MEDICAL
Administered by Aetna.
Birch Family Services is thrilled to be able to offer a comprehensive medical plans to employees for the April 1, 2025 - March 31, 2026 plan year.
(NEW!) Aetna Medical EPO w/ HRA
Enrolling in this Medical Plan, you will have access to $2,500 (single), or $5,000 (family) in HRA funds provided by Birch. The funds can be used for qualified expenses that are applied to the deductible. When you take into consideration the employer-funded HRA, the net employee deductible is $2,500 for single coverage or $5,000 for family coverage. Once you meet your deductible, AETNA will pay 80% towards medical service, until you reach your out-of-pocket maximum.
(NEW!) This plan has copays for frequently used services such as Primary Care Visits, Specialist Visits, Urgent Care, and Prescription Drugs. You do not have to hit the deductible before copays kick in for these services!
Medical expenses subject to the deductible will be paid for using the employer-funded HRA (now integrated with Aetna). The Aetna HRA will process payments automatically. Once HRA funds are depleted, you can pay remaining claims with your preferred payment method. You should always wait until AFTER you have received both an invoice from your provider and the Explanation of Benefits (EOB) from Aetna. Scroll down to read more about the HRA.
This Medical Plan offers in-network coverage only. Employees must utilize in-network providers to receive the reimbursements and discounts stated in the plan summary.
Find an in-network provider using this link: Aetna Find a Doctor, Dentist, or Hospital.
Aetna Hospital Indemnity
Hospital Indemnity coverage is included with the Aetna Medical Plans.
This coverage pays benefits when you have a planned/unplanned hospital stay for an illness, injury, surgery, or having a baby. The plan pays a lump-sum benefit for admission and a daily benefit for a covered hospital stay. You can use the benefits to help pay out-of-pocket medical costs or personal expenses.
More details in the links below:
Provider Assistance Program (PAP) – For Prescription Drugs
The Graham Concierge Line is a key resource in assisting employees who want to utilize Provider Assistance Programs!
1)Reach out to the Graham Concierge Team
2)Tell us what medication you are on
3)Give us a couple of days to investigate, as each medication is unique
4)If you qualify, your medication will be free!
Note: Specialty Drugs cost 50% up to $250 per script through Birch’s Medical Plan. Enrolling in a PAP program would drop the cost to $0!
Health Reimbursement Arrangement (HRA)
The HRA helps pay for a portion of your out-of-pocket medical costs.
(NEW!) This coverage is now integrated with Aetna and payments will be deducted automatically.
A Health Reimbursement Arrangement (HRA) is an employer-funded benefit that you can use for eligible expenses related to your medical deductible. Birch will fund $2,500 (single) and $5,000 (family).
Note: These funds are available at the beginning of the plan year and they are employer-owned. Unspent funds will not roll over into the next plan year.
HOW IT WORKS
Present your Aetna ID Card
Complete visit with provider
Provider will submit claim to Aetna
Aetna will adjust the claim and prepare the EOB (Explanation of Benefits)
(NEW!) Aetna will AUTOMATICALLY pay the claim using your HRA Account
The provider will receive the adjusted claim and, if applicable, generate an invoice for any remaining amount
After reviewing your EOB, and the invoice, pay the amount due using your preferred payment method
The Value of an HRA for Employees
Save on Eligible Expenses
- You can spend HRA funds on qualifying expenses subject to the deductible, as determined by Birch.
Employer Funded
- HRAs are funded by Birch to help offset out-of-pocket healthcare costs. Funds are tax-free!
Easy Spending and Account Management
- There will no longer be a card for the HRA. Qualifying medical expenses will process automatically!
TELEHEALTH
Access to healthcare is now even easier with (NEW!) CVS Virtual Care & Nurse Line
