January 1, 2022 through December 31, 2022
Aetna is the administrator for Pace University’s medical plans.
FOR ALL HEALTH PLANS: annual deductibles, plan maximums, etc., are based upon a calendar year.
The 3 Aetna medical plan options are: Consumer Core High Deductible Health Plan (HDHP), Network Core Plan, and the Choice Plan (formerly, the Choice PPO Plan). The Side-By-Side Comparison (PDF) enables participants to evaluate one medical plan option in relation to the other two.
Aetna ID Cards
The medical ID card is a “family style” card, with the employee and up to 3 dependents (under age 18) included on the same card. If there are more than 3 dependents, a second ID card will be issued. A covered spouse/registered domestic partner will receive a medical ID card as will each dependent over the age of 18.
For those who will be enrolled in the High Deductible Health Plan (HDHP) or in the Network Core Plan, the network is the Aetna Elect Choice Network. For those who will be enrolled in the Choice Plan, the network is the Aetna Managed Choice Network. The same contracted providers are available in both networks (Aetna is required to offer 2 networks due to the out-of-network benefits associated with the Choice Plan).
Aetna Mobile App and Website
With the Aetna Mobile App (PDF), it’s easy to view your plan summary, review and pay claims, search for providers, access your ID cards, etc. This information can also be accessed by logging into the Aetna website.
Aetna Telemedicine Through Teladoc
Aetna offers telemedicine services through Teladoc (PDF). A participant can set up an account via Aetna's Teladoc website or by calling 1 (855) 835-2362. For those enrolled in the Network Core or Choice Plans:
- General Medical follows the Primary Care Physician copayment - $30
- Behavioral Health follows the Behavioral Health office visit/outpatient copayment - $30
- Dermatology follows the Specialist copayment - $50
For those enrolled in the High Deductible Health Plan (HDHP), the amounts listed in the attached brochure will apply.
Aetna Informed Health Line (for Medical Plan Participants)
The Informed Health Line (PDF) is a telephonic service provided to members 24 hours a day, seven days per week. This line provides live access to a Registered Nurse for health education and information. Informed Health nurses can be reached at 1 (800) 556-1555.
Fitness Reimbursement Program through GlobalFit (for Medical Plan Participants)
Aetna offers employees covered under the medical plan up to $200 for visiting the gym 50 times in a 6-month period. Covered spouses/registered domestic partners can receive up to $100 for visiting the gym 50 times in a 6-month period. Find out more information about the fitness reimbursement program (PDF).
- Network Core Plan
- Choice Plan
- Consumer Core HDHP/HSA Plan
- Medical Plan Summaries (includes all medical plans)
- Side-By-Side Comparison of Medical Plans (PDF)
- Per Paycheck Premiums (PDF) (January 1, 2022–December 31, 2022)
- Explanation of Benefits (EOB) Information
- No referrals to see in-network specialists
- No requirement to select a Primary Care Physician (although it is recommended for coordination of care)
- Co-payments of $30 to see a Primary Care Physician and $50 to see a Specialist under the Network Core and Choice plans
- In-network preventive care exams (PDF) are covered at 100%
- Emergency care is covered 24 hours/day, no matter where the member receives such services (for the Network Core and Choice plans, the ER co-payment is waived if you or a covered dependent are admitted to the hospital)
- For the Network Core and Choice medical plans, in-network mental health and substance abuse outpatient visits will be covered at the primary office visit copayment ($30). Previously these services were covered at the specialist office visit copayment ($50).
Coverage to the End of Calendar Year in Which a Dependent Turns Age 26.
A dependent is eligible for coverage under the medical/vision and dental plans until the end of the calendar year in which he/she turns age 26. A dependent who ages off the plans at age 26 will be offered the opportunity to continue dental coverage on COBRA and medical coverage on COBRA or under the New York State Young Adult Option (premiums are 2% less than COBRA).
Urgent Care Facilities
In recent years, many Urgent Care centers have emerged in towns and cities, including within drug stores and medical groups. Urgent Care centers provide individuals with care when the situation isn’t life threating, but requires immediate attention. Urgent Care centers will typically cover conditions such as: earaches and infections, minor cuts, sprains and burns, fever and flu. Pace’s Network Core and Choice plans require a co-payment of $30 for Urgent Care vs. an Emergency Room co-payment of $85. If a participant is enrolled in the Consumer Core HDHP, the cost of services will be less at an Urgent Care center than at the Emergency Room, so out-of-pocket costs will be less.
It is important to note that while a facility may be advertised as “Urgent Care”, the Urgent Care center or medical offices providing “urgent care services” could very well not be contracted with Aetna as a participating Urgent Care facility. Aetna participants may encounter this issue when a medical group has an Urgent Care center; however, this center is actually contracted with Aetna as a “specialist provider.” In this case, the Network Core and Choice specialist co-payment – of $50 - applies. In order to find a contracted Urgent Care center ($30 co-payment), please contact Aetna or utilize the Aetna Health Mobile App (PDF).
For severe and life-threatening conditions (such as shortness of breath, chest pain, uncontrollable bleeding, etc.), the Emergency Room could be the more appropriate setting and a hospital will be better-equipped to handle these situations.