WEBTPA HDHP 1

More detailed information about your WEBTPA HDHP 1 plan offering.

WEBTPA HDHP 1

Plan Details

Carrier: WebTPA
Plan Type: HDHP
Network: EHN / Aetna
Out-of-Network Coverage: Yes
HSA Eligible: Yes

Monthly Contributions

Coverage Tier	MONTHLY CONTRIBUTIONS
Employee Only	$265.52
Employee + Spouse	$736.95
Employee + Child(Ren)	$555.44
Employee + Family	$1,002.93

Coverage Tier: Employee Only
MONTHLY CONTRIBUTIONS: $265.52

Coverage Tier: Employee + Spouse
MONTHLY CONTRIBUTIONS: $736.95

Coverage Tier: Employee + Child(Ren)
MONTHLY CONTRIBUTIONS: $555.44

Coverage Tier: Employee + Family
MONTHLY CONTRIBUTIONS: $1,002.93

Covered Services

For Residents Within Designated EHN Service Area

Services	EHN PROVIDER	AETNA NETWORK	OUT-OF-NETWORK
Calendar Year Deductible & Coinsurance - Individual	$2,000	$2,600	$3,300
Calendar Year Deductible & Coinsurance - Family	$4,000¹	$5,200¹	$6,600¹
Coinsurance (Plan Pays)	90%	70%	50%
Calendar Year Out-Of-Pocket Maximum (Includes Deductible) - Individual	$5,000	$6,200	Unlimited
Calendar Year Out-Of-Pocket Maximum (Includes Deductible) - Family	$10,000	$12,400	Unlimited
Preventive Care ^	No charge	No charge	50%**
Primary Care	10%*	30%*	50%**
Specialist Services	10%*	30%*	50%**
Urgent Care	10%*	30%*	50%**
Emergency Room	$200 + 20%*	$200 + 20%*	$200 + 20%*
Surgery	10%*	30%*	50%**
Surgery Through Lantern Surgery Care	0%****	0%****	N/A

Services: Calendar Year Deductible & Coinsurance - Individual
EHN PROVIDER: $2,000
AETNA NETWORK: $2,600
OUT-OF-NETWORK: $3,300

Services: Calendar Year Deductible & Coinsurance - Family
EHN PROVIDER: $4,000¹
AETNA NETWORK: $5,200¹
OUT-OF-NETWORK: $6,600¹

Services: Coinsurance (Plan Pays)
EHN PROVIDER: 90%
AETNA NETWORK: 70%
OUT-OF-NETWORK: 50%

Services: Calendar Year Out-Of-Pocket Maximum (Includes Deductible) - Individual
EHN PROVIDER: $5,000
AETNA NETWORK: $6,200
OUT-OF-NETWORK: Unlimited

Services: Calendar Year Out-Of-Pocket Maximum (Includes Deductible) - Family
EHN PROVIDER: $10,000
AETNA NETWORK: $12,400
OUT-OF-NETWORK: Unlimited

Services: Preventive Care ^
EHN PROVIDER: No charge
AETNA NETWORK: No charge
OUT-OF-NETWORK: 50%**

Services: Primary Care
EHN PROVIDER: 10%*
AETNA NETWORK: 30%*
OUT-OF-NETWORK: 50%**

Services: Specialist Services
EHN PROVIDER: 10%*
AETNA NETWORK: 30%*
OUT-OF-NETWORK: 50%**

Services: Urgent Care
EHN PROVIDER: 10%*
AETNA NETWORK: 30%*
OUT-OF-NETWORK: 50%**

Services: Emergency Room
EHN PROVIDER: $200 + 20%*
AETNA NETWORK: $200 + 20%*
OUT-OF-NETWORK: $200 + 20%*

Services: Surgery
EHN PROVIDER: 10%*
AETNA NETWORK: 30%*
OUT-OF-NETWORK: 50%**

Services: Surgery Through Lantern Surgery Care
EHN PROVIDER: 0%****
AETNA NETWORK: 0%****
OUT-OF-NETWORK: N/A

*After Deductible
**After deductible and subject to out-of-network reimbursement limitations
****Deductible and coinsurance may be waived for surgeries performed through Lantern Surgery Care. Refer to the SPD for more information
1If you choose to enroll you and your dependents in the HDHP 1 plan, you must meet the entire family deductible before the plan starts to pay benefits for any covered member. The deductible can be met by one person or all family members combined
^Please refer to the SPD for preventive services with a capped benefit
^^The employer HSA contribution is a dollar-for-dollar match of the amount you contribute, up to these limits

For Residents Outside of Designated EHN Service Area

Services	AETNA IN-NETWORK	OUT-OF-NETWORK
Calendar Year Deductible - Individual	$2,200	$3,300
Calendar Year Deductible - Family	$4,400¹	$6,600¹
Coinsurance (Plan Pays)	80%	50%
Calendar Year Out-Of-Pocket Maximum (Includes Deductible) - Individual	$6,000	Unlimited
Calendar Year Out-Of-Pocket Maximum (Includes Deductible) - Family	$12,000	Unlimited
Preventive Care^	No charge	50%**
Primary Care	20%*	50%**
Specialist Services	20%*	50%**
Urgent Care	20%*	50%**
Diagnostic Care	20%*	50%**
Emergency Room	20%*	20%*
Surgery	20%*	50%**
Surgery Through Lantern Surgery Care	0%****	N/A

Services: Calendar Year Deductible - Individual
AETNA IN-NETWORK: $2,200
OUT-OF-NETWORK: $3,300

Services: Calendar Year Deductible - Family
AETNA IN-NETWORK: $4,400¹
OUT-OF-NETWORK: $6,600¹

Services: Coinsurance (Plan Pays)
AETNA IN-NETWORK: 80%
OUT-OF-NETWORK: 50%

Services: Calendar Year Out-Of-Pocket Maximum (Includes Deductible) - Individual
AETNA IN-NETWORK: $6,000
OUT-OF-NETWORK: Unlimited

Services: Calendar Year Out-Of-Pocket Maximum (Includes Deductible) - Family
AETNA IN-NETWORK: $12,000
OUT-OF-NETWORK: Unlimited

Services: Preventive Care^
AETNA IN-NETWORK: No charge
OUT-OF-NETWORK: 50%**

Services: Primary Care
AETNA IN-NETWORK: 20%*
OUT-OF-NETWORK: 50%**

Services: Specialist Services
AETNA IN-NETWORK: 20%*
OUT-OF-NETWORK: 50%**

Services: Urgent Care
AETNA IN-NETWORK: 20%*
OUT-OF-NETWORK: 50%**

Services: Diagnostic Care
AETNA IN-NETWORK: 20%*
OUT-OF-NETWORK: 50%**

Services: Emergency Room
AETNA IN-NETWORK: 20%*
OUT-OF-NETWORK: 20%*

Services: Surgery
AETNA IN-NETWORK: 20%*
OUT-OF-NETWORK: 50%**

Services: Surgery Through Lantern Surgery Care
AETNA IN-NETWORK: 0%****
OUT-OF-NETWORK: N/A

*After Deductible
**After deductible and subject to out-of-network reimbursement limitations
****Deductible and coinsurance may be waived for surgeries performed through Lantern Surgery Care. Refer to the SPD for more information
1If you choose to enroll you and your dependents in the HDHP 1 plan, you must meet the entire family deductible before the plan starts to pay benefits for any covered member. The deductible can be met by one person or all family members combined
^Please refer to the SPD for preventive services with a capped benefit
^^The employer HSA contribution is a dollar-for-dollar match of the amount you contribute, up to these limits.

Pharmacy Benefits

For Residents Within Designated EHN Service Area

Tier	EHN PROVIDER	AETNA NETWORK	OUT-OF-NETWORK
Rx Calendar Year Out-Of-Pocket Maximum - Individual	Included in medical	Included in medical	N/A
Rx Calendar Year Out-Of-Pocket Maximum - Family	Included in medical	Included in medical	N/A
Generic	20%*; $15 min to $45 max	20%*; $15 min to $45 max	Not covered
Preferred Brand	20%*; $40 min to $120 max	20%*; $40 min to $120 max	Not covered
Non-Preferred Brand	20%*; $55 min to $165 max	20%*; $55 min to $165 max	Not covered

Tier: Rx Calendar Year Out-Of-Pocket Maximum - Individual
EHN PROVIDER: Included in medical
AETNA NETWORK: Included in medical
OUT-OF-NETWORK: N/A

Tier: Rx Calendar Year Out-Of-Pocket Maximum - Family
EHN PROVIDER: Included in medical
AETNA NETWORK: Included in medical
OUT-OF-NETWORK: N/A

Tier: Generic
EHN PROVIDER: 20%*; $15 min to $45 max
AETNA NETWORK: 20%*; $15 min to $45 max
OUT-OF-NETWORK: Not covered

Tier: Preferred Brand
EHN PROVIDER: 20%*; $40 min to $120 max
AETNA NETWORK: 20%*; $40 min to $120 max
OUT-OF-NETWORK: Not covered

Tier: Non-Preferred Brand
EHN PROVIDER: 20%*; $55 min to $165 max
AETNA NETWORK: 20%*; $55 min to $165 max
OUT-OF-NETWORK: Not covered

*After Deductible
***90-day supply through mail order is available at 2.5x the retail copay for PPO and 2x the retail copay for HDHP1 and HDHP2

For Residents Outside of Designated EHN Service Area

Tier	AETNA IN-NETWORK	OUT-OF-NETWORK
Rx Calendar Year Out-Of-Pocket Maximum - Individual	Included in medical	N/A
Rx Calendar Year Out-Of-Pocket Maximum - Family	Included in medical	N/A
Generic	20%*; $15 min, $45 max	Not covered
Preferred	20%*; $40 min, $120 max	Not covered
Non-Preferred	20%*; $55 min, $165 max	Not covered

Tier: Rx Calendar Year Out-Of-Pocket Maximum - Individual
AETNA IN-NETWORK: Included in medical
OUT-OF-NETWORK: N/A

Tier: Rx Calendar Year Out-Of-Pocket Maximum - Family
AETNA IN-NETWORK: Included in medical
OUT-OF-NETWORK: N/A

Tier: Generic
AETNA IN-NETWORK: 20%*; $15 min, $45 max
OUT-OF-NETWORK: Not covered

Tier: Preferred
AETNA IN-NETWORK: 20%*; $40 min, $120 max
OUT-OF-NETWORK: Not covered

Tier: Non-Preferred
AETNA IN-NETWORK: 20%*; $55 min, $165 max
OUT-OF-NETWORK: Not covered

*After Deductible
***90-day supply through mail order is available at 2.5x the retail copay for PPO and 2x the retail copay for HDHP1 and HDHP2

Plan Notes

ACE’s HSA employer contribution is a dollar-for-dollar match, up to $600 (Employee) or $1,200 (Family). You must make an employee contribution in order to receive the employer contribution.
Lantern will waive the deductible once the IRS minimum is incurred and coinsurance on the HDHP 1 and HDHP 2 plans.
The Prescription Drug Program for the WebTPA plans is coordinated through CVS/Caremark, with specialty pharmacy coordinated through Vivio.

OneImaging

Within the WebTPA medical plans there are caps on imaging services. To help you control your costs and ensure quality outcomes, you have access to OneImaging.
OneImaging partners are all ACR accredited facilities with Board certified radiologists.
Concierge-based navigation covers the entire radiology journey, helping you access high quality and affordable MRI, CT scans, x-rays, ultrasounds, and mammograms.
Navigation assists with appointment scheduling and communication between referring providers, imaging centers, and the health plan.
More information is available through the WebTPA Health Hub.

Vida

Employees and dependents enrolled in a WebTPA plan have access to Vida Health, a Pre-Diabetes program that helps those struggling with their metabolic health and assigns a care team of registered dietitians and health coaches.
Remote monitoring for weight and activity tracking.
Self-directed CBTs to help develop skills for lasting behavioral change.
Nutritional coaching.
To access Vida, call the WebTPA Health Hub to see if you may be a candidate or go to their website. More information will be available on Club Hub.

Lantern Surgery Care – A Concierge Surgery Network

Lantern is a supplemental benefit available at no additional cost to members enrolled in a WebTPA medical plan. Lantern offers high-quality surgeons at a lower cost for non-emergency, pre-planned surgical procedures.
Lantern is the exclusive source of coverage for planned bariatric, joint replacement and spine surgeries; you are required to use the Lantern network for these procedures.
Optional categories include, but are not limited to, orthopedics, general surgery, ENT, GYN, GI, pain management and some cardiac procedures.
If you have a pre-planned surgery and utilize Lantern, ACE will waive the deductible once the IRS minimum is incurred and coinsurance.
A dedicated Care Advocate manages the entire process, including scheduling appointments, transferring medical records and arranging all logistics.
Contact Lantern at 855-200-2106 or visit my.lanterncare.com.

Lantern Cancer Care

If you ever need cancer care, Lantern is here to light your path. Lantern provides personalized guidance and support throughout the cancer journey. Their expert support team will help you or a loved one navigate the path ahead, connecting you with the best providers while coordinating care along the way.
An experience with you at the center: Lantern is here to answer your questions and ensure that you understand the path ahead and that you have confidence in your team and treatment plan. They put the patient and their loved ones at the center of care, as they believe that a better more compassionate experience leads to better outcomes.
Guided Support: Your personal Oncology Nurse Navigator-led team will be with you every step of the journey, coordinating appointments, explaining treatment information, and answering questions.
Accessing Excellent Care: Connect with the best in-network community oncology clinics, hospitals, and National Cancer Institutes for high-quality care as close to home as possible.
Expert Review & Advice: The team will assist in coordinating the expert review of members’ diagnoses and treatment plans, recommending second opinions and referrals as needed.
Eligibility: For those enrolled in the WebTPA plans only.
Call Lantern’s Cancer Care navigators to learn more at 855-204-3923 or email guide@lanterncare.com.

Hinge Health

Hinge Health helps you conquer back and joint pain, recover from injuries, prepare for surgery, or stay healthy and pain-free. Best of all, Hinge Health’s programs are provided at no cost to you and your eligible dependents (over age 19) enrolled in the WebTPA medical plans.
What’s Included: Hinge Health provides all the tools you need to get moving again from the comfort of your home.
Get a personal care team, including a physical therapist and health coach
Schedule personal physical therapy sessions as needed
Receive wearable sensors that give live feedback on your form in the app
Get a second opinion on your recommended surgery and treatment plan
Staying Healthy: If you don’t have pain and are just looking to stay healthy, you can sign up for their free app. Recommended exercises will be tailored to you based on your job and lifestyle.
Eligibility: For those enrolled in the WebTPA plans only.
Cost: no cost to you and your eligible dependents (over age 19)
For questions, you can call Hinge Health at 855-902-2777 or send an email to hello@hingehealth.com.

Amazon One Medical

If you are enrolled in a WebTPA Plan, ACE is excited to offer you and your enrolled dependents unlimited on demand through Amazon One Medical. They offer 24/7 on-demand virtual care at no extra cost to you. In addition, if you live near an Amazon One Medical location, you now have access to their providers, within our networks if you would like to use them as your primary care doctor.
Immediate Help Includes: From the app on your phone, you can have immediate help including prescriptions for ailments such as:
COVID-19, colds, and the flu
Allergies
Stomach bugs
Vomiting
Headaches
Injuries
Urinary tract infections
Contraception
Yeast infections
Skin issues
Minor cuts
Eye issues
Eligibility: For those enrolled in the WebTPA plans only.
Virtual on-demand care through Amazon One Medical is available at no cost to you. In-person visits at an Amazon One Medical location may be subject to your plan’s cost share. We encourage you to check with their providers before going to an urgent care or convenience care clinic, as it could save you money. More information will be available after January 1st on Club Hub or to your email on file with Alight.
www.onemedical.com