Aetna PPO
Administered by: Aetna
A traditional Preferred Provider Organization (PPO) plan that offers a fixed out of pocket cost through copays, lower deductibles, and cost sharing after you meet the plan deductible.
To support your health and financial wellness, Informatica provides valuable benefits that help you and your family stay healthy and pay for care in the event of illness or injury.
2021 Medical Plans:
Our benefits program includes medical plan options with a range of coverage levels and costs designed to meet the diverse needs of our employees.
Aetna Saver
Administered by: Aetna
A high deductible health plan (HDHP) that puts you in charge of your spending through lower paycheck deductions, higher deductibles, and a tax-free Health Savings Account (HSA).
Kaiser HMO
Administered by: Kaiser
A Health Maintenance Organization (HMO) plan with only in-network coverage coordinated by your primary care provider.
Compare the Plans
Key features at a glance
All our medical plans provide:
Comprehensive, affordable coverage
for a wide range of health care services.
Free in-network preventive care,
with services such as annual physicals, recommended immunizations, and routine cancer screenings covered at 100%. See more covered preventive services.
Prescription drug coverage
included with each medical plan.
Financial protection
through annual out-of-pocket maximums that limit the amount you’ll pay each year.
Get to know your plan
Save money
Access health resources
How the Plans work with HSA
| Aetna PPO | Aetna Saver | Kaiser HMO | |
|---|---|---|---|
| HSA eligible | No | Yes | No |
| Company HSA contribution | None | $400/Employee; $800/Family | None |
Your costs for covered services
| Aetna PPO | Aetna Saver | Kaiser HMO | |
|---|---|---|---|
| Preventive doctor’s visit | Covered at 100% in-network | Covered at 100% in-network | Covered at 100% in-network |
| Individual/family deductible | |||
| In-network | $500/$1,200 | $1,600/$3,200 | None |
| Out-of-network | $1,000/$2,400 | $3,200/$6,400 | Not applicable |
| Individual/family out-of-pocket maximum | |||
| In-network | $2,700/$5,300 | $3,000/$6,000 | $1,500/$3,000 |
| Out-of-network | $4,000/$7,800 | $6,000/$12,000 | Not applicable |
| Your coinsurance | |||
| In-network | 10% after deductible | 10% after deductible | Copays for services |
| Out-of-network | 30% after deductible* | 30% after deductible* | Not applicable |
| Office visit | |||
| In-network | $20 primary care $30 specialist | 10% after deductible | $20 primary care and specialist |
| Out-of-network | 30% after deductible* | 30% after deductible* | Not applicable |
| Telemedicine visit | |||
| In-network only | $20 per visit | $40 per visit | No Cost |
| Emergency Room visit | 10% after a $150 copay | 10% after deductible | $150 |
Retail prescriptions (your cost for a 30-day supply)
| Aetna PPO | Aetna Saver | Kaiser HMO | |
|---|---|---|---|
| Generic | In-network: $10 Out-of-network: $10 + 50% of the Rx cost |
In-network 10% after deductible Out-of-network 30% after deductible Deductible doesn’t apply to preventive medications. |
$10 |
| Brand Name | In-network: $35 Out-of-network: $35 + 50% of the Rx cost |
In-network 10% after deductible Out-of-network 30% after deductible Deductible doesn’t apply to preventive medications. |
$35 |
| Non-formulary | In-network: $50 Out-of-network: $50 + 50% of the Rx cost |
In-network 10% after deductible Out-of-network 30% after deductible Deductible doesn’t apply to preventive medications. |
$35 Specialty |
Mail order prescriptions (your cost for a 90-day supply)
| Aetna PPO | Aetna Saver | Kaiser HMO | |
|---|---|---|---|
| Generic | In-network: $20 Out-of-network: not covered |
In-network 10% after deductible Out-of-network not covered Deductible doesn’t apply to preventive medications. |
$20 |
| Brand Name | In-network: $70 Out-of-network: not covered |
In-network 10% after deductible Out-of-network not covered Deductible doesn’t apply to preventive medications. |
$70 |
| Non-formulary | In-network: $100 Out-of-network: not covered |
In-network 10% after deductible Out-of-network not covered Deductible doesn’t apply to preventive medications. |
$70 Specialty |
| All Non-Specialty Drugs | You may fill 90-day supplies of (non-specialty) medication through any retail location. You will need a 90-day prescription from your providers and you will pay 3X the applicable 30-day cost.*** | Not applicable | |
* Out-of-network benefits are based on reasonable and customary charges.
** Deductible does not apply.
*** Important note on maintenance medications through Aetna: For maintenance medications, you can fill a 30-day supply of the prescription at any retail pharmacy twice. For any subsequent refills, a 90-day supply must be filled through the Aetna Rx Home Delivery® mail order program or specifically at a CVS pharmacy. If you continue to fill the prescription at a non-CVS pharmacy, you will pay an additional fee.
The Aetna Saver has a lower-paycheck deduction and a higher deductible paired with a tax-free Health Savings Account (HSA) that helps you save up for future expenses. This combination gives you more control over your money and rewards you for making healthy, cost-conscious choices.
Under this plan you can choose any in-network or out-of-network provider each time you receive care. You will generally pay a lower out of pocket cost when you use an in-network provider.
How the Aetna Saver works
You pay the plan paycheck deductions from your paycheck to have coverage.
Fund your HSA
You can set aside tax-free money from your paycheck and receive company contributions to help cover your costs — now, or in the future.
Deductible
You pay 100% of costs until you meet the annual deductible.
Coinsurance
After meeting the deductible, you and the plan share the cost of certain services, with the plan paying the majority.
OOP Maximum
Once you reach your out of pocket maximum the plan pays 100% of any further covered expenses for the rest of the year.
Money-saving Tip
Use your HSA to budget for deductibles and other out-of-pocket expenses while also saving money – your HSA contributions are tax-free! You can also pair your HSA with a Limited Purpose Flexible Spending Account (FSA).
Make the most of your coverage
Take advantage of these resources to manage your care and your costs.
Budgeting for your costs
With the Aetna Saver Plan, you pay less in paycheck deductions and assume more financial responsibility when you receive care. So, it’s important to plan ahead for your out-of-pocket expenses. Here are some ideas to consider:
- Think about your costs. Contribute at least enough to your HSA to cover your expected out-of-pocket costs, such as your annual deductible and coinsurance. Remember — because you’re keeping more of your paycheck by paying lower medical plan paycheck deductions, you may have extra money available to put in your HSA.
- Plan ahead. You can only spend HSA money that’s actually been deposited into your account. Adjust your contributions as necessary during the year to make sure you have money available when you need it. And if you don’t, remember to reimburse yourself later so you take full advantage of your HSA’s tax savings.
- Look long term. You will never forfeit any money left in your HSA — it rolls over year after year. If you know about future expenses — or if you want to save for your health care costs in retirement — set aside a little extra each paycheck so your balance can grow over time.
The Aetna PPO offers lower out-of-pocket costs in exchange for higher paycheck contributions. With the Aetna PPO, your costs are more predictable, but over the course of the plan year, you may have out-of-pocket expenses.
Under this plan you can choose any in-network or out-of-network provider each time you receive care. You will generally pay a lower out of pocket cost when you use an in-network provider.
How the Aetna PPO works
You pay the plan paycheck deductions from your paycheck to have coverage.
Copay
You pay a fee at the time of service for doctor visits and prescriptions. Copays do not count toward your deductible.
Deductible
For care not covered by a copay, such as hospital services or x-rays, you pay 100% of costs until you meet the annual deductible.
Coinsurance
After meeting the deductible, you and the plan share the cost of certain services.
OOP Maximum
Once you reach your out of pocket maximum the plan pays 100% of any further covered expenses for the rest of the year.
Money-saving Tip
A Health Care Flexible Spending Account (FSA) lets you take advantage of tax-free savings when paying for care. Be sure to plan your FSA contributions carefully: You can only carry over up to $550 of unused money in your FSA to the next year; you will forfeit any remaining amount above $550.
Make the most of your coverage
Take advantage of these resources to manage your care and your costs.
If you live in California, you have the option of enrolling in the Kaiser HMO plan. The plan provides coverage only when you receive care from providers within the Kaiser HMO network. Your Primary Care Provider (PCP) will coordinate your care to help manage costs.
Do you have a PCP?
Kaiser will select a Primary Care Provider (PCP) for you and your covered family members. Your PCP will manage your care and provide referrals if you need to see a specialist. If you would like to select a different Kaiser PCP, you must contact Kaiser directly. Find a Doctor
How the HMO works
You pay the plan paycheck deductions from your paycheck to have coverage.
Copay
You pay a fee at the time of service for doctor visits and prescriptions.
OOP Maximum
Once you reach your out of pocket maximum the plan pays 100% of any further covered expenses for the rest of the year.
Money-saving Tip
A Health Care Flexible Spending Account (FSA) lets you take advantage of tax-free savings when paying for care. Be sure to plan your FSA contributions carefully: You can only carry over up to $550 of unused money in your FSA to the next year; you will forfeit any remaining amount above $550.
Make the most of your coverage
Take advantage of these resources to manage your care and your costs.
When you enroll in an Informatica Aetna medical plan, you automatically receive prescription drug benefits through Aetna. If you live in California and enroll in Kaiser HMO, prescription drug benefits are provided through Kaiser.
Drug tiers
The cost of your prescription drugs depends on the tier of the medication:
Generic
Generic drugs contain the same active ingredients as their brand-name equivalents and meet the same federal standards for safety, but typically cost significantly less.
Preferred brand
Preferred brand-name prescription medications are favored by a prescription plan based on drug effectiveness and cost.
Nonpreferred brand
Nonpreferred brand-name prescription medications are not on a prescription plan’s favored list (or formulary) based on drug effectiveness and cost. Nonpreferred drugs still may be covered, but may require prior authorization and cost more.
Mail order
For ongoing maintenance medication, you can take advantage of the convenience and cost savings of using the mail order program.
Why use mail order:
- Prescriptions are shipped to you for free — no waiting in line at the pharmacy.
- You save money with a reduced cost for a three-month supply.
- You can set up automatic refills.
Save money
The cost of prescription drugs is rising faster than many other health care services and supplies. But, there are ways for you to save on your cost of prescriptions.
Ask your doctor about generic medications.
Generic medications are generally just as effective as brand-name medications, yet the cost of generics is substantially lower, both for you and the plan. They typically cost between 30% and 75% less than brand-name drugs.
Use the plan’s mail order feature.
If you regularly take medication to treat a chronic condition — such as an allergy, heart disease, high blood pressure, or diabetes — the mail order prescription program is a convenient and money-saving option for you.
Generic vs. Brand
Specialty drugs
Specialty pharmacies provide medications that are used to treat certain complex conditions. Aetna has established a network of retail pharmacies experienced in dispensing and monitoring these special medications. To learn more about the specialty pharmacy network, call Aetna at (888) 792-3862.
Manage prescriptions
Start or refill a mail order prescription, compare costs, and more.
Review coverage
Access health resources
Take advantage of these valuable resources to better manage your health and financial well-being.
Prescription tools
Teladoc
Seek medical advice from board-certified physicians who are available 24/7, 365 days a year to consult with you over the phone or through live video right from your mobile device or computer. Teladoc physicians can provide fast, convenient diagnosis and treatment for many common conditions. The cost is just $20 per visit in the Aetna PPO and $40 per visit in the Aetna Saver. Visit Teladoc or call (855) 835-2362 to enroll or learn more.
Aetna Nurse Care Manager
If you’re enrolled in an Aetna medical plan and are hospitalized or diagnosed with an ongoing condition, you’ll get personal assistance from a Nurse Care Manager — who will help you work better with your doctor, get needed follow-up care, and much more.
Your Nurse Care Manager will be your single point of contact and personal health advocate, with whom you can build a lasting, trusting relationship. He or she can:
- Save you time and money: Your nurse will help you navigate your benefits to get conditions treated or addressed today, helping you avoid costly services and procedures that you don’t need later on.
- Coordinate your care: Your nurse will work with your doctors, hospitals, and care team for a more coordinated, easier experience.
- Give you peace of mind: You’ll know what to expect before and after surgery or a hospital stay.
- Connect you to available programs: They’ll help you get in touch with other programs and services to help you stay healthy.
- Think ahead about your health needs: They’ll reach out to help you prevent urgent medical issues before they happen.
Your Nurse Care Manager will call you if you have an ongoing condition or a hospital stay, so you don’t have to figure out the next steps. Of course, you can always call Aetna at (800) 784-3985. For more information, see the Aetna Nurse Care Manager Flyer.
Aetna Maternity Resources
Aetna offers the Beginning Right® maternity program to support members throughout pregnancy. The program is included at no cost to you if you enroll in an Aetna medical plan through Informatica. And remember, Informatica offers support after pregnancy, too, with the section.
Learn more about the Beginning Right program:
Health Advocate
Get free, personalized assistance to help you navigate the health care system, from understanding claims to choosing providers and negotiating fees. Available to you and your family members (including parents and parents-in-law), this service can save you time and money. Help is just a phone call away at (866) 695-8622. Learn more at Health Advocate.