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MEDICAL PLANS
AEP offers three consumer-directed health Plans (CDHPs). The HRA includes AEP funds.
All of AEP’s Medical Plans:
- Utilize the Anthem Blue Cross Blue Shield Network
- Are available in all areas
- Include access to Care Coordinators provided by Quantum Health
- Include behavioral health benefits
- Fully cover in-network preventive care
- Include prescription drugs through Optum Rx
The three plans have different:
- Deductibles
- Out-of-pocket maximums
- Coinsurance
Health Reimbursement Account (HRA) Plan
The HRA Plan provides medical coverage and convenience with an AEP-funded account that covers out-of-pocket costs associated with your Medical Plan.
- AEP credits to your HRA annually, and the funds are available for use at the beginning of the calendar year.
- The amount of AEP’s contribution depends on the coverage level you elect.
- Your account is automatically set up by AEP when you enroll in the Plan.
- The balance in your HRA is automatically applied to your medical, prescription drug and behavioral health claims until it is gone.
- You cannot make contributions to this account.
- Any unused balance can be carried over from year to year ONLY if you remain in the HRA Plan.
- Remaining balances in your HRA when you convert to a Medicare Plan will rollover to a Retiree Reimbursement Account (RRA), as long as you remain enrolled in an AEP Retiree Medical Plan.
Health Savings Account Plus (HSA Plus) Plan
The HSA Plus Plan provides health care coverage and the ability to contribute to a Health Savings Account (HSA). You can use the funds for out-of-pocket costs associated with your Medical Plan.
- There is no annual AEP contribution to your HSA or any other account under this Plan. Exception: Individuals who are within the first 12 months of their severance period on January 1 still receive an employer contribution under this Plan.
- With an HSA you have control of where, when and how you use your funds. You can even save the funds in your HSA and invest them for future expenses.
- Because you aren’t actively working and receiving a paycheck directly from AEP, you can’t elect to contribute to an HSA through AEP.
- The HSA is yours to keep if you move to another Plan. Any unused balance can be carried over from year to year.
- You can open an HSA and make your own contribution directly to the account, up to the IRS limits, and deduct those contributions on your federal income tax return.
Health Savings Account Basic (HSA Basic) Plan
The HSA Basic Plan provides health care coverage and convenience with an optional participant-funded Health Savings Account (HSA) that you can use for out-of-pocket costs associated with your Medical Plan.
- With an HSA you have control of where, when and how you use your funds. You can even save the funds in your HSA and invest them for future expenses.
- Because you aren’t actively working and receiving a paycheck directly from AEP, you can’t elect to contribute to an HSA through AEP.
- The HSA is yours to keep if you move to another Plan. Any unused balance can be carried over from year to year.
- You can open an HSA and make your own contribution directly to the account, up to the IRS limits, and deduct those contributions on your federal income tax return.
Retiree and surviving spouse/dependent Medical Plan contribution rates are dependent upon various factors, including, but not limited to, termination date, and age and years of service at the time of termination.
A personalized worksheet was mailed to your home address on October 13th which reflects the rates that are specific to you for 2023. You can also see your 2023 rates by clicking here, starting October 18th, 2022. Once you login, click Start Here and your updated contribution rates will be reflected as part of the 2023 enrollment process.
Quantum Health’s Advocacy
A new experience with the same provider network through Anthem.
Think of Quantum Health as your personal team of nurses, benefits experts and claims specialists who will do all they can to support your unique health care needs. Each time you contact them, you’ll talk to a real person who knows your health benefits from top to bottom.
Empowered and resourceful, Quantum Health Care Coordinators will do things like:
• Verify coverage.
• Provide health education resources.
• Advocate for your care.
• Help manage chronic conditions.
• Find in-network providers.
• Answer claims, billing and benefits questions.
• Help you shop for quality, cost-effective care.
• Connect you with different benefits programs.
What you can expect:
- You’ll always talk to a person, not an automated system.
- Option to schedule a time for a Care Coordinator to call you when it fits your schedule best.
- Speak to someone who genuinely cares, is empathetic and that has master knowledge of AEP health care benefits.
- Connect with the same Care Coordinator each time if you prefer.
- They will face off to the insurance company on claims concerns on your behalf.
They’ll be your one resource to contact whenever you need help with your medical, wellness or pharmacy benefits.
More details, including contact information, will be coming soon!
What happens when you turn age 65?
Approximately two months prior to your 65th birthday, the AEP Benefits Center will send you information outlining eligibility and other details about benefits that will go into effect the first of the month in which you turn age 65, or the first of the month prior if your birth date falls on the first day of the month. The information will include the options and costs available to you under the Group Medicare Advantage Plans.
IMPORTANT: You must be enrolled in Medicare Parts A and B to be eligible to participate in AEP’s Group Medicare Advantage Plans upon turning age 65. If a covered dependent under the age of 65 becomes eligible for Medicare, for any reason, including disability, the plan will assume they are enrolled in Medicare Parts A and B and will coordinate its payment of benefits accordingly.
You will also receive a letter from Optum Rx Medicare with information about the group-based, company-sponsored Medicare Part D Plan.
Please note that, when transitioning from an AEP under-age-65 Medical Plan to an AEP Medical Plan for participants age 65 and over, year-to-date accumulated deductibles and out-of-pocket maximum amounts do NOT transfer, due to rules governed by Medicare.
Waiving Medical Coverage
Even if you have previously waived AEP Retiree Medical coverage or do not elect it this Annual Enrollment, you may still elect this coverage in the future—either during a future Annual Enrollment or within 31 days of a qualified change in family status.
Surviving spouses and dependents: Once you waive AEP Retiree Medical coverage, you lose your eligibility for this coverage permanently and will not be able to enroll at a later date.
Not sure which plan is right for you? Ask ALEX!
ALEX® is an online tool that will help you select the best benefit plan for you and your family. When you talk to ALEX he’ll ask you a few questions about your health care needs, crunch some numbers and point out what makes the most sense for you. Even if you have had the same Plan for several years, it’s never a bad idea to talk to ALEX to make sure that Plan still fits your needs. And anything you tell ALEX remains anonymous. Find ALEX at myalex.com/aep/2023/retirees.
If you find that some of your prescription medications are covered at $0 on the new preventative list, don't include those in your prescriptions that the tool asks for.
Visit the Optum Rx Pre-Enrollment site today to see what your prescription costs will be under the new Plan.
Prescription Drug Coverage
Prescription Drug Coverage is included with Medical Plan Coverage
Optum Rx will be the new pharmacy benefit manager, as part of the AEP Medical Plan.
AEP is enhancing its Prescription Drug Coverage to include a Preventative & Maintenance medication program. The program will eliminate the cost of many medications for conditions like diabetes, high blood pressure, etc. To see a full list of medications covered under this program click here.
Note: If your medications are covered under this new program, it may impact your Medical Plan choice. Visit ALEX to check which plan best fits your needs.
The Optum Rx Pre-Enrollment site provides tools to:
- Look up medications for coverage and cost information
- Locate in-network pharmacies
- Request a call from Optum Rx to discuss your questions (available after November 1)
Optum Rx will provide similar services as the prior Plan, including:
- Prescriptions via mail order
- Specialty pharmacy services
- Mandatory 90-day maintenance medications via mail or retail CVS pharmacies
In order to help you transition to Optum Rx:
- Mail order prescriptions with remaining refills will transfer to Optum Rx
- Active Prior Authorizations will transfer to Optum Rx
Watch your mail and email for more information from Optum Rx about the new Plan!
If you need more information on the DMO Plan, refer to the Aetna DMO Summary Plan Description at aepbenefits.com or contact Aetna at 1-800-243-1809.
To find a DMO primary care dentist click here.
Dental Plans
Retirees: Once you waive AEP Dental coverage, you will lose your eligibility for this coverage permanently and will not be able to enroll at a later date. Note: Exception for individuals on or after November 12, 2015 where AEP sold an operation. Please refer to the Aetna PPO and DMO Summary Plan Descriptions for additional details.
Surviving spouses and dependents: Once you waive AEP Dental coverage, you will lose your eligibility for this coverage permanently and will not be able to enroll at a later date. Please refer to the Aetna PPO and DMO Summary Plan Descriptions for additional details.
Dental health is an important part of your overall health. Depending on where you live, you may have more than one Dental Plan option to choose from.
The two dental options are:
Aetna Dental Preferred Provider Organization (DPPO) Plan:
Offered in all areas
The DPPO Plan pays 100% of your preventive care expenses (subject to frequency limits) with no deductible, up to Aetna’s recognized charges. It also pays a percentage of Aetna’s recognized charges for most other expenses after you meet an annual deductible.
With the DPPO Plan option, you can visit a dentist who participates in the Aetna DPPO Plan network, or you can visit a dentist who does not participate in the Aetna dental network. You generally pay less out of your own pocket when you visit in-network dentists.
For more information, call Aetna at 1-800-243-1809.
Aetna Dental Maintenance Organization (DMO) Plan:
Offered in limited areas; availability is based on your home ZIP code
With the DMO Plan, you must choose a Primary Care Dentist (PCD) who participates in the Aetna DMO Plan network. Each covered dental procedure has a set dollar copay that you must pay for services. There is no out-of-network coverage associated with the DMO Plan so it’s important that you choose and visit a dentist who participates in the Aetna DMO network in order for services to be covered under the Plan.
If you are currently enrolled in the DMO Plan, review your Dental Plan options to ensure the DMO Plan is still available to you based on your home ZIP code. If the DMO Plan is no longer available to you, you will be defaulted into the Dental Preferred Provider Organization (DPPO) Plan, covering your same eligible dependents, and you will not see the DMO Plan as a Dental Plan option.
Because there is no out-of-network coverage for the DMO Plan, only participants who live in a DMO network area will be eligible to participate in the DMO Plan. If you are eligible to participate in the DMO Plan, it will appear as a Dental Plan option during the Annual Enrollment process. If you are enrolled in the DMO Plan for the current year and you are no longer eligible for the DMO Plan for subsequent year, you will automatically be defaulted into the DPPO Plan covering the same eligible dependents, if you do not make an affirmative election during Annual Enrollment.
- To elect a DMO provider or confirm your existing dentist participates in the Aetna DMO network, contact Aetna at 1-800-243-1809.
- Please note: All dental providers do not participate in the DMO network so it’s recommended that you confirm whether or not your dental provider participates in the DMO network.
- Each covered family member you enroll can select their own PCD.
- You can change your PCD as often as once a month. Any change made on or prior to the 15th of the month will take effect the first of the next month. Any change made after the 15th will take effect the first of the month following next month.
To locate an EyeMed network provider, call EyeMed at 1-866-723-0513 or visit eyemed.com.
Vision Plan
Retirees: Even if you have previously waived AEP Vision coverage or do not elect it this Annual Enrollment, you may still elect this coverage in the future—either during a future Annual Enrollment or within 31 days of a qualified change in family status.
Surviving spouses and dependents: Once you waive AEP Vision coverage, you will lose your eligibility for this coverage permanently and will not be able to enroll at a later date.
AEP’s Comprehensive Vision Plan provides coverage through EyeMed Vision Care, in conjunction with Fidelity Security Life, for eye exams, contacts (including disposable contacts) and eyeglass lenses and frames. It also offers discounts on special features, such as scratch-resistant lenses, non-prescription sunglasses, laser eye surgery and more.
Participants who have Type 1 or Type 2 diabetes are eligible for a follow-up exam and additional testing twice per benefit year.
Create an account at their website to view their long list of special offers, track claims, find a provider and more.
Eyemed Secondary Purchase Plan After your initial benefits have been utilized, you are able to receive the following additional discounts when you use network providers:
- 20% discount off frames or lenses.
- 40% discount off a complete pair of eyeglasses.
- 15% discount off conventional contact lenses.
