Aetna

Employer Application
Package		 Employee Application Package for New Group
Add Employee to Existing Group Plan Employee Waiver
Employee forms can be faxed to our office at (303) 721-1085. Please confirm that application was received by calling (303) 721-1145. Please call with any questions regarding eligibility or waiting periods.

Plan Descriptions (12/1/2009)

Health Plan Name
Office Visit Copay
Deductible

Coinsurance
$30/$50
$500
10% to $2500
$30/$50
$500
30% to $3000
$30/$50
$1000
20% to $4000
$30/$50
$2000
20% to $5500
$30/$50
$2500
20% to $5500
$30/$50
$3000
0%
$30/$50
$750
10-50% to $3750
$30/$50
$1500

20-50% to $5000

Deductible
$5000
0%
$30/$50
$750
50% to $4750
$30 (max 3)
$1500
30% to $5500
Deductible
$7500
0%
Deductible & Coinsurance
$2800
20% to $5000
Deductible
$3500
0%
Deductible & Coinsurance
$3500
20% to $5600
Deducible & Coinsurance
$5000
20% to $5800

 

 

 

Plan Descriptions

PPO Plans

Health Plan Name
Office Visit Copay
Deductible

Coinsurance
Basic PPO
$40

$4000

 30% to $8000
Standard PPO $25 $1500

20% to $3500
500 90/60 $15 $500 10% to $2500
750 90/50/50 $15 $750 10-50% to $3750
1000 80/60 $20 $1000 20% to $4000
1000 90/60 $15 $1000 10% to $3500
1500 80/50/50 $20 $1500 20-50% to $5000
1500 90/60 $20 $1500 10% to $4000
1500 100/60 $20 $1500 0%
2000 80/60 $20 $2000 20% to $5500
2500 80/50 $25 $2500 20% to $8500
2500 100/60 $20 $2500 0%
3000 100/50 $25 $3000 0%
Value Plus 750 50/50 $25 $750 50% to $4750
Value 1500 70/50 $25 (limit 3) $1500 30% to $5500
Value Limited 1000 50/50 Deductible & Coinsurance $1000 50% to $4000
HRA 2000 100/50 Deductible $2000 0%
HRA 2500 100/50 Deductible $2500 0%
HRA 5000 100/50 Deductible $5000 0%

 

HSA Plans

Plan Name
Deductible
Coinsurance
Max Out-of-Pocket (includes deductible)
$2800/$5600
0%
$3300/$6600
$3500/$7000
0%
$4000/$8000