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2015
Benefits Info for Newly Eligible Employees
Topics for DiscussionMedical• Aetna HSA• KeySolution MVP
Next Steps / Forms
McGohan Brabender Customer Care
RetireMEDiQ
Aetna Medical HSA PlanIn-Network Non-Network
Deductible$2,750 / $5,500
Embedded, Calendar Year$5,000 / $10,000
Embedded, Calendar Year
Coinsurance 80% / 20% 50% / 50%
Out-of-Pocket Maximum $4,000 / $8,000 $12,000 / $24,000
Office Visit Deducible & Coinsurance Deducible & Coinsurance
Preventive Care Covered in Full Deductible & Coinsurance
Emergency Room Co-pay Deducible & Coinsurance Covered as Network Benefit
Urgent Care Co-pay Deducible & Coinsurance Deductible & Coinsurance
Retail Pharmacy (30 day supply)
Deductible Applies$10 (Preferred Generic)$40 (Preferred Brand)$60 (Non-Preferred)
30% ($250 max Preferred Specialty)
Deductible Applies$10 (Preferred Generic)$40 (Preferred Brand)$60 (Non-Preferred)
Specialty Not Covered
Mail Order Pharmacy (90 day supply)
Deductible Applies$20 (Preferred Generic)$80 (Preferred Brand)$120 (Non-Preferred)
Not Covered
KeySolution MVP PlanIn-Network
Deductible$0 / $0
Calendar Year
Coinsurance 100%
Out-of-Pocket Maximum $1,850 / $12,700
Office Visit$15 Copay Primary Care$25 Copay Specialists
Preventive Care Covered in Full
Emergency Room Co-pay $400 Copay
Retail Pharmacy (30 day supply)$15 Copay (Generic)
$25 Copay (Preferred)$75 Copay (Non-Preferred)
NOTE: Th is p lan does not inc lude hosp i ta l i zat ion / hosp i ta l care coverage .
Medical Monthly CostsAetna HSA KeySolution MVP Plan
Employee $98.80 $37.87
Employee + Spouse $762.44 $140.54
Employee + Child(ren) $646.53 $136.08
Family $1,293.50 $244.33
Next Steps
EVERYONE MUST:• Complete the Benefi t Election Form
NEWLY ENROLLING:• Complete the carrier enrollment form
WAIVERS:• Complete the Aetna waiver form if waiving Aetna
coverage
** Turn in forms to HR ASAP
McGohan Brabender Customer Care Team
Should you encounter issues that you are unable to resolve by contacting the insurance carrier, you may
contact our McGohan Brabender Customer Care Team by calling:
937-260-4300 or 1-877-635-5372
or e-mail us at:
McGohan Brabender -
1-844-388-6565
Questions?
Thank you!