Dealer Tire partners with Aetna to offer medical and prescription drug insurance.
Plan Highlights
You have the option of choosing one of four 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.
If enrolled in one of the PPO plans, regular CVS Virtual Health visits are covered at 100% — no cost to you! Register for CVS Virtual Health today.
Review more information about CVS Virtual Health under our Aetna Resources page!
Click the below links to view your 2024 medical SBCs:
PPO1: Summary of Benefit & Coverage |
PPO2: Summary of Benefit & Coverage |
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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.
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 SBC, Summary of Benefits and Coverage documents. In the event there is a discrepancy between what is reflected in this guide and what is communicated in your Summary of Benefits and Coverage documents, the terms of your Summary of Benefits and Coverage document 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 | $750 | $1,125 | $1,000 | $1,750 | $1,200 | $4,100 | $3,200 | $3,200 | |
| Family | $2,250 | $3,375 | $3,000 | $5,200 | $3,600 | $12,300 | $5,400 | $6,400 | |
| Coinsurance | |||||||||
| 90% | 70% | 80% | 60% | 70% | 40% | 80% | 60% | ||
| Out-of-Pocket Maximum (includes deductible) | |||||||||
| Embedded* | Embedded* | Embedded* | Embedded* | ||||||
| Individual | $4,000 | $6,000 | $4,500 | $7,050 | $7,500 | $11,600 | $4,500 | $5,000 | |
| Family | $8,000 | $12,900 | $9,000 | $15,200 | $15,000 | $34,800 | $9,000 | $10,000 | |
| 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% | $75 copay | Ded + 60% | Ded + 20% | Ded + 40% | |
| Specialist Visit | $35 copay | Ded + 30% | $40 copay | Ded + 40% | $100 copay | Ded + 60% | Ded + 20% | Ded + 40% | |
| Hospital Care | |||||||||
| Emergency Room | $300 copay | $300 copay | $300 copay | $300 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% | $100 copay | Ded + 60% | Ded + 20% | Ded + 40% | |
| Urgent Care | |||||||||
| $50 Copay | Ded + 30% | $75 Copay | Ded + 40% | $150 Copay | Ded + 60% | Ded + 20% | Ded + 40% | ||
| Prescription Drugs | |||||||||
| Deductible | N/A | N/A | N/A | N/A | $150 / $450 Waive for Tier 1 | $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.