Select from two medical options through Aetna. Both plans cover in-network preventive care at 100%, prescription drugs and include an annual limit on your expenses. The differences are:

1. What you pay for the plan
2. What you pay when you get care
3. How out-of-network care is covered and
4. Your annual maximum cost of care.

Your medical benefit: to most, it’s the most important benefit we have available, but many of us don’t use our plan to the fullest. Medical benefits are not just for when you are sick… For example, if you use preventive benefits when you are well, you might actually be able to avoid getting sick!

Understanding your prescription drug benefit, and knowing how different types of medications will be covered, can help you save money and learn how to talk with your doctor about your options.

Your prescription drug benefit gives you options for paying more or less for your prescription. When you fill a prescription from your doctor, you and the company share the cost. How you share costs depends on how your plan is set up.

  • Deductible

    The amount of covered expenses you must pay before the Plan starts paying benefits.

    In-network:

    Individual: $3,500
    Family: $7,000

    Out-of-network:

    Individual: $7,000
    Family: $21,000

  • Coinsurance

    Cost-sharing between you and the company. This is applied after you meet your deductible.

    In-network:

    You pay 20% (after deductible)
    Plan pays 80%

    Out-of-network:

    You pay 50% (after deductible)
    Plan pays 50%

  • Out-of-Pocket Maximum

    The most you are required to pay out of your own pocket in a plan year. Some expenses may not apply.

    In-network:

    Individual: $7,000
    Family: $14,000

    Out-of-network:

    Individual: $17,000
    Family: $51,000

  • Doctor’s Office Visit

    In-network:

    You pay a $20 copay (deductible does not apply)

    Out-of-network:

    You pay 50% (after deductible)
    Plan pays 50%

  • Specialist Office Visit

    Specialists include doctors trained in a specific area or function of the body, or a specific age group (cardiologist, pediatrician, orthopedic surgeon, neurologist, etc.).

    In-network:

    You pay a $40 copay (deductible does not apply)

    Out-of-network:

    You pay 50% (after deductible)
    Plan pays 50%

  • Preventive/Well Child Care

    Care focused on prevention or early detection of health conditions. Includes routine physical exam, immunizations, cancer screenings, vision and hearing exams, etc.

    In-network:

    You pay $0
    Plan pays 100%

    Out-of-network:

    You pay 50% (after deductible)
    Plan pays 50%

  • Emergency Room

    Provides accidental injury and medical emergency care. Note: Call your plan immediately if you are admitted to the hospital.

    In-network:

    You pay $500 copay (deductible does not apply, copay waived if admitted), and plan pays 100%

    Out-of-network:

    You pay $500 copay (deductible does not apply, copay waived if admitted), and plan pays 100%

  • Urgent Care

    Non-emergency care received from an urgent care clinic or other medical facility; typically used after hours or when your regular doctor is not available.

    In-network:

    You pay $50 copay (deductible does not apply), and plan pays 100%

    Out-of-network:

    You pay 50% (after deductible)
    Plan pays 50%

  • Hospitalization

    Inpatient In-network:

    You pay 20% (after deductible)
    Plan pays 80%

    Inpatient Out-of-network:

    You pay 50% (after deductible)
    Plan pays 50%

    Outpatient In-network:

    You pay 20% (after deductible)
    Plan pays 80%

    Outpatient Out-of-network:

    You pay 50% (after deductible)
    Plan pays 50%

  • Are you required to use network providers?

    No (but your costs will be lower when you do)

  • Do you need a referral to a specialist?

    No

  • Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

    A feature of high-deductible or consumer-driven medical plans, this is a tax-advantaged savings account you can use for medical expenses now or save for later.

    No

  • Can I use a Health Care Flexible Spending Account (FSA)?

    An account you contribute to before taxes, then use the money for qualified health-related expenses.

    Yes

  • Prescription Drug

    Deductible – Does not apply

    Retail (Up to 30-day supply)

    In-network Only
    Generic: You pay $10 (deductible does not apply)
    Preferred Brand: You pay $35 (deductible does not apply)
    Non-Preferred Brand: You pay $50 (deductible does not apply)

    Retail and Home Delivery (per 30-day supply):

    In-network Only
    Specialty Preferred: You pay 20% (deductible does not apply), up to a maximum of $250
    Specialty Non-Preferred: You pay 40% (deductible does not apply), up to a maximum of $500

    Retail and Home Delivery (per 90-day supply):

    In-network Only
    Generic: You pay $20 (deductible does not apply)
    Preferred Brand: You pay $70 (deductible does not apply)
    Non-Preferred Brand: You pay $100 (deductible does not apply)

    Retail:

    Out-of-network
    You pay 50% (deductible does not apply)
    Plan pays 50%

    Home Delivery:

    Not Covered

  • Payroll Deduction

    Employee Only: $155.66
    Employee + Spouse: $706.16
    Employee + Child(ren): $488.53
    Family: $972.72

PA OAMC Premier 3500 80/50 PY V26

Provider: Aetna

Phone: 888-792-3862

Website: https://www.aetna.com/

Find a Doctor: https://www.aetna.com/individuals-families/find-a-doctor.htm

PA OAMC Premier 3500 80/50 PY V26 PA OAMC 3000 HSA 100/50 T PY V26

Deductible

In-network: Individual: $3,500
Family: $7,000
Out-of-network: Individual: $7,000
Family: $21,000

Deductible

In-network: Individual: $3,000 Family: $6,000
Out-of-network: Individual: $10,000
Family: $30,000

Coinsurance

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Coinsurance

In-network: You pay 0% (after deductible)
Plan pays 100%
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Out-of-Pocket Maximum

In-network: Individual: $7,000
Family: $14,000
Out-of-network: Individual: $17,000
Family: $51,000

Out-of-Pocket Maximum

In-network: Individual: $3,750
Family: $7,500
Out-of-network: Individual: $20,000
Family: $60,000

Doctor’s Office Visit

In-network: You pay a $20 copay (deductible does not apply)
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Doctor’s Office Visit

In-network: You pay $0 (after deductible)
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Specialist Office Visit

In-network: You pay a $40 copay (deductible does not apply)
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Specialist Office Visit

In-network: You pay $0 (after deductible)
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Preventive/Well Child Care

In-network: You pay $0
Plan pays 100%
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Preventive/Well Child Care

In-network: You pay $0
Plan pays 100%
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Emergency Room

In-network: You pay $500 copay (deductible does not apply, copay waived if admitted), and plan pays 100%
Out-of-network: You pay $500 copay (deductible does not apply, copay waived if admitted), and plan pays 100%

Emergency Room

In-network: You pay $500 copay (after deductible, copay waived if admitted), and plan pays 100%
Out-of-network: You pay $500 copay (after deductible, copay waived if admitted), and plan pays 100%

Urgent Care

In-network: You pay $50 copay (deductible does not apply), and plan pays 100%
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Urgent Care

In-network: You pay $0 (after deductible), and plan pays 100%
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Hospitalization

Inpatient In-network: You pay 20% (after deductible)
Plan pays 80%
Inpatient Out-of-network: You pay 50% (after deductible)
Plan pays 50%
Outpatient In-network: You pay 20% (after deductible)
Plan pays 80%
Outpatient Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Hospitalization

Inpatient In-network: You pay $0 (after deductible)
Plan pays 100%
Inpatient Out-of-network: You pay 50% (after deductible)
Plan pays 50%
Outpatient In-network: You pay $0 (after deductible)
Plan pays 100%
Outpatient Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Are you required to use network providers?

No (but your costs will be lower when you do)

Are you required to use network providers?

No (but your costs will be lower when you do)

Do you need a referral to a specialist?

No

Do you need a referral to a specialist?

No

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

No

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

Yes for HSA- no for HRA (no longer available as of 8/1/26)

Can I use a Health Care Flexible Spending Account (FSA)?

Yes

Can I use a Health Care Flexible Spending Account (FSA)?

No- FSA can not be used in conjunction with HSA.

Prescription Drug

Retail (Up to 30-day supply) In-network Only
Generic: You pay $10 (deductible does not apply)
Preferred Brand: You pay $35 (deductible does not apply)
Non-Preferred Brand: You pay $50 (deductible does not apply)
Retail and Home Delivery (per 30-day supply): In-network Only
Specialty Preferred: You pay 20% (deductible does not apply), up to a maximum of $250
Specialty Non-Preferred: You pay 40% (deductible does not apply), up to a maximum of $500
Retail and Home Delivery (per 90-day supply): In-network Only
Generic: You pay $20 (deductible does not apply)
Preferred Brand: You pay $70 (deductible does not apply)
Non-Preferred Brand: You pay $100 (deductible does not apply)
Retail: Out-of-network
You pay 50% (deductible does not apply)
Plan pays 50%
Home Delivery: Not Covered

Prescription Drug

Retail (Up to 30-day supply) In-network Only
Generic: You pay $10 (after deductible)
Preferred Brand: You pay $50 (after deductible)
Non-Preferred Brand: You pay $80 (after deductible)
Retail and Home Delivery (per 30-day supply): In-network Only
Specialty Preferred: You pay 20% (after deductible), up to a maximum of $250
Specialty Non-Preferred: You pay 40% (after deductible), up to a maximum of $500
Retail and Home Delivery (per 90-day supply): In-network Only
Generic: You pay $20 (after deductible)
Preferred Brand: You pay $100 (after deductible)
Non-Preferred Brand: You pay $160 (after deductible)
Retail: Out-of-network
You pay 50% (after deductible)
Plan pays 50%
Home Delivery: Not Covered

Payroll Deduction

Employee Only: $155.66
Employee + Spouse: $706.16
Employee + Child(ren): $488.53
Family: $972.72

Payroll Deduction

Employee Only: $37.47
Employee + Spouse: $452.01
Employee + Child(ren): $299.14
Family: $649.89

  • Deductible

    The amount of covered expenses you must pay before the Plan starts paying benefits.

    In-network:

    Individual: $3,000 Family: $6,000

    Out-of-network:

    Individual: $10,000
    Family: $30,000

  • Coinsurance

    Cost-sharing between you and the company. This is applied after you meet your deductible.

    In-network:

    You pay 0% (after deductible)
    Plan pays 100%

    Out-of-network:

    You pay 50% (after deductible)
    Plan pays 50%

  • Out-of-Pocket Maximum

    The most you are required to pay out of your own pocket in a plan year. Some expenses may not apply.

    In-network:

    Individual: $3,750
    Family: $7,500

    Out-of-network:

    Individual: $20,000
    Family: $60,000

  • Doctor’s Office Visit

    In-network:

    You pay $0 (after deductible)

    Out-of-network:

    You pay 50% (after deductible)
    Plan pays 50%

  • Specialist Office Visit

    Specialists include doctors trained in a specific area or function of the body, or a specific age group (cardiologist, pediatrician, orthopedic surgeon, neurologist, etc.).

    In-network:

    You pay $0 (after deductible)

    Out-of-network:

    You pay 50% (after deductible)
    Plan pays 50%

  • Preventive/Well Child Care

    Care focused on prevention or early detection of health conditions. Includes routine physical exam, immunizations, cancer screenings, vision and hearing exams, etc.

    In-network:

    You pay $0
    Plan pays 100%

    Out-of-network:

    You pay 50% (after deductible)
    Plan pays 50%

  • Emergency Room

    Provides accidental injury and medical emergency care. Note: Call your plan immediately if you are admitted to the hospital.

    In-network:

    You pay $500 copay (after deductible, copay waived if admitted), and plan pays 100%

    Out-of-network:

    You pay $500 copay (after deductible, copay waived if admitted), and plan pays 100%

  • Urgent Care

    Non-emergency care received from an urgent care clinic or other medical facility; typically used after hours or when your regular doctor is not available.

    In-network:

    You pay $0 (after deductible), and plan pays 100%

    Out-of-network:

    You pay 50% (after deductible)
    Plan pays 50%

  • Hospitalization

    Inpatient In-network:

    You pay $0 (after deductible)
    Plan pays 100%

    Inpatient Out-of-network:

    You pay 50% (after deductible)
    Plan pays 50%

    Outpatient In-network:

    You pay $0 (after deductible)
    Plan pays 100%

    Outpatient Out-of-network:

    You pay 50% (after deductible)
    Plan pays 50%

  • Are you required to use network providers?

    No (but your costs will be lower when you do)

  • Do you need a referral to a specialist?

    No

  • Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

    A feature of high-deductible or consumer-driven medical plans, this is a tax-advantaged savings account you can use for medical expenses now or save for later.

    Yes for HSA- no for HRA (no longer available as of 8/1/26)

  • Can I use a Health Care Flexible Spending Account (FSA)?

    An account you contribute to before taxes, then use the money for qualified health-related expenses.

    No- FSA can not be used in conjunction with HSA.

  • Prescription Drug

    Deductible - See Deductible above

    Retail (Up to 30-day supply)

    In-network Only
    Generic: You pay $10 (after deductible)
    Preferred Brand: You pay $50 (after deductible)
    Non-Preferred Brand: You pay $80 (after deductible)

    Retail and Home Delivery (per 30-day supply):

    In-network Only
    Specialty Preferred: You pay 20% (after deductible), up to a maximum of $250
    Specialty Non-Preferred: You pay 40% (after deductible), up to a maximum of $500

    Retail and Home Delivery (per 90-day supply):

    In-network Only
    Generic: You pay $20 (after deductible)
    Preferred Brand: You pay $100 (after deductible)
    Non-Preferred Brand: You pay $160 (after deductible)

    Retail:

    Out-of-network
    You pay 50% (after deductible)
    Plan pays 50%

    Home Delivery:

    Not Covered

  • Payroll Deduction

    Employee Only: $37.47
    Employee + Spouse: $452.01
    Employee + Child(ren): $299.14
    Family: $649.89

PA OAMC 3000 HSA 100/50 T PY V26

Provider: Aetna

Phone: 888-792-3862

Website: https://www.aetna.com/

Find a Doctor: https://www.aetna.com/individuals-families/find-a-doctor.htm

PA OAMC 3000 HSA 100/50 T PY V26 PA OAMC Premier 3500 80/50 PY V26

Deductible

In-network: Individual: $3,000 Family: $6,000
Out-of-network: Individual: $10,000
Family: $30,000

Deductible

In-network: Individual: $3,500
Family: $7,000
Out-of-network: Individual: $7,000
Family: $21,000

Coinsurance

In-network: You pay 0% (after deductible)
Plan pays 100%
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Coinsurance

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Out-of-Pocket Maximum

In-network: Individual: $3,750
Family: $7,500
Out-of-network: Individual: $20,000
Family: $60,000

Out-of-Pocket Maximum

In-network: Individual: $7,000
Family: $14,000
Out-of-network: Individual: $17,000
Family: $51,000

Doctor’s Office Visit

In-network: You pay $0 (after deductible)
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Doctor’s Office Visit

In-network: You pay a $20 copay (deductible does not apply)
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Specialist Office Visit

In-network: You pay $0 (after deductible)
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Specialist Office Visit

In-network: You pay a $40 copay (deductible does not apply)
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Preventive/Well Child Care

In-network: You pay $0
Plan pays 100%
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Preventive/Well Child Care

In-network: You pay $0
Plan pays 100%
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Emergency Room

In-network: You pay $500 copay (after deductible, copay waived if admitted), and plan pays 100%
Out-of-network: You pay $500 copay (after deductible, copay waived if admitted), and plan pays 100%

Emergency Room

In-network: You pay $500 copay (deductible does not apply, copay waived if admitted), and plan pays 100%
Out-of-network: You pay $500 copay (deductible does not apply, copay waived if admitted), and plan pays 100%

Urgent Care

In-network: You pay $0 (after deductible), and plan pays 100%
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Urgent Care

In-network: You pay $50 copay (deductible does not apply), and plan pays 100%
Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Hospitalization

Inpatient In-network: You pay $0 (after deductible)
Plan pays 100%
Inpatient Out-of-network: You pay 50% (after deductible)
Plan pays 50%
Outpatient In-network: You pay $0 (after deductible)
Plan pays 100%
Outpatient Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Hospitalization

Inpatient In-network: You pay 20% (after deductible)
Plan pays 80%
Inpatient Out-of-network: You pay 50% (after deductible)
Plan pays 50%
Outpatient In-network: You pay 20% (after deductible)
Plan pays 80%
Outpatient Out-of-network: You pay 50% (after deductible)
Plan pays 50%

Are you required to use network providers?

No (but your costs will be lower when you do)

Are you required to use network providers?

No (but your costs will be lower when you do)

Do you need a referral to a specialist?

No

Do you need a referral to a specialist?

No

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

Yes for HSA- no for HRA (no longer available as of 8/1/26)

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

No

Can I use a Health Care Flexible Spending Account (FSA)?

No- FSA can not be used in conjunction with HSA.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes

Prescription Drug

Retail (Up to 30-day supply) In-network Only
Generic: You pay $10 (after deductible)
Preferred Brand: You pay $50 (after deductible)
Non-Preferred Brand: You pay $80 (after deductible)
Retail and Home Delivery (per 30-day supply): In-network Only
Specialty Preferred: You pay 20% (after deductible), up to a maximum of $250
Specialty Non-Preferred: You pay 40% (after deductible), up to a maximum of $500
Retail and Home Delivery (per 90-day supply): In-network Only
Generic: You pay $20 (after deductible)
Preferred Brand: You pay $100 (after deductible)
Non-Preferred Brand: You pay $160 (after deductible)
Retail: Out-of-network
You pay 50% (after deductible)
Plan pays 50%
Home Delivery: Not Covered

Prescription Drug

Retail (Up to 30-day supply) In-network Only
Generic: You pay $10 (deductible does not apply)
Preferred Brand: You pay $35 (deductible does not apply)
Non-Preferred Brand: You pay $50 (deductible does not apply)
Retail and Home Delivery (per 30-day supply): In-network Only
Specialty Preferred: You pay 20% (deductible does not apply), up to a maximum of $250
Specialty Non-Preferred: You pay 40% (deductible does not apply), up to a maximum of $500
Retail and Home Delivery (per 90-day supply): In-network Only
Generic: You pay $20 (deductible does not apply)
Preferred Brand: You pay $70 (deductible does not apply)
Non-Preferred Brand: You pay $100 (deductible does not apply)
Retail: Out-of-network
You pay 50% (deductible does not apply)
Plan pays 50%
Home Delivery: Not Covered

Payroll Deduction

Employee Only: $37.47
Employee + Spouse: $452.01
Employee + Child(ren): $299.14
Family: $649.89

Payroll Deduction

Employee Only: $155.66
Employee + Spouse: $706.16
Employee + Child(ren): $488.53
Family: $972.72