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MEDICAL

The School Health Insurance Fund (SHIF) is the plan administrator for the school district’s health benefits.  Aetna is the medical carrier for Moorestown Township Board of Education employees.   

 


2019 Medical Benefits

 

Effective July 1, 2019, the following benefit plans are available for the 2019-2020 plan year.

MEA Base Plans -

  • Aetna ACPOS II $15 copay with 10% Rx
  • Aetna HMO $15 copay with $5/$10/$20 Rx

* Any member who selects a higher cost plan will have to pay the difference in premium in addition to their employee contributions under Chapter 78 Legislation.

 

* 2019 MEA Employee Side-By-Side Plan Comparison - Click Here

* 2019 MEA Enrollment/Change Form -  Click Here


Non-Affiliates (NA) Base Plans -

 

Hired Prior to 7/1/2016

  •  Aetna ACPOS II $15 copay with 10% Rx
  • Aetna HMO $15 copay with $5/$10/$20 Rx

 

Internal Hire After 7/1/16

  • Aetna HDHP $1,500/$3,000 & 20% Rx

 

External Hire After 7/1/16

  • Aetna HDHP $2,500/$5,000 & 20% Rx

* Any member who selects a higher cost plan will have to pay the difference in premium in addition to their employee contributions under Chapter 78 Legislation.

 
* 2019 NA Employee Side-By-Side Plan Comparison- Click Here

* 2019 NA Enrollment/Change Form -  Click Here

 

MAA Base Plans -

 

Hired Prior to 7/1/2016

  • Aetna ACPOS II $15 copay with 10% Rx

Internal Hire After 7/1/16

  • Aetna HDHP $1,500/$3,000 & 20% Rx

External Hire After 7/1/16

  • Aetna HDHP $2,500/$5,000 & 20% Rx

* Any member who selects a higher cost plan will have to pay the difference in premium in addition to their employee contributions under Chapter 78 Legislation.

 

* 2019 MAA Employee Side-By-Side Plan Comparison - Click Here

* 2019 MAA Enrollment/Change Form -  Click Here

 

Bus Drivers Base Plans -

  • Aetna ACPOS II $15 copay with 10% Rx
  • Aetna HMO $15 copay with $5/$10/$20 Rx
* Any member who selects a higher cost plan will have to pay the difference in premium in addition to their employee contributions under Chapter 78 Legislation.

 

* 2019 Bus Drivers Employee Side-By-Side Plan Comparison - Click Here

* 2019 Bus Drivers Enrollment/Change Form -  Click Here

 

Save Money With These Plan Alternatives for ALL Employees!!

    

Aetna $1500 & $2,500 High Deductible Health Plan

  • For this plan, the school district will contribute $1,200 of the single deductible and $2,400 of the family deductible towards a health savings account which the member can use to pay for eligible expenses.
  • Once the In-Network deductible is met ($1,500 individual/$3,000 family), all In-Network medical benefits are covered at 100% for the remainder of the calendar year.
  • Preventative Care (in-network) is covered 100% no deductible applies.
  • Members pay 20% coinsurance for prescription drugs once the deductible is met.
  • For more information about Health Savings Accounts - Click Here

 

 To check out these 5 tips to Maximizing Your HSA - Click Here

 

ACPOS II Core Choice

  • This plan includes a $500 employer contribution to a Health Reimbursement Account that the member can use to pay for eligible medical and prescription expensessuch as the deductible, medical copays, medical coinsurance, and prescription copays
  • The deductible is based on Calendar Year and must be met prior to certain eligible medical expenses being covered. Once you have met your deductible, you are then responsible for your copay or coinsurance listed on the benefit summary.
  • For many of the Preventative Care (in-network) services, the deductible is waived, such as Primary Care visits, Specialist visits, as Preventive Care, Chiropractic Care, Inpatient Hospital Care, and Diagnostic Laboratory and X-Ray services.

  • For more information on Health Reimbursement Accounts - Click Here


 

Plan Documents

SNJREBF Aetna HMO Summary Plan Description

SHIF Supplemental Summary Plan Description

Choice POS II Plan Description


Summary of Benefits Information:

Click on "Summary of Benefits" under the plan name below to view the 2019-2020 benefit summary.

 

Aetna ACPOS II $15 with 10% Rx

Summary of Benefits (SBC)

 

Aetna HMO $15 with $5/$10/$20 Rx

Summary of Benefits (SBC)

 

Aetna HDHP $1,500 with HSA

Summary of Benefits (SBC)

 

Aetna HDHP $2,500 with HSA

Summary of Benefits (SBC)

 

Aetna ACPOS II Core $25/$40 with $15/$35/$50 Rx

Summary of Benefits (SBC)

 

Aetna ACPOS II $15 with $5/$10/$20 Rx

Summary of Benefits (SBC)

 

Aetna ACPOS II $10 with 10% Rx

Summary of Benefits (SBC)

 

Aetna ACPOS II $10 with $5/$10/$20 Rx

Summary of Benefits (SBC)

 

HMO $10 with $5/$10/$20 Rx

Summary of Benefits (SBC)

 


Health Care Reform: Summary of Benefits and Coverage

The Summary of Benefits and Coverage (SBC) is a standard document that was developed to help program participants better understand their health benefits and provides a high level overview of your medical and prescription benefit programs.  It also includes a uniform glossary of terms commonly used in the health industry.  The SBC is not a comprehensive plan document and is not intended to replace the medical or prescription benefit summaries on this handbook. For copies of the SBC’s for both your medical and prescription coverage, please visit the Healthcare Reform tab.

For the SBC Glossary of Terms - Click Here 


 Understanding the Payment Limit

The Payment Limit is the most you pay during the policy period (January to December) before your health insurance plan begins to pay 100% of the allowed amount for eligible/approved expenses.

Certain member cost sharing under the Aetna Choice POS II, HMO, and High Deductible Health plans apply towards the Payment Limit. 

For more information on expenses that apply towards the Payment Limit - Click Here


 Aetna Navigator – Resources to Help You Manage Your Health Benefits On-Line:

Aetna Members- Get in the know about your health at Aetna Navigator the one spot to manage your health and coverage.

  • Look up a claim status
  • Find a doctor
  • Check account balances
  • Find costs of tests and doctor visits
  • Print your temporary ID card and issue a new one. – Cards can also be issued by calling Aetna Customer Service at 855-281-8857
  • And much more!

To learn more about Aetna Navigator - Click Here


 Participating Providers

DocFind provides instructions on using the Aetna Doc Find to locate participating providers.  To search for participating providers in your area - Click Here 

Finding a provider on Aetna’s website & selecting the right network for your plan.

 

If you are in any of the following plans:

·       Aetna Choice POS II $15

·       Aetna Choice POS II $10

·       Aetna Choice POS II Core $25/$40

·       Aetna Choice POS II HDHP $1,500/$3,000 (HSA)

·       Aetna Choice POS II HDHP $2,500/$5,000 (HSA)

 

you will select Aetna Open Access Plans under Select a Plan and choose the Aetna Choice POS II (Open Access) network.

 

If you are in any of the following plans:

·       HMO $10

·       HMO $15

 

you will select Aetna Standard Plans under Select a Plan and choose the HMO network.

 


Aetna Extras

Aetna has many programs to help you stay well and save money.

  • Disease Management
  • Vision Discount
  • Beginning Right Maternity
  • Discount Programs
  • Weight Management

For more information - Click Here


Health Benefits Mobile Phone Apps Now Available

Aetna Mobile App- Aetna HMO and Aetna Medicare Plan (HMO) members
Connect to Aetna right now from a cell phone, smartphone, or other web-enabled mobile device and access Aetna’s most popular online tools from just about anywhere!

When someone goes to www.aetna.com from their mobile phone’s web browser, they can: Find a doctor, dentist, or other facility Access your personal health record, Look up a claim, or View your Aetna member ID card It is safe, quick, and easy.  Just type www.aetna.com in your mobile browser or check your device’s App Store for availability.

For additional details visit the Aetna Mobile information page.

With Aetna, good health information is always at your fingertips!


 What Are Some General Differences Between the Aetna HMO and Choice POS II (Open Access) Plans?


Aetna HMO Managed Choice POS (Open Access) Plans
Selection of Primary Care Physician? Yes, you must select a Primary Care Physician. Your Primary Care Physician will provide your care and will refer you to specialists or facilities for treatment when medically necessary. No need to select a PCP.
Referrals Required? Yes No referrals needed for specialty care
Out of Network Benefits? No (Except for emergency care.) Yes. Out-of-network benefits provide reimbursement for expenses for eligible services rendered for the treatment of illness and injury. Most out-of-network care is usually reimbursed at a percentage of the reasonable and customary allowance after an annual member deductible is met. Please see you member handbook for further details.
Precertification Needed? Yes, precertification is required for some services. Please refer to your member handbook. Yes, precertification is required for some services. Please refer to your member handbook.


Please remember your insurance benefits are limited to the terms, conditions, exclusions and limitations of the insurance carrier’s policy. Nothing contained on this website shall be deemed to have altered, waived, or extended the coverage provided by the policy. This overview contains a general description of your benefits program for your use as a convenient reference. Complete details of your program appear in the policy, which govern the benefits and operation of your program. The policy supersedes if there should be any inconsistency or difference between its provisions and the information in this overview.

 

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