Medical and Prescription Drugs
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Medical Plans
Quantum Health Care Coordinator 1-877-324-3032 Monday through Friday, 8:30 a.m. - 10:00 p.m. EST
AEP offers three Consumer-Directed Health Plans (CDHPs). The HRA and the HSA Plus Plans include employer 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 in-network medical and prescription drug claims until it is gone.
- You cannot make contributions to this account.
- Any unused balances are carried over from year to year ONLY if you remain in the HRA Plan.
Health Savings Account Plus (HSA Plus) Plan
The HSA Plus Plan provides health care coverage and an AEP-funded Health Savings Account (HSA) that you can use for eligible out-of-pocket medical, dental and vision expenses.
- 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.
- AEP will contribute the full annual employer contribution to your HSA with your first paycheck of 2025.
- You have control of when the HSA funds are used. You can also make pre-tax contributions to your HSA through payroll deductions or make direct deposits to your HSA up to the IRS limit.
- The HSA is yours to keep if you move to another Plan or leave AEP. Any unused balance is carried over from year to year.
Health Savings Account Basic (HSA Basic) Plan
The HSA Basic Plan provides health care coverage with an optional employee-funded Health Savings Account (HSA) that you can use for eligible out-of-pocket medical, dental and vision expenses.
- There is not an annual AEP contribution to your HSA or any other account.
- You can elect to contribute to an HSA through payroll deduction on a before-tax basis to an HSA.
- HSA funds are yours to keep if you move to another Plan or leave AEP. Any unused balance is carried over from year to year.
Not sure which Medical Plan is right for you?
Enroll using the decision support tool—just click I'd Like Help Choosing Plans when you start your enrollment!
If you are unsure of which benefits to choose, our decision support tool can help. Simply answer a series of questions about your medical history, risk tolerance, and ability to pay out-of-pocket expenses. Using your answers to those questions (which are never shared with AEP), the decision support tool will display the Medical Plan that most closely matches your responses. You can either accept the Best Match Plan that is suggested or choose your own Plan.
Note: The Best Match list will display once you've selected who you want to cover for the year.
2025 Annual AEP Contributions
New Hires: Depending on your date of hire, the amount AEP contributes to your HSA or HRA may be prorated.
Surcharges
Spousal/Domestic Partner Surcharge For Medical Plan Coverage
If your spouse or domestic partner has access to employer-subsidized Medical coverage through their employer, but you choose to cover them under the AEP Medical Plan, you will be assessed a surcharge of $50 per month (note that the $50 surcharge will not apply if the covered spouse or domestic partner is also an AEP employee or retiree). This status must be updated every year through the Annual Enrollment process to avoid the surcharge being automatically applied for the next year.
Tobacco Use
Participants and spouses or domestic partners enrolled in an AEP-sponsored Medical Plan who attest to the use of tobacco and/or nicotine products in the past six months, will each be assessed a monthly tobacco surcharge of $50 unless steps are taken as described below. Only participants who attest that they do not use tobacco and/or nicotine products will receive a monthly credit of $10.
Tobacco/nicotine products include cigarettes, pipes, cigars/cigarillos, snuff, dissolvable and chewing tobacco, e-cigarettes and nicotine replacement therapies such as patches and gum. “Use” includes any recreational use and/or use on “special occasions.” Please remember that certifying any statement related to eligibility requirements that known to be false, or not notifying the company of a change in tobacco/nicotine-use status, could result in disciplinary action, up to and including termination of employment and loss of coverage for the participant and anyone else they enroll.
Tobacco Surcharge Reasonable Alternatives
In order to avoid the tobacco/nicotine surcharge, participants and spouses/domestic partners must individually enroll in one of the Tobacco Cessation Programs by January 31, 2025. To continue having the surcharge waived for the remainder of the year, one of the following Tobacco Cessation Programs must be completed by June 30, 2025:
- Five coaching calls. Enroll by calling Sharecare at 1-877-393-0543 (Option 3) or
- Craving to Quit online modules. Enroll at aepwell.com.
ID Cards
New Hires: Once you enroll in Medical coverage, you will receive your ID card in the mail within 30 days. The ID card 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.
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.
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.
No-Cost Maintenance Drugs
Prescription Drug coverage includes many preventive and maintenance drugs at no cost. Medications are provided at no cost, but after three 30-day fills at a retail pharmacy, they must be filled for 90 days at a local CVS or through Optum Mail.
Optum Rx Price Edge Program—Save More on Medications!
Price Edge through Optum Rx is a cost-saving program that can 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.
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.
Voluntary Benefits
More Health Benefits
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.