RCA Benefit Guide

Medical & Prescription Benefit Summaries
Gold Plan Silver Plan Bronze Plan
PA 18 OAMC 500
PA 18 OAMC 2500 PA 17 OAMC 4000 100/70 HSA
In-Network
100/50 Rx10
90/60 Rx10
(emb) Rx25.25
Deductible (single/family) $500/$1,000 $2,500/$5,000 $4,000/$8,000
Coinsurance (you pay) 0% 10% 0%
Out-of-Pocket Maximum (single/family) $6,600/$13,200 $4,000/$8,000 $6,000/$12,000
Primary Care Copay $10 copay $25 copay 0% after ded
Specialist Copay $20 copay $50 copay 0% after ded
Preventive Care Covered 100% Covered 100% Covered 100%
Diagnostic X-ray 0% after ded 10% after ded 0% after ded
Diagnostic Laboratory 0% after ded 10% after ded 0% after ded
Complex Imagine (MRI, CT scan, PET scan) 0% after ded 10% after ded 0% after ded
Urgent Care $35 copay $75 copay 0% after ded
Emergency Room (waived if admitted) $150 copay $200 copay 0% after ded
Inpatient Hospitalization 0% after ded 10% after ded 0% after ded
Outpatient Surgery 0% after ded 10% after ded 0% after ded
Mental Health & Substance Abuse (inpatient) 0% after ded 10% after ded 0% after ded
Mental Health & Substance Abuse (office visits) $20 copay $50 copay 0% after ded
Mental Health & Substance Abuse (other services) 0% after ded 10% after ded 0% after ded
Prescription Drug
Generic/Preferred Brand/Non-Preferred
Specialty Drugs (Preferred/Non-Preferred)
Mail-order (up to 90 day supply)
$10/$50$/90
50% to $500 max
2 times retail
$10/$50$/90
50% to $500 max
2 times retail
This benefit overview describes highlights of the programs offered to RCA employees for the 2018 plan year. It is a general summary only and is not a guarantee
of current or future benefits. The plan documents, policies and certificates contain official language governing the plans and eligibility.
$10/$35/$60 after ded
$150/$300 after ded
2 times retail
Out-of-Network
Deductible (single/family) $5,000/$10,000 $5,000/$10,000 $5,000/$10,000
Coinsurance (you pay) 50% 40% 30%
Out-of-Pocket Maximum (single/family) $10,000/$20,000 $10,000/$20,000 $10,000/$20,000
TAX-ADVANTAGED ACCOUNT OPTIONS
Health Savings Account (HSA)
The Bronze plan is a qualified High Deductible Health Plan (HDHP). With an HDHP, benefits begin to pay after the deductible has been
met (for all services with the exception of preventive care). Employees enrolled in a qualified HDHP are eligible to contribute to a taxadvantaged
Health Savings Account (HSA). Money in the savings account can help pay the deductible and other qualified expenses.
HSA money is yours to keep. Unlike a Flexible Spending Account (FSA); unused money in your HSA is not forfeited at the end of the
year, it continues to grow tax-deferred. See page 6 for more information.
Flexible Spending Account (FSA)
All employees are eligible to elect Flexible Spending Account (FSA), regardless of enrollment in an RCA medical plan. However, please
note that you cannot have both an HSA and a Healthcare FSA. See page 6 for more information.
Contact or visit Aetna:
Online: www.aetna.com
By Phone: 1-877-238-6200
2018 Recovery Centers of America Benefit Guide | 5