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:

CustomerService@mcgohanbrabender.com

McGohan Brabender -

1-844-388-6565

Questions?

Thank you!