Medical & Prescription
Medical & Prescription Benefits
We’re proud to offer you the following medical and pharmacy plan choices through Aetna, designed to help you and your family get the care you need at an affordable price.
Your Medical Plan Options
There’s no “one size fits all” when it comes to medical coverage. Explore the different plans TOI offers to see which might be right for you.
| Health Maintenance Organization (HMO) | Exclusive Provider Organization (EPO) | Point of Service Plan (POS) | High Deductible Health Plan (HDHP) |
|---|---|---|---|
| The HMO only covers in-network care and requires you to choose a PCP who manages your care and referrals. You’ll pay copays for services, with no out-of-network coverage. | The EPO covers in-network care only, but you don’t need a PCP or referrals for specialists. You’ll pay copays for services, but there’s no out-of-network coverage. | The POS offers in- or out-of-network flexibility for a higher premium. You’ll usually pay a copay, with mid-range deductibles and out-of-pocket costs. You don’t need a set PCP or referrals for specialists. | The HDHP covers in- or out-of-network care, but you pay in full until meeting your deductible. It’s HSA-eligible, with tax free contributions from TOI. |
Explore the Plans
Choosing the right plan starts with understanding how they differ. The charts below highlight key features, including cost for care, eligibility, deductibles, premiums, coverage, savings accounts and more! You can find more detailed information in the documents linked in the sidebar.
Medical Plan Comparison
Review this chart to see what you’ll pay for care with each of TOI’s five Aetna medical plans.
| What’s Included in Your Coverage | HMO Whole Health (California residents only) |
HMO 1000 (California residents only) |
EPO 1000 | POS 1500 | HDHP 3300 |
|---|---|---|---|---|---|
| In-Network Only | In-Network Only | In-Network Only | In-Network* | In-Network* | |
| TOI Annual HSA Contribution Teammate / Teammate + Spouse or Child(ren) / Family |
N/A | N/A | N/A | N/A | $700 / $950 / $1,200 |
| Here’s how much you’ll pay | |||||
| Annual Deductible / Individual / Family | $1,000 / $2,000 | $1,000 / $2,000 | $1,000 / $2,000 | $1,500 / $3,000 | $3,300 / $6,600 |
| Annual Out-of-Pocket Maximum / Individual / Family | $4,500 / $9,000 | $4,500 / $9,000 | $4,000 / $8,000 | $4,000 / $8,000 | $6,000 / $12,000 |
| Preventive Care | Covered in full | Covered in full | Covered in full | Covered in full | Covered in full |
| Telehealth / CVS Health Virtual Care | $0 | $0 | $0 | $0 | 20%** |
| Primary Care | $30 | $30 | $30 | $25 | 20%** |
| Specialty | $50 | $50 | $50 | $50 | 20%** |
| Urgent Care | $50 | $50 | $50 | $75 | 20%** |
| Emergency Room (copay waived if admitted) | $150** | $150** | $200 | $300 + 20% | 20%** |
| Outpatient & Inpatient Hospital | 30%** | 30%** | 30%** | 20%** | 20%** |
| Outpatient Mental Health | $50 | $50 | $50 | $50 | 20%** |
| Chiropractic (20 visits per year) | $15 | $15 | $50 | $50 | 20%** |
*This plan includes out-of-network coverage. Please review your plan documents for details.
Which Plan Is Right for You?
There are a lot of things to consider when choosing a plan. Different people have different priorities and considering all the variables can be helpful in finding the plan that is best for you.
| Plan | HMO Whole Health | HMO 1000 | EPO 1000 | POS 1500 | HDHP 3300 |
|---|---|---|---|---|---|
| Eligibility | California residents only | California residents only | All teammates | All teammates | All teammates |
| Annual deductible to satisfy | Low | Low | Low | Mid | High |
| Per pay period premium cost | Low | Low | Mid | High | Low |
| In-network coverage | Yes | Yes | Yes | Yes | Yes |
| Out-of-network coverage | No | No | No | Yes | Yes |
| Mental health coverage | Yes | Yes | Yes | Yes | Yes |
| Health Savings Account (HSA) | No | No | No | No | Yes |
| Flexible Spending Account (FSA) | Healthcare | Healthcare | Healthcare | Healthcare | Limited purpose |
| Who Is It Best for? | Teammates in California who want low premiums and are comfortable with only in-network care, a PCP, and referrals. | Teammates in California who want low premiums and are comfortable with only in-network care, a PCP, and referrals. | Those who want in-network coverage only, but without needing a PCP or referrals. | Teammates who want flexibility to see in- or out-of-network providers, and are comfortable with higher premiums. | Teammates who want lower premiums, can handle a high deductible, and want the HSA with TOI’s contribution. |
All In-Network Preventive Care covered at 100%
All of our medical plans offer in-network preventive care, covered at 100%! Regardless of the plan you choose, annual checkups help you stay healthy, and don’t cost a thing. Take care of yourself and your family by using your in-network preventive care benefits each year! Preventive care visits allow you to take action early and keep treatable health issues from becoming chronic conditions.
Considering the HDHP?
The HDHP works differently than the other plans. You’ll pay more upfront until you meet your deductible, but it also comes with lower premiums and access to an HSA with contributions from TOI. With a little planning, it can be a smart, cost-effective option. Check out the Health Savings Account (HSA) page to see if the HDHP is right for you.
Prescription Plan Comparison
Your Pharmacy Coverage
Prescription drug coverage is included with all our Aetna medical plans, and in many cases, the cost you’ll pay for prescriptions is similar. Explore the Aetna Rx site to see if your prescription is covered and find in-network pharmacies.
| What’s Included in Your Coverage | HMO Whole Health (California residents only) | HMO 1000 (California residents only) | EPO 1000 | POS 1500 | HDHP 3300 |
|---|---|---|---|---|---|
| In-Network Only | In-Network Only | In-Network Only | In-Network* | In-Network* | |
| Annual Rx Deductible Individual / Family | $200 / $400 | $200 / $400 | $200 / $400 | $200 / $400 | Combined with medical |
| Retail (up to a 30-day supply) | |||||
| Generic | $10 | $10 | $10 | $10 | $10 |
| Preferred Brand | $30 | $30 | $30 | $30 | $30 |
| Non-Preferred Brand | $55 | $55 | $55 | $55 | $50 |
| Specialty | 30% up to $250 | 30% up to $250 | 30% up to $250 | 30% up to $250 | 30% up to $250 |
| Mail Order (up to a 90-day supply) | |||||
| Generic | $20 | $20 | $20 | $20 | $20 |
| Preferred Brand | $60 | $60 | $60 | $60 | $60 |
| Non-Preferred Brand | $110 | $110 | $110 | $110 | $100 |
Save Time & Money with Mail Order!
With CVS Caremark Mail Service Pharmacy, you can have maintenance medications delivered to your home—often for less than it costs at a retail pharmacy. Call 888-792-3862 or log into your Aetna account to learn more.
Questions About Your Options or Coverage?
When you’re struggling to make sense of your options—or your coverage—the Alliant Benefit Advocates can help. Learn more about what Health Advocacy can do for you!
Health Advocacy
Connect with a Benefit Advocate who can guide you through the healthcare system, answer questions, and help you make confident, informed decisions. They can save you time and money, too, helping you with a variety of questions and concerns, including:
- Explaining your plan options
- Confirming your or your dependent’s eligibility
- Connecting you with in-network providers
- Resolving billing or claims issues
Cost for Coverage
Cost for Coverage
Your per pay period payroll deductions for medical are shown here.
| Benefit Plan | Teammate Only | Teammate + Spouse | Teammate + Child(ren) | Teammate + Family |
|---|---|---|---|---|
| HMO Whole Health (California residents only) | $20.00 | $128.63 | $78.49 | $174.16 |
| HMO 1000 (California residents only) | $37.88 | $173.96 | $110.27 | $256.31 |
| EPO 1000 | $95.85 | $321.92 | $236.92 | $422.31 |
| POS 1500 | $143.58 | $379.15 | $280.31 | $489.61 |
| HDHP 3300 | $47.46 | $201.23 | $151.23 | $305.00 |
Need Help?
Aetna
Alliant Benefit Advocates
aetna.com
Plan Decision Support:
Alliant Benefit Advocates
benefitssupport@alliant.com
800-489-1390
General Benefits Questions:
TOI Total Rewards Benefits Team
benefits@theoncologyinstitute.com