Health Care Plans
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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 >
- Cover the same medical services and medications
- Fully cover in-network preventive care >
- Include Optum Rx Prescription Drug coverage >
Health Reimbursement Account (HRA) Plan
The HRA Plan provides medical coverage and an AEP-funded account which is applied to out-of pocket costs associated with your Medical Plan.
- AEP credits 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 and prescription drug 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 medical, dental and vision expenses.
- 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 as of January 1, 2025, still receive an employer contribution under this Plan.
- You have control of when the HSA funds are used. 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 eligible out-of-pocket medical, dental and vision expenses.
- You have control of when the HSA funds are used. 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.
2025 Monthly Medical Rates
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.
If your preferred communication is mail, a personalized worksheet was mailed to your home address on October 17th which reflects the rates that are specific to you for 2025. You can also see your 2025 rates on aepbenefits.com, starting October 22nd, 2024. Once you login, click Start Here and your updated contribution rates will be reflected as part of the 2025 enrollment process.
ID Cards
If you change your AEP Medical Plan for 2025, or are enrolled in the HSA Basic or HSA Plus Plans, you will receive a new ID card in late December. The cards will be issued in the name of the participant (subscriber) and will be valid for everyone you cover. The Medical ID Card is also your Pharmacy ID card. Make sure to use the new ID Card beginning January 1, 2025.
Additional cards: Contact Quantum Health for a replacement ID card.
Call or visit Quantum Health at 1-877-324-3032, Monday through Friday, 8:30 a.m. - 10:00 p.m. EST.
Waiving Medical Coverage
If you are eligible for retiree medical coverage and have previously waived it 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.
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 Medicare Advantage Plan, including any covered dependents, year-to-date accumulated deductibles and out-of-pocket maximum amounts do NOT transfer, due to rules governed by Medicare.
Health Care Advocacy
Think of Quantum's Health Coordinators as your personal team of nurses, benefit experts and claims specialists who will support your unique health care needs. They will be your one source to contact whenever you need help navigating your medical, wellness and pharmacy benefits.
To speak to a Quantum Health Care Coordinator, call 1-877-324-3032, Monday through Friday, 8:30 a.m. - 10:00 p.m. EST. You can even schedule time for a Care Coordinator to call you.
Visit the Quantum Health website to:
- View claims.
- Check deductible status.
- Download an ID card.
- Visit the Health Library.
- Make an appointment to talk to a Care Coordinator for a scheduled time.
Clinical Support with a Personal Touch
Quantum Health Nurse Care Coordinators are licensed clinicians providing dedicated, one-on-one support. A Nurse Care Coordinator is one nurse assigned to support entire families.
Nurse Care Coordinators go above and beyond to provide expert guidance on:
- AEP-provided benefit enhancements.
- Managing health conditions like diabetes, high blood pressure, high cholesterol, asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure, kidney disease or high-risk pregnancy.
- Preparing for and recovering from inpatient hospital stays.
- Ensuring understanding of coverage and obtaining prior approval when needed.
- Collaborating with providers on care and healthcare needs.
- Solving claims issues and explaining medical bills.
- Understanding medical and prescription drug coverage.
To speak to a Quantum Nurse Care Coordinator, call 1-877-324-3032, Monday through Friday, 8:30 a.m. - 10:00 p.m. EST.
Understanding Prior Approvals
Some medical services require a prior approval before they are covered by a Medical Plan. Quantum Health Care Coordinators are happy to help patients and doctors through the process of obtaining the preauthorization.
The preauthorization process helps confirm whether a service will be covered before being billed. Care Coordinators will gather the necessary information from doctors to confirm Medical Plan coverage.
Services that require preauthorization include:
- Inpatient hospital admissions
- Surgery (inpatient or outpatient)
- Home healthcare and hospice care
- Skilled nursing facility admissions
- Transplants
- MRI, MRA and PET scans
- Durable medical equipment (DME)
- Oncology Care and services
- Outpatient surgeries
- Dialysis
- Partial hospitalization and intensive outpatient for mental health/substance abuse
- Genetic testing
- Specialty medications
Care Coordinators can answer any questions regarding preauthorizations or prior approvals at 1-877-324-3032, Monday through Friday, 8:30 a.m. - 10:00 p.m. EST.
Prescription Drugs
If you participate in the AEP Comprehensive Medical Plan, your Prescription Drug Coverage, provided by Optum Rx, is integrated with your Medical benefits. This means that any out-of-pocket costs for prescriptions and medical care will accumulate towards the Plan deductible and out-of-pocket maximum. Depending on the Medical Plan you select, HRA or HSA funds are available to help cover the costs of prescription drugs.
Whether using HRA funds or funds from your HSA, or another source, you'll pay the full discounted cost of prescription until the annual deductible is met. After meeting the deductible, you'll be responsible for a percentage of each drug's cost (coinsurance), and AEP will pay for the rest. If you met the annual out-of-pocket maximum, the Plan will cover 100% of additional covered claims.
Not currently enrolled in an AEP Medical Plan? Visit the Optum Rx Welcome Site at welcome.optumrx.com/aep to review pharmacy benefit coverages.
Optum Rx provides tools at optumrx.com to help you:
- Look up a drug to learn about the medication.
- Price a drug to see the cost of the medication and compare to a generic option.
- Search for a network pharmacy near you or when you are traveling.
Optum Rx Price Edge Program—Save More on Medications!
Starting January 1, 2025, we’re introducing the Price Edge program to your Optum Rx pharmacy coverage. This new cost-saving initiative will help you find the best prices on generic non-specialty medications at in-network pharmacies. While your claim is being processed, Price Edge will actively search for discounts from other sources. If it finds a lower price for a covered medication, you’ll pay that reduced amount! Plus, any out-of-pocket expenses will count toward your deductible and out-of-pocket maximum.
Price Edge will also look for the best prices on medications not covered by the AEP Medical Plan; however, those costs will not contribute to your deductible or out-of-pocket maximum.
Maintenance Medications
Medications can be filled at any in-network pharmacy. After three 30-day fills at a retail pharmacy, maintenance medications must be filled for 90 days through Optum Mail Order or a local CVS in order to continue to receive the in-network discounted price.
Specialty Medications
Specialty medications can only be filled through Optum Rx Specialty Pharmacy. Specialty medications often require an approved Prior Authorization before the medication can be filled. Specialty medication prescriptions are limited to 30 days.
ID Cards
The Medical Plan ID card is also the Prescription Drug ID card. The card is issued in the name of the AEP participant (subscriber). For additional ID cards, contact Quantum Health.
Call Optum Rx at 1-866-208-5184 or talk to a Quantum Health Care Coordinator at 1-877-324-3032 for questions about Prescription Drug coverage or how to find an in-network pharmacy.
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 DPPO and DMO Summary Plan Descriptions for additional details.
AEP offers two options for Dental Health coverage through Aetna Dental, with the DMO Plan only being offered in limited areas.
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 meeting 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.
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. 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.
Compare the Plans
Note: Participating DPPO Plan dentists offer discounts on procedures not covered by the Plan.
Vision and Hearing Coverage
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 offers vision health coverage through EyeMed Vision Care, in conjunction with Fidelity Security Life. Coverage includes 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 eyemed.com to view their long list of special offers, track claims, find a provider and more.
EyeMed Secondary Purchase Plan
After your initial in-network benefits have been used, you are able to receive ongoing discounts on additional eyewear purchases for the remainder of the 12-month period (365 days).
Your ongoing secondary purchase discounts are:
- 20% discount on non-covered items, including non-prescription sunglasses;
- 40% discount on a complete pair of prescription eyeglasses; or
- 15% discount on conventional contact lenses (not available for disposable/soft contacts)
This guide is not intended to be a Plan document, Summary Plan Description, or required notice with respect to any of the Plans mentioned. AEP reserves the right to modify, amend, suspend, or terminate the Plans at any time. Refer to the applicable Plan document if you have any questions relating to a specific Plan or benefit.