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Health Insurance Plan Options
Post-65 Plans
Emeriti Health Plan V – Aetna Pharmacy Management (Prescription Drug-only Coverage)
For more information, please review the Health Plan Comparison Chart
or the more detailed Summary of Plan Benefits.
To estimate your health care expenses in retirement, use the Retirement Health Care Cost Calculator.
To calculate the monthly premiums for the different 2007 Emeriti Health Insurance Plan Options, use the Emeriti Online Premium Rate Guide.
The Emeriti Program provides these distinctive features:
- Catastrophic protection
- A choice of Medicare-approved Part D prescription drug coverages
- Coverage of any doctor or facility that accepts Medicare
- National access to insurance
- Annual choice among Emeriti Health Insurance Plan Options
- Preventive care
- Urgent or emergency coverage for up to six months while traveling abroad.
More information on Medicare can be found on the Henry J. Kaiser Family Foundation
website, or by visiting Medicare.Gov.
Emeriti Health Plan V – Aetna Pharmacy Management (Prescription Drug-only Coverage)
How Prescription Drug Coverage Works
The Aetna Pharmacy Management plan is Medicare-approved Part D coverage that helps you pay for prescription medications at retail pharmacies (for short-term prescriptions) or through Aetna's mail order service (for long-term prescriptions). The plan uses different levels (or "stages") of cost sharing. Here's how it works:
- Stage 1: You meet an annual deductible of $265.
- Stage 2: You pay a copayment for each prescription until the total amount paid by you and the plan combined reaches $2,400. Your copayment depends on the type of drug prescribed, as follows:
$5 for generic drugs on the formulary list
$25 for brand-name drugs on the formulary list
25% coinsurance for specialty medications on the formulary
If your drug is not on the formulary list, you must pay the full cost of the drug. For a list of formulary drugs, click here.
- Stage 3: You pay 100% of drug expenses between $2,400 and $3,850.
- Stage 4: If your true out-of-pocket expenses (the total of Stages 1, 2 and 3) exceed $3,850 in a given calendar year, you pay $2.15 (generic) or $5.35 (brand-name) for each prescription OR 5% of the prescription cost, whichever is greater, for the rest of the year. The plan pays the rest of the cost. The plan will only pay for preferred drugs on the formulary. You will continue to pay the full cost of drugs not on the formulary.
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Emeriti Health Plan V – Aetna Pharmacy Management
How to Fill Your Prescriptions
There are two ways to fill prescriptions with the Aetna Pharmacy Management plan:
- You may fill short-term prescriptions at retail pharmacies that belong to Aetna's network. You can use DocFind® to locate participating pharmacies near you. When you visit the pharmacy, show your Aetna ID card. If you haven't met your deductible, you'll need to pay the full cost of the prescription unless you are using a Medicare prescription drug card or other discount program. If you've met your deductible, the pharmacist will know how much to collect for your share of the cost. Important: You must visit one of Aetna's 53,000 participating pharmacies in order to receive prescription drug benefits.
- You may fill long-term prescriptions (up to a 90-day supply) through Aetna Rx Home Delivery,® Aetna's mail order service. When you enroll, you'll receive information about this service, including how to order. When you order, Aetna will bill you for your medication if your share of the expense is $100 or less. If your share is more than $100, Aetna will contact you with cost and payment information. Your medication will be mailed once Aetna has received your payment. You can order refills by mail, phone or online at Aetna Navigator.
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Aetna provides all coverage for institutions and their retirees in 48 states and the District of Columbia. For institutions and their retirees in Minnesota, HealthPartners provides comprehensive coverage, and Aetna provides prescription drug only plans. There will be some differences in coverage from what is described in this website. Call 1-866-EMERITI and talk to an Emeriti Specialist from HealthPartners to find out about the plans offered.
If your institution has fewer than 50 employees, your Emeriti insurance option will be limited to a separate insurance offering mandated by your state insurance department as part of small group insurance reform. Please call an Emeriti Specialist from Aetna to find out what insurance coverage is available to you.
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