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2027

WEBTPA PPO

More detailed information about your WEBTPA PPO plan offering.

WEBTPA PPO

Plan Details

Carrier
WebTPA
Plan Type
PPO
Network
EHN / Aetna
Out-of-Network Coverage
Yes

Monthly Contributions

Coverage Tier
Employee Only
MONTHLY CONTRIBUTIONS
$360.97
Coverage Tier
Employee + Spouse
MONTHLY CONTRIBUTIONS
$879.92
Coverage Tier
Employee + Child(Ren)
MONTHLY CONTRIBUTIONS
$714.01
Coverage Tier
Employee + Family
MONTHLY CONTRIBUTIONS
$1,283.31

Covered Services

For Residents Within Designated EHN Service Area
Services
Calendar Year Deductible & Coinsurance - Individual
EHN PROVIDER
$800
AETNA NETWORK
$1,400
OUT-OF-NETWORK
$4,000
Services
Calendar Year Deductible & Coinsurance - Family
EHN PROVIDER
$1,600²
AETNA NETWORK
$2,800²
OUT-OF-NETWORK
$8,000²
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
$3,500
AETNA NETWORK
$4,500
OUT-OF-NETWORK
Unlimited
Services
Calendar Year Out-Of-Pocket Maximum (Includes Deductible) - Family
EHN PROVIDER
$7,000
AETNA NETWORK
$9,000
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
$50
AETNA NETWORK
$70
OUT-OF-NETWORK
50%**
Services
Urgent Care
EHN PROVIDER
$100
AETNA NETWORK
$150
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
  • 2If you choose to enroll you and your dependents in the PPO or HDHP 2 plan, a family member can meet the individual deductible and the plan will begin paying benefits for that individual only. Once two or more covered family members’ combined expenses meet the family deductible the plan will begin paying benefits for any covered family member
  • ^Please refer to the SPD for preventive services with a capped benefit
For Residents Outside of Designated EHN Service Area
Services
Calendar Year Deductible - Individual
AETNA IN-NETWORK
$1,000
OUT-OF-NETWORK
$4,000
Services
Calendar Year Deductible - Family
AETNA IN-NETWORK
$2,000²
OUT-OF-NETWORK
$8,000²
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
$4,100
OUT-OF-NETWORK
Unlimited
Services
Calendar Year Out-Of-Pocket Maximum (Includes Deductible) - Family
AETNA IN-NETWORK
$8,900
OUT-OF-NETWORK
Unlimited
Services
Preventive Care^
AETNA IN-NETWORK
No charge
OUT-OF-NETWORK
50%**
Services
Primary Care
AETNA IN-NETWORK
$30
OUT-OF-NETWORK
50%**
Services
Specialist Services
AETNA IN-NETWORK
$50
OUT-OF-NETWORK
50%**
Services
Urgent Care
AETNA IN-NETWORK
$100
OUT-OF-NETWORK
50%**
Services
Diagnostic Care
AETNA IN-NETWORK
20%*
OUT-OF-NETWORK
50%**
Services
Emergency Room
AETNA IN-NETWORK
$200 + 20%*
OUT-OF-NETWORK
$200 + 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
  • 2If you choose to enroll you and your dependents in the PPO or HDHP 2 plan, a family member can meet the individual deductible and the plan will begin paying benefits for that individual only. Once two or more covered family members’ combined expenses meet the family deductible the plan will begin paying benefits for any covered family member
  • ^Please refer to the SPD for preventive services with a capped benefit

Pharmacy Benefits

For Residents Within Designated EHN Service Area
Tier
Rx Calendar Year Out-Of-Pocket Maximum - Individual
EHN PROVIDER
$3,000
AETNA NETWORK
$3,000
OUT-OF-NETWORK
N/A
Tier
Rx Calendar Year Out-Of-Pocket Maximum - Family
EHN PROVIDER
$6,000
AETNA NETWORK
$6,000
OUT-OF-NETWORK
N/A
Tier
Generic
EHN PROVIDER
$10
AETNA NETWORK
$10
OUT-OF-NETWORK
Not covered
Tier
Preferred Brand
EHN PROVIDER
$45
AETNA NETWORK
$45
OUT-OF-NETWORK
Not covered
Tier
Non-Preferred Brand
EHN PROVIDER
$60
AETNA NETWORK
$60
OUT-OF-NETWORK
Not covered
  • ***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
Rx Calendar Year Out-Of-Pocket Maximum - Individual
AETNA IN-NETWORK
$3,000
OUT-OF-NETWORK
N/A
Tier
Rx Calendar Year Out-Of-Pocket Maximum - Family
AETNA IN-NETWORK
$6,000
OUT-OF-NETWORK
N/A
Tier
Generic
AETNA IN-NETWORK
$10
OUT-OF-NETWORK
Not covered
Tier
Preferred
AETNA IN-NETWORK
$45
OUT-OF-NETWORK
Not covered
Tier
Non-Preferred
AETNA IN-NETWORK
$60
OUT-OF-NETWORK
Not covered
  • ***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

  • Which benefit chart applies depends on where you live: if you reside in a designated EHN county or ZIP code (Southern California or Dallas/Fort Worth) you use the EHN provider network; otherwise you access Aetna network providers.
  • If you have a pre-planned surgery and utilize Lantern, ACE will waive your deductible and coinsurance on the PPO plan.
  • 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 your deductible 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