Tier 2 Medical


Overview and Eligibility
The Company offers the Aetna Open Access Managed Choice POS HDHP Plan (Basic PPO) to eligible Telepictures employees without a 3-year contract. This coverage is in effect from August 1, 2019 through July 31, 2020.

Aetna Basic PPO is a high deductible, catastrophic PPO plan that offers both in- & out-of network services. Cost sharing kicks in only after you satisfy the deductible.

Who’s eligible?
Non-union, fulltime Telepictures employees without a 3-year contract may enroll themselves, their spouse or domestic partner, and their dependent child(ren) up to age 26 in group medical coverage. For eligibility details, refer to the Summary Plan Description and List of Participating Employers. Note: You will need to provide a copy of your marriage certificate in order to enroll your spouse, birth certificates to enroll your children and the Domestic Partner Affidavit to enroll your domestic partner.

You can choose from three coverage levels: Employee only, Employee + 1, or Family.

Use Provider Search to find in-network medical and dental providers.

How to enroll
•    As a new hire: Take these steps to enroll within 30 days of your eligibility date.
•    During Open Enrollment: Complete and submit the Open Enrollment Form available on this website during the open enrollment window each year. Outside of annual Open Enrollment, you can only make changes to your benefits if you experience a qualified life event such as a birth, marriage, divorce, loss of other coverage, etc.

Preventive Care
The basic PPO medical plan covers in-network preventive care at 100%, so you pay nothing. Preventive services include:
•    Annual checkups
•    Well-baby and well-child care
•    Routine cancer screenings
•    Blood pressure and cholesterol tests
•    Immunizations
•    Contraceptives
•    Prenatal care

How the Basic PPO plan works
•    You pay for your initial medical and prescription costs until you meet your annual deductible.  
•    Once the deductible is met, you’ll pay a percentage of your covered medical expenses. This amount is called your coinsurance.
•    If your share of expenses reaches an amount up to the out-of-pocket maximum, you won’t have to pay anything for certain services for the rest of the calendar year.

More about the Basic PPO plan  
•    Find in-network providers
•    Summary of Benefits (SBC)
•    Aetna Basic PPO Claim Form
•    Disclosure
•    Schedule of Benefits
•    Certificate of Coverage

Contribution Rates 

Find a Doctor
Provider Search makes it easy to search for in-network providers that meet your criteria. You can either log in to search (if you’re already registered) or search as a guest by entering your ZIP code.
•    Aetna Basic PPO: Select “Aetna Open Access Plans,” then “Managed Choice POS (Open Access).” See step-by-step search instructions

Aetna Navigator
Aetna Navigator is your secure member website with all your personalized medical plan details at your fingertips. Visit Aetna’s website at www.aetna.com, click on the “Login” button, then log in with your user name and password (first-time users, click “Register” to set up your account first).  

Once you’re logged in, you can:
•    See your coverage details, claims, and billing information
•    Find in-network doctors, dentists, pharmacies, and hospitals
•    See how much of your deductible you’ve paid so far and how much you have left
•    Check what a procedure may cost in your area
•    Look up the price of a drug before you go the pharmacy, or sign up for easy home delivery
•    Print or order a new ID card
•    Look up estimated costs for over 650 labs, tests, surgeries, also health topics and much more

Pharmacy Benefits
When you enroll in a medical plan, you will automatically receive prescription drug coverage through Aetna Pharmacy.  

What will you pay?
The cost you pay for prescription drugs under each medical plan depends on the tier of the medication. You can quickly look up a drug using Aetna’s 2019 online formulary.   

·         Preferred generic medications contain the same active ingredients as their brand-name equivalents and meet the same federal standards for safety, but typically cost much less. You typically pay the lowest cost.

·         Preferred brand name medications are favored by the pharmacy plan based on drug effectiveness and cost. You typically pay a slightly higher cost.

·         Non-preferred generic and brand name medications are not on a pharmacy plan’s formulary based on drug effectiveness and cost. They may still be covered, but may require prior authorization and cost more. You typically pay a higher cost.

·         Specialty drugs generally require special handling or monitoring by a health professional or are relatively difficult to dispense, so they cost more. You typically pay the highest cost.

Use mail order to save money
If you regularly take medication to treat a chronic condition such as an allergy, heart disease, high blood pressure, or diabetes, you can take advantage of the convenience and cost savings of using the Aetna Rx Home Delivery service. Prescriptions are shipped to you for free, no waiting in line at the pharmacy, and you can save money with a reduced cost for a three-month supply.

Aetna Pharmacy forms
•    Mail Order Form
•    Out-of-Network Claim Form

When You’re Sick
When you or a covered family member needs medical attention, you have options. Going to the right place for your situation will help you save money, avoid a long wait, and get the most appropriate care.

  • 24-Hour Informed Health® Line: Get your health questions answered anytime, anywhere. Call the 24-hour nurse line at (800) 556-1555.

  • Teladoc: You have access to board-certified doctors who are available 24/7/365 to consult with you over the phone or through live video right from your mobile device or computer. Teladoc physicians can provide fast, convenient diagnosis and treatment for many common conditions. Learn more and access Teladoc.

  • Urgent Care: When you have an urgent — but not life or limb threatening — medical issue, you’ll pay less (and likely face a shorter wait) if you go to an urgent care clinic instead of the ER. There are over 3,000 participating urgent care clinics to choose from, and many are open 7 days a week. Learn more and find a clinic.

  • Walk-In Clinics: If you come down with a minor illness or injury, and need to see the doctor but it’s after business hours, head to your local participating retail walk-in clinic. It’s quicker, more affordable, and more convenient than the ER. Learn more and find a clinic.

  • CVS MinuteClinics®: Aetna makes a variety of health services available to you at MinuteClinic walk-in medical clinics inside select CVS Pharmacy locations. Get help with smoking cessation or weight loss, monitoring diabetes, high cholesterol, or high blood pressure, and more. Learn more and find a MinuteClinic.

  • Disease Management: Aetna’s disease management program is here to help if you have a chronic condition such as diabetes, heart disease, asthma, or low back pain. Get one-on-one support whenever from a nurse by phone or email, or try online coaching. Learn more and get started.

  • Travel Assistance Program: If a medical emergency or a natural disaster happens while traveling, would you know where to go or who to call? If you’re traveling more than 100 miles from your home (for up to 120 days) and an emergency arises, you have the support of travel assistance services through AXA Assistance USA, Inc. One phone call will connect you to a broad range of emergency assistance services available worldwide, 24/7/365..

  • Aetna Mobile App: Use your cell phone to view your health plan information whenever you want and wherever you are.

  • Patients Like Me: Connect with others who know firsthand what you are going through.

  • Employee Assistance Program: Round-the-clock confidential service that helps you and your family balance the demands of work, life and personal issues.

  • AbleTo Support: Convenient eight-week free program with counseling and coaching by video or phone to help you through difficult times.

As required each year under the Employee Retirement Income Security Act of 1974, as amended (ERISA), TW Ventures Inc. files financial information on its benefit plans with the Internal Revenue Service. ERISA also requires that a summary of this information be distributed to employees. Click here for information on the health and welfare benefit plans in effect from August 1, 2016 through July 31, 2017. The format of the Summary Annual Report is prescribed by Department of Labor regulations. Please note that these plans may not be applicable to you or your production.

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