25/26 Open Enrollment for Health Plans
Open Enrollment begins on June 30, 2025 and ends on July 11, 2025. This is the time of year when you can make changes to your health coverage for an August 1, 2025 effective date. Only those of you who want to enroll, cancel, add or delete dependents, switch plans or make any other changes to your current medical, dental and/or vision coverage need to take action during Open Enrollment. Otherwise, your coverage will continue for you and your covered eligible dependents.
WHAT’S NEW EFFECTIVE AUGUST 1, 2025
Basic Fertility Coverage will now include artificial insemination for all medical plans.
Maximum of 3 cycles per lifetime
CVS Virtual Care will be available in the POS and Basic PPO Medical Plans.
Changes to employees contributions
Click here to see the New Contributions Rates
WHAT’S NOT NEW
Aetna will continue to be our medical and dental vendor and Vision Service Plan for vision coverage.
OPEN ENROLLMENT TOOLS
Open Enrollment Guide for current employees
Aetna Cost Comparison Tool for current employees
COBRA Guide for former employees
AETNA HMO MEDICAL PLAN:
Aetna Medical HMO Deductible Plan (HMO) is a Health Maintenance Organization available only in California. It provides coverage for in-network care only, and is coordinated by your primary care physician (PCP). It covers most services at 100% after you pay a flat copay. However, a deductible applies for certain services such as inpatient hospitalization.
The Aetna HMO Network is an expanded network that includes more medical groups.
Note: while the network will be larger, it is still important to always check your provider's network status prior to accessing services because it can change throughout the year.
Visits to designated Walk-in clinics, such as CVS Minute Clinics, are covered at 100%.
Aetna HMO Summary of Benefits & Coverage / Benefits Summary
Provider Search (instructions for finding in-network medical providers)
Each medical plan covers in-network preventive care at 100%
AETNA POS MEDICAL PLAN:
Aetna Open Access Managed Choice POS Plan (POS) is similar to a traditional Preferred Provider Organization (PPO) since it provides both in- & out-of network coverage. Cost-sharing kicks in after you satisfy the deductible although some services require a flat copay only and are not subject to the deductible. Compared to the Basic PPO, the POS plan has higher employee contributions but a lower deductible, which helps minimize your out-of-pocket costs when you receive care.
Aetna POS Pharmacy retail prescription coverage will be subject to the following provisions:
Choose generics - When you fill your prescription, a generic drug will automatically be dispensed, if available. If you request a brand-name drug when a generic equivalent is available, you will pay the brand-name copay plus the difference between the generic cost and the brand-name cost.
Mandatory Maintenance Choice - Maintenance drugs are prescriptions commonly used to treat conditions that require regular, daily use of medicines. If you are taking a maintenance medication, the first two prescriptions (of a 31-day supply each) that you fill at a retail pharmacy will be charged at the 31-day supply cost. Thereafter, if you choose to continue to refill your 31-day supply at a retail pharmacy every month instead of opting for a 90-day supply through CVS Caremark® Mail Service Pharmacy or at a participating CVS retail pharmacy, you will pay the full cost of your medication.
Aetna POS Summary of Benefits & Coverage (traditional PPO) / Benefits Summary
Provider Search (instructions for finding in-network medical providers)
Each medical plan covers in-network preventive care at 100%
AETNA BASIC PPO MEDICAL PLAN :
Aetna Open Access Managed Choice POS HDHP Plan (Basic HDHP 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. Compared to the POS plan, the Basic HDHP PPO has the lowest employee contributions but the highest deductible, so you get to keep more of your take-home pay but will have higher out-of-pocket costs if you need medical care
Choose generics - When you fill your prescription, a generic drug will automatically be dispensed, if available. If you request a brand-name drug when a generic equivalent is available, you will pay the brand-name copay plus the difference between the generic cost and the brand-name cost.
Mandatory Maintenance Choice -Maintenance drugs are prescriptions commonly used to treat conditions that require regular, daily use of medicines. If you are taking a maintenance medication, the first two prescriptions (of a 31-day supply each) that you fill at a retail pharmacy will be charged at the 31-day supply cost. Thereafter, if you choose to continue to refill your 31-day supply at a retail pharmacy every month instead of opting for a 90-day supply through CVS Caremark® Mail Service Pharmacy or at a participating CVS retail pharmacy, you will pay the full cost of your medication.
Aetna Basic PPO Summary of Benefits & Coverage (high deductible, catastrophic PPO) / Benefits Summary
Provider Search (instructions for finding in-network medical providers)
Each medical plan covers in-network preventive care at 100%
AETNA DENTAL BENEFITS
Aetna DMO Summary of Benefits & Coverage / Benefits Summary
Aetna PPO Summary of Benefits & Coverage / Benefits Summary
Aetna’s Dental PPO plan will reimburse Out-of-network (OON) dental claims based on the allowable prevailing geographic charge.
If you are seeing an OON dentist, this may result in a higher bill amount than what was previously billed for common procedures. This will be dependent on what your dentist charges and where they are located
Provider Search (instructions for finding in-network dental providers)
VISION SERVICE PLAN
No change in vision coverage. Vision coverage is still available at no cost to you.
Vision Service Plan (VSP) Benefit Summary
IMPORTANT NOTICES
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HOW TO ENROLL
Complete the Open Enrollment Form (current employees)
Complete the COBRA Open Enrollment Form (former employees)
Upload by July 11th via SECURE WEB LINK FOR EMPLOYEE FORMS (drag and drop) or the “Submit” button. Faxes and scans to emails will not be accepted. If you send via US Mail, please be advised that there may be a delay in processing your forms. If you have questions or need help with your enrollment, please contact Benefits at (818) 331-1041.
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