2025 Medical Benefits
Wiss employees are eligible to enroll in one of two Aetna Health Savings Account (HSA) Medical Plans. Both Medical Plans have access to Aetna’s National Managed Choice POS Network.
Please remember to stay in-network whenever possible. In-network providers have contracted rates with the insurance carrier and cannot balance bill you.
Medical Plan Benefit Summaries can be found in the Plan Documents Library.
Please review our HSA Information Guide (PDF) to learn more about how you can make your HSA work for you.
| Calendar Year | BASE HSA PLAN | ENHANCED HSA PLAN | ||
|---|---|---|---|---|
| Plan Benefits | In-Network | Out-of-Network | In-Network | Out-of-Network |
| Annual Deductible (Single / Family) | $2,500 / $5,000 | $6,000 / $12,000 | $2,500 / $5,000 | $2,500 / $5,000 |
| Coinsurance (Paid by Employee) |
30% | 50% | 10% | 30% |
| Out-of-pocket Maximum (incl. Deductible) (Single / Family) |
$3,250 / $6,500 | $6,500 / $13,000 | $3,500/ $7,000 | $5,500/ $11,000 |
| Lifetime Maximum | Unlimited | Unlimited | ||
| Office Visit Copay (PCP / Specialist) |
Deductible + Coinsurance | Deductible + Coinsurance | Deductible + Coinsurance | Deductible + Coinsurance |
| Preventive Care | No Charge | Deductible + Coinsurance |
No Charge | Deductible + Coinsurance |
| Inpatient Hospital | Deductible + Coinsurance | Deductible + Coinsurance | Deductible + Coinsurance | Deductible + Coinsurance |
| Outpatient Surgery | Deductible + Coinsurance |
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 |
Medical Deductible Applies |
| Retail Prescription Drugs (Generic / Brand / Non-Formulary) | $20 / $40 / $70 | 50% of submitted cost |
$10 / $35 / $60 | 50% of submitted cost |
| Mail Order Rx (up to 90 days) |
2x Retail | Not Covered | 2x Retail | Not Covered |
| Out-of-Network UCR Level |
N/A | 70th Percentile | 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.