Health Plan Benefits
Medical
Medical coverage offers valuable benefits to help you stay healthy, treat ongoing conditions and receive care if you or your covered family members become sick or injured. The Adena Health Plan offers a range of coverage levels and costs, giving you flexibility to select the plan that is right for you. You can choose from the following plans:
- Health Savings Account (HSA) Plan 1
- Health Savings Account (HSA) Plan 2
- PPO Plus Plan
How Your Medical Plans Work
Your Adena Health Plan options:
- Provide 100% coverage for preventive care services at in in-network provider.
- Have an annual deductible.
- Begin paying a portion of expenses once the annual deductible has been met (called coinsurance).
- Allow you to use any Anthem provider, but you will pay the least when you see Adena Care Network providers and the most when you see Anthem Network providers.
- Limit the amount you pay each year in out-of-pocket costs.
- Apply prescription drug cost sharing and medical copays (when applicable) to the out-of-pocket maximum.
Prescription Drugs
If you elect medical coverage, you automatically recieve coverage for both one-time (retail) and maintenance (mail) prescriptions. Your cost for prescriptions is based on the medical plan and the type of drug.
How to Fill You Prescriptions
If you need to fill a maintenance (mail-order) prescription, use Adena Health System Retail Pharmacy. Mail order is available from Adena Pharmacy - no need to come pick-up prescriptions in person. If you need to fill a non-maintenance prescriptions, go to Adena Retail Pharmacy or to a Maxor Plus participating retail pharmacy.
To find a MxorPlus pharmacy network includes more than 67,000 retail pharmacies, including CVS, Costco, Giant Eagle, Kroger, Sam's Club, Walgreens, and Walmart pharmacies.
How Your Prescription Drug Coverage Works
Under the PPO plan, prescriptions are not subject to a deductible but have applicable copays. Under HSA Plan 1 or HSA Plan 2, you pay the full cost of you prescriptions until you meet the annual deductible. After that, under HSA Plan 1, you pay coinsurance, up to a maximum amount, while the plan covers the remainder of the cost of any covered prescriptions. Under HSA Plan 2, after meeting the annual deductible, you pay coinsurance for prescriptions until your combined medical and prescription expenses reach the plan's out-of-pocket maximum.
Maintenance Medications
A maintenance medication is one you consistently take for an extended period of time, usually for more than 30 days, to treat conditions such as diabetes or high blood pressure. You are given two courtesy fills at a non-Adena pharmacy. After two fills are used, all maintenance medications must be filled at an Adena Retail Pharmacy, or through mail order.
Your Cost for Medical Coverage
Your per-pay-period cost for medical and prescription drug coverage is based on the plan you choose, your coverage level and whether you are a full-time or part-time caregiver.
Telehealth
Adena Healthy Plan members have access to two telehealth option:
Adena Telehealth
Adena Healthy plan offers visits with your Adena physicians and APP's. Visits are covered through the health plan and are available during normal office hours. Copays/Deductibles apply.
Teledoc
Teledoc gives you 24/7/365 access to U.S. board-certified physicians for acute illness. It is affordable alternative to Urgent Care or Emergency Department visits when you need care immediately. Costs are $55 for HSA plans, until deductible is met: $5 copay for PPO plan. Behavioral health visits are also available.