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

Medical Plan Bi-Weekly Contribution Rates

Full-Time

Part-Time

$50.01k -$110k

$110.01k - $150k

$150.01k - $200k

$200.01k +

$50.01k -$110k

$110.01k - $150k

$150.01k - $200k

$200.01k +

$0 - $50k

$0 - $50k

Aetna Select Plan Employee

$45.76 $57.20 $85.79 $102.95 $114.39 $91.51 $108.67 $160.15 $200.19 $228.79

Employee + Spouse $82.36 $102.95 $154.43 $185.32 $205.91 $164.73 $195.61 $288.27 $360.34 $411.81 Employee + Child(ren) $64.06 $80.08 $120.11 $144.14 $160.15 $128.12 $152.14 $224.21 $280.26 $320.30 Family $128.12 $160.15 $240.23 $288.27 $320.30 $256.24 $304.29 $448.42 $560.53 $640.60

Aetna Choice Plan Employee

$153.90 $180.09 $212.84 $232.48 $252.13 $203.01 $235.76 $288.15 $340.54 $392.93

Employee + Spouse $277.02 $324.17 $383.11 $418.47 $453.83 $365.43 $424.36 $518.67 $612.97 $707.27 Employee + Child(ren) $215.46 $252.13 $297.97 $325.48 $352.98 $284.22 $330.06 $403.41 $476.76 $550.10 Family $430.91 $504.26 $595.94 $650.95 $705.97 $568.44 $660.12 $806.82 $953.51 $1,100.21

*$25surchargewillbeadded toyourbi-weeklydeductions ifyouutilize tobaccoproducts.ASpouse&PartnerPreferredChoicePremiummayalsoapply.Seepage11 fordetails. **Note,salarychangesmay result inchanges toyourcontribution rate

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