled with injuries and medications.

Let's take a look...

All of the family gets their physicals and the kids get their immunizations.

$300 x  4 = $1,200

100% paid by the Company!
Nathan sees a specialist twice for an ongoing condition. He receives a new, preferred brand prescription to help him better manage it and fills it at the pharmacy once and then switches to mail order.

$225 visit x 2
$65 preferred x 1
$195 preferred mail order x 1

His wife sees the doctor to renew an allergy prescription for the year. Nathan uses mail order to fill it.

$150 visit x 1
$45 generic mail order x 1

Both of the kids get sick a few times. Each time they receive multiple generic prescriptions to help them get better.

$150 visit x 6
$15 generic x 15

This is the year of the sports injury at Nathan's house. They rack up three trips to urgent care. After lingering pain, his son has to have  two X-rays and one MRI at an outside facility.

$250 visit x 3
$400 X-ray x 2
$1,000 MRI

His son needs surgery to repair a badly injured knee.

$9,000 surgery

Then his son has to do physical therapy for a few months.

$130 visit x 6

Nathan has incurred a total of $15,560 in expenses. Now let's see which plan would have been better for Nathan!

$15,560

in total expenses

Wait!

We also need to remember that Nathan has been paying for medical coverage from his paycheck. He and his wife both get a biometric screening and neither one uses tobacco, so he gets the full wellness incentives. We'll add that in too!

Remember, Nathan incurred $15,560 in expenses. 

In both plans, Nathan met his deductible. When he hit his deductible, both he and the company shared the costs with coinsurance.

Value Plan Classic Plan
Costs paid by Nathan $7,405 $4,229
Nathan's paycheck deductions $6,318 $12,350
Company-provided contributions $0 $0
And the winner is...

The Value Plan is the winner!

Value Plan* Classic Plan
Costs paid by Nathan $7,405 $4,229
Nathan's paycheck deductions $5,928 $11,674
Company-provided contributions $0 $0
Nathan's Total Cost $13,723 $16,579
*Team member contributions to the optional HSA can further reduce the Value Plan total.
To see a more detailed calculation of Nathan's care click here.

Maria

Meet Maria

Maria, her husband and her three kids are typically in good health. They use in-network doctors and pharmacies. But this is a tough year due to several serious health conditions.

Let's take a look...

All of the family gets their physicals and the kids get their immunizations.

$300 x  5 = $1,500

100% paid by the Company!
Everyone gets sick a few times. Each time they receive multiple generic prescriptions to help them get better.

$150 visit x 10
$15 generic x 25

Maria, her husband and her son all see specialists regularly for ongoing conditions. To treat their conditions, she fills three preferred brand medications by mail order.

$225 visit x 24
$195 preferred mail order x 3 x 4

Midyear Maria's condition gets very serious and she's rushed to the ER. She's admitted to the hospital for two days of monitoring.

$1,100 visit x 1
$5,000 hospital stay

Her husband's specialist schedules him for surgery given his condition is getting worse. In addition to his hospital stay, he's in the ICU for two days.

$40,000 surgery
$10,000 ICU

Her son also needs physical therapy for an injury.

$130 visits x 12

Maria has incurred a total of $68,775 in expenses. Now let's see which plan would have been better for Maria!

$68,775

in total expenses

Wait!

We also need to remember that Maria has been paying for medical coverage from her paycheck. She and her husband both get a biometric screening and neither one uses tobacco, so she gets the full wellness incentives. We'll add that in too!

Remember, Maria incurred $68,775 in expenses. 

In both plans Maria pays up to the out-of-pocket max for medical care. So the only costs she has to pay the rest of the year for the Value Plan are copays forPreventive Therapy Drug List prescriptions. In the Classic Plan she'll still have to pay some copays, including for prescription drugs.

Value Plan Classic Plan
Costs paid by Maria $12,000 $8,000
Maria's paycheck deductions $6,318 $12,350
Company-provided contributions $0 $0
And the winner is...

The Value Plan is the winner for Maria!

Value Plan* Classic Plan
Costs paid by Maria $12,000 $8,000
Maria's paycheck deductions $6,318 $12,350
Company-provided contributions $0 $0
Maria's Total Cost $18,318 $20,350
*Team member contributions to the optional HSA can further reduce the Value Plan total.
To see a more detailed calculation of Maria's care click here.

Content on this site is intended for U.S. Benefits eligible employees.

Disclaimer

Need help understanding all of your benefits options? Call (800) 374-3985 to speak with your Aetna Health Concierge.