Aetna California HSA Compatible Medical Insurance Plan

Aetna California small group health insurance plans which are compatible with California Health Savings Accounts (HSA) have several unique features:

  • they have “embedded deductibles,”
  • pay 100 percent after the deductible,
  • pay for preventive care before the deductible is paid,
  • limit the family deductible,
  • have two separate deductibles for preferred and non-preferred providers, and,
  • don’t have that many preferred providers in the Managed Choice provider network.

What’s an “embedded deductible” and is it something that you want?

Aetna’s California Managed Choice High Deductible Health Plan (CA MC HDHP) has a $2,100 deductible. Usually, a California HSA compatible health plan must double the deductible when two or more family members enroll in the same HDHP. In this case the deductible would become $4,200. However, under the Aetna California MC HDHP, the insurance company will begin paying benefits after a single person reaches the $2,100 deductible.

Preventive Care Paid Before Deductible

One other unique feature of the Aetna CA MC HDHP $2,100 plan is that members can obtain “routine physical exams” for only $15 before having to pay the calendar year deductible. So, adults can get a physical (up to $300 every 24 months,) children can get Well Child Care including immunizations, women can receive one routine GYN exam every calendar year and a routine mammography exam – all without having to pay the $2,100 deductible. (See Aetna Evidence of Coverage (EOC), Summary of Coverage (SOC).)

Family Deductible is Limited to $4,200

The annual deductible is $2,100 per member $4,200 per family (SOC p. 6). The calendar year deductible applies to each person and it includes covered prescription medicine and coverd medical expenses. (EOC p. 18) According to the EOC page 18, “The family deductible limit: If Covered Medical Expenses and Prescription Drug Expenses incurred in a calendar year by you and your dependents and applied against the separate Calendar Year Deductibles equal the Family Deductible Limit, you and your dependents will be considered to have met the separate Calendar Year Deductibles for the rest of that calendar year.”

Separate Deductible for In-Network and Out-of-Network Providers – with small network

While the embedded deductible make the Aetna CA MC HDHP plan desirable, beware of the separate out of network deductible. With this plan, if you access care from non-preferred providers you must pay an additional $2,100 deductible. These are “two pots of money.” Also, Aetna’s California Managed Choice network is not that extensive, so going out of network is easy to do.

Plan Pays 100 Percent after Deductible

Another unique feature of California Health Savings Accounts like the Aetna CA MC HDHP $2,100 plan is, that Aetna pays 100% of the medical expenses after the single deductible is met when a member uses preferred providers. This means that if only one person gets very ill and is able to use preferred providers, generally, the out of pocket expenses would be limited to $2,100. A very low amount for a family on an California HSA compatible health plan.

So, in summary: embedded deductible good; separate deductible for non-preferred providers bad.