Aetna Voluntary Benefits

Aetna voluntary benefits offer a financial safety net to help you with funding out-of-pocket medical expenses as well as non-medical expenses (like mortgage payments, day care, or bills). Coverage is guaranteed and Aetna won't ask you any questions about your health. Premiums are paid through payroll deduction. You can choose to have your benefits direct deposited into your bank account, or you can opt to receive a check.

Accident Plan

An Aetna Accident Plan can help you manage unexpected costs in the event of an accident. It pays you cash to help you pay for the health care costs and other expenses when you have a covered injury. If you have a covered injury under your Aetna Accident Plan, you can file a claim and receive cash benefits for certain covered treatments.

Aetna Voluntary Covered Benefits

Accidental Plan Initial Care Covered Benefit

Initial Care Covered Benefit	Plan 1	Plan 2
Ground Ambulance	$300	$300
Air Ambulance	$1,500	$1,500
Initial Treatment - Emergency Room	$100	$150
Initial Treatment - Physician's Office or Urgent Care	$100	$150
X-ray	$25	$50
Medical Imagin	$100	$150

Follow-up Care Covered Benefit

Follow-up Care Covered Benefit	Plan 1	Plan 2
Accident Follow-up	$50 (2 visits, 6 visits) Accident Follow-up maximum visits per Accident, per plan year	$50 (3 visits, 9 visits) Accident Follow-up maximum visits per Accident, per plan year
Appliances	$50	$100
Prosthetic Device/Artificial Limb - One	$500	$750
Prosthetic Device/Artificial Limb - Multiple	$1,000	$1,500
Pain Management (Epidural Anesthesia)	$50	$100
Therapy Services	$15 (10 visits)	$25 (10 visits)
Chiropractic Treatment	$15 (10 visits)	$25 (10 visits)

Hospital Care Covered Benefits

Hospital Care Covered Benefit	Plan 1	Plan 2
Inpatient Hospital Admission - initial day	$500	$1,000
Inpatient ICU Admission - initial day	$1,000	$2,000
Inpatient Hospital Daily	$100	$200
Inpatient ICU Daily	$200	$400
Inpatient Rehabilitation Unit Daily	$50	$100
Observation Unit	$100	$100

Surgical Care Covered Benefits

Surgical Care Covered Benefit	Plan 1	Plan 2
Blood, Plasma, Platelets	$300	$400
Eye Injury	$200	$300
Ruptured Disc	$500	$750
Tendon, Ligament, Rotator Cuff - single	$500	$750
Tendon, Ligament, Rotator Cuff - multiple	$1,000	$1,500
Torn Knee Cartilage Surgery (with repair)	$500	$750
Torn Knee Cartilage Surgery (with repair) - Cranial, Open Abdominal, Thoracic	$500	$750
Hernia Surgery (with no repair) - Exploratory or Arthroscopic	$100	$150

Dislocations Covered Benefits

Dislocations - Closed Reduction Open reduction pays 2.0 times the closed reduction benefit value	Plan 1	Plan 2
Hip	$2,000	$3,000
Knee (except Patella)	$1,000	$1,500
Ankle - Bone or Bones of the Foot (other than toes)	$500	$750
Collarbone (Sternoclavicular)	$400	$600
Lower Jaw	$400	$600
Shoulder (Glenohumeral)	$400	$600
Elbow	$400	$600
Wrist	$400	$600
Bone or Bones of the Hand (other than Fingers)	$400	$600
Collarbone (Acromioclavicular and separation)	$100	$150
One Toe or One Finger	$100	$150

Fractures Covered Benefits

Fractures - Closed Reduction Open reduction pays 2.0 times the closed reduction benefit value	Plan 1	Plan 2
Skull (except Bones of the Face or Nose), Depressed	$2, 750	$4,125
Skull (except Bones of the Face or Nose), Non-Depressed	$2,750	$4,125
Hip, Thigh (Femur)	$1,150	$1,725
Vertebrae, Body of (excluding Vertebral Processes)	$750	$1,125
Pelvis (including Ilium, Ischium, Pubis, Acetabulum except Coccyx)	$750	$1,125
Leg (Tibia and/or Fibula Malleolus)	$750	$1,125
Bones of the Face or Nose (except Mandible or Maxilla)	$400	$600
Upper Jaw, Maxilla (except Mandible or Maxilla)	$400	$600
Upper Arm between Elbow and Shoulder (Humerus)	$400	$600
Lower Jaw, Mandible (except Alveolar Process)	$400	$600
Collarbone (Clavicle, Sternum)	$400	$600
Shoulder Blade (Scapula)	$400	$600
Vertebral Process	$400	$600
Forearm (Radius and/or Ulna)	$300	$450
Kneecap (Patella)	$300	$450
Hand / Foot (except Fingers, Toes)	$300	$450
Ankle	$300	$450
Wrist	$300	$450
Rib	$150	$225
Coccyx	$150	$225
Finger, Toe	$150	$225

Transportation Lodging Covered Benefits

Transportation / Lodging Assistance Covered Benefit	Plan 1	Plan 2
Lodging	$100	$100
Transportation	$200	$250

AD&D and Paralysis Benefits Covered Benefit

AD&D and Paralysis Benefits Covered Benefit	Plan 1	Plan 2
Accidental Death - Employee	$25,000	$50,000
Accidental Death - Insured Spouse	$12,500	$25,000
Accidental Death - Insured Children	$12,500	$25,000
Accidental Death Common Carrier - Employee	$50,000	$100,000
Accidental Death Common Carrier - Insured Spouse	$25,000	$50,000
Accidental Death Common Carrier - Insured Children	$25,000	$50,000
Accidental Dismemberment - One Hand, Foot, or Eye	$2,500	$5,000
Accidental Dismemberment - One Hand and One Foot, One Hand and One Eye, One Foot and One Eye	$5,000	$10,000
Accidental Dismemberment - Both Hands, Both Feet, or Both Eyes	$5,000	$10,000
Paralysis - Paraplegia	$2,500	$5,000
Paralysis - Quadriplegia	$5,000	$10,000

Other Accidental Injuries Covered Benefit

Other Accidental Injuries Covered Benefit	Plan 1	Plan 2
Burn - 2nd Degree (greater than 5% of total body surface	$500	$1,000
Burn - 3rd Degree (less than 5% of total body surface)	$750	$1,500
Burn - 3rd Degree (between 5% and 10% of total body surface)	$3,000	$6,000
Burn - 3rd Degree (greater than 10% of total body surface)	$9,000	$18,000
Burn Skin Graft	50% of Burn Benefit	50% of Burn Benefit
Coma	$5,000	$10,000
Concussion	$100	$150
Dental Treatment - Extractions	$50	$75
Dental Treatment - Crown	$150	$225
Laceration - Without Stitches	$25	$25
Laceration - With Stitches (less than 7.5 cm)	$75	$75
Laceration - With Stitches (between 7.6 cm and 20 cm)	$300	$300
Laceration - With Stitches (greater than 20 cm)	$600	$600

Monthly Rates for Aetna Voluntary Benefits

Monthly Rates	Plan 1	Plan 2
Employee Only	$6.22	$9.64
Employee + Spouse	$10.93	$16.85
Employee + Child(ren)	$13.60	$21.20
Family	$17.48	$27.14

Hospital Indemnity Plan

Important: This is a fixed indemnity policy, NOT health insurance

This fixed indemnity policy may pay you a limited dollar amount if you're sick or hospitalized. You are still responsible for paying the cost of your care.

The payment you get isn't based on the size of your medical bill.
There might be a limit on how much this policy will pay each year.
This policy isn't a substitute for comprehensive health insurance.
Since this policy isn't health insurance, it doesn't have to include most Federal consumer protections that apply to health insurance.

Looking for comprehensive health insurance?

Visit HealthCare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325) to find health coverage options.
To find out if you can get health insurance through your job, or a family member's job, contact the employer.

Questions about this policy?

For questions or complaints about this policy, contact your State Department of Insurance. Their telephone number can be found on the National association of Insurance Commissioners' website (naic.org) under "Insurance Departments."
If you have this policy through your job, or a family member's job, contact the employer.

Medical plans help you pay for covered out-of-pocket costs when you're in the hospital, but they don't cover all expenses. For a little help paying these other costs, the Aetna Hospital Indemnity Plan.

Important features include:

It's affordable and you won't be turned down for health reasons.
Covered benefits include payments for planned and unplanned events.
Payments are made directly to you.
Your premium payments can be made through payroll deductions at work.

Important Note: All daily inpatient stay benefits begin on day two and count toward the plan year maximum.
Covered Benefits for Inpatient Stays	Plan 1	Plan 2	Plan 3
Hospital Stay - Admission Maximum 1 stay per plan year	$500	$1,000	$1,500
Hospital Stay - Daily Pays a daily benefit, beginning on day two of your stay in a non-ICU room of a hospital Maximum 30 days per plan year	$50	$100	$150
Hospital Stay - (ICU) Daily Pays a daily benefit, beginning on day two of your stay in an ICU room of a hospital Maximum 30 days per plan year	$100	$200	$300
Observation Unit Provides a lump sum benefit for the initial day of your stay in an observation unit as the result of an illness or accidental injury. Maximum 1 day per plan year.	$100	$100	$200
Substance Abuse Stay - Daily Pays a daily benefit for each day you have a stay in a hospital or substance abuse treatment facility for the treatment of substance abuse. Maximum 30 days per plan year.	$50	$100	$150
Mental Disorder Stay - Daily Pays a daily benefit for each day you have a stay in a hospital or mental disorder treatment facility for the treatment of mental disorders. Maximum 30 days per plan year.	$50	$100	$150
Rehabilitation Unit Stay - Daily Pays a benefit each day of your stay in a rehabilitation unit immediately after your hospital stay due to an illness or accidental injury. Maximum 30 days per plan year.	$25	$50	$75

Hospital Indemnity Plan Rates

Monthly Rates	Plan 1	Plan 2	Plan 3
Employee Only	$6.51	$12.83	$19.35
Employee + Spouse	$14.56	$28.69	$43.25
Employee + Child(ren)	$11.28	$22.07	$33.35
Family	$18.62	$36.49	$55.11