Gold Plan
The Gold plan is a high-deductible health plan or “HDHP” in the Aetna Choice network. The plan combines traditional medical coverage with a tax-free health savings account (HSA) and consists of these key components:
- You must pay the deductible before the plan begins to pay. The deductible is the amount of eligible medical and prescription drug expenses you must pay each plan year before the plan begins to pay a percentage of those expenses.
- 100% coverage for preventive care when provided by an in-network physician. There is no cost to you or your account.
- Lower monthly premiums than traditional health insurance plans.
- A Health Saving Account (HSA) savings account established through WEX that you use to pay health care expenses. You can and Carnegie will deposit tax-free contributions (subject to federal limits) to this savings account.
All the features and benefits of the Gold (HSA) high-deductible health plan are designed to make health care expenses more manageable for employees. Additionally, the Gold plan can save you money overall with the interest earned and tax advantages given to deposits and qualified withdrawals in an Health Savings Account (HSA).
How the Plan Works:
The Health Savings Account (HSA)
If you elect coverage under the Gold plan, an HSA account will be opened on your behalf. Our third-party administrator, WEX, may contact you directly in order for you to complete setting up your HSA account. Once the account is established, Carnegie will deposit tax-free contributions, subject to federal limits, into to your HSA savings account. In addition to the contributions made by Carnegie, employees can also make contributions, up to the federal limit. HSA funds are tax free when used to pay for qualified medical, dental and vision care expenses not covered by the Gold Plan. There is no "use it or lose it" -- unspent funds remain in your account if you change jobs or retire, and any interest you may earn on your HSA grows income tax free.
*Not everyone is eligible to participate in an HSA. You must be enrolled in the Gold Plan. If you are enrolled in TRICARE, Medicare Part A, or another plan that is not a high-deductible health plan, you
are not eligible to enroll in an HSA.
**If you do not contribute the maximum, the catch-up contribution won't be as meaningful because it is meant to allow you to contribute more than the annual limit.
Limited-Purpose Flexible Spending Account (Gold Plan Only)
Because IRS rules prevent employees who open an HSA from participating in and contributing to a traditional Healthcare Flexible Spending Account, employees who elect coverage under the Gold plan may elect to open a Limited-Purpose Flexible Spending Account (LPFSA). Funds are deposited as tax-free contributions into this account and can only be used to pay for eligible dental and vision expenses. The Limited-Purpose FSA can be opened in addition to your Health Savings Account (HSA).
How do you benefit from having both a Limited-Purpose FSA and an HSA? With a Limited Purpose FSA, you can set aside money specifically for dental and vision expenses. By eliminating the need to use your HSA funds for these expenses, you have more money to spend on regular medical expenses. More importantly, funding dental and vision expenses from a Limited Purpose FSA may allow you to keep more savings in your HSA. Overtime, those additional savings can help your retirement nest egg grow larger.
Two levels of benefits:
- In-Network Benefits - When you use in-network providers, you pay a fixed dollar amount, called a copayment (or copay), for doctor’s office visits and routine exams. For other services, you pay a lower deductible and the plan pays a larger share of your expenses. Also, the network provider files claims for you and takes care of the plan’s precertification requirement(s) for hospital admissions.
- Out-of-Network Benefits - If you decide to use an out-of-network provider, you will receive a lower level of benefits and you must meet a higher deductible. The plan pays a smaller share of your expenses. You must file your own claims and call Aetna when your doctor recommends care that must be pre-certified.
Staying In-Network
- While you are free to use any provider, you save money when you use in-network providers.
- If your doctor refers you to another provider (such as a specialist), be sure to ASK if the provider belongs to the network. If he or she doesn’t, benefits will be paid at the lower, out-of-network level AND only up to what Aetna determines to be the reasonable charge for the service. You’ll be billed for any amount that exceeds the reasonable charge.
- The Aetna Choice POS network is large and comprehensive. It consists of primary care physicians and specialists ranging from cardiologists, podiatrists, and OB/GYNs to oncologists, ophthalmologists, and orthopedists. Facilities such as hospitals, urgent care centers, and labs also belong to the network. To find preferred providers near you visit www.aetna.com.
Prescription Drug Coverage - Express Scripts
When you enroll in any one of the Aetna medical plan options, you’ll automatically have prescription drug coverage through Express Scripts. This program includes a Formulary Management Program that uses a “four-tier” co-payment approach to covered drugs and is designed to control cost for you and the plan.
NOTE: The Aetna Gold high-deductible plan, is a non-embedded or "aggregate" deductible plan where all family members' out-of-pocket expenses count towards the family deductible until it is met. Once the family deductible is met, all eligible family are covered with the plan's usual co-pays. It doesn't matter if one person incurs all the expenses that meet the deductible or if two or more family members contribute toward meeting the family deductible. Shared out-of- pocket deductibles for the Aetna Gold plan are $4,000 for individuals and $8,000 for family.
Click here to learn more about prescription benefits.
Fertility Coverage
Female and male fertility treatment and care will be covered subject to the deductible and coinsurance in all three medical plans. There is a limitation of 3 attempts/live birth up to a lifetime maximum benefit of $50,000.
Is a High Deductible Health Plan Right for Me?
A high-deductible health plan can be a good option for those:
- Who need only preventive care and do not expect to need to pay for prescriptions or frequent visits to the doctor.
- With a chronic condition since there are often no additional copays and coinsurance payments once the deductible has been met.
- Who would like the lowest monthly premium in exchange for higher out-of-pocket costs when you use your benefits
- Prefer to manage your healthcare expenses through a triple tax-advantaged Health Savings Account (HSA)
Review your claims and expenses for the previous year at www.aetna.com. (You will need to log in to see your claims and expenses). Reviewing your medical expenses may help you determine the coverage that is best for you and your family.
2023 Gold HDHP-HSA Resources
- Aetna - Gold (HSA) Summary of Benefits & Coverage - 2023
- Benefit Summary
- Gold Plan SPD - 2023
- HDHP with HSA vs Traditional Health Plan Calculator
Federal Transparency in Coverage Rule
The link below leads to the machine readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.