Group Number
V1194
Provided By
Auxiant/Aetna Signature Administrators
Provider Website
Customer Service
Resources
Frequently Asked QuestionsMedical Benefits
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.auxiant.com/asa.
Benefits |
In-Network |
|---|---|
Deductible |
$2,000/$6,000 |
Out-of-Pocket Max |
$5,000/$10,000 |
Member Coinsurance |
20% |
Preventive Care |
No Member Cost Share |
Primary Care Visit |
$40 Copay |
Specialist Visit |
$40 Copay |
Diagnostic Lab Tests & Imaging |
Deductible + 20% |
Inpatient Hospital |
Deductible + 20% |
Outpatient Hospital |
Deductible + 20% |
Urgent Care |
$40 Copay |
Emergency Room |
$100 Copay, then Deductible + 20% |
Retail Prescriptions |
|
Tier 1-Generic Drugs |
$15 Copay |
Tier 2-Preferred Brand Drugs |
$70 Copay |
Tier 3-Non-Preferred Brand Drugs |
$110 Copay |
Tier 4- Specialty Drugs |
$200 Copay |
Bi-Weekly Payroll Deduction |
Standard Rate |
Wellness Rate |
|---|---|---|
Employee Only |
$154.37 |
$131.29 |
Employee + Spouse |
$426.04 |
$402.96 |
Employee + Child(ren) |
$254.10 |
$231.02 |
Employee + Family |
$456.19 |
$433.11 |
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please www.auxiant.com/asa.
Benefits |
In-Network |
|---|---|
Deductible |
$4,000/$8,000 |
Out-of-Pocket Max |
$5,500/$11,000 |
Member Coinsurance |
20% |
Preventive Care |
No Member Cost Share |
Primary Care Visit |
Deductible + 20% |
Specialist Visit |
Deductible + 20% |
Diagnostic Lab Tests & Imaging |
Deductible + 20% |
Inpatient Hospital |
Deductible + 20% |
Outpatient Hospital |
Deductible + 20% |
Urgent Care |
Deductible + 20% |
Emergency Room |
Deductible + 20% |
Retail Prescriptions |
|
Tier 1-Generic Drugs |
Deductible + 20% |
Tier 2-Preferred Brand Drugs |
Deductible + 20% |
Tier 3-Non-Preferred Brand Drugs |
Deductible + 20% |
Tier 4- Specialty Drugs |
Deductible + 20% |
Bi-Weekly Payroll Deduction |
Standard Rate |
Wellness Rate |
|---|---|---|
Employee Only |
$92.62 |
$69.54 |
Employee + Spouse |
$378.70 |
$355.62 |
Employee + Child(ren) |
$152.46 |
$129.38 |
Employee + Family |
$317.94 |
$294.87 |
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.auxiant.com/asa.
Benefits |
In-Network |
|---|---|
Deductible |
$5,000/$10,000 |
Out-of-Pocket Max |
$6,450/$12,900 |
Member Coinsurance |
10% |
Preventive Care |
No Member Cost Share |
Primary Care Visit |
Deductible + 10% |
Specialist Visit |
Deductible + 10% |
Diagnostic Lab Tests & Imaging |
Deductible + 10% |
Inpatient Hospital |
Deductible + 10% |
Outpatient Hospital |
Deductible + 10% |
Urgent Care |
Deductible + 10% |
Emergency Room |
Deductible + 10% |
Retail Prescriptions |
|
Tier 1-Generic Drugs |
Deductible + 10% |
Tier 2-Preferred Brand Drugs |
Deductible + 10% |
Tier 3-Non-Preferred Brand Drugs |
Deductible + 10% |
Tier 4- Specialty Drugs |
Deductible + 10% |
Bi-Weekly Payroll Deduction |
Standard Rate |
Wellness Rate |
|---|---|---|
Employee Only |
$66.89 |
$43.81 |
Employee + Spouse |
$321.89 |
$298.81 |
Employee + Child(ren) |
$110.10 |
$87.03 |
Employee + Family |
$248.83 |
$225.75 |
Group Number
V1194
Provided By
Auxiant/Aetna Signature Administrators
Provider Website
Customer Service
Resources
Frequently Asked Questions