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Oatey offers the choice between two comprehensive medical plan options through Aetna to meet the individual needs of you and your family.

Basic Plan (PPO) has a $500 deductible per individual or $1,000 per family. You will have copays when visiting a primary care physician, specialists, Teladoc visits, Urgent care, and the Emergency Room that will apply toward your deductible accumulation. Once you meet your deductible, you will then be responsible for 20% of the expenses for care received up to the out-of-pocket maximum.
High Deductible Health Plan (HDHP) has a $1,600 deductible per individual or $3,200 deductible per family. In this plan, you’ll pay for all expenses up to the deductible, and then coinsurance will kick in between the deductible and out-of-pocket maximum. With HDHP enrollment, you may set aside tax-free dollars into a Health Savings Account to use toward these expenses, and Oatey will contribute to it as well! See below and in the following sections for further details.

Refer to the Medical Benefits Overview on the following pages for a brief outline of the plans. For complete plan details, refer to the summaries of benefit coverage and summary plan details on the company intranet.

The cost to enroll in these plans is a pre-tax benefit that is shared by you and Oatey.

Note for HDHP Participants: If you enroll in the High Deductible Health Plan, do NOT forget to set-up your Health Savings Account (HSA) with Fidelity. You MUST open a Health Savings Account to receive Oatey’s HSA contribution.

Oatey will contribute up to $1,440 to your HSA if you’re enrolled in single only coverage, and up to $2,880 if you’re enrolled in family coverage (the amount is prorated for new hires based on hire date).

If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. Refer to the notices for further details.

Medical Bi-weekly Associate Contributions

(26 pays per year)

Basic Plan

	Tobacco Free	Tobacco User
Single	$49.26	$72.34
Associate & Spouse	$98.36	$121.44
Associate & Child(ren)	$83.62	$106.70
Family	$147.47	$170.55

High Deductible Health Plan

	Tobacco Free	Tobacco User
Single	$36.22	$59.30
Associate & Spouse	$72.30	$95.37
Associate & Child(ren)	$61.47	$84.55
Family	$108.36	$131.44

Aetna Basic Plan (PPO)

Policy #466092

	In-Network	Out-of-Network
Annual Deductible
Individual	$500	$1,000
Family	$1,000	$2,000
Coinsurance	80%	50%
Maximum Out-of-Pocket*
Individual	$3,250: Rx: $3,350	$5,400
Family	$5,400: Rx: $7,800	$10,800
Physician Office Visit
Teladoc	$40 copay	N/A
Primary Care	$40 copay	50% after deductible
Specialty Care	$40 copay	50% after deductible
Preventive Care
Adult Periodic Exams	100%	50% after deductible
Well-Child Care	100%	50% after deductible
Diagnostic Services
X-ray and Lab Tests	20% after deductible	50% after deductible
Complex Radiology	20% after deductible	50% after deductible
Urgent Care Facility	$50 copay	50% after deductible
Emergency Room Facility Charges	$150 copay	$150 copay
Inpatient Facility Charges	$250 copay, then 20%	$250 copay, then 20%
Outpatient Facility and Surgical Charges	20% after deductible	50% after deductible
Mental Health Therapy
Inpatient	$250 copay, then 20%	$250 copay, then 50%
Outpatient	$40 copay, facility services covered at 20%	50% after deductible
Substance Abuse
Inpatient	$250 copay, then 20%	$250 copay, then 50%
Outpatient	$40 copay, facility services covered at 20%	50% after deductible
Other Services
Chiropractic	20% after deductible	50% after deductible
Retail Pharmacy (30 Day Supply)
Generic (Tier 1)	$25 copay	Not covered
Preferred (Tier 2)	$45 copay	Not covered
Non-Preferred (Tier 3)	$80 copay	Not covered
Mail Order Pharmacy (90 Day Supply)
Generic (Tier 1)	$50 copay	Not covered
Preferred (Tier 2)	$90 copay	Not covered
Non-Preferred (Tier 3)	$160 copay	Not covered

* Medical and Pharmacy expenses apply to the maximum out-of-pocket limit.

Aetna High Deductible Health Plan (HDHP)

Policy #466092

	In-Network	Out-of-Network
Annual Deductible
Individual	$1,600	$3,200
Family	$3,200	$6,400
Coinsurance	80%	50%
Maximum Out-of-Pocket*
Individual	$4,000*	$6,000*
Family	$7,350*	$12,000*
Physician Office Visit
Teladoc	20% after deductible ($49 per consult)	N/A
Primary Care	20% after deductible	50% after deductible
Specialty Care	20% after deductible	50% after deductible
Preventive Care
Adult Periodic Exams	100%	50% after deductible
Well-Child Care	100%	50% after deductible
Diagnostic Services
X-ray and Lab Tests	20% after deductible	50% after deductible
Complex Radiology	20% after deductible	50% after deductible
Urgent Care Facility	20% after deductible	50% after deductible
Emergency Room Facility Charges	20% after deductible	20% after deductible
Inpatient Facility Charges	20% after deductible	50% after deductible
Outpatient Facility and Surgical Charges	20% after deductible	50% after deductible
Mental Health Therapy
Inpatient	20% after deductible	50% after deductible
Outpatient	20% after deductible	50% after deductible
Substance Abuse
Inpatient	20% after deductible	50% after deductible
Outpatient	20% after deductible	50% after deductible
Other Services
Chiropractic	20% after deductible	50% after deductible
Retail Pharmacy (30 Day Supply)
Generic (Tier 1)	20% after deductible	Not covered
Preferred (Tier 2)	20% after deductible	Not covered
Non-Preferred (Tier 3)	20% after deductible	Not covered
Mail Order Pharmacy (90 Day Supply)
Generic (Tier 1)	20% after deductible	Not covered
Preferred (Tier 2)	20% after deductible	Not covered
Non-Preferred (Tier 3)	20% after deductible	Not covered