Medical

Transparency Coverage 

Under a recent federal Transparency in Coverage Rule, Aetna is required to share machine-readable files that include information on negotiated service rates for in-network coverage and out-of-network allowed amounts between health plans and healthcare providers.  

The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data. 

To access the files, visit https://bit.ly/3zvXHgB. Please note that the files will be updated each month. 

FREE In-Network Preventive Care

Annual checkups help you stay healthy. Take care of yourself and your family by using your FREE 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.

Call your doctor and dentist to schedule your FREE annual checkup today. Need to find a doctor? Let Aetna Cradlepoint Health Concierge help. Call 1-833-915-3870, Monday through Friday from 8 a.m. to 6 p.m. Kaiser participants can visit www.kp.org to find a doctor.

Medical Plans – Aetna

We’re proud to offer you the following medical plan choices, designed to help you and your family get the care you need at an affordable price.

Aetna Choice Point of Service Plan (POS)

The Point of Service (POS) plan offers the flexibility to choose an in-network or out-of-network doctors. Keep in mind, you will save money when you visit in-network providers. Find an in-network provider at 1-833-915-3870 or www.aetna.com.

Aetna Healthfund Choice (HSA Qualified)

Aetna’s Healthfund Choice is a High Deductible Health Plan (HDHP). The Healthfund Choice offers health coverage with the ability to choose to visit in-network or out-of-network providers. Like with normal HDHPs, deductibles are higher and must be met before the carrier will begin paying toward your medical services. However, with this plan, you are eligible to enroll in a Health Savings Account (HSA) which allows you to pay for certain medical expenses with tax-free money. Find an in-network provider at 1-833-915-3870 or www.aetna.com.

Aetna Medical Plans

Plan Features Aetna Choice POS Aetna Healthfund Choice (HSA Qualified)*
In-Network Out-of-Network In-Network Out-of-Network
Annual Deductible Individual/Family $1,000 / $2,000 $2,800 / $5,600
Annual Out-of-Pocket Maximum Individual/Family $3,000 / $6,000 $6,000 / $18,000 $5,000 / $10,000 $6,000 / $18,000
Cradlepoint Annual HSA Contribution Individual/Family N/A $1,250 / $2,500 Prorated for the year, depending on when your benefits begin
  You pay: You pay:
Preventive Care Visit Covered in full 40% after deductible Covered in full 30% after deductible
Teledoc $30 copay Not covered $49 copay until deductible is met, then 20% after deductible Not covered
Physician Visit $30 copay 40% after deductible 20% after deductible 40% after deductible
Lab & X-ray 100% after deductible 40% after deductible 20% after deductible 40% after deductible
Urgent Care $30 copay 40% after deductible 20% after deductible 40% after deductible
Emergency Room $100 copay, then 20%, deductible waived 20% after deductible
Inpatient & Outpatient Hospital Services 20% after deductible 40% after deductible 20% after deductible 40% after deductible
Outpatient Mental Health Services $30 copay 40% after deductible 20% after deductible 40% after deductible
Chiropractic (20 visits/year) $30 copay 40% after deductible 20% after deductible 40% after deductible
Comprehensive Infertility Services 20% after deductible 40% after deductible 20% after deductible 40% after deductible
Acupuncture (12 visits/year) $30 copay 40% after deductible 20% after deductible 40% after deductible
Prescription Drugs: Retail (up to a 30-day supply)
Generic $0 copay 20% Certain Preventive Medications*
Deductible Waived – Generic covered in full and Brand Name 20%;
All other Generic, Brand Name, and Specialty medications, 20% after deductible
40% after deductible
Preferred Brand $45 copay 20% 40% after deductible
Non-Preferred Brand $70 copay 20% 40% after deductible
Specialty** 20% to $100 max Not covered Not covered
Prescription Drugs: Mail Order (up to a 90-day supply)
Generic $0 copay N/A Certain Preventive Medications*
Deductible Waived – Generic covered in full and Brand Name 20%;
All other Generic, Brand Name, and Specialty medications, 20% after deductible
N/A
Preferred Brand $90 copay
Non-Preferred Brand $140 copay

*List of certain preventive medications can be found here: www.aetna.com/individuals-families/find-a-medication/2022-aetna-standard-plans.html 

**After first specialty drug fill at a retail or specialty pharmacy, subsequent fills must be through the Aetna Specialty Pharmacy network.

Cradlepoint Aetna Health Concierge

Insurance coverage can be complicated. Cradlepoint Aetna Health Concierge can help you navigate the healthcare system when you need it most. Find doctors, get cost estimates, or solve billing problems with help.

Benefits of Concierge Services:

  • Understand your insurance benefits.
  • Find the best doctor, dentist, or eye care professional in your area to meet your healthcare needs.
  • Save money on medical care with price comparisons before receiving care.
  • Pay less for prescriptions by exploring lower cost options.
  • Get help reviewing your medical bills to make sure you’re not being overcharged.

Medical Plan – Kaiser (CA Employees Only)

Kaiser Deductible Health Maintenance Organization (HMO)

The Kaiser HMO plan provides coverage through in-network doctors where you can select a primary care physician (PCP) who can refer you to specialists if you need them. You are responsible for copays when you receive services.

Coverage for out-of-network providers is not available with this plan. If you seek treatment from an out-of-network provider, you will be responsible for the full cost of treatment. Find an in-network provider at www.kp.org.

Kaiser Medical Plan

Plan Features Kaiser Deductible HMO
In-Network Only
Annual Deductible Individual/Family $1,000 / $2,000
Annual Out-of-Pocket Maximum Individual/Family $3,000 / $6,000
Cradlepoint Annual HSA Contribution Individual/Family N/A
  You pay
Preventive Care Visit Covered in full
Telehealth Covered in full
Physician Visit $20 copay
Lab & X-ray $10 per encounter
Urgent Care $20 copay
Emergency Room 20% after deductible
Inpatient & Outpatient Hospital Services 20% after deductible
Outpatient Mental Health Services $20 copay
Chiropractic $15 copay (20 visits/year combined)
Acupuncture
Comprehensive Infertility Services Covered, but limitations may apply. Please refer to your plan documents for details
Retail (up to a 30-day supply)
Generic $10 copay
Preferred Brand $30 copay
Non-Preferred Brand $30 copay
Specialty 20% to $250 max
Mail Order (up to a 100-day supply)
Generic $20 copay
Preferred Brand $60 copay
Non-Preferred Brand $60 copay