Your medical benefit: to most, it’s the most important benefit we have available, but many of us don’t use our plan to the fullest. Medical benefits are not just for when you are sick… For example, if you use preventive benefits when you are well, you might actually be able to avoid getting sick!
Understanding your prescription drug benefit, and knowing how different types of medications will be covered, can help you save money and learn how to talk with your doctor about your options.
Your prescription drug benefit gives you options for paying more or less for your prescription. When you fill a prescription from your doctor, you and the company share the cost. How you share costs depends on how your plan is set up.
Are you Medicare-eligible? Click here to learn about how our Medicare-Eligible Senior Insurance Advocate works wtih you to help you pick the best coverage for you.
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Deductible
The amount of covered expenses you must pay before the Plan starts paying benefits.
In-network:
Individual: $0
Family: $0Out-of-network:
Individual: $1,000
Family: $3,000
-
Coinsurance
Cost-sharing between you and the company. This is applied after you meet your deductible.
In-network:
You pay 0%
Plan pays 100%Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Out-of-Pocket Maximum
The most you are required to pay out of your own pocket in a plan year. Some expenses may not apply.
In-network:
Individual: $5,500
Family: $11,000Out-of-network:
Individual: $5,500
Family: $11,000
-
Doctor’s Office Visit
In-network:
You pay a $20 copay
Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Specialist Office Visit
Specialists include doctors trained in a specific area or function of the body, or a specific age group (cardiologist, pediatrician, orthopedic surgeon, neurologist, etc.).
In-network:
You pay a $20 copay
Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Preventive/Well Child Care
Care focused on prevention or early detection of health conditions. Includes routine physical exam, immunizations, cancer screenings, vision and hearing exams, etc.
In-network:
You pay $0
Plan pays 100%Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Emergency Room
Provides accidental injury and medical emergency care. Note: Call your plan immediately if you are admitted to the hospital.
In-network:
$150 copay/visit, deductible doesn’t apply
Out-of-network:
$150 copay/visit, deductible doesn’t apply
-
Urgent Care
Non-emergency care received from an urgent care clinic or other medical facility; typically used after hours or when your regular doctor is not available.
In-network:
You pay a $20 copay
Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Hospitalization
Inpatient In-network:
Plan Pays 100% after $200 per copay
Inpatient Out-of-network:
Plan Pays 50% after $200 per copay
Outpatient In-network:
You pay 0%
Plan pays 100%Outpatient In-network:
You pay 50% (after deductible)
Plan pays 50%
-
Laboratory (LabCorp & Quest)
In-network:
You pay 0%
Plan pays 100%Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Radiology
In-network:
You pay 0%
Plan pays 100%Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Complex Imaging MRI/CAT/PET
In-network:
You pay 0%
Plan pays 100%Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Durable Medical Equipment
In-network:
You pay 0%
Plan pays 100%Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Vision
Vision Eyewear: Covered 100% up to $300 every 24 months; not subject to any plan deductible, if applicable
-
Are you required to use network providers?
No (but your costs will be lower when you do)
-
Do you need a referral to a specialist?
No.
-
Prescription Drug
Deductible - See Deductible above
Retail (Up to 31-day supply)
In-network Only
Tier 1: $5 copay
Tier 2: $20 copay
Tier 3: $25 copayMail Order (Up to 90-day supply)
In-network Only
Tier 1: $10 copay
Tier 2: $40 copay
Tier 3: $50 copay
-
Express Scripts’ Home Delivery Pharmacy – save time and money
If you take medicine on a long-term basis, consider Express Scripts’ Home Delivery Mail-Order Pharmacy. You will save time and money because for certain drugs you can get up to a three-month supply at a lower cost (2x retail copay instead of 3x). You will also find it handy to have your prescriptions delivered right to your door at no extra cost. Here’s how you can get started with home delivery:
- ePrescribe
- Ask your doctor to send your prescription electronically to the Express Scripts Pharmacy. - Call 800-698-3757
- Talk with a prescription plan specialist. - Mail
- Complete a home delivery order form.
- Get a 90-day prescription from your doctor.
- Mail your form, payment (or payment info) and prescription to the address on the form.
- ePrescribe
High Plan
Provider: Aetna
Phone: 800-962-6842
Website: http://www.aetna.com/
If you have any questions about your new prescription benefit program, please contact Express Scripts’ Customer Service at 855-832-7897.
Aetna - Find a Provider
- Go to www.aetna.com.
- Click on “Find a Doctor”.
- Click on “Search for Doctor, Dentist, or Facility”.
- Log-In as a Member, or click on “Find Doctors,
Dentists, and Hospitals in Our Plans
- Click on “Through an Employer Organization”.
- You can enter the type of doctor you are searching for, or even search by conditions.
- Enter the zip code that you want to search around.
- Select your plan:
- To search for a medical provider, select Aetna Choice POS II (Open Access).
- Click “Search” to view your results.
Aetna Navigator Registration Instructions
*In order to take full advantage of Aetna’s website for access to the following and more:
- Check Claim Status
- Paperless Explanation of Benefits
- Request an ID card
- Go to www.aetna.com
- Click on “Log In/Register”
- Under First-time users click on “Register Now”.
- Enter your personal information. If you do not have your member ID number, there is an option to use your social security number.
- You will then create a username and password.
2026 Dental Delta DPPO Copay 6 Booklet
2026 Dental Delta DPPO Copay 6 Contract
| High Plan | Basic Plan |
|---|---|
DeductibleIn-network: Individual: $0 |
DeductibleIn-network: Individual: $500 |
CoinsuranceIn-network: You pay 0% |
CoinsuranceIn-network: You pay 30% (after deductible) |
Out-of-Pocket MaximumIn-network: Individual: $5,500 |
Out-of-Pocket MaximumIn-network: Individual: $5,500 |
Doctor’s Office VisitIn-network: You pay a $20 copay |
Doctor’s Office VisitIn-network: You pay 30% (after deductible) |
Specialist Office VisitIn-network: You pay a $20 copay |
Specialist Office VisitIn-network: You pay 30% (after deductible) |
Preventive/Well Child CareIn-network: You pay $0 |
Preventive/Well Child CareIn-network: You pay $0 |
Emergency RoomIn-network: $150 copay/visit, deductible doesn’t apply |
Emergency RoomIn-network: You pay 30% (after deductible) |
Urgent CareIn-network: You pay a $20 copay |
Urgent CareIn-network: You pay 30% (after deductible) |
HospitalizationInpatient In-network: Plan Pays 100% after $200 per copay |
HospitalizationInpatient In-network: 30% coinsurance after $200 copay |
Laboratory (LabCorp & Quest)In-network: You pay 0% |
Laboratory (LabCorp & Quest)In-network: You pay 30% (after deductible) |
RadiologyIn-network: You pay 0% |
RadiologyIn-network: You pay 30% (after deductible) |
Complex Imaging MRI/CAT/PETIn-network: You pay 0% |
Complex Imaging MRI/CAT/PETIn-network: You pay 30% (after deductible) |
Durable Medical EquipmentIn-network: You pay 0% |
Durable Medical EquipmentIn-network: You pay 30% (after deductible) |
VisionVision Eyewear: Covered 100% up to $300 every 24 months; not subject to any plan deductible, if applicable |
VisionVision Eyewear: Covered 100% up to $300 every 24 months; not subject to any plan deductible, if applicable |
Are you required to use network providers?No (but your costs will be lower when you do) |
Are you required to use network providers?No (but your costs will be lower when you do) |
Do you need a referral to a specialist?No. |
Do you need a referral to a specialist?No. |
Prescription DrugRetail (Up to 31-day supply) Mail Order (Up to 90-day supply) |
Prescription DrugRetail (Up to 31-day supply) Mail Order (Up to 90-day supply) |
Express Scripts’ Home Delivery Pharmacy – save time and moneyIf you take medicine on a long-term basis, consider Express Scripts’ Home Delivery Mail-Order Pharmacy. You will save time and money because for certain drugs you can get up to a three-month supply at a lower cost (2x retail copay instead of 3x). You will also find it handy to have your prescriptions delivered right to your door at no extra cost. Here’s how you can get started with home delivery:
|
Express Scripts’ Home Delivery Pharmacy – save time and moneyIf you take medicine on a long-term basis, consider Express Scripts’ Home Delivery Mail-Order Pharmacy. You will save time and money because for certain drugs you can get up to a three-month supply at a lower cost (2x retail copay instead of 3x). You will also find it handy to have your prescriptions delivered right to your door at no extra cost. Here’s how you can get started with home delivery:
|
-
Deductible
The amount of covered expenses you must pay before the Plan starts paying benefits.
In-network:
Individual: $500
Family: $1,500Out-of-network:
Individual: $1,000
Family: $3,000
-
Coinsurance
Cost-sharing between you and the company. This is applied after you meet your deductible.
In-network:
You pay 30% (after deductible)
Plan pays 70%Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Out-of-Pocket Maximum
The most you are required to pay out of your own pocket in a plan year. Some expenses may not apply.
In-network:
Individual: $5,500
Family: $11,000Out-of-network:
Individual: $7,500
Family: $22,500
-
Doctor’s Office Visit
In-network:
You pay 30% (after deductible)
Plan pays 70%Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Specialist Office Visit
Specialists include doctors trained in a specific area or function of the body, or a specific age group (cardiologist, pediatrician, orthopedic surgeon, neurologist, etc.).
In-network:
You pay 30% (after deductible)
Plan pays 70%Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Preventive/Well Child Care
Care focused on prevention or early detection of health conditions. Includes routine physical exam, immunizations, cancer screenings, vision and hearing exams, etc.
In-network:
You pay $0
Plan pays 100%Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Emergency Room
Provides accidental injury and medical emergency care. Note: Call your plan immediately if you are admitted to the hospital.
In-network:
You pay 30% (after deductible)
Plan pays 70%Out-of-network:
You pay 30% (after deductible)
Plan pays 70%
-
Urgent Care
Non-emergency care received from an urgent care clinic or other medical facility; typically used after hours or when your regular doctor is not available.
In-network:
You pay 30% (after deductible)
Plan pays 70%Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Hospitalization
Inpatient In-network:
30% coinsurance after $200 copay
Inpatient Out-of-network:
50% coinsurance after $200 copay
Outpatient In-network:
You pay 30% (after deductible)
Plan pays 70%Outpatient In-network:
You pay 50% (after deductible)
Plan pays 50%
-
Laboratory (LabCorp & Quest)
In-network:
You pay 30% (after deductible)
Plan pays 70%Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Radiology
In-network:
You pay 30% (after deductible)
Plan pays 70%Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Complex Imaging MRI/CAT/PET
In-network:
You pay 30% (after deductible)
Plan pays 70%Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Durable Medical Equipment
In-network:
You pay 30% (after deductible)
Plan pays 70%Out-of-network:
You pay 50% (after deductible)
Plan pays 50%
-
Vision
Vision Eyewear: Covered 100% up to $300 every 24 months; not subject to any plan deductible, if applicable
-
Are you required to use network providers?
No (but your costs will be lower when you do)
-
Do you need a referral to a specialist?
No.
-
Prescription Drug
Deductible - See Deductible above
Retail (Up to 31-day supply)
In-network Only
Tier 1: $5 copay
Tier 2: $30 copay
Tier 3: $40 copayMail Order (Up to 90-day supply)
In-network Only
Tier 1: $10 copay
Tier 2: $60 copay
Tier 3: $80 copay
-
Express Scripts’ Home Delivery Pharmacy – save time and money
If you take medicine on a long-term basis, consider Express Scripts’ Home Delivery Mail-Order Pharmacy. You will save time and money because for certain drugs you can get up to a three-month supply at a lower cost (2x retail copay instead of 3x). You will also find it handy to have your prescriptions delivered right to your door at no extra cost. Here’s how you can get started with home delivery:
- ePrescribe
- Ask your doctor to send your prescription electronically to the Express Scripts Pharmacy. - Call 800-698-3757
- Talk with a prescription plan specialist. - Mail
- Complete a home delivery order form.
- Get a 90-day prescription from your doctor.
- Mail your form, payment (or payment info) and prescription to the address on the form.
- ePrescribe
-
Click To Download Plan Documents:
Basic Plan
Provider: Aetna
Phone: 800-962-6842
Website: http://www.aetna.com/
If you have any questions about your new prescription benefit program, please contact Express Scripts’ Customer Service at 855-832-7897.
Aetna - Find a Provider
- Go to www.aetna.com.
- Click on “Find a Doctor”.
- Click on “Search for Doctor, Dentist, or Facility”.
- Log-In as a Member, or click on “Find Doctors,
Dentists, and Hospitals in Our Plans
- Click on “Through an Employer Organization”.
- You can enter the type of doctor you are searching for, or even search by conditions.
- Enter the zip code that you want to search around.
- Select your plan:
- To search for a medical provider, select Aetna Choice POS II (Open Access).
- Click “Search” to view your results.
Aetna Navigator Registration Instructions
*In order to take full advantage of Aetna’s website for access to the following and more:
- Check Claim Status
- Paperless Explanation of Benefits
- Request an ID card
- Go to www.aetna.com
- Click on “Log In/Register”
- Under First-time users click on “Register Now”.
- Enter your personal information. If you do not have your member ID number, there is an option to use your social security number.
- You will then create a username and password.
2026 Dental Delta DPPO Copay 6 Booklet
2026 Dental Delta DPPO Copay 6 Contract
| Basic Plan | High Plan |
|---|---|
DeductibleIn-network: Individual: $500 |
DeductibleIn-network: Individual: $0 |
CoinsuranceIn-network: You pay 30% (after deductible) |
CoinsuranceIn-network: You pay 0% |
Out-of-Pocket MaximumIn-network: Individual: $5,500 |
Out-of-Pocket MaximumIn-network: Individual: $5,500 |
Doctor’s Office VisitIn-network: You pay 30% (after deductible) |
Doctor’s Office VisitIn-network: You pay a $20 copay |
Specialist Office VisitIn-network: You pay 30% (after deductible) |
Specialist Office VisitIn-network: You pay a $20 copay |
Preventive/Well Child CareIn-network: You pay $0 |
Preventive/Well Child CareIn-network: You pay $0 |
Emergency RoomIn-network: You pay 30% (after deductible) |
Emergency RoomIn-network: $150 copay/visit, deductible doesn’t apply |
Urgent CareIn-network: You pay 30% (after deductible) |
Urgent CareIn-network: You pay a $20 copay |
HospitalizationInpatient In-network: 30% coinsurance after $200 copay |
HospitalizationInpatient In-network: Plan Pays 100% after $200 per copay |
Laboratory (LabCorp & Quest)In-network: You pay 30% (after deductible) |
Laboratory (LabCorp & Quest)In-network: You pay 0% |
RadiologyIn-network: You pay 30% (after deductible) |
RadiologyIn-network: You pay 0% |
Complex Imaging MRI/CAT/PETIn-network: You pay 30% (after deductible) |
Complex Imaging MRI/CAT/PETIn-network: You pay 0% |
Durable Medical EquipmentIn-network: You pay 30% (after deductible) |
Durable Medical EquipmentIn-network: You pay 0% |
VisionVision Eyewear: Covered 100% up to $300 every 24 months; not subject to any plan deductible, if applicable |
VisionVision Eyewear: Covered 100% up to $300 every 24 months; not subject to any plan deductible, if applicable |
Are you required to use network providers?No (but your costs will be lower when you do) |
Are you required to use network providers?No (but your costs will be lower when you do) |
Do you need a referral to a specialist?No. |
Do you need a referral to a specialist?No. |
Prescription DrugRetail (Up to 31-day supply) Mail Order (Up to 90-day supply) |
Prescription DrugRetail (Up to 31-day supply) Mail Order (Up to 90-day supply) |
Express Scripts’ Home Delivery Pharmacy – save time and moneyIf you take medicine on a long-term basis, consider Express Scripts’ Home Delivery Mail-Order Pharmacy. You will save time and money because for certain drugs you can get up to a three-month supply at a lower cost (2x retail copay instead of 3x). You will also find it handy to have your prescriptions delivered right to your door at no extra cost. Here’s how you can get started with home delivery:
|
Express Scripts’ Home Delivery Pharmacy – save time and moneyIf you take medicine on a long-term basis, consider Express Scripts’ Home Delivery Mail-Order Pharmacy. You will save time and money because for certain drugs you can get up to a three-month supply at a lower cost (2x retail copay instead of 3x). You will also find it handy to have your prescriptions delivered right to your door at no extra cost. Here’s how you can get started with home delivery:
|