Employee Benefits

The Benefits Section of Human Resources & Risk Management is a customer service and benefits processing operation. We handle the daily activities of managing your benefits, design communications to keep you apprised of changes, prepare you for retirement, conduct data analysis, provide training on our technology-based benefits and new employee orientation. Our staff continuously strives to provide comprehensive benefits to employees, dependents and retirees while maintaining reasonable costs and a high level of service.      We recognize each employee has different needs and since time is of the essence, technology and convenience are the key factors in conducting business. Plan participants may log on to http://www.aetna.com/ to check claims payment status, eligibility, order an ID card, Price A Procedure, Price A Drug, print your Explanation of Benefits (EOB) statements, check out the Clinical Policy Bulletins, refill mail order prescriptions, monitor Flexible Spending Account (FSA) balances, query for medical information or just search for a provider anywhere in the country. Utilizing the Aetna tools enables you to get the most value out of your plan and saves time! Those who prefer personal contact may call Aetna’s Harris County dedicated customer service line at (800) 279-2401 or the Harris County Benefits staff at (713) 755-5117, toll free (866) 474-7475.                                  Aetna Choice POS II Plan Design - Plan Highlights             BASE PLAN BASE PLAN   IN NETWORK OUT OF NETWORK Annual Deductible (per calendar year) $250 Individual $750 Family $   600 Individual $1,800 Family Coinsurance Limit $1,750 Individual (plus deductible) $5,250 Family (plus deductible) $6,000 Individual (plus deductible) $18,000 Family (plus deductible) Lifetime Maximum Benefit Unlimited except where otherwise indicated Unlimited except where otherwise indicated Physician's Office Copay Primary Care Specialist (Aexcel provider) Specialist (non-Aexcel prov) 100% after $20 copay 100% after $30 copay 100% after $50 copay 60% after deductible Inpatient Services 80% after deductible 60% after deductible Outpatient Surgery      Outpatient Facility 90% after deductible 60% after deductible Outpatient Laboratory & Radiology Services Included in office visit copayment 60% after deductible Maternity Care   Physician's Office    (prenatal & post natal)   In the Hospital    (for mother & newborn) $30/$50 for first visit only 80% after deductible  60% after deductible 60% after deductible Emergency & Urgent Care    Emergency Room    Urgent Care Facility 100% after $150 per visit; waived if confined, 80% after deductible if admitted 100% after a $40 copay 100% after $150 per visit; waived if confined, 60% after deductible if admitted 60% after deductible International care n/a 60% after deductible Mental Health    Outpatient Visits      Inpatient Services 100% after $30 copay 80% after deductible 60% after deductible 60% after deductible Chemical Dependency     Outpatient Visits     Inpatient Services 100% after $30 copay; up to 60 visits per calendar year* 80% after deductible, up to 60 days per calendar year* 60% after deductible; up to 60 visits per calendar year* 60% after deductible; up to 60 days per calendar year* Home Health Care 90% after deductible, up to 100 visits per calendar year* 60% after deductible up 100 visits per calendar year* Rehabilitation, Speech, Occupational and Physical Therapy 100% after a $25 copay, up to 60 visits per calendar year* 60% after deductible, up to 60 visits per calendar year* Allergy Services (includes testing, serum and injections) 100% after $30/$50  copay  60% after deductible Prescription Drugs   Participating Pharmacy    Copayment       (30 day supply)   Mail Order Copayment       (31-90 day supply)    Specialty Drugs/Self-     Injectables (30-day     supply) through Aetna    Specialty Pharmacy                                 Minimum/Maximum                                      Copayments 25% Generic                   $ 5 min/$20 max 25% Brand                     $20 min/$75 max 25% Generic                  $10 min/$ 40 max 25% Brand                     $40 min/$150 max 25% Generic                  $25 min/$100 max 25% Brand                     $25 min/$100 max       - 80% after deductible at non-participating     pharmacy (for emergency prescriptions,     only)                                               BASE PLUS PLAN BASE PLUS PLAN   IN NETWORK OUT OF NETWORK Annual Deductible (per calendar year) None  $   600 Individual $1,800 Family Coinsurance Limit None  $6,000 Individual (plus deductible) $18,000 Family (plus deductible) Lifetime Maximum Benefit Unlimited except where otherwise indicated Unlimited except where otherwise indicated Physician's Office Copay Primary Care Specialist (Aexcel provider) Specialist (non-Aexcel prov) 100% after $20 copay 100% after $20 copay 100% after $40 copay 70% after deductible Inpatient Services 100% after $400 copay 70% after deductible Outpatient Surgery      Outpatient Facility 100% after $250 copay 70% after deductible Outpatient Laboratory & Radiology Services Included in office visit copayment 70% after deductible Maternity Care   Physician's Office    (prenatal & post natal)   In the Hospital    (for mother & newborn) $20/40 for first visit only $400 per admission, per person 70% after deductible 70% after deductible Emergency & Urgent Care    Emergency Room    Urgent Care Facility 100% after $150 per visit; waived if confined, $400 copay if admitted 100% after a $40 copay 100% after $150 per visit; waived if confined, 70% after deductible if admitted 70% after deductible International care n/a 70% after deductible Mental Health    Outpatient Visits      Inpatient Services 100% after $30 copay 100% after $400 confinement copay 70% after deductible 70% after deductible Chemical Dependency     Outpatient Visits     Inpatient Services 100% after $30 copay; up to 60 visits per calendar year* 100% after $400 confinement copay, up to 60 days per calendar year* 70% after deductible; up to 60 visits per calendar year* 70% after deductible; up to 60 days per calendar year* Home Health Care 100% up to 100 visits per calendar year* 70% after deductible up 100 visits per calendar year* Rehabilitation, Speech, Occupational and Physical Therapy 100% after a $20 copay, up to 60 visits per calendar year* 70% after deductible, up to 60 visits per calendar year* Allergy Services (includes testing, serum and injections) 100% after $20/40 copay  70% after deductible Prescription Drugs   Participating Pharmacy    Copayment       (30 day supply)   Mail Order Copayment       (31-90 day supply)  Specialty Drugs/Self-     Injectables (30-day     supply) through Aetna    Specialty Pharmacy                                 Minimum/Maximum                                      Copayments 25% Generic                   $ 5 min/$ 20 max 25% Brand                    $20 min/$ 75 max 25% Generic                  $ 10 min/$ 40 max 25% Brand                     $40 min/$150 max 25% Generic                  $25 min/$100 max 25% Brand                     $25 min/$100 max      - 80% after deductible at non-participating     pharmacy (for emergency prescriptions,     only) * Maximums are a combined limit for in-network and out-of-network services.