Choice Plan

(January 1, 2024 through December 31, 2024)

The Choice plan, offers both in- and out-of-network coverage. This plan introduces a deductible and coinsurance for both in- and out-of-network services. In-network providers must be within the Aetna Managed Choice Network, which is a national network (in-network providers are available nation-wide).

• Coverage for Acupuncture – the coverage is limited to 10 visits per calendar year. In-network, $30 copayment per visit; out-of-network, member pays 30% coinsurance after the deductible has been satisfied.
• Coverage for Hearing Aids (for medical plans sitused in New York) – the coverage is limited to 1 hearing aid per ear every 3 years; in-network, member pays 15% coinsurance after deductible has been satisfied; out-of-network, member pays 40% coinsurance after deductible has been satisfied.

In-Network Benefits

• Co-payments of $30 to see a Primary Care Physician and $50 to see a Specialist. No referrals are needed.
• In-network mental health and substance abuse outpatient visits are covered at the primary office visit copayment ($30). Previously, these services were covered at the specialist office visit copayment ($50).
• Preventive care exams (PDF) are covered at 100%.
• All services beyond a regular office visit , including lab work performed at an in-network independent lab, are subject first to a $850 calendar year deductible for individual coverage, $1,700 calendar year deductible for employee + 1 and family coverage, then 15% member co-insurance. This includes lab work and x-ray s performed at an outpatient hospital facility, outpatient surgery, and inpatient hospitalization.
• $100 Emergency Room co-payment, which is waived if you (or a covered dependent ) are admitted to the hospital.
• The calendar year (in-network) Out-of-Pocket Maximum is $2,000 for an individual and $4,000 for employee + 1 and family coverage.
• In-network prescription co-payments of: $20 for generic medications, $45 for preferred brand medications, and $70 for non-preferred brand medications, after the calendar year deductible for non-generic prescriptions ($125 per person, $375 for +1 and family) has been satisfied. $0 co-payments for generic preventive medications on this list (PDF).
• Please review the Aetna Advance Control Plan Drug Guide brochure.

Out-of-Network Benefits

• The calendar year deductible is $2,500 for individual coverage and $5,000 for employee + 1 and family coverage.
• After the (calendar year) deductible is met, all services are subject to 40% employee co-insurance, until the Out-of-Pocket Maximum is reached.
• The annual (calendar year) Out-of-Pocket Maximum, which is based on 300% of Medicare rates, is $6,000 for individual coverage and $12,000 for employee + 1 and family coverage. For out-of-network providers, you may, in fact, pay more than the Out-of-Pocket Maximum if your provider charges rates that are above the 300% of Medicare guidelines.
• In most cases, for out-of-network services, employees pay in advance for services and submit a claim form to Aetna Healthcare. All claim forms are located on the Human Resources web page under "Forms."

Benefits Disclaimer
_{The HR/Benefits website is intended only to provide information for the guidance of Pace University employees. The writers of the content have exercised their best efforts to ensure accuracy of the information, but accuracy is not guaranteed. If there are any discrepancies between the information on the website, verbal representations and the Plan documents, the Plan documents will always govern. The information is subject to change from time to time, and the University reserves the right to change or terminate these Plans at any time. The information contained on the website is not intended to replace the plan documents, nor is the information in any way intended to imply a contract.}