• ENROLLMENT

     

    When can I enroll in new coverage?

    New hires have 31 days from their hire date to enroll in coverage. Otherwise, you may only enroll or apply for new coverage during the designated annual enrollment period (Oct. 13 – Oct. 25, 2021), unless you have a qualifying event that allows you to enroll during a special enrollment period. 

    What are qualifying life events or family status changes?

    Qualifying Life Events (QLEs) are special occurrences that would allow you to change your coverage outside of open enrollment. Events that are considered acceptable  include:

    • involuntary loss of coverage
    • birth or adoption of a child
    • marriage
    • divorce
    • loss of existing health coverage because of a job loss or job change
    • loss of eligibility for Medicaid or CHIP
    • expiration of your COBRA benefits

    You must apply for coverage within 31 days of a life event.  Coverage is effective 1st of month following receipt of paperwork (except for births). 

     What happens if I miss the deadline to enroll or make changes?

    You are not eligible to enroll or make changes until the next annual enrollment period, unless you apply for a coverage change (consistent with the event) within 31 days of a life event.

     Do I have to enroll in Health Coverage?

    The individual mandate from the government that most Americans must obtain health insurance or face a tax penalty ended in 2019.  If you have coverage through a spouse or through another source, you can purchase other benefits with credits available each pay period ($75 no health).

     I do not need medical coverage through PCS. Will I still receive the $75 per pay Board credit?

    Yes.  If you refuse medical coverage, you are entitled to use the $75 per pay period Board credit toward the cost of supplemental benefits.

     

    HEALTH PLAN

    What is the difference between a “deductible” and an “out-of-pocket maximum”?

    The deductible is what you pay out-of-pocket before your insurance starts paying its share of your costs.  Your deductible amount varies based upon the plan you choose.   Out-of-pocket costs refers to the amount you and your covered family members must pay out-of-pocket for medical and prescription drugs.  Generally, your out-of-pocket costs include the deductibles, copayments, or coinsurance of any eligible expense the insurance doesn’t pay.  After you meet your individual out-of-pocket maximum, all benefits are paid at 100% through the end of the calendar year.  

    Which health plan should I select? 

     The best way to select a plan is by reviewing the comparsion chart in the Annual Enrollment Newsletter.  The chart includes information about co-pays, co-insurance and deductibles.  How much you pay when you need services and the bi-weekly deductions are also important factors.  Each person should pick what is best for his or her circumstances.  

    If I am automatically enrolled in a plan and I don’t like it, can I change it at any time?

    If you do not log in to Employee Self Service and make a change to your medical plan, you will be defaulted to the same plan for 2022.  You may only change your election if you experience a qualifying change in status (life event) during the year or during annual enrollment in 2022.

    How do I know if my doctor is in Aetna’s network?

    There is over a 98% provider match across the Aetna networks.  Networks for all four plans are national networks.  You can search for your provider at www.aetna.com.

    Is the Aetna Select Open Access (OA) plan an HMO?

    The Aetna Select OA is not actually an HMO.  You do pay co-pays for services, but you do not need primary care physician or referrals for specialists. 

    Do I have to have a Primary Care Physician on the Aetna Select Open Access plan?

    No. You do not need to select a Primary Care Physician on the Aetna Select OA plan.

    Do I need a referral to see a specialist on the Aetna Select OA plan?

    No.  You do not need a referral to see a specialist on the Aetna Select OA plan.

    Is the Health Reimbursement Account (HRA) the same as a health savings account (HSA)?

    No.  The HRA is not a Health Savings Account (HSA). You may not contribute your own funds to the HRA.  Unused balances do rollover (capped for 2023), providing you remain in the CDHP plan. HRA funds may be used for medical or prescription costs only. You may not use HRA funds for dental or vision expenses. 

    Do we have on-site Aetna representatives?

    Yes. We have an on-site Aetna Claims Representatives.  Janet Lang, 588-6367,   Gina DeOrsey, RN, 588-6137, and Jessica O'Connell, RN 588-6134.