Medical and Prescription Drugs
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Medical Plans
Medical Plans
AEP offers four Medical Plan options.
The HRA and the HSA Premium 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 >
All Plans provide coverage for the same medical services and medications, but have different:
- Deductibles
- Out-of-pocket maximums
- Coinsurance
Quantum Health Care Coordinator 1-877-324-3032 Monday through Friday 8:30 a.m. - 10:00 p.m. EST
Optum Rx 1-866-208-5184
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.
The Best Match list will display once you've selected who you want to cover for the year.
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 Surcharge
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 employees 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, 2026. 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, 2026:
- Five coaching calls. Enroll by calling Sharecare at 1-877-393-0543 (Option 3) or
- Craving to Quit online modules. Enroll at aepwell.com.
If you were previously enrolled in Craving to Quit (whether you completed all modules or not), you MUST RESTART your Craving to Quit program to qualify for the 2026 tobacco surcharge waiver. Visit the Craving to Quit app, select the Account button, My Settings, and Restart Core Modules to complete the requirements.
The AEP Medical Plans use the Anthem Network. If you are not currently enrolled in an AEP Medical Plan you can check to see if a provider is in the Anthem Network at anthem.com.
- Select Find Care at the top of the page and use the Guests option.
- Select Medical as the type of care, select the state.
- Then select Medical (Employer-Sponsored) and National PPO (BlueCardPPO) for Plan/Network.
Quantum's Health Coordinators can help you find quality, in-network care.
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.
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.
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.
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
Prescription Drugs
Prescription drug benefits are provided by Optum Rx and are integrated with your medical coverage.
Coverage details vary by plan:
HRA & HSA Plans
- Costs apply to both the deductible and out-of-pocket maximum.
- You pay the discounted cost of prescriptions until your deductible is met.
- After meeting the deductible, you pay coinsurance; AEP covers the rest.
- Once you reach the out-of-pocket maximum, prescriptions are covered at 100%.
- You can use HRA or HSA funds to help pay for prescriptions.
- Many preventive and maintenance medications are available at no cost. After three 30-day fills at a retail pharmacy, these must be filled as 90-day supplies at CVS or through Optum Mail.
PPO Plan
- Prescription costs do not apply to the deductible.
- You pay 20% coinsurance for prescriptions from the start.
- These costs count toward your out-of-pocket maximum.
- Many preventive and maintenance medications are available at no cost. After three 30-day fills at a retail pharmacy, these must be filled as 90-day supplies at CVS or through Optum Mail.
Visit optumrx.com
- 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 Drug List
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.
Download the 2026 No Cost Drug List >
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.
Download the 2026 Maintenance Medications List >
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
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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.