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2026 Medical Benefits

Apple Bank gives you the option to choose between one of two medical plan options with Aetna.

Our Aetna High Deductible Health Plan (HDHP) option offers you a degree of flexibility when selecting the type of care that is best for you and your dependents. The plan is designed to provide you with the option to use a health savings account (HSA).

The Aetna Point of Service Plan (POS) option is a more traditional program. You will still share the cost of services with a deductible and coinsurance, but routine office visits will have predictable $25 or $50 copays.

Both of our medical plans are Open Access (search the Aetna Choice POS II network), which means that you do not need a referral to visit a specialist.

When you enroll in the HDHP and open an HSA, Apple Bank will contribute to your HSA. Please see the HSA overview page for more information. Those without an HSA may enroll in the FSA plan.

Note: Employees over age 65 who have enrolled in Medicare, who are claimed as a dependent on someone else’s tax return, or whose spouse contributes to an FSA are not eligible to contribute to a Health Savings Account (HSA).

Medicare Coordination of Benefits FAQ

No-Cost Preventive Drug List

Certain maintenance drugs can be filled at no charge. These include medications for cholesterol, diabetes, high blood pressure and others. Refer to Aetna’s 2025 Health Care Reform Preventive Drug List to see if your maintenance medication qualifies for this program.

Forget your deductible, just pay your copay or coinsurance when buying certain medication. Refer to Aetna’s 2025 Preventive Medicine List to help reduce your out-of-pocket costs for the medicines you need.

Both of the Aetna medical plan options include coverage for prescription drugs. Medications are classified by tier on the Aetna formulary. This is simply a drug list which is reviewed periodically. You may be subject to step therapy, quantities limits, or your prescription drug may not be covered under the new formulary.

To check your prescriptions:

  1. Visit the Aetna website at www.aetna.com/individuals-families/find-a-medication.html
  2. Scroll to Step 1: “Choose a plan year” drop down and enter plan year
  3. Scroll to Step 2: ”Choose a plan” and enter “Aetna Standard Plan”.
  4. Click on “Go to Aetna Standard Plan”

The companies that make specialty medications sometimes offer financial assistance programs. Often called copay cards, these programs can help reduce the amount you pay out of your own pocket.

The following example shows how a copay card could work with a prescription benefit after changes are made to the cost share and deductible calculations.

As you can see, only the amount paid out-of-pocket is applied to the deductible. (This does not apply to copay assistance programs provided by foundations or copay assistance that’s based on financial needs.)

 
Example After plan changes:
Medication Cost $2,000 (for a 30-day supply)
20% Coinsurance $750
Copay Card Savings $745
Amount Paid $5
Amount applied to the deductible $5

Please note: This is an example only and does not show the actual amount you will pay under your prescription benefits.

Visit Specialty Medications for a list of medications, the manufacturer, and information for available coupon programs.

Important things to know about copay cards

Whether a copay card is available to you — While copay cards aren’t available for every specialty medication, many of those used to treat multiple sclerosis, rheumatoid arthritis, anemia, and other chronic conditions have a copay card or other assistance program you can use.

When your copay card expires — Manufacturers set their own expiration dates, and the length of time you can use the card varies from program to program. Once your copay card expires, you will be responsible for paying the full copay or coinsurance required by your plan. Alternatively, you can check to see if you can renew your copay card with the manufacturer.

No one wants to spend any more than necessary on healthcare.

The most important factor in the increase of healthcare costs is how you use healthcare services. In order for our health plans to continue to provide high-quality care in the most cost-effective way, we all must take greater responsibility for making healthier lifestyle choices and more informed healthcare decisions.

Use in-network providers and generic drugs whenever possible and pursue treatments at the appropriate level (for example, not using an emergency room when an urgent care or primary care office visit may be more appropriate). Being a conscientious health care consumer will make a positive impact on your out-of-pocket health care costs and help limit our cost increases in the future.

Below are eight ways to be a smart healthcare consumer and save money.

  1. Use the Aetna Network. Using doctors, hospitals, and facilities that participate in the Aetna Choice POS II network can save you a lot of money. “In-Network” services apply to all health care services, including doctors and hospitals, as well as outpatient testing, treatment and surgery centers that are participating in the Aetna network. To verify that a doctor or facility is in the network, visit www.aetna.com or call the number on the back of your Aetna ID card.
  2. Use convenience care clinics. For minor illnesses and injuries, convenience care clinics located in pharmacies, grocery stores and other retail stores provide quick, affordable care.
  3. Use the emergency room only for true emergencies. For non-life-threatening emergencies, visit an urgent care center instead of the emergency room. You’ll get treated more quickly and pay less. Emergency Rooms (ER) provide immediate specialized care to people with serious, often life-threatening issues. Treatment for non-emergency conditions in an ER costs hundreds of dollars more than treatment at an urgent care center or your doctor’s office.
  4. Visit a doctor online. All plans offer this service; you can consult with a doctor about minor illnesses or injuries virtually by phone or online.
  5. Ask for generic drugs. You can save up to 80% compared to brand-name drugs.
  6. Use cost-saving tools. Compare the costs of medical tests, services, and procedures online at www.aetna.com. Once you log in, you will have access to the cost comparison tool.
  7. Avoid the hospital. Many procedures like MRIs and colonoscopies cost less when done at independent outpatient centers instead of a hospital. Outpatient surgery is also less expensive than hospitalization.
  8. Get regular preventive care. Doctor’s visits are for healthy people too. Getting checkups, immunizations and other health screenings can help detect health problems early when they are less expensive to treat. Each of our plans covers in-network preventive care at no cost.

Medical Plans Overview

Aetna HDHP with HSA
Benefits In-Network Out-of-Network
 Calendar Year Deductible
(Individual / Family)		 $2,000 / $4,000 $4,000 / $8,000
 Apple Bank HSA Contribution
(Individual /Family)		 $600 / $1,200
Out-of-pocket Maximum
(Individual /Family)		 $3,000 / $6,000 $10,000 / $20,000
Coinsurance (you pay) 10% 30%
Preventive Care No Charge 30% after deductible
PCP/Specialist
 10% after deductible 30% after deductible
Urgent Care 10% after deductible 30% after deductible
Emergency Room 10% after deductible 10% after deductible
Inpatient Hospital 10% after deductible 30% after deductible
Outpatient Hospital 10% after deductible 30% after deductible
Prescription Drug Coverage
Deductible Medical deductible applies N/A
Retail Prescriptions (30-day supply)
Generic / Preferred Brands / Non-preferred Brands / Specialty		 Deductible, then
$5 / $30 / $60 / 20%		 Not covered
Mail Order (90-day supply)
Generic / Preferred Brands / Non-preferred Brands / Specialty		 Deductible, then
$10 / $60 / $120 / 20%		 Not covered
Aetna POS
Benefits In-Network Out-of-Network
 Calendar Year Deductible
(Individual /Family)		 $500 / $1,000 $4,000 / $8,000
 Apple Bank HSA Contribution
(Individual /Family)		 N/A
Out-of-pocket Maximum
(Individual /Family)		 $3,000 / $6,000 $10,000 / $20,000
Coinsurance (you pay) 20% 30%
Preventive Care No Charge 30% after deductible
PCP/Specialist
 $25 / $50 copay 30% after deductible
Urgent Care $50 copay 30% after deductible
Emergency Room $500 copay $500 copay
Inpatient Hospital 20% after deductible 30% after deductible
Outpatient Hospital 20% after deductible 30% after deductible
Prescription Drug Coverage
Deductible $50 / $100 N/A
Retail Prescriptions (30-day supply)
Generic / Preferred Brands / Non-preferred Brands / Specialty		 Deductible, then
$5 / $30 / $60 / 20%		 Not covered
Mail Order (90-day supply)
Generic / Preferred Brands / Non-preferred Brands / Specialty		 Deductible, then
$10 / $60 / $120 / 20%		 Not covered
This is only a summary of benefits. Any discrepancy between the above and the insurance contracts, summary plan descriptions (SPDs) or any other legal documents that govern the plans of benefits described above will be resolved according to those documents.
CVS VIRTUAL CARE
 When you enroll in one of our Aetna Medical plans, you get access to CVS Virtual Care. 
CVS Virtual Care makes it easy to get quality virtual care via laptop or phone.
  • 24/7 Care: Available for adults and children over 18 months. If you have symptoms of a cold, flu, sore throat, sinus infection, rash, or other minor illnesses, you can receive medical care from home at any time.
  • Mental Health Services: Schedule virtual mental health services by appointment 7 days a week for children and adults ages 13 and up. Services include counseling for anxiety, mood disorders, depression screening, medication management, and other mental health concerns.
*See CVS Virtual Care flyer for more information.
Scan the QR code to register and schedule an appointment with CVS Virtual CareGet started today. Scan the QR code or go to CVS.com/virtual-care to register and schedule an appointment.
STAY IN-NETWORK TO GET THE MOST FROM YOUR BENEFITS
Both plans offer access to a large national network of providers and healthcare facilities. Visit www.aetna.com to find an in-network provider.
Once on the website, follow these simple steps:
  1. Select ‘Find a Doctor’ from menu across top of page
  2. Scroll to and click ‘Plan through employer.’
  3. Enter your search parameters and zip code and click ‘Search’
  4. Review your choices in the ‘Aetna Choice POS II (Open Access)’ network.
Aetna Mobile App
Download the Aetna mobile app to have instant access to your ID card, coverage details, and claims. You can also find in-network providers that are near you.

Button - click here to download app from Google Play     Button - click here to download app from Apple App store

NOT SURE WHERE TO GO FOR CARE?
Watch this quick video from Aetna.

Health Care Terms - click to play video

WHAT DO ALL THESE HEALTH CARE TERMS MEAN?
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