Medical and prescriptions

Aetna Health Insurance

ACE, APA, Exempt, Food Service, Maintenance, Non-represented, and TOTEM employees are covered by Aetna's Open Choice PPO Plan and Consumer Driven Health Plan (Group #658742). For more information contact Member Services or visit Aetna Navigator online.

 

Plan benefits

Medical

2017/2018 Plan Documents--PPO

2017/2018 Plan Documents-CDHP

2017/2018 Summary of Benefits and Coverage--CDHP

2017/2018 Summary of Benefits and Coverage--PPO

Medical claim form

 

Open Choice PPO

  • $1,000 individual/$3,000 family deductible
  • Preventive services paid at 100%
  • Pays 80% after deductible for In-Network
  • Pays 60% of allowed amount after deductible for Out-of-Network
  • Out-of-pocket maximum $4,800/individual, $12,900/family--then plan will pay 100% of covered charges for In-Network
  • $50 general office visit co-pay
  • $75 specialist office visit co-pay (includes Physical Therapy, Massage Therapy, Chiropractic Care, etc.)

Consumer Driven Health Plan

  • $1,300 individual/$2,600 aggregate family deductible
  • Preventive services paid at 100%
  • Pays 80% after deductible for In-Network
  • Pays 60% of allowed amount after deductible for Out-of-Network
  • Out-of-pocket maximum $5,300/individual, $6,850/for any one person on the plan, $10,600/aggregate family--then plan will pay 100% of covered charges for In-Network
  • All services are subject to deductible first and then co-insurance
  • Receives District contribution to Health Savings Account (HSA) to be used on qualifying health, dental and vision expenses

  

Prescription

 

Prescription drug claim form

Prescription home delivery form

2016 Preventive Medications

HCR Contraceptives

 

Prescription plans:
Type of drugRetailMail order
Generic drugs $15 co-pay for each 30-day supply
or cost of prescription if less than co-pay
$30 co-pay for each 90-day supply
or cost of prescription if less than co-pay
Brand name formulary drugs 20% coinsurance
up to $120 cap
20% coinsurance
up to $80 cap
Brand name formulary drugs 20% coinsurance
up to $240 cap
20% coinsurance
up to $160 cap

 

Mandatory generic (MG) - If the member requests a brand prescription when a generic prescription is available, the member will be responsible for paying the applicable copay, plus the difference between the generic price and the brand price. The physician may state "dispensed as written" for the tiers above to apply.

 

Aetna Specialty Pharmacy

 

Learn more about this program for employees with chronic conditions:

 

 

**NOTE:  Participants in the Consumer Driven Health Plan must first meet their deductible before pharmacy copays/coinsurances apply, unless the prescription is listed in the 2017 Preventive Medications or HCR Contraceptives lists.


Dependent eligibility verification

 

Dependent Eligibility Verification

 

Your health benefits are an important part of your life and we are continually working to provide good service while keeping costs as low as possible. To do that we need to ensure that the district health plan pays claims only for those dependents who are eligible for benefits. All of the following criteria must be met for a dependent child to be eligible:

  • Coverage will be offered for children until age 26
  • Children must be enrolled according to the terms of the plan
  • Coverage of enrolled children will cease at age 26 unless applicable law requires us to offer coverage for a longer period of time

 

Newborns

 

Please come to the Benefits Office to enroll your newborn within 31 days of birth with a state or hospital birth certificate. Failure to enroll your child within this period will result in loss of medical coverage. You will need to enroll your dependent during the next open enrollment period for coverage to begin the following fiscal year.

 

Spouse

 

To be eligible for coverage, your spouse must elect their employer's medical plan as primary coverage if enrollment in the plan is available to them.  If your spouse elects their employer's medical as primary coverage, they are eligible to enroll in the district's plan as secondary coverage.  When adding a spouse, complete the Anchorage School District Spousal Insurance Affidavit and return it to the Benefits Department.

 

Spousal Insurance Affidavit

Click here for the 2016 Benefit Summary Guide


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