PEBB - Aetna Public Employees Plan

Notice

The HCA will close its Lacey office at 3 p.m. Friday, February 17, to relocate staff to its office at Cherry Street Plaza, 626 8th Avenue SE, in Olympia. Details.

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Contact Information

Toll-Free Phone: 1-800-222-9205
TTY/TDD Phone: 1-800-628-3323
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Benefits Summary

Annual Costs	2012 Coverage
	Member Pays
Deductible What is the difference between deductibles and out-of-pocket maximums?
Out-of-pocket maximum What is the difference between deductibles and out-of-pocket maximums?
Prescription drug deductible

Medical Benefits	2012 Coverage
	Member Pays
Ambulance
Per trip, air
Per trip, ground
Diagnostic tests, laboratory, and x-rays
Durable medical equipment, supplies, and prostheses
Emergency room (Copay waived if admitted) When should I go to the emergency room?
Hearing
Hardware
Routine annual exam
Home health
Hospital services
Inpatient
Outpatient
Mental health care
Outpatient
Obstetric care
Inpatient
Outpatient
Office visit
Chemotherapy
Mental health
Primary care
Radiation
Specialist
Urgent care
Physical, occupational and speech therapy (Per-visit cost for 60 visits/year combined)
Prescription drugs How can I find out more about drugs and supplements?
Mail order (up to a 90-day supply) Value tier
Mail order (up to a 90-day supply) Tier 1
Mail order (up to a 90-day supply) Tier 2
Mail order (up to a 90-day supply) Tier 3
Retail pharmacy (up to a 30-day supply) Value tier
Retail pharmacy (up to a 30-day supply) Tier 1
Retail pharmacy (up to a 30-day supply) Tier 2
Retail pharmacy (up to a 30-day supply) Tier 3
Preventive care Which immunizations are needed and when?
Spinal manipulations
Vision care
Exam (annual)
Glasses and contact lenses