| Description: |
There are two High Deductible Health Plan (HDHP) options, one with a Health Savings Account (HSA) and one without. The medical benefits are administered by Aetna and the pharmacy benefits are administered by CVS/caremark.
Members will continue to have full access to all in-network pharmacies for their prescription needs.
Your plan is based on a combined deductible of medical and prescription claims. The deductible is the total out-of-pocket spending required by you before benefits are paid. Your annual deductible is $2,000 for an individual or $4,000 for a family. Until this deductible is met, you will pay 100 percent for your medical and pharmacy.
Pima County Medical - Administered by Aetna.png "Aetna")
- Aetna Choice POS II (Open Access) Network
- Preventive care covered at 100 percent
- No referral necessary (prior authorization required for some services)
- May choose non-participating providers with higher deductible and co-insurance
Pima County Pharmacy - Administered by CVS/caremark
- Members will have access to all in-network pharmacies (not limited to CVS pharmacies)
- Mail-order available
- Specialty medications will be dispensed at CVS pharmacies only
- Use your medical/RX card for both your medical and prescription needs.
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| Eligibility: |
Refer to Pima County Personnel Policy 8-122 for more information. |
| Rates: |
Medical, Dental & Vision Rates 2019/20 |
| Additional Resources: |
Schedule of Benefits 2019/20
Summary Plan Description 2019/20
Summary of Benefits and Coverage (SBC) 2019/20
CVS Preventative Drug List
CVS Caremark Benefits Overview
Medical Claim Form
CVS/caremark Reimbursement Claim Form |
Health Management Support Programs
Learn how you can prevent health-related medical conditions and/or manage your current health condition.
Employee Assistance Program (EAP)
EAP counseling is a no-cost benefit where you may access a counselor for any problem that is affecting your personal and/or professional life. You may see a counselor for up to five sessions per problem. EAP is available to all active Pima County employees. This program also covers your spouse, significant other (living in the
Aetna Maternity Programs
With Aetna’s Maternity Program, you can get special attention for a healthier pregnancy and baby. This no-cost program can give your baby a healthier start.
Call us toll-free at 1-800-CRADLE-1 (1-800-272-3531), weekdays from 8 a.m. to 7 p.m. ET. or log in to Aetna Navigator at www.aetna.com , look under "Health Programs" and choose "Maternity Program".
Learn more by visiting the Maternity Program webpage.
In Touch Care (Disease Management Program)
The In Touch Care program offers support and guidance for covered individuals and their family members looking to manage costly, chronic conditions, including asthma, diabetes, congestive heart failure, coronary heart disease, end-stage renal disease, depression, hypertension, arthritis, and more. Individuals with multiple conditions can also benefit from the In Touch Care program.
Learn more by visiting the
In Touch Care Program webpage.
Healthy Lifestyle Coaching (HLC) Tobacco Free Program
The Healthy Lifestyle Coaching (HLC) Tobacco Free program is for employees and their family members 18 years and older who have Pima County medical insurance. To find out more information about getting started call the Aetna Tobacco Free program at
1-866-213-0153.
The HLC Tobacco Free program has specialty coaches, flexible appointment times, wellness counselors and nutrition specialists. Coaching is available in 20-minute weekly one-to-one sessions for up to one year and/or six 30 minutes “live-meeting” group sessions within a 12-week period. You can elect to have 8-weeks of Nicotine Replacement Therapy (NRT) to support your healthy behavior change. There’s also access to online programs available through Simple Steps to a Healthier Life that include a wealth of educational materials, at-home activities, online workbooks, MP3’s and videos.
Please visit our
Tobacco Cessation webpage to learn more about the tobacco cessation programs available to you and your family.
Earn a Healthy Lifestyle Premium Discount if you are tobacco-free for at least the past three months.
Tools & Resources
Aetna Navigator
Aetna Navigator is your member website that is personalized and packed with health and benefits information. To use all of its features, you will need to register at www.aetna.com. A Spanish version of the Aetna Navigator website is also available.
Once you are registered, you will have a home page where you may:
- Review benefits and claims information
- Email Aetna Member Services
- Find network doctors, hospitals and other health care providers with
DocFind
- Manage your health and health care with online tools
- Review your online Personal Health Record (PHR)
- Complete your health assessment
- Find the latest health and wellness information
If you're a new member, go to
www.aetna.com and select "Register now". Already signed up? Log in now to take advantage of the features and tools.
Teladoc
In order to use this service, members must be registered. To register, visit www.teladoc.com/Aetna or call (855) TELADOC (855) 835-2362.
Teladoc give you access 24 hours, 7 days a week to a U.S. board-certified doctor through the convenience of phone, video or mobile app visits. Once you’ve requested a consult, a doctor will call you back typically within 10 minutes.
It’s an affordable option ($40 per visit) for quality medical care. It is less expensive compared to an urgent care or emergency room visit.
GET THE CARE YOU NEED
Teladoc doctors can treat many medical conditions, including:
- Cold & flu symptoms
- Allergies
- Pink eye
- Ear infection
- Respiratory infection
- Sinus problems
- Urinary Tract Infection
- And more!
WHEN CAN I USE TELADOC?
Teladoc does not replace your Primary Care Physician (PCP), but it is a convenient and affordable option for quality care.
- When you need care now
- If you're considering the ER or Urgent Care for a non-emergency issue
- On vacation, on a business trip or away from home
- For short-term prescription refills
Being a Smart Healthcare Consumer
Taking an active role in your health is the best way to prevent disease, get great care, and reduce costs at the same time. A smart healthcare consumer doesn’t just ask the right questions of their doctor, but knows it’s also about prevention, self-care, and knowing where to find resources. By being a smart healthcare consumer you can make good decisions that will have a positive impact on your physical and financial health. Here are some tips:
Choosing a Primary Care Physician (PCP) - Putting in as much time to select a new vehicle or appliance as you do your PCP will benefit you greatly.
Maintain a Healthy Lifestyle - Healthy living is one area of your life you can control. By exercising regularly, eating a healthy diet, being tobacco free, and getting adequate rest, you may help to ward off preventable chronic conditions such as diabetes, cancer, and cardiovascular disease.
Practice Prevention - By getting the age-appropriate health screenings and immunizations, you are taking a proactive approach to prevent potential conditions. In addition, by knowing what you can do at home to help minimize the symptoms of a cold or flu, you can prevent unnecessary trips to the doctor’s office.
Look for Ways to Save Money - There are many ways to save money when it comes to seeking care, such as using in-network doctors and facilities. Look for ways to save on your prescription drugs by asking for a generic equivalent or using the mail order option. You should also check your medical bills and explanation of benefits for accuracy, and seek the most appropriate and cost-effective places for your condition.
Finally, you can earn up to 100 Healthy Lifestyle Activity Points(HLAPs) by signing up and completing the Self-Care Essentials Program.
Additional Resources:
Preventive Care
Preventive health exams or screening services are covered at 100%. They include:
Important Note: These services do not include diagnostic exams for current chronic health conditions. Please request a routine preventive exam with your doctor when scheduling your appointment.