Core Option Overview
The Core option is a High Deductible Health Plan, which offers higher out-of-pocket costs with lower monthly contributions. It includes:
  • A Health Savings Account (HSA)
    • You must open your account when you enroll
    • You may fund it with pre-tax deductions
    • You may fund it with Healthmatters Rewards
    • You may use it to pay for medical care
  • Aetna is the only administrator
  • In-network preventive care 100% paid by American
  • Prescription drug coverage through Express Scripts (formerly Medco) with both retail and mail order pharmacies

Is this option for you?You may be interested in this option if you only visit the doctor once or twice a year for annual exams or preventive screenings or want to take advantage of pre-tax savings for the future.

Core Option Features
Core Option Features
This chart shows the amount you pay for covered expenses with the Core option.
FeaturesCore Option
 In-Network You PayOut-of-Network You Pay
Deductible (Single/Family)$2,000/$4,0001$4,000/$8,0001
Out-of-Pocket Maximum
(Includes deductible)
(Includes deductible)
Co-insurance30% co-insurance after deductible50% co-insurance after deductible
Preventive Care2$050% co-insurance after deductible
Non-Preventive Care
Primary Care Physician Office Visit30% co-insurance after deductible50% co-insurance after deductible
Specialist Office Visit30% co-insurance after deductible50% co-insurance after deductible
Urgent Care Clinic30% co-insurance after deductible50% co-insurance after deductible
Emergency Room230% co-insurance after deductible30% coinsurance after deductible
Inpatient Hospital
(preauthorization required)
30% co-insurance after deductible50% co-insurance after deductible
Pharmacy (Retail – up to 30-day supply)
Generic30% co-insurance after deductible330% co-insurance after deductible5
Formulary Brand4
Non-Formulary Brand4
Pharmacy (Mail – up to 90 day supply)
Generic30% co-insurance after deductible3Not covered
Formulary Brand4
Non-Formulary Brand4
After your initial purchase plus two refills at retail pharmacy, you will pay 50% of the drug cost for long-term (maintenance) medications if you don’t move your prescription to mail order. Visit Express Scripts (ESI) to determine if your medication is affected by this requirement.
Both the annual deductible and co-insurance apply to your out-of-pocket maximum.
1If more than one person is covered, the family deductible/family out-of-pocket maximum must be met.
2For more detailed information on Emergency Room visits, see the Employee Benefits Guide.
3Certain preventive prescription drugs purchased in-network do not count toward the deductible; co-insurance still applies.
4If you select a brand drug when a generic is available, you pay the generic co-pay or co-insurance plus the cost difference between generic and brand prices. Maximums do not apply.
5If you use an out-of-network pharmacy, reimbursement is based on the Express Scripts in-network rate. Members pay the full difference.

Everyday Guide
Download the PDF Guide to using your medical benefits here.

How the Core Option Works
The Core option offers both in- and out-of-network benefits, but your costs are lower when you use in-network doctors, hospitals, labs and other network providers. Here’s how it works.
How the Core Option Works
First, You Pay …Next, You and American …Then, American Pays …
100% of your health care cost until you reach the deductible (with the following exceptions):
  • American pays 100% of preventive care if you use an in-network provider
Annual deductible (in-network)
Single: $2,000
Family: $4,000

TIP: You can use your HSA or LPFSA to help meet your deductible.
Share the health care cost once you reach your deductible. Your share is called co-insurance:
  • 30% for most in-network care
  • 50% for most out-of-network care
You continue to pay co-insurance until you reach the out-of-pocket maximum. Your annual deductible and medical and prescription co-insurance apply toward the out-of-pocket maximum.

Out-of-pocket maximum (in-network)
Single: $6,000
Family: $12,000

Your out-of-pocket costs are much higher if you use out-of-network doctors, hospitals, labs etc.

TIP: Using in-network providers will save you money.
100% of eligible expenses for the rest of the year once you reach the out-of-pocket maximum.*
*Exception: You will also be responsible for the cost difference between brand and generic drugs if you purchase a brand name drug when a generic equivalent is available. If you do not move your long term medication to mail order after the third retail purchase you will be responsible for 50% of the drug cost even after you meet the out-of-pocket maximum.

How the HSA Works
The Core option works with the Health Savings Account (HSA). An HSA is a savings account for medical expenses. You can contribute funds to the account on a pre-tax basis.

The HSA can be used to pay eligible medical, prescription drug, dental and vision out-of-pocket maximum expenses for you, your spouse and children.You can only use the HSA money after it has been deposited into your account.

You, the account holder, own your HSA funds, and the account balance rolls over from year to year. You may continue to make HSA contributions as long as you remain enrolled in the Core option.

HSAs are a great way to save for your health care needs now and in the future. The money you contribute:
  • Is tax-free when it goes in,
  • Earns interest tax-free, and
  • Is tax-free when it comes out to pay for eligible expenses.
You’ll receive a debit card you can use to pay for eligible expenses.

The HSA is compatible with the Limited Purpose Flexible Spending Account (LPFSA). That means if you also enroll in the LPFSA, you can pay for eligible dental and vision expenses with this account.. The LPFSA is different. The total annual LPFSA amount is available at the beginning of the year.

Any Healthmatters Rewards you earn throughout the year will be contributed to your HSA 6 – 8 weeks after they are earned. You must open up an HSA with PayFlex during enrollment to have Healthmatters Rewards dollars deposited into your account.

Your HSA has a maximum contribution level:
  • Employee Only:            $3,000    
  • Employee + Spouse/Domestic Partner $5,950
  • Employee + Family:      $5,950    
  • Employee + Child(ren) $6,200
These amounts assume that you will earn the maximum Healthmatters Rewards in 2013

You can take your HSA — including your savings, Healthmatters Rewards and any investment earnings — with you if you leave the Company.

Contribution Costs
Contribution Costs
Monthly contribution costs for the Core option:
Aetna onlyEmployee Only
Employee + Spouse/DP
Employee + Child(ren)

Summary of Benefits