MEDICAL & PRESCRIPTION DRUGS
Elect a medical plan administered by Aetna.
Modern Group, Ltd. will continue to offer eligible employees and their dependents medical coverage through Aetna. There are three plan options available to choose from. Each plan utilizes the Aetna Open Access Elect Choice Network (OA EPO).
WHO IS ELIGIBLE?
Active employees that work 30+ hours per week and their dependents (spouse and children) are eligible upon date of hire.
Open Access EPO HDHP 2500
This Medical Plan offers you direct access to any network provider for covered services. You must pay the full cost of health care expenses incurred until you meet the plan deductible. Once the deductible is met, you will be required to pay fixed copays for medical services or prescription drugs. The plan pays for any expenses beyond the copays at 100%. Preventitive care is always covered under this plan at 100%.
Employees who enroll in this plan as a single will receive $2,500 into their Health Reimbursement Arrangement (HRA) from Modern Group, Ltd. Those enrolled with dependents will receive $5,000 of funding in their HRA accounts.
This plan is the most costly and will result in the most dollars being deducted from your paycheck. Please see the Employee Contributions page for more details.
Open Access EPO HDHP 3500
This Medical Plan offers you direct access to any network provider for covered services. Preventive care is always covered under this plan at 100%. For all other care, you must meet a deductible before the plan pays. Once the deductible is met, the plan will pay for 80% of eligible expenses.
Employees who enroll in this plan as a single will receive $3,500 into their Health Reimbursement Arrangement (HRA) from Modern Group, Ltd. Those enrolled with dependents will receive $7,000 of funding in their HRA accounts.
This plan is a middle-cost plan in terms of the amount that will be deducted from your paycheck. Please see the Employee Contributions page for more details.
Open Access EPO HDHP 6000
This Medical Plan offers you direct access to any network provider for covered services. Preventitive care is always covered under this plan at 100%. For all other care, you must meet a deductible before the plan pays. Once the deductible is met, the plan will pay for 80% of eligible expenses.
Employees who enroll in this plan as a single will receive $3,500 into their Health Reimbursement Arrangement (HRA) from Modern Group, Ltd. Those enrolled with dependents will receive $7,000 of funding in their HRA accounts.
This plan is the least amount that will be deducted from your paycheck. Please see the Employee Contributions page for more details.
PREVENTIVE MEDICATION
Under any of the three Aetna Medical & Prescription Drug Plans, your deductible will be waived for specific preventive drugs used for managing chronic conditions. These conditions may include hypertension, high cholesterol, diabetes, asthma, and osteoporosis. When the deductible is waived, it means that only the applicable copay or coinsurance will apply.
Your deductible is waived under each of the three Aetna Medical/Rx plans for the following drugs:
- Xarelto - Symbicort
- Lisinopril - Trulicity
- Atenolol - Matformin
- Trazadone - Calcitonin
- Prenatal Vitamins - Albuterol
- Pediatric Vitamins (with fluoride)
PRESCRIPTION LOOK-UP
Click here to search from drugs covered under your Aetna plan.
- Select 2023 as the plan year and Advanced Control Plan as your plan.
- Click View Pharmacy Plan.
- Click the Find a Covered Drug button
- Use the search bar to find a specific drug or sort by therapeutic class.
OTHER PHARMACY BENEFITS
Click the buttons below to learn how to opt into Aetna's mail-order program, CVS Caremark Mail Service Pharmacy, and the Aetna Maintenance Choice program.
TO LEARN MORE ABOUT THE MODERN GROUP MEDICAL PLANS
For questions and additional information, please contact/visit Modern's Human Resources Department or the Graham Company Service Line. More information can also be found on Aetna's website or in the Aetna 2023 Health Care Benefits communication, both found below.
HOW TO LOCATE A PROVIDER
Visit the Online Doctor & Hospital Finder by clicking here and:
- Sign in to your Aetna account or continue as a guest.
- Enter your home location and set your search range (from 0 - 100 miles away).
- If searching as a Guest, select your plan from the list provided (OA EPO).
- Next, search for a specific provider or type of care needed. You may also scroll down to sort by category.
- If sorting by category, you may click Filter & Sort to search based on more specific preferences.
- Use the Doctor Affiliation filter to get a list of all the participating health care professionals that are part of a group practice or enter the name of a hospital for all the doctors who can care for you at the facility.
- Check the Add to Compare box under the names of providers you are interested in to see how they compare to one another.
Remember, you pay less out of pocket when you get health services from providers that are in-network for your Aetna health plan, even when you have out-of-network benefits.
AETNA MEMBER RESOURCES
Aetna offers an array of tools and services to help members maximize their benefits. Some examples of these tools/services are listed below:
- Aetna Health App
- Teladoc and CVS Health Virtual Care
- CVS Minute Clinic
- CVS HealthHUB
- Specialty Pharmacy Management
- Blood Glucose Meter Program
- 24-Hour Nurse Line
- Aetna Maternity Program
- Aetna One Choice
Login to your Aetna account through the link below to view a full list of tools and services available to you.
TELEMEDICINE
Access to healthcare is now even easier with Teladoc
When your primary doctor isn't available, Teladoc is available 24/7/365 for treatment of acute conditions.
Teladoc
When you need to see a doctor - anytime day or night - simply sign into Teladoc.com/Aetna or through the Teladoc app. As an Aetna member, you have 24/7 access to U.S. board-certified doctors via video and phone from the comfort of your home.
You and your dependents can avoid unnecessary visits to the Emergency Room and/or Urgent Care and long waits for doctor appointments by utilizing Teladoc.
General Medical
$49 or less per visit
Talk to a licensed doctor for non-emergency conditions like the flu, sinus infections, sore throats, and more.
Mental Health
$85 or less per therapist visit
$190 or less per first psychiatrist visit
$95 per psychiatrist ongoing visit
Talk to a therapist 7 days a week (7 a.m. to 9 p.m. local time).
Dermatology
$75 or less per consult
Upload images of a skin issue online and get a custom treatment plan within 2 days. Conditions may include eczema, acne, rashes, and more.
WHERE SHOULD I SEEK CARE?
When you need care and your primary care doctor isn’t available, remember you have other options that don’t involve a trip to the emergency room. Using virtual care, retail clinics, or urgent care centers can save you time and money.
Members have access to Emergency Rooms, Urgent Care centers, Primary Care Physicians, and Retail Clinics through the Aetna Open Access Network. In-network providers are the doctors and hospitals in your plan’s network. You’ll save the most money by visiting network providers. Members can also receive care virtually through Teladoc, the select telehealth vendor of Aetna.
If you’re suddenly faced with symptoms of an illness or injury, how can you determine which facility is most appropriate for your condition? Continue reading to learn about each care option.
The following lists are only recommendations, not official medical guidance. Please keep in mind that the conditions under which young children and infants should go to the Emergency Room may differ from those of adults.
The Emergency Room (ER)
Emergency rooms are equipped to handle life-threatening injuries and illnesses and other serious medical conditions. An emergency is a condition that may cause loss of life or permanent or severe disability if not treated immediately.
You should seek care from the ER if you experience any of the following:
Urgent Care (UC)
Urgent Care Centers are not equipped to handle life-threatening injuries, illnesses, or medical conditions. Urgent medical conditions are those that are not considered emergencies but still require care within 24 hours. These centers are designed to address conditions where delaying treatment could cause serious problems or discomfort.
You should seek care from an UC facility if you experience any of the following:
Although Urgent Care Centers are usually more cost-effective, please remember they are NOT a substitute for emergency care! If an injury/illness is life threatening, head to the ER!
Primary Care Physician (PCP)
Primary Care Physicians are equipped to handle routine and minor illnesses or injuries. These are conditions that are not considered emergencies but still require medical attention.
You should also see your PCP for annual wellness exams and vaccinations.
You should consider seeking care from your PCP if you experience any of the following conditions or require any of the following services:
Depending on the severity of their condition, patients that require certain care outside of their PCP's operating hours or whose PCP lacks availability may consider seeking care from a UC facility.
Telehealth (Teladoc)
Teladoc is a telehealth provider available to you through your Aetna medical plans. Like your PCP, the board-certified physicians available through Teladoc are equipped to handle routine and minor illnesses or injuries. These are conditions that are not considered emergencies but still require medical attention.
You should consider seeking care from a board-certified Teladoc physician if you experience any of the following conditions or require any of the following services:
Teladoc physicians are available on weekends and holidays, making telehealth a good option for patients seeking care outside of their PCP's operating hours. Teladoc is also a good option for those suffering from a minor illness/injury that:
- Have limited transportation options
- Have a tight schedule
- Have experienced similar symptoms in the past
- Have a contagious illness (cold, flu, etc.)
- Do not want to leave the house (due to fatigue, child care needs, etc.)
CVS MinuteClinic
CVS MinuteClinic locations have similar capabilities to PCPs or the physicians available through Teladoc. Each location offers in-person services, and select MinuteClinic physicians offer virtual appointments. MinuteClinics are equipped to handle routine and minor illnesses or injuries that are not considered emergencies but still require medical attention.
MinuteClinic is a great option for receiving vaccinations and pre-travel testing/consultations.
You should consider seeking care from a CVS MinuteClinic if you experience any of the following conditions or require any of the following services:
CVS HealthHUB
CVS HealthHUB locations offer expanded MinuteClinic services, one-on-one guidance, and resources for people to manage their health — with a focus on chronic conditions. What’s more? You can access the expanded MinuteClinic services at CVS HealthHUB locations at no or low cost to you.
HealthHUB may be a good fit for those suffering from chronic conditions like Type II diabetes, sleep disorders, high blood pressure, and high cholesterol.
Learn more about what CVS HealthHUB has to offer below.
