Guarantee Issue Group Medical
& Dental Insurance Coverage

Group Medical Insurance from Aetna

• Superb, Guarantee Issue, Group Medical Insurance
  
  
  • All full-time P.A.C.E. employees and their dependent family members qualify for P.A.C.E. Group medical insurance. Coverage goes into effect on the first day of the month following your first 30 days of employment. Insurance is guarantee issue, meaning that plan availability and premium cost are unaffected by preexisting medical conditions. Note: If there has been a lapse in coverage, then preexisting conditions may be excluded for a period of one year.
    
    
  • Premium cost is based solely on the type of plan you select and the number of parties insured (e.g., you, you plus your spouse or domestic partner, you plus your children, or your entire family).
    
    
  • Your division of P.A.C.E. will pay for 90% of your group insurance premiums with tax-free dollars funded by your division's revenue stream. You pay the other 10% with tax-free dollars from your gross wage. This particular 90% + 10% arrangement is a requirement of Aetna that allows employees to opt out of coverage.
    
    
  • Your division will also reimburse you with tax-free dollars for out-of-pocket copays, deductibles, and other non-covered dental and medical expenses up to $10,000 per year. Qualified expenses must be supported by proof of payment. Reimbursement is subject to the availability of funds in your P.A.C.E. division operating account.
    
    
  • Your Division Administrator will send you an application packet when you join P.A.C.E.

 

• VSP Vision Care Included With All Medical Plans
  
  
  • Summary of Coverage
    
    

    Vision Benefit	VSP Network Doctor*	Non-VSP Provider
    WellVision® Exam	Covered in full	Reimbursed up to $45.00
    Single Vision Lenses	Covered in full	Reimbursed up to $45.00
    Bifocal Lenses	Covered in full	Reimbursed up to $65.00
    Trifocal Lenses	Covered in full	Reimbursed up to $85.00
    Lenticular Lenses	Covered in full	Reimbursed up to $125.00
    Frame	Covered up to $120.00 allowance ($46.00 wholesale)	Reimbursed up to $47.00
    Contact Lenses:
    Elective (instead of glasses)	Covered up to $120.00 (includes contact lens services and materials)	Reimbursed up to $105.00
    Necessary	Covered in full	Reimbursed up to $210.00

* When covered in full services are obtained from a VSP Network doctor, the patient will have no out-of-pocket expense other than any applicable copays.



• VSP Vison Care Benefit Highlights
  
  
  • WellVision Exam
    Thorough eye exams can detect symptoms of serious eye conditions and health conditions, like diabetes and high cholesterol.
    
    
  • Lenses
    In addition to covered in full glass or plastic lenses, VSP Network doctors provide cost controls on lens options, saving VSP members an average of 30% off their normal fees. Members also receive a 20% discount on additional pairs of prescription and non-prescription glasses, including sunglasses. Plus, dependent children of members are eligible for covered in full polycarbonate lenses.
    
    
  • Frames
    To ensure members get the best value, VSP retail frame allowances are backed by a guaranteed wholesale allowance. This means the member receives the same value no matter which VSP Network doctor they visit. Members also receive 20% off any amount exceeding their allowance.
    
    
  • Contact Lenses
    VSP Network doctors provide a 15% discount off their contact lens services. Plus, current soft contact lens wearers may qualify for a covered in full contact lens evaluation and initial supply of approved replacement lenses, when provided by a VSP Network doctor. With pre-approval from VSP, medically necessary contact lenses are covered in full from a VSP Network doctor.
    
    
  • Laser VisionCare Program™
    VSP contracted laser centers provide discounts for laser surgery, including PRK, LASIK and Custom LASIK.* Discounts average 15% off or 5% off if the laser center is offering a promotional price. Plus, members who’ve had PRK, LASIK or Custom LASIK vision correction surgery can use their covered in full benefit for sunglasses, instead of a prescription pair of glasses. (*Custom LASIK coverage only available using wavefront technology with the microkeratome surgical device. Other LASIK procedures may be performed at an additional cost to the member.)
    
    
  • Low Vision
    Low vision is vision loss sufficient enough to prevent reading and performing daily activities. With pre-approval from VSP, low vision supplemental testing is covered every 2 years. VSP will pay 75% of the cost for approved low vision aids, up to the maximum of $1,000 (less any amount paid for supplemental testing) per member every 2 years.
    
    
  • Primary EyeCare
    VSP network doctors provide supplemental medical coverage for specialty eyecare services and conditions, such as pink eye, and other urgent eyecare needs. Members can see their VSP doctor without a referral, as often as needed. A $5.00 copay applies for each visit.
    
    
  • Exclusions and Limitations
    There may be some materials and services with either limited or no coverage under this plan. Please contact your VSP representative for more information.

 

• Frequency of Vision Service and Cost of Copay
  
  
• Eye exam: Each 12 months.
  
  
• New Lenses: Each 12 months.
  
  
• New Frames: Each 12 months.
  
  
• Co-pay for eye examination is $20.
  
  
• Co-pay for material costs is $20.

 

• Choose From Three Exceptional Medical Plans
  
  
  • Health Maintenance Organization – HMO Plan
    (Available in states with at least 5 P.A.C.E. employees. Inquire regarding availability.)
    
    
    • Detailed HMO Medical Plan Description
      
      
    • Highlights of the Aetna HMO Plan
      
      
      • Annual deductible – None
        
        
      • Annual out-of-pocket maximum:
             Individual – $1,500
             Family – $3,000
        
        
      • Lifetime maximum – Unlimited
        
        
      • Typical office visit copay:
             General – $15
             Specialist – $25
        
        
      • Urgent care and emergency room copay – $100
        
        
      • Inpatient admission copay – $500
        
        
      • Outpatient surgery copay – $200
        
        
      • Routine eye exam copay – $25
        
        
      • Pharmacy copay:
             Generic – $15
             Formulary – $25
             Non-formulary – $40

 

• Plan Cost:
  
  

Coverage For	Monthly Premium
Employee only	$596.69
Employee + Spouse or Domestic Partner	$1,367.02
Employee + Children	$1,191.08
Family	$1,905.92

 

• Preferred Provider Organization – PPO Plan
  Available nationwide
  
  
• Detailed PPO Medical Plan Description
  
  
• Highlights of the Aetna PPO Plan
  
  
  • Annual deductible:
    • In-network
           Individual – $500
           Family – $1,000
    • Out-of-network
           Individual – $750
           Family – $1,500
  • Coinsurance rate:
    • In-network – 10%
      Out-of-network – 30%
  • Annual out-of-pocket maximum:
    • In-network
           Individual – $3,000
           Family – $6,000
    • Out-of-network
           Individual – $6,000
           Family – $12,000
  • Lifetime maximum – Unlimited
    
    
  • Typical office visit copay:
         General – $15
         Specialist – $25
    
    
  • Routine eye exam copay – $25
    
    
  • Routine hearing exam copay – $25
    
    
  • Pharmacy copay:
         Generic – $15
         Formulary – $25
         Non-formulary – $40

 

• Plan Cost:
  
  

Coverage For	Monthly Premium
Employee only	$536.45
Employee + Spouse or Domestic Partner	$1,228.48
Employee + Children	$1,070.63
Family	$1,713.18

 

• High Deductible Health Savings Account – PPO/HSA Plan
  Available nationwide
  
  
  • Detailed HSA Medical Plan Description
    
    
  • HSA Pamphlet
    
    
  • HSA Custodial Account Information
    
    
  • Highlights of the Aetna HSA Savings Account
    
    
    • You may make contributions to your HSA up to the annual limits set by the IRS.
      
      
    • Your HSA contributions are tax-free.
      
      
    • Your HSA funds are invested in a fixed-interest account that earns interest tax free! In this regard, your HSA account is similar to a typical IRA.
      
      
    • You may pay for all qualified out-of-pocket medical expenses such as deductibles, copays, prescriptions, non-covered medical products and procedures, and a wide variety of over-the-counter items (typically by using your HSA debit card) with tax-free dollars from your health savings account.
      
      
    • You may pay for COBRA premiums from your HSA account durings periods of unemployment.
      
      
    • You may pay for long term care and home care from your HSA account.
      
      
    • At the end of the year, money left in the account rolls over to the next year.
      
      
    • Should you leave P.A.C.E., you take your HSA with you.

   

  • Highlights of the Aetna HSA Medical Plan
    
    
  • The HSA Medical Plan is a high-deductible PPO plan.
    
    
  • Annual deductible:
    • In-network
           Individual – $4,000
           Family – $8,000
    • Out-of-network
           Individual – $4,500
           Family – $9,000
  • Coinsurance rate:
    • In-network – 30%
      Out-of-Network – 50%
  • Annual out-of-pocket maximum:
    • In-network
           Individual – $5,000
           Family – $10,000
    • Out-of-network
           Individual – 6,250
           Family – $12,500
  • Lifetime maximum:
    • In-network – Unlimited
      Out-of-network – $2,000,000
  • Pharmacy copay:
    • Generic – $15
      Formulary – $25
      Non-formulary – $35
      Coverage after after combined medical and Rx deductible is met – 100%
  • Plan Cost:
    
    

• Coverage For	Monthly Premium
  Employee only	$336.86
  Employee + Spouse or Domestic Partner	$769.45
  Employee + Children	$671.45
  Family	$1,074.53

 

• How to Find a Doctor

Group Dental Insurance from Aetna

• We Think It's The Best Plan in The Industry
  
  
  • All full-time P.A.C.E. Employees and their dependent family members qualify for P.A.C.E. Group dental insurance. Coverage goes into effect on the first day of the month following your first 30 days of employment. Insurance is guarantee issue, meaning that plan availability and premium cost are unaffected by preexisting dental conditions.
    
    
  • Premium cost is based solely on the number of parties insured (e.g., you, you plus your spouse or domestic partner, you plus your children, or your entire family).
    
    
  • Your division of P.A.C.E. Will pay for 90% of your group insurance premiums with tax-free dollars funded by your division's revenue stream. You pay the other 10% with tax-free dollars from your gross wage. This particular 90% + 10% arrangement is a requirement of Aetna that allows employees to opt out of coverage.
    
    
  • Your division will also reimburse you with tax-free dollars for out-of-pocket copays, deductibles, and other non-covered medical and dental expenses up to $10,000 per year. Qualified expenses must be supported by proof of payment. Reimbursement is subject to the availability of funds in your P.A.C.E. division operating account.
    
    
  • Your Division Administrator will send you an application packet when you join P.A.C.E.

 

• Choose From Two Exceptional Dental Plans
  
  
  • Dental Health Maintenance Organization – DMO Plan
    Available nationwide
    
    
  • Dental Preferred Provider Organization – PPO Plan
    Available nationwide
    
    
    • Detailed DMO and PPO Dental Plan Descriptions
      
      
    • Highlights of the Aetna DMO Dental Plan
      
      
      • Annual deductible – None
        
        
      • Annual Maximum – Unlimited
        
        
      • You are restricted to plan-approved dentists.
        
        
      • Office visit copay – $5
        
        
      • Preventive, diagnostic, and basic restorative treatments – 100%
        
        
      • Surgical procedures, crowns, inlays, bridges, and dentures, etc. – 60%
        
        
      • Orthodontics for adults and dependent children:

        Copay – $2000
        After copay – 100%
        Lifetime maximum – None

      • You may switch from DMO plan to PPO plan and back again monthly.

     

    • Highlights of the Aetna PPO Dental Plan
      
      
    • Annual deductible – $50
      
      
    • Annual maximum – $1000
      
      
    • The schedules of in-network and out-of-network benefits are virtually the same. Plan-approved dentists agree to charge reasonable and customary rates. Out-of-network benefits pay 90th percentile of reasonable and customary expenses not on the schedule.
      
      
    • Office visit copay – None
      
      
    • Preventive and most diagnostic treatments – 100%
      
      
    • Surgical and basic restorative treatments – 80%
      
      
    • Crowns, inlays, bridges, and dentures, etc. – 50%
      
      Orthodontic procedures – Not covered (see DMO plan)
      
      
    • You may switch from PPO plan to DMO plan and back again monthly.

     

    • Plan Cost for Both DMO and PPO Dental Plans:
      
      

    Coverage For	Monthly Premium
    Employee only	$42.47
    Employee + Spouse or Domestic Partner	$85.73
    Employee + Children	$92.96
    Family	$136.23

     

• How to Find a Dentist

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• Contact P.A.C.E. today:
  
  
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