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Active Members Information: Bronze Plan

Summary

  • The Bronze Plan is offered to non-permanent employees working an average of 30 hours a week.
  • It offers both an in-network and an out-of-network benefit.
  • You are responsible for the first $7,900 of in-network covered medical and prescription drug expenses for single coverage or $15,800 for family coverage. This is known as the annual deductible.
  • Once you pay the annual deductible, the plan will pay 100% of the allowable amount for medically-necessary services that are covered under the plan.
  • Preventive care is covered in-network at 100%.
  • A prescription drug benefit is provided by CVS Caremark. These costs are also subject to the annual deductible and out-of-pocket maximum.
  • You have an out-of-network benefit but you will have greater out-of-pocket costs – an annual deductible of $8,000 for single coverage or $16,000 for family coverage. The plan will then pay 70% of the plan allowance up to your annual out-of-pocket of $10,750 for single coverage/$21,500 for family coverage. In addition, an out-of-network provider may bill you for the difference between their charge and the plan allowance.

For more information, refer to your Summary Plan Description or contact PEBTF.

Aetna: www.aetna.com Provider Directory: www.aetna.com/dse/custom/pebtf