![]() ![]() For employee only coverage, you meet the individual In-Network deductible - $4,000 for the Basic plan, $2,000 for Essential plan, $1,400 for the Advantage and the Premier plan.The HSA contribution will be based on an employee's annual salary and the coverage level elected for medical coverage. HealthEquity administers the HSA to pay eligible expenses with pre-tax dollars - and when you enroll in a Healthy Focus plan, the Company may contribute to your HSA. If the participant fails to obtain the required precertification, benefits may be reduced or the Plan may not pay any benefits. The participant or provider must contact Aetna regarding an emergency admission, regardless of whether the facility is in-network or out-of-network. If an emergency occurs, and it is not possible to get advance authorization, the participant or provider must notify Aetna of all inpatient treatment within 48 hours of the admission. ![]() Inpatient precertification must be requested at least 14 days before admission.Īetna will work with a participant’s doctor to ensure that the hospitalization is appropriate, medically necessary, and timely, and then let the participant know the number of days for which admission has been certified. For out-of-network services, the participant is responsible for obtaining precertification.Īetna will certify the medical necessity and length of any applicable hospital confinement for inpatient care. If a participant is enrolled in the Healthy Focus Plan, precertification is required for the following types of services: hospitalization, skilled nursing care, home healthcare, hospice care, residential treatment facility or partial hospitalization for mental health disorders or substance abuse, bariatric surgery, gene therapy, gender affirming treatment, stays in a rehabilitation facility, comprehensive infertility services, Advanced Reproductive Technology (ART) services, injectables (immunoglobulins, growth hormones, etc.), kidney dialysis, knee surgery, wrist surgery, outpatient back surgery, private duty nursing, hi-tech radiology and sleep studies, applied behavioral analysis, cosmetic and reconstructive surgery, transcranial magnetic stimulation and non-emergency transportation by airplane.įor in-network services, the in-network providers are responsible for obtaining pre-certification.
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