Updates For January 1, 2022–December 31, 2022
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.
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).
Aetna Telemedicine Through Teladoc
Aetna offers telemedicine services through Teladoc (PDF). Beginning in January 2022, you 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.
Aetna Prescription Drug Formulary
The Aetna formulary is called the Advanced Control Plan. Employees can check their medication by accessing the drug guide brochure.
Key for the Formulary:
- Generic (Tier 1): $20 copayment for a 30-day retail supply
PG = Preferred Generic
- Preferred Brand (Tier 2): $45 copayment for a 30-day retail supply
- Non-Preferred (Tier 3): $70 copayment for a 30-day retail supply
NP=Non-preferred Brand and Generic**
- There is a $0 co-payment for generic preventive medications on this list (PDF).
- Aetna has several national chains in their Aetna National Pharmacy Network including CVS, Costco, Duane Reade, ShopRite, Stop and Shop, and Walgreens. Additionally, Aetna contracts with independent pharmacies.
- Mail order is available through Aetna Rx Home Delivery. Please enroll in mail order (PDF) if you would like to continue to participate and include a 90-day prescription from your doctor.
Consumer Core High Deductible Health Plan (HDHP) – Deductible and Transition to PayFlex HSA
- The 2022 HSA deductibles will remain the same at $1,400 (individual) and $2,800 (family).
The Health Savings Account (HSA), which may accompany the HDHP, will transition from HSA Bank (under Cigna) to PayFlex HSA (under Aetna). If you would like to move your HSA Bank funds to the new PayFlex HSA, please submit the PayFlex HSA Transfer Form (PDF) to HSA Bank in 2022 (HSA Bank, P.O. Box 939, Sheboygan, WI 53082-0939). It will generally take 3 – 4 weeks for the funds (from your HSA Bank account) to appear in your PayFlex HSA account.
Please refer to information concerning the Individual Transfer Option (PDF) from HSA Bank (current Cigna HSA provider).
Current funds may remain in your HSA Bank account; however, no new funds will be contributed to HSA Bank via payroll deduction after December 31, 2021.
2022 HSA Contribution Limits
- Coverage Type: Individual $3,650
- Coverage Type: Family $7,300
Copayments for In-Network Mental Health and Substance Abuse (Outpatient) Visits
For the Network Core and Choice Plan medical plans, in-network mental health and substance abuse outpatient visits continue to be covered at the primary office visit copayment ($30) in 2022.
2022 Health Care FSA and Dependent Care FSA Limits
- The limit for the Health Care FSA (January 1, 2022–December 31, 2022) has increase to $2,850 ($118.75 per paycheck).
- The limit for the Dependent Care FSA (January 1, 2022–December 31, 2022) is unchanged at $5,000 ($208.33 per paycheck); $2,500 ($104.16 per paycheck) if both spouses contribute via separate employers.
You must enroll, during each Open Enrollment period, in order to participate in an FSA for the new plan year.
Eligible Expense Items List (scroll down to “Find Out if an Expense is Eligible”)
Deductibles Under the Aetna Choice Plan
Under Aetna, the out-of-network deductibles and out-of-pocket maximums do not accumulate towards the in-network deductibles and in-network out-of-pocket maximums; they are separate accumulators. This is a change from the way that in-network and out-of-network deductibles were handled under the Cigna Choice PPO Plan.
Reminder: Deductibles and annual limits are calculated on a calendar year basis. Please plan accordingly.
Per Paycheck Premiums (January 1, 2022–December 31, 2022)
Medical Plan Waiver Reimbursement For Those Newly Waiving Coverage
For those who are currently covered under our Cigna medical plans and will be waiving coverage for the first time as of January 1, 2022, you will receive an annual (12-month) reimbursement of $1,800 ($75 per paycheck). After 1 year (as of January 1, 2023), your annual (12-month) reimbursement will revert to $750 ($31.25 per paycheck). Those who are currently waiving medical coverage, and will continue to do so as of January 1, 2022, will receive an annualized reimbursement of $750 ($31.25 per paycheck).
Coverage to End of Calendar Year in Which 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 they turn 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 Plan and Choice Plan 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. In order to find a contracted Urgent Care center ($30 co-payment), please contact Aetna or utilize the Aetna Mobile App or provider search tool to find a contracted provider in your area.
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.
Annual Deductibles, Out-Of-Pocket Maximums, Etc.
Annual deductibles, out-of-pocket maximums, etc. are based upon a calendar year.