Medical & Pharmacy
What is the medical plan network?
All plans (Meritain and SimplePay) use the ‘Aetna Choice POS II’ network. Note: the SimplePay plan has a tiered provider network.
How does SimplePay work?
With SimplePay, you no longer have to worry about deductibles, coinsurance or copays from your provider. SimplePay identifies top quality providers and show you a price for every medical service, giving you control over your healthcare. You get one monthly statement and the option to pay your medical copays out over time with zero percent financing.
Due to the provider claim payment in full structure (SimplePay members pay their copays into the SimplePay plan) the plan cannot support or accommodate members with secondary insurance and coordination of benefits.
Medical Plan Comparison
All plan coverage shown represents in-network coverage. For out-of-network coverage, reference your plan documents.
| HSA Buy-Up Plan | HSA Core Plan | HSA Buy-Down Plan | SimplePay Plan | |
|---|---|---|---|---|
| Carrier | Meritain | Meritain | Meritain | SimplePay |
| Plan Type | HDHP | HDHP | HDHP | Copay Plan |
| Deductible | $1,650 Employee $3,300 Family | $2,000 Employee $4,000 Family | $2,500 Employee $5,000 Family | None |
| Out-of-pocket Maximum | $2,000 Employee $4,000 Family | $3,275 Employee $6,550 Family | $3,700 Employee $7,400 Family | $4,500 Employee $9,000 Family |
| Primary Care Visit | Deductible then you pay 0% | Deductible then you pay 10% | Deductible then you pay 20% | Tier 1: $20 Tier 2: $30 Tier 3: $45 |
| Specialist Visit | Deductible then you pay 0% | Deductible then you pay 10% | Deductible then you pay 20% | Tier 1: $45 Tier 2: $55 Tier 3: $95 |
| Urgent Care | Deductible then you pay 0% | Deductible then you pay 10% | Deductible then you pay 20% | $55 (all in-network tiers) |
| Emergency Room | Deductible then you pay 0% | Deductible then you pay 10% | Deductible then you pay 20% | $345 |
| Outpatient Hospital | Deductible then you pay 0% | Deductible then you pay 10% | Deductible then you pay 20% | Tier 1: $695 Tier 2: $925 Tier 3: $1,540 |
| Inpatient Hospital | Deductible then you pay 0% | Deductible then you pay 10% | Deductible then you pay 20% | Tier 1: $2,135 Tier 2: $2,845 Tier 3: $4,500 |
| Prescription Drugs | Deductible then: Generic: $10 Preferred: $20 Non-preferred: $40 | Deductible then: Generic: $10 Preferred: $20 Non-preferred: $40 | Deductible then: Generic: $10 Preferred: $20 Non-preferred: $40 | Copays vary - please reference plan summary |
Medical Plan Contributions
| HSA Buy-Up Plan | HSA Core Plan | HSA Buy-Down Plan | SimplePay Plan | |
|---|---|---|---|---|
| Bi-Weekly Cost | ||||
| Employee Only | $156.33 | $90.24 | $56.80 | $50.00 |
| Employee + 1 | $420.89 | $275.47 | $201.88 | $150.00 |
| Employee + Family | $613.52 | $421.83 | $324.82 | $200.00 |
Preventive Care Incentive
Earn a $25 Gift Card
In our ongoing preventative care campaign, we encourage you to take proactive steps towards your health. By completing your annual physical or an age-appropriate screening, you will receive a $25 wellness gift card. It’s our way of saying thank you for taking charge of your wellbeing. Simply schedule your physical and/or screening, the insurance company will provide reporting on who has completed without sharing personal information. Incentives are available for both CATIC plan members and non-CATIC plan members. For those not on a CATIC plan simply complete the Preventative Care Form and return to Jesenia Pagan (jpagan@catic.com) by 12/31. Incentives are paid January/February.
Contact Meritain
Contact Simplepay
Contact MedOne Rx
Register at medone-rx.com (or using the app) to access tools and resources that make managing your pharmacy benefits easier.
Lookup a prescription under the Meritain plans:
medone-rx.com/members/drug-lookup
Group ID: CATIC
Dental
Dental Plan Comparison
All plan coverage shown represents in-network coverage – for out-of-network coverage reference your plan documents.
| Buy-Down Plan | Buy-Up Plan | |
|---|---|---|
| Plan Details | ||
| Network Name | DentalGuard Preferred | DentalGuard Preferred |
| Annual Deductible | $50 per person $150 family max | $50 per person $150 family max |
| Annual Maximum Benefit | $1,000 per person | $2,000 per person |
| Services | ||
| Preventive Care | 100% covered | 100% covered |
| Basic Care | Deductible then you pay 20% | Deductible then you pay 0% |
| Major Care | Deductible then you pay 50% | Deductible then you pay 50% |
| Orthodontia Coverage | ||
| Coverage | Not covered | 50% covered (adults and children) |
| Lifetime Maximum Benefit | $1,500 | |
Dental Plan Contributions
| Buy-Down Plan | Buy-Up Plan | |
|---|---|---|
| Bi-Weekly Cost | ||
| Employee Only | $0.00 | $5.05 |
| Employee + Spouse | $15.22 | $25.47 |
| Employee + Child(ren) | $17.86 | $29.89 |
| Employee + Family | $27.18 | $45.48 |
Vision Discount Benefit
Vision exams are a covered benefit under CATIC’s medical plans.
What is covered by the the vision discount plan?
Put simply, the plan offers discounts on vision materials like glasses, frames, and contacts. EyeMed also has a number of discount programs that offer savings on things like lasik eye surgery or hearing aids.
What is the vision discount plan network?
The network name is ‘Insight’.
Vision Plan Details
All plan coverage shown represents in-network coverage. For out-of-network coverage reference your plan documents.
| Vision Plan | |
|---|---|
| Network Name | Insight Network |
| Lenses (every 12 months) | $0 copay (copay varies for enhancements) |
| Frames (every 24 months) | $130 allowance, 20% off balance over allowance |
| Contact lenses (every 12 months) | $130 allownce, 15% off balance over allowance |
Vision Plan Contributions
| Vision Plan | |
|---|---|
| Bi-Weekly Cost | |
| Employee Only | $2.69 |
| Employee + 1 | $5.11 |
| Employee + Family | $7.50 |
Supplemental Health
Accident Insurance
Accident coverage pays you a cash benefit for events like: stitches, an emergency room visit, ambulance ride, broken bone, concussion, and much more. You cannot plan for an accident, but you can help protect your wallet! This benefit pays a lump sum directly to you to spend however you need. You can spend the money on medical bills – or use it for parking, groceries, a babysitter, etc.
Critical Illness Insurance
Critical illness coverage pays you a cash benefit when you experience a critical illness – your plan may include coverage for: cancer, stroke, heart attack, organ transplants, coronary bypass, and more. Critical illnesses are often unexpected and can come with a high cost for a prolonged period of time. Use the payment you receive to pay bills, buy groceries, cover expense while away from work, etc.
Health Screening Benefit: When you go for your annual preventive care visit or tests, you can receive a $50 health screening benefit, per employee and spouse (if applicable).
Hospital Indemnity Insurance
Hospital Indemnity coverage pays you a cash benefit to help with your expenses – your deductible or copays, transportation, groceries and more – if you or a covered family member is admitted to the hospital. The money is yours to use as you choose.
Contact Aflac
Katie Farrington
Benefit Advisor
katherine_farrington@us.aflac.com