Medical Plans

Enjoy offers three medical plans through
Aetna nationwide and one medical plan through
Kaiser Permanente for employees in CA, OR and WA.

Download the Aetna Member toolkit to learn more about the programs, resources and tools available to you as an Aetna member. Additional Aetna resources can be found here.

Depending on your region, your Aetna network name may differ; however, you have the same access to quality care and providers. 

Aetna Managed Choice PPO

Glossary

PPO

PPO stands for Preferred Provider Organization and is a type of plan that offers coverage when you see in-network or out-of-network providers.  PPO plans also allow you to visit any providers without first requiring a referral from a primary care physician

  • In-network and out-of-network coverage

  • No PCP requirement

  • You pay a fixed copay for each doctor visit and some services, and coinsurance for other services

  • Covers 100% of preventive care

  • 2nd highest per paycheck cost
     

Aetna Managed Choice PPO+HSA

HSA

HSA stands for Health Savings Account.  The Aetna Managed Choice PPO+HSA plan is a high-deductible health plan that can be paired with a tax-advantaged Health Savings Account.  The plan offers coverage when you see in-network or out-of-network providers.

  • In-network and out-of-network coverage

  • No PCP requirement

  • The Health Savings Account (HSA) is available with this plan. You can contribute to the HSA up to the IRS limit. Enjoy also contributes $50 monthly to your account.

  • You pay 100% out-of-pocket for everything other than preventive care, including prescriptions, until you reach your deductible.

  • Covers 100% of preventive care

  • Lowest per paycheck cost 
     

Aetna EPO

EPO

EPO stands for Exclusive Provider Organization. Aetna EPO plan provides coverage when you obtain care from physicians, hospitals or other providers within the EPO network. The plan does not provide coverage when you obtain care outside of the network, except in emergency situations. You are not required to obtain Primary Care Physician (PCP) referrals to see a specialist.

  • In-network coverage only (except in cases of emergency)

  • PCP referral is not required under the EPO 

  • You pay mostly copay amounts for in-network services
  • Covers 100% of preventive care

  • Highest per paycheck cost

  • Aetna EPO plan is not available in all states. For those who live in AK, ID, MT, ND, NM, OH, SD, VT and WY, Aetna EPO Out-of-Area plan is offered. This plan has similar benefits to the EPO plan. 

Kaiser HMO

  • Available to employees who live in Kaiser service areas in CA, WA, and the Northwest region. (When you sign on to Lumity to elect your medical plan, you will see a Kaiser HMO plan if it is available for you to elect.)

  • In-network coverage only (except in cases of emergency).  Benefits closely match the Aetna EPO plan with slight differences.

  • Require employees to select a PCP

  • You pay mostly copay amounts for in-network services

  • Covers 100% of preventive care

  • Highest per paycheck cost

Primary Care Physician

PCP is an abbreviation used to refer to primary care physicians or primary care providers. There are many types of providers that can be considered a PCP, such as internal medicine, family practice, general practice, pediatrician, certain nurse practitioner or physician assistant, etc.
 
When you join the Kaiser HMO plan, you will be asked to choose a PCP who will oversee your care. You will be required to obtain a referral from your PCP before you can get care from a specialist.
 

Compare plan features and find your network

 
To compare the medical plans, select your location below and the comparison chart will open in a new window. Instructions on how to find your network are on the next page.
To view employee contributions for each plan, go to Plan Costs. To learn about tax treatment for Domestic Partner Coverage, go here.

Transition of Care

Some medical conditions are eligible for Transition of Care (TOC) until a safe transfer to an Aetna health care professional can be arranged. TOC gives new Aetna members the option to request extended coverage for your current, out-of-network health care provider at network rates for a limited time. Please be aware that transition of care allowance will vary by condition, but typically Aetna allows the transition to last 90 days (1/1/2022 - 3/31/2022).

 

Examples of common medical conditions that may qualify for TOC include (but are not limited to):

  • Pregnancy

  • Ongoing chemotherapy or radiation therapy

  • Transplant

  • Previously scheduled major surgeries 

 

Routine care, chronic conditions, minor illnesses and elective surgeries do not qualify for TOC. 

You will need to download and complete the TOC form beginning 12/15/21 and then submit it to Aetna. Please register on the Aetna website (www.aetna.com) so that you can submit the completed TOC form by clicking on the envelope icon next to your name on the upper righthand side of the page. You will be taken to the Message Center where you can click on New Message and upload the completed TOC form as an attachment and submit. 

 

You can also fax the completed TOC form to either: 

  • Medical requests: 859-455-8650

  • Mental Health/Substance requests: 888-463-1309

All applicants will be evaluated by Aetna based on a medical necessity determination and formal prior authorizations requirements. 

 

Special Note on transition of Prescription Drugs

Mail Order Drugs

If you currently have a mail order prescription with Cigna, your mail order or specialty prescription will not automatically be transferred to Aetna. You will need to contact your doctor to obtain a new prescription. Make sure you have enough medication on hand as you go through the process of transitioning to Aetna.

Pre-certification for Aetna medications

You can find out if your current medication requires pre-certification through the pharmacy search tool link: Aetna Pharmacy Search Tool.  You can also call Aetna’s Concierge Service Team at 833-382-2210

Transition Refills

In the first quarter of 2022, you will be able to receive a one-time refill for any non-specialty prescription medication you take that requires pre-certification or step-therapy. Refills are be limited to 30 days for retail or 90 days for mail order prescriptions. A transition fill letter will be mailed to you within 3-5 business days from the date the transition fill claim is processes by your pharmacy. The letter will inform you of any covered medication alternatives you can take.  

 

Need help choosing a medical plan?

Check out several scenarios that can help you decide the plan that's best for you and your family. 

How to choose a medical plan that is right for you

Click here to review a few scenarios that show the annual cost of each Enjoy medical plan based on health care usage and family needs.

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