Dealer Tire partners with Aetna to offer medical and prescription drug insurance.

Plan Highlights

You have the option of choosing one of 4 plans through Aetna. Our plans offer coverage for most healthcare services. When you receive care in-network you benefit from our negotiated discounts with Aetna.

For 2021, regular Teladoc visits are covered at 100% — no cost to you! Register for Teladoc today at https://member.teladoc.com/aetna or call 855.835.2362.

Click the below links to view your 2021 medical SBCs:

PPO1: Summary of Benefit & Coverage
PPO2: Summary of Benefit & Coverage
PPO3: Summary of Benefit & Coverage
HSA: Summary of Benefit & Coverage
Aetna Member Site

Visit www.aetna.com to take advantage of all the helpful tools and resources available including the following.

  • In-network provider and pharmacy searches
  • A list of prescription drugs covered by our plans
  • Access to temporary ID cards and means to order another ID card
  • Information regarding paid and pending claims

Important Insurance Terms

Deductible: the amount of money you are responsible for paying up-front before your plan shares your costs

Coinsurance: the percentage you and the plan pay; in our plans, you pay a smaller percentage and the plan pays a larger percentage

Copay: a fixed amount for certain services you pay in some of our plans

Out-of-pocket maximum: the limit on your expenses; once you reach this limit, the plan covers all eligible expenses for the remainder of the plan year

Prescription Formulary: List of prescriptions covered by your plan.  Your Aetna plans access the Aetna Standard Open Formulary listing.

 

Benefitexpress logo

What is a Network?

A network is a group of providers your plan contracts with at discounted rates. You will almost always pay less when you receive care in-network.

If you choose to see an out-of-network provider, you may be balance billed, which means you will be responsible for charges above Aetna’s reimbursement amount. 

Click here to find an in-network provider! The plans below will access the ‘Aetna Choice POS II (Open Access) Network’.

 

Medical Plan Details

This is a high level summary of your benefit coverage. Full coverage details are available in your summary plan description (SPD). In the event there is a discrepancy between what is reflected in this guide and what is communicated in your SPD, the terms of your SPD will prevail.

AETNA
PPO 1 PPO 2 PPO 3 HSA Plan
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Calendar Year Deductible
Embedded* Embedded* Embedded* Embedded*
Individual $300 $550 $550 $1,100 $1,350 $3,600 $2,800 $2,800
Family $900 $1,650 $1,650 $3,300 $4,050 $10,800 $5,000 $5,600
Coinsurance
90% 70% 80% 60% 70% 40% 80% 60%
Out-of-Pocket Maximum (includes deductible)
Embedded* Embedded* Embedded* Embedded*
Individual $2,500 $4,850 $3,250 $5,900 $6,600 $11,600 $3,500 $4,500
Family $5,000 $10,300 $6,500 $12,900 $14,800 $34,800 $7,000 $9,000
Preventive Care
No Cost Ded + 30% No Cost Ded + 40% No Cost Ded + 60% No Cost Ded + 40%
Physician Office Visits
Primary Care Visit $25 copay Ded + 30% $30 copay Ded + 40% Ded + 30% Ded + 60% Ded + 20% Ded + 40%
Specialist Visit $35 copay Ded + 30% $40 copay Ded + 40% Ded + 30% Ded + 60% Ded + 20% Ded + 40%
Hospital Care
Emergency Room $250 copay $250 copay $250 copay $250 copay Ded + 30% Ded + 60% Ded + 20% Ded + 20%
Inpatient Coverage Ded + 10% Ded + 30% Ded + 20% Ded + 40% Ded + 30% Ded + 60% Ded + 20% Ded + 40%
Outpatient Surgery Ded + 10% Ded + 30% Ded + 20% Ded + 40% Ded + 30% Ded + 60% Ded + 20% Ded + 40%
Outpatient Short-Term Therapy (limited to 60 visits per year)
Speech $35 Copay Ded + 30% $40 Copay Ded + 40% Ded + 30% Ded + 60% Ded + 20% Ded + 40%
Physical $35 Copay Ded + 30% $40 Copay Ded + 40% Ded + 30% Ded + 60% Ded + 20% Ded + 40%
Occupational $35 Copay Ded + 30% $40 Copay Ded + 40% Ded + 30% Ded + 60% Ded + 20% Ded + 40%
Mental Health Services
Inpatient Ded + 10% Ded + 30% Ded + 20% Ded + 40% Ded + 30% Ded + 60% Ded + 20% Ded + 40%
Office Visits $35 Copay Ded + 30% $40 Copay Ded + 40% Ded + 30% Ded + 60% Ded + 20% Ded + 40%
Urgent Care
$50 Copay Ded + 30% $75 Copay Ded + 40% Ded + 30% Ded + 60% Ded + 20% Ded + 40%
Prescription Drugs
Deductible N/A N/A N/A N/A $150 / $450 $150 / $450 Included in medical Included in medical
 • Retail
Tier 1 $15 copay Not Covered $15 copay Not Covered $10 copay Not Covered Ded + 20% Not Covered
Tier 2 $25 copay Not Covered $30 copay Not Covered $50 copay Not Covered Ded + 20% Not Covered
Tier 3 $45 copay Not Covered $50 copay Not Covered $75 copay Not Covered Ded + 20% Not Covered
Tier 4 20% up to $200 Not Covered 20% up to $200 Not Covered Not Covered Ded + 20% Not Covered
 • Mail Order
Tier 1 $30 copay N/A $30 copay N/A $20 copay N/A Ded + 20% Not Covered
Tier 2 $50 copay N/A $60 copay N/A $100 copay N/A Ded + 20% Not Covered
Tier 3 $90 copay N/A $100 copay N/A $150 copay N/A Ded + 20% Not Covered
Tier 4 20% up to $200 N/A 20% up to $200 N/A N/A Ded + 20% Not Covered

* Embedded plans are important to consider if you are going to cover family members on your plan.

With family coverage in embedded plans, the individual deductible and out-of-pocket maximum still applies to each individual on the plan. You can satisfy the individual limit and the plan begins covering your eligible expenses. Additionally, once a combination of family members satisfies the full family deductible and out-of-pocket maximum, the plan begins covering all family members eligible expenses.