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

Helpful Tip

What if AtlantiCare does not provide the service I require? AtlantiCare is able to provide you with enhanced benefits when you utilize our services because the dollars spent for these services stay within AtlantiCare. While AtlantiCare ofers most services, not all services are provided at the AtlantiCare Inner Circle level. If you require services outside of AtlantiCare you will still have access to these services. However, depending on the plan you choose, you will be required to pay for them at the HTC (Tier 2) or Aetna (Tier 3) benefit level. If the service can only be provided through an out-of-network provider, please contact Aetna to file an appeal prior to receiving the service. Never assume your provider is referring you to an Inner Circle provider. Please contact Aetna Customer Service Center at 1-833-313-1962 for verification of provider’s tier level or by accessing your account through Aetna’s website or downloading the Aetna Health app.

If you know that you will need services performed at a non-AtlantiCare facility, utilize your Flexible Spending Account (FSA) to help you budget for the expense and reduce your taxable income at the same time. Interested in a FSA? Enroll during your new hire enrollment period or the annual enrollment period.

Aetna connects you to care and support wherever you are!

The Aetna Health app ofers 24/7 connection to all the ins and outs of your plan. We’re always looking for ways to make things more convenient for you.

Search for Aetna Health SM app in the App Store or Google Play, or scan this QR code to download the app.

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