2026 AtlantiCare Benefits Booklet

MEDICAL (CONT.)

WELCOME....................................2 WHAT’S NEW..............................3 HOW TO ENROLL......................4 HEALTHCARE TRANSFORMATION CONSORTIUM (HTC)...............6 GETTING TO KNOW YOUR PLAN.................................7 MEDICAL......................................8 PRESCRIPTION DRUG.......... 17 FQHC........................................... 19 ADDITIONAL MEDICAL PLAN RESOURCES................. 20 WELLNESS PROGRAM......... 21 DENTAL...................................... 23 VISION........................................ 25 LIFE INSURANCE.................... 28 DISABILITY............................... 30 VOLUNTARY OFFERINGS... 31 EDUCATIONAL SUPPORT & CAREER DEVELOPMENT...................... 31 FINANCIAL WELL-BEING.... 32 HEALTH &WELLNESS.......... 33 SAVINGS.................................... 34 VOLUNTARY BENEFITS....... 35 SPENDING ACCOUNTS............................... 38 RETIREMENT BENEFITS................................... 39 CONTACTS................................ 41 LEGAL NOTICES....................... 43 WELLNESS CHECKLIST........ 45

Aetna Choice Plan (PPO) The Aetna Choice Plan covers the same services as the Select Plan and includes three levels of In-Network benefits as well as reimbursement for non participating (i.e. Out-of-Network) physicians and facilities. This plan is the most expensive when it comes to howmuch you contribute each pay period, but you have greater flexibility in where you can seek medical care. Wellness Credits earned in 2025 will be applied to your AtlantiCare-funded Health Reimbursement Account in 2026.

Features of theAetna Choice Plan: Four levels of providers and benefits: 1) Inner Circle Tier 1 (AtlantiCare and its affiliates) providers: No deductibles, lowest copays and and the least amount out-of-pocket costs 2) In-Network (HTC Tier 2 and Aetna Tier 3 national network): After satisfying a deductible and/or a copay, benefits are covered at 100% 3) Out-of-Network (non-participating):

Most cost sharing – covered services are reimbursed at 50% after the deductible. It is also important to note that an Out-of-Network provider may “balance bill” for any amounts in the event their charges are over what is considered over the reasonable and customary charge. Charges that are balanced billed are not counted towards the Plan’s out-of-pocket maximum limits. If services are not available at AtlantiCare, your responsibility will be at either the In-Network or Out-of-Network level of coverage. For both plans, visit https://aetnaresource.com/n/AtlantiCare-Health to find a participating physician, facility or other service provider.

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