How to Save Time and Money
Use in-network providers
Use alternatives to the emergency room
Contribute to your Health Savings Account
Prevent serious health conditions
Use prescription drug cost-saving features
Call Health Advocate for help with medical bills
Get expert advice for a health condition
At CMSU, we strive to bring you a benefits program that is made for your life, and one of the most vital benefits we offer is medical coverage. But even with a good medical plan, an accident or illness can be costly. Fortunately, your CMSU benefits offer many ways to help you save time and money.
Aetna contracts with doctors, hospitals, labs, and other facilities. If you are enrolled in the EPO medical plan, all services must be received with the EPO network.
If you are enrolled in one of the Company's CDHP medical plans, you have the option of seeking care with in-network providers or out-of-network providers. When you use in-network providers you save money in three ways:
- Higher benefits. Your deductible and coinsurance are lower when you use in-network providers.
- Contracted rates. In-network providers agree to charge Aetna members contracted (i.e., discounted) rates, which means that your medical bill will be as low as possible right from the start.
- No excess fees. Unlike in-network providers, out-of-network providers can charge you more than Aetna allows for a covered service. Aetna does not cover any charges over their allowed amount, so you will be responsible for all charges over the allowed amount.
To see how this would work, the following example assumes you are a single employee in the CDHP Select plan. After meeting your deductible for the year, you need to have surgery. The example shows your share of costs (coinsurance).
| |
In-Network Provider
(Plan pays 80%) |
Out-of-Network Provider
(Plan pays 50%) |
| Actual charge without the network discount: |
$8,000 |
$8,000 |
| Amount allowed by the medical plan: |
$6,000 (the discounted rate agreed to by the provider) |
$6,000 (the plan does not cover the $2,000 difference) |
| Medical plan pays: |
80% of the discounted rate:
$6,000 x 80% = $4,800 |
50% of the allowed amount:
$6,000 x 50% = $3,000 |
| You pay: |
20% of the discounted rate:
$6,000 x 20% = $1,200 |
50% of charges ($6,000) plus 100% of the amount the plan does not allow ($2,000):
$3,000 + $2,000 = $5,000 |
To find an in-network provider for one of the CDHPs, visit Aetna’s website.
An accident or illness can happen outside of normal office hours, making it difficult to see your regular doctor. In the case of a life-threatening emergency, such as a heart attack, stroke, heavy bleeding, broken bones, or anything that threatens life or limb, call 911 or go directly to an ER.
However, if you go to the ER for a non-emergency, you will pay for expensive life-saving ER equipment and specialized ER staff, even if you don’t need it, and you won’t be treated until all the true emergency patients have been seen first. The typical ER visit based on Aetna’s national average is $2,430.
For non-emergencies, you have the following convenient and cost-saving alternatives:
- NurseLine—if you don’t know if you should see a doctor, NurseLine can direct you to the most appropriate resource for your situation. Call NurseLine at 800-556-1555, 24/7. NurseLine is available at no cost to you.
- Teladoc—if you need to consult with a doctor without having to leave your home or visit a medical facility, call Teladoc for secure, private video chats with U.S. board-certified doctors. Visit the Teladoc website or download the free Teladoc app on your mobile device and follow the instructions to sign up and/or request a video visit. Teladocv is available 24/7 for $56 per video consult.
- Urgent Care—in-person visits for urgent but not life-threatening issues. Availability varies by location. Costs are generally much lower than an ER visit ($129 based on Aetna’s national average).
CMSU’s CDHP medical plans come with a Health Savings Account (HSA). An HSA is a tax-advantaged savings account to help pay for health care expenses, such as your deductible and coinsurance. The HSA can help you save money on your health care expenses as follows:
- Money from CMSU. Each January that you are enrolled in a Company CDHP medical plan, CMSU makes a base Company HSA contribution to your account. If you are new to CMSU, or enroll mid-year due to a qualifying life event, you will receive a pro-rated contribution amount. Plus, you can earn more dollars for your HSA if you complete the Annual Wellness Incentive.
- Federally-approved tax advantages. Your HSA contributions are made with pre-tax dollars, interest and investment earnings grow tax free, and funds used to pay for eligible expenses are tax free. (Most states provide a state triple tax advantage that mirrors the federal tax rules, but not all—consult your tax advisor regarding state tax treatment.)
Learn more about HSAs
One of the best ways to avoid costly medical expenses is to prevent health issues before they start. Here are some ways your CMSU benefits can help prevent major illness:
- Get inspired to live a healthy life. Our Personify Health program will make physical activity more fun with contests and prizes and motivate you to meet your health goals.
- Avoid tobacco. Call 866-QUIT-4-LIFE (866-784-8454) or visit the Quit For Life website to learn how to quit tobacco for good.
- Maintain a healthy weight. Newtopia is an innovative weight-loss program designed to help people who are
at risk of developing diseases such as diabetes, heart disease, or stroke. To find out if you are eligible, take
Newtopia’s online screener.
- Get preventive care and routine screenings. Your Aetna health plan covers annual preventive exams and preventive screenings at 100% in the Aetna network. And the Critical Illness, Accident Insurance, and Hospital Insurance plans pay a wellness benefit each year that you receive covered screenings.
Our prescription drug plan has two key features that help you save money on medications:
- Ask about less-expensive alternative drugs. When your doctor prescribes a medication, ask if it is the most cost-effective medication available. In addition, CMSU offers an extensive list of preventive drugs at no cost to you. Share this list with your physician to find out if you can take advantage of this benefit.
- Use mail order prescriptions. If you take medication for an ongoing health condition, take advantage of the mail order service. You’ll receive a 90‑day supply of your medication for less than the cost of three retail copays and avoid unnecessary trips to the pharmacy.
It’s always important to check your medical bills to be sure that they make sense and you are not being overcharged. If anything seems out of place or if you have questions about a provider’s bill, you can call Health Advocate at 866-695-8622. Health Advocate will reach out to your doctors and insurance company on your behalf and resolve any billing issues for you. Health Advocate is a Company benefit, and available at no cost to you.
If you’re unsure about a diagnosis, 2nd.MD can provide an expert second opinion and review your doctor’s treatment plan. 2nd.MD that refers you to the top specialists in their field so you have peace of mind when making decisions about your medical care.
2nd.MD can help you:
- Find an expert second opinion from a world-renowned specialist in your Aetna network, with in person and remote options
- Refer you to in-network specialists for treatment and urgent issues
- Collect medical records and schedule appointments
- Learn more about your condition and compare your treatment options
- Prepare you for elective surgery and expected recovery
- Ask your doctor the right questions for your situation
- Cope with the stress of having a medical condition
2nd.MD is available at no cost to all employees and their covered dependents who are enrolled in one of CMSU’s Aetna medical plans. You may call them at 866-841-2575 or visit the 2nd.MD website.