2026 Medical Benefits
Wiss employees are eligible to enroll in one of two Aetna Health Savings Account (HSA) Medical Plans, both offering access to Aetna’s National Managed Choice POS Network.
- The EPO HSA Plan has in-network benefits only. There will be no services covered out-of-network unless a member experiences a true emergency and seeks care at an out-of-network emergency room.
2026 Wiss & Co. Aetna EPO HSA Plan Benefit Summary (pdf) - The Enhanced HSA Plan offers both in- and out-of-network benefits. However, in-network providers have a contracted rate with Aetna and cannot balance bill you. It is always less money out of your pocket when seeking care from an in-network provider.
2026 Wiss & Co. Aetna Enhanced HSA Plan Benefit Summary (pdf)
Please remember to stay in-network whenever possible. In-network providers have contracted rates with the insurance carrier and cannot balance bill you.
Please review our 2026 Wiss Informational HSA Guide (pdf) to learn more about how you can make your HSA work for you.
| Calendar Year | EPO HSA PLAN | ENHANCED HSA PLAN | ||
|---|---|---|---|---|
| Plan Benefits | In-Network | In-Network | Out-of-Network | |
| Annual Deductible (Single / Family) | $2,500 / $5,000 | $2,500 / $5,000 | $3,000 / $6,000 | |
| Coinsurance (Paid by Employee) | 30% | 10% | 30% | |
| Out-of-pocket Maximum (incl. Deductible) (Single / Family) | $6,000 / $9,000 | $4,000 / $8,000 | $6,000 / $12,000 | |
| Lifetime Maximum | Unlimited | Unlimited | ||
| Office Visit Copay (PCP / Specialist) | Deductible + Coinsurance | Deductible + Coinsurance | Deductible + Coinsurance | |
| Preventive Care | No Charge | No Charge | Deductible + Coinsurance | |
| Inpatient Hospital | Deductible + Coinsurance | Deductible + Coinsurance | Deductible + Coinsurance | |
| Outpatient Surgery | Deductible + Coinsurance | Deductible + Coinsurance | Deductible + Coinsurance | |
| Emergency room | In-Network Deductible + Coinsurance | In-Network Deductible + Coinsurance | ||
| Rx Deductible | Medical Deductible Applies | Medical Deductible Applies | Medical Deductible Applies | |
| Retail Prescription Drugs (Generic / Brand / Non-Formulary) | $20 / $40 / $70 | $10 / $35 / $60 | 50% of submitted cost | |
| Mail Order Rx (up to 90 days) | 2x Retail | 2x Retail | Not Covered | |
| Out-of-Network UCR Level | N/A | N/A | 80th Percentile | |
| Dependent Definition | Age 26 | |||
| Out-of-Network benefits are subject to usual and customary allowances as determined by Aetna. Amounts in excess of usual and customary allowances are the responsibility of the member. | ||||
Mail Order Pharmacy
Aetna Mail Order Pharmacy is available to all members who take a maintenance medication. Members will receive a 90 day supply shipped to their home for free by paying two retail copays. Download the Aetna Rx Home Delivery Form (PDF) to get started.