Aetna Choice POS II Consumer Driven Health Plan
Administered by: Aetna
With an optional Health Savings Account (HSA)
At Arkema, we offer comprehensive and affordable benefits to ensure that you and your family have the coverage you need to feel healthy and safe. While you pay for a portion of the cost for some benefits, Arkema pays for the majority of the cost of all your benefits.
No Surprises Act and Transparency in Coverage
The Departments of Health and Human Services, Labor, and Treasury (the Departments) released The Consolidated Appropriations Act (CAA) and Transparency in Coverage (TiC) rules that put several new compliance mandates on group health plan sponsors. Arkema is working with our carriers and third-party administrators (TPAs) to ensure we have the necessary information in the proper format to comply with the new rules.
Learn more about the No Surprises Act through Aetna and access Aetna’s machine-readable files for Transparency in Coverage.
You are eligible to participate in the U.S. health and welfare benefits program if you are a regular, full-time employee or a regular, part-time employee who works at least 20 hours per week.
If you are eligible for health benefits, you may also cover eligible dependents for medical, dental, vision and dependent life insurance coverage. Eligible dependents include:
- Your lawfully married spouse, including your common-law spouse in states where such relationships are recognized
- Your children, including stepchildren, legally adopted children and foster children until the end of the month in which they turn age 26
- Your disabled children, regardless of their age, provided they became disabled before age 26
Enrolling Dependents
You are required to provide the Social Security number (SSN) for any dependent you wish to cover over the age of two. Call the Arkema Benefits Center at 1-800-406-9823 to enroll dependents without a valid SSN. These are required for annual government filings.
You will need to provide the required Dependent Verification Documentation for each dependent you add to Arkema benefits when you enroll. Please ensure that your dependent(s) meets the eligibility criteria and be ready to provide the documentation. You must upload it to Arkema Benefits Online, fax it, or submit by mail within 60 days of enrollment or your dependent’s coverage will be dropped.
If you are eligible for medical coverage, Arkema offers you the choice of two comprehensive medical plans:
Aetna Choice POS II PPO
Administered by: Aetna
For a full overview of each plan’s coverage of all conditions and services, visit the Documents and Resources page and consult the Summaries of Benefits and Coverage for each plan.
Travel and Lodging Benefits
Through your Arkema medical plan, you have access to a travel and lodging benefit that provides access to Aetna Institutes of Quality (IOQ) for organ transplant, bariatric surgery and major orthopedic surgery at an Aetna IOQ. Facility charges for major orthopedic surgery are reduced for those who do not receive knee, hip, shoulder replacement or back and/or neck surgery at an Aetna IOQ facility. Expenses for bariatric surgery are not covered outside of an IOQ.
This benefit also applies to services to access infertility, abortion, and gender-affirming medical services not available within 100 miles of your home. Please contact Aetna Member Services at 1-800-238-3488 for benefit details and claim reimbursement guidance.
Review the table below for a high-level view of how the medical plan options compare. Consult the Medical Plans rate sheet to view how much you will pay for coverage.
| Aetna Choice POS II CDHP with HSA | Aetna Choice POS II PPO | |||
|---|---|---|---|---|
| In-Network | Out-of-Network* | In-Network | Out-of-Network* | |
| Annual deductible |
$1,800/employee only coverage
$3,600/all other coverage levels
|
$3,600/employee only coverage
$7,200/all other coverage levels
|
$750/person
$1,500/family
|
$1,500/person
$3,000/family
|
| Annual out-of-pocket maximum |
$4,000/employee only coverage
$8,000/all other coverage levels
|
$8,000/employee only coverage
$16,000/all other coverage levels
|
$3,000/person
$6,000/family
|
$6,000/person
$12,000/family
|
| (includes the deductible, coinsurance, and prescription drug payments, and excludes prescription drug penalties, and any amount exceeding recognized charges) | (includes the deductible, copays and coinsurance, and excludes prescription drug payments, any prescription drug penalties, and any amount exceeding recognized charges) | |||
| Preventive care including immunizations | Plan pays 100% (no deductible) | Plan pays 60% after deductible | Plan pays 100% (no deductible, no copay) | Plan pays 60% after deductible |
| HSA Contributions |
$600/employee only coverage $1,200/dependent coverage |
N/A | ||
| Office visits | ||||
| PCP | Plan pays 80% after deductible | Plan pays 60% after deductible | $30 copay (no deductible) | Plan pays 60% after deductible |
| Specialist | Plan pays 80% after deductible | Plan pays 60% after deductible | $40 copay (no deductible) | Plan pays 60% after deductible |
| X-rays and lab work** | Plan pays 80% after deductible diagnostic lab plan pays 100% (no deductible) | Plan pays 60% after deductible |
X-rays: Plan pays 80% after deductible
Lab work: Plan pays 100% for outpatient;
80% after deductible for inpatient
|
Plan pays 60% after deductible |
| Maternity*** for Mother and Baby (including nurse and/or midwife services) | ||||
| Office Visits | Plan pays 80% after deductible | Plan pays 60% after deductible | $40 copay for first visit, then plan pays 100%; | Plan pays 60% after deductible |
| Inpatient Physician Care | Plan pays 80% after deductible | Plan pays 60% after deductible | Plan pays 80% after deductible | Plan pays 60% after deductible |
| Emergency room | Plan pays 80% after deductible | Plan pays 80% after deductible | Plan pays 80% after deductible | Plan pays 80% after deductible |
| Outpatient surgical facility | Plan pays 80% after deductible | Plan pays 60% after deductible | Plan pays 80% after deductible | Plan pays 60% after deductible |
|
Inpatient hospital
Bariatric surgery is only covered when performed at an Aetna Institute of Quality
|
Plan pays 80% after deductible | Not covered | Plan pays 80% after deductible | Not covered |
|
Inpatient hospital
Orthopedic surgery is only covered at in-network levels when performed at an Aetna Institute of Quality
|
Plan pays 80% after deductible | Plan pays 60% after deductible | Plan pays 80% after deductible | Plan pays 60% after deductible; you pay $250 per inpatient stay |
| Inpatient mental health and substance abuse | Plan pays 80% after deductible | Plan pays 60% after deductible | Plan pays 80% after deductible | Plan pays 60% after deductible; you pay $250 per inpatient stay |
| Outpatient mental health and substance abuse | Plan pays 80% after deductible | Plan pays 60% after deductible | $30 copay (no deductible) | Plan pays 60% after deductible |
| Infertility treatment and benefits |
Plan pays 80% after deductible for up to six cycles of most fertility treatments, with a $15,000 lifetime maximum for advanced reproductive technology benefits;****
combined in- and out-of-network
|
Plan pays 60% after deductible for up to six cycles of most fertility treatments, with a $15,000 lifetime maximum for advanced reproductive technology benefits;****
combined in- and out-of-network
|
Plan pays 80% after deductible for up to six cycles of most fertility treatments, with a $15,000 lifetime maximum for advanced reproductive technology benefits;****
combined in- and out-of-network
|
Plan pays 60% after deductible for up to six cycles of most fertility treatments, with a $15,000 lifetime maximum for advanced reproductive technology benefits;****
combined in- and out-of-network
|
| Chiropractic care | Plan pays 80% after deductible limited to 30 visits per year; combined in- and out-of-network | Plan pays 60% after deductible; limited to 30 visits per year; combined in- and out-of-network | Plan pays 80% after deductible; limited to 30 visits per year; combined in- and out-of-network | Plan pays 60% after deductible; limited to 30 visits per year; combined in- and out-of-network |
* The plan bases the payment on what Aetna considers to be the discounted cost (recognized charge) for an expense. If the charge is more than the discounted cost set by the plan, you pay 100% of the amount that exceeds the discounted cost, in addition to any applicable deductible and coinsurance amounts. If you reach the annual out-of-network, out-of-pocket maximum (excluding amounts exceeding the recognized charge), the plan will pay 100% of eligible expenses the rest of the year.
** Under the PPO, lab work billed by the provider is subject to the applicable copay. Lab work billed by an independent network lab is covered at 100%.
*** Lab work and inpatient hospital stays for maternity are covered as all other regular lab work and inpatient hospital stays.
****Advanced reproductive technologies include treatments such as IVF, ZIFT, GIFT, ICSI, PGD and PGS.
Accessing Your ID Card and Filing Claims
If you enrolled in Medical coverage for the first time or made any changes to your medical plan elections for this year, you should have received a new ID card in the mail. If you haven’t made any changes to your medical plan or coverage, you can continue to use your existing card. You may view/download an electronic card when you log into aetna.com. You may also request a new card via mail on the site or by speaking to a member services representative at 1-800-238-3488.
To file a claim for out-of-network expenses, log into aetna.com, hover over the "Claims" tab, and click "Submit a Claim." The claims submission tool will walk you through what supporting documentation you need to submit your claim.
Choosing a medical plan can be difficult, but Arkema is here to help demystify the benefits and drawbacks of each plan. See below for some scenarios to help you see what your out-of-pocket costs may look like under each Arkema medical plan depending on factors like how many dependents you cover, how frequently you require medical care, and more.
Meet Matt
Matt is 26 and enrolling in coverage for the first time. He is unmarried with no children. He is generally healthy and doesn’t need a lot of medical care.
| Matt’s total annual costs for health care usage for 2024 services | |||
|---|---|---|---|
| Service (in-network) | Fee | CDHP | PPO |
| Annual physical | $141.43 | Covered at 100% | Covered at 100% |
| 2 generic prescriptions | $67.56 | $67.56 (deductible is not yet met) |
$20 copay (x2) =$40 |
| Cost of care for the year | $67.56 | $40 | |
| Less $600 Contribution to the HSA. | -$67.56 (Matt uses $67.56 to cover his cost of care for the year and saves $532.44 for future use) |
N/A | |
| Annual Contributions (based on earning the Wellness Matters incentive) | $1,140.00 ($43.85 X 26) |
$2,112.00 ($81.23 X 26) |
|
| Total Annual Costs (Contributions + Cost of Care) | $1,140.00* | $2,152.00 | |
*This number represents the total annual cost after using the Health Savings Account contribution and Matt still has $532.44 in his HSA to use for future healthcare expenses.
Meet Jasmine
Jasmine and her husband are enrolled in employee + spouse coverage and are having a baby this year. They are both generally healthy, but Jasmine will require pre- and post-natal care.
| Jasmine’s total annual costs for health care usage for 2024 services | |||
|---|---|---|---|
| Service (in-network) | Fee | CDHP | PPO |
|
Maternity experience includes:
|
$16,887.11 |
$6,257.42 |
$3,000.00 |
| Cost of care for the year | $6,257.42 | $3,000 | |
| Less $1200 Contribution to the HSA. | -$1,200.00 | N/A | |
| Annual Contributions (based on earning the Wellness Matters incentive) |
$2,856.00 ($109.85 X 26) |
$4,932.00 ($189.69 X 26) |
|
| Total Annual Costs (Contributions + Cost of Care) |
$7,913.42* |
$7,932.00 |
|
*This number represents the total annual cost after using the Health Savings Account contribution.
Meet Jim
Jim is married and has four children. He and his family are generally healthy, however, one of his sons injures his arm playing basketball and his wife accidentally slices her hand while preparing dinner.
| Jim’s total annual costs for health care usage for 2024 services | |||
|---|---|---|---|
| Service (in-network) | Fee | CDHP | PPO |
|
6 annual physicals |
$1,077.90 |
Covered at 100% |
Covered at 100% |
|
ER visit for son (including X-ray and cast) |
$2,641.00 |
$2,641.00 |
$1,128.20 |
|
ER visit for wife (including stitches) |
$820.17 |
$820.17 (20% after deductible) |
$764.03 (20% after deductible) |
| Cost of care for the year | $3,461.17 | $1,892.23 | |
| Less $1200 Contribution to the HSA. | -$1,200.00 | N/A | |
| Annual Contributions (based on earning the Wellness Matters incentive) |
$4,344.00 ($167.08 X 26) |
$7,524.00 ($289.38 X 26) |
|
| Total Annual Costs (Contributions + Cost of Care) |
$6,605.17* |
$9,416.23 |
|
*This number represents the total annual cost after using the Health Savings Account contribution.
If Jim’s family medical expense usually involves Accidents, Jim might also want to consider the Accident Insurance coverage offered as a supplemental benefit that pays cash directly to the employee in the event of an accident.
Meet Dolores
Dolores is married and has one child still on her plan. She and her family are generally healthy; however, her husband is managing high cholesterol and high blood pressure and needs regular medication and doctor visits. He has had negative side effects from the generic form of his high blood pressure medication and has a doctor’s prescription for the brand-name drug, Zestril. Dolores’ family meets their deductible in June.
| Dolores’ total annual costs for health care usage for 2024 services | |||
|---|---|---|---|
| Service (in-network) | Fee | CDHP | PPO |
|
3 annual physicals |
$538.95 |
Covered at 100% |
Covered at 100% |
|
12 doctor visits with lab work to check on cholesterol and blood pressure (Outpatient lab work is covered at 100% under both Arkema medical plans) |
$2,155.80 |
$1,077.90 (deductible is $215.58 (20% of remaining $1,077.90 after deductible) |
$40 copay (x12) = $480 |
|
Annual cost of 90 day supply of generic cholesterol medication ($192.00) and brand-name high blood pressure medication ($5,040.00) |
$5,232.00 |
$1,444.20 (deductible is not yet met $757.56 (20% of remaining $3,787.80 after deductible) |
$20 copay + $120 copay = $140 copay (x4) = $560 |
| Cost of care for the year | $3,495.24 | $1,040 | |
| Less $1200 Contribution to the HSA. | -$1,200.00 | N/A | |
| Annual Contributions (based on earning the Wellness Matters incentive) |
$4,344.08 ($167.08 X 26) |
$7,523.88 ($289.38 X 26) |
|
| Total Annual Costs (Contributions + Cost of Care) |
$6,639.32 |
$8,563.88 |
|
HSA
You can set aside tax-free money from your paycheck and receive company contributions to help cover your costs — now, or in the future.
Deductible and Coinsurance
The deductible is how much you pay before insurance covers your medical costs. You pay 100% of your costs until you meet the deductible.
Then you pay coinsurance; you share the cost of covered medical expenses, but the plan pays the majority.
Prescription Drugs
You pay the full price of prescription drugs until you meet the deductible. Certain preventive drugs are not subject a deductible and no copay is charged. See the Preventive Drug List for more information.
Out-of-Pocket Maximum
You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.
Deductible
Your deductible is the amount you must pay before your insurance will cover your medical costs. You pay 100% of your medical costs until you meet the deductible. This plan has a lower deductible than the CDHP.
Copay
You pay a small fee at the time of service for doctor visits and prescriptions called a copay. Copays do not count toward your deductible.
Out-of-Pocket Maximum
You’re protected by an annual limit on costs called the out-of-pocket maximum. Once you meet it, the plan pays 100% of any further covered expenses for the rest of the year.
Discovering health issues early can often help you avoid costly treatments in the future. Arkema believes in prevention and well-being and most IN-NETWORK annual preventive care is covered at 100%, with no copay or deductible required.
Covered preventive care services include, but are not limited to:
- Well-Child Care
- Adult Physical (including routine lab work)
- Routine OB/GYN Exams
- Screening Mammogram
- Routine Digital Rectal Exam/Prostate-specific Antigen Test (men age 40 and over)
- Colorectal Cancer Screening
- Routine Eye and Hearing Exams
- Skin Cancer Screening (If you are going to be screened for skin cancer, the cost for the office visit and any lab test or procedure for that visit only is covered in full. If you are charged for the visit, please contact Aetna member services and notify them that your visit on a specific date with your physician was a skin cancer screening and should be paid at 100%. They will confirm with the physician’s office and adjust the claim.) If Aetna member services does not adjust the claim, please contact the Arkema Benefits Center at 1-800-406-9823, Monday to Friday, 9 a.m.-6 p.m. EST to create a case.
- Eye exams are covered at 100% with no deductible for routine vision exams. We include the following procedures in the fee paid for a routine eye exam under the Arkema medical plan:
- Contrast sensitivity test
- Corneal pachometry
- Determination of refractive state
- Dilation
- Direct ophthalmoscopy – detects glaucoma
- Eyeglass fitting
- Glare Amsler Grid (w/wo Maddox)
- Guyton acuity test
- Muscle balance assessment
- Pupil check
- Retinal check
- Shirmer tear test
- Slit lamp exam
- Teller acuity test
- Visual analysis
- One hearing exam every 24 months is covered at 100% with no deductible or copay. Typically hearing exams/screenings are in conjunction with a routine physical as a preventive measure. If a member suspects something is wrong like hearing loss and makes an appointment and is charged for hearing aids, the visit would be considered diagnostic.
- If a member is seeing an ENT for a preventive visit and they have no concerns prior to visit it will be considered preventive. If they are scheduling an appointment with an ENT for a concern, it will not be preventive.
Prevention and Mammogram Coverage for High-Risk Patients
Because we believe strongly in supporting preventive screenings, there is 100% coverage for diagnostic mammograms (and ultrasounds and MRIs of the breast) for those who are at higher risk and BRCA genetic screening at 100% when provided in-network. This means you do not pay for diagnostic mammograms or ultrasounds or MRIs as part of regular screening.
You are considered high-risk (and as a result, fully covered for a mammogram) if you have:
- Personal history of atypical breast histologies
- Personal history or family history of breast cancer
- Genetic predisposition for breast cancer
- Prior therapeutic thoracic radiation therapy
- Extremely dense breast tissue based on breast composition categories of the Breast Imaging and Reporting Data System established by the American College of Radiology
- Heterogeneously dense breast tissue based on breast composition categories of the Breast Imaging and Reporting Data System established by the American College of Radiology with any 1 of the following risk factors:
- Lifetime risk of breast cancer of greater than 20%, according to risk assessment tools based on family history
- Personal history of BRCA1 or BRCA2 gene mutations
This does not change the 100% in-network coverage available for bilateral screening mammograms. Arkema’s plan has no age or frequency limit for this service. If you need to be screened more than one time a year, it will be covered.
Confirm Your Preventive Care Services Are 100% Covered
When you attend an appointment for preventive care services, you should advise your in-network provider that your plan will pay 100% for certain preventive services each calendar year. The Aetna medical plan also will reimburse an eye exam every 24 months.
Services will not be covered as preventive care if medical diagnosis coding is listed on the provider’s invoice. Check with your provider to be sure the services you receive are coded as preventive care.
Aetna Transgender and Gender Affirming Services
If you enroll in an Aetna plan, you also have access to transgender and gender affirming services. This includes connecting you with advocates for transgender people.