Value Option Overview
The Value option offers lower out-of-pocket costs with higher monthly contributions. It includes:
  • A Health Incentive Account (HIA)
  • Choice of BlueCross BlueShield, Aetna or UnitedHealthcare
  • In-network preventive care 100% paid by American
  • Co-pays with no deductible for in-network, non-preventive doctor office visits, and urgent care clinic visits.
  • Prescription drug coverage through Express Scripts (formerly Medco) with both retail and mail order pharmacies

Value Option Features
Is this option for you?
The Value option may be the best choice for you if you prefer to pay more out of your paycheck and less when you receive care.
Value Option Features
This chart shows the amount you pay for covered expenses with the Value option.
FeaturesValue Option
 In-Network You Pay:Out-of-Network You Pay:
Deductible (Single/Family)$300/$900$1,500/$4,500
Out-of-pocket maximum (Single/Family)$1,750/$4,375
Does not include deductible or co-pays
Does not include deductible
Co-insurance20% after deductible40% after deductible
Preventive Care1$040% co-insurance after deductible
Non-Preventive Care
Primary Care Physician$20 co-pay40% co-insurance after deductible
Specialist Office Visit$40 co-pay40% co-insurance after deductible
Urgent Care Clinic$40 co-pay40% co-insurance after deductible
Emergency Room2$100 co-pay + 20% co-insurance after deductible$100 co-pay + 20% co-insurance after deductible
Inpatient Hospital (preauthorization required)20% co-insurance after deductible40% co-insurance after deductible
Pharmacy Co-insurance (Retail – up to 30-day supply)
Does not count toward deductible; Does count toward out-of-pocket maximum
Generic$10 co-pay$10 co-pay based on ESI pricing
30% co-insurance ($20 min/$75 max) based on ESI pricing
50% co-insurance ($35 min/$90 max) based on ESI pricing
Formulary Brand330% co-insurance ($20 min/$75 max)
Non-Formulary Brand350% co-insurance ($35 min/$90 max)
Pharmacy Co-insurance (Mail – up to 90-day supply)
Does not count toward deductible; Does count toward out-of-pocket maximum
Generic20% co-insurance ($0 min/$80 max)Not covered
Formulary Brand330% co-insurance ($40 min/$150 max)
Non-Formulary Brand350% co-insurance ($70 min/$180 max)
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.

Co-insurance applies to your out-of-pocket maximum.
Co-pays do not apply toward the annual deductible or out-of-pocket maximum.
Annual deductibles do not apply toward out-of-pocket maximum.
1 Does not count toward deductible or co-insurance; in-network only.
2 For more detailed information on Emergency Room visits, see the Employee Benefits Guide
3 You’ll pay the $10 co-pay (retail) or 20% co-insurance (mail) plus the cost difference between generic and brand prices if you select a brand drug when a generic is available. In this case, maximums do not apply.

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

How the Value Option Works
How the Value Option Works
The Value option offers both in- and out-of-network benefits, here’s how it 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)
  • You do not have to meet a deductible to purchase prescriptions.
  • You pay a co-pay for in-network primary care physician, specialist and urgent care visits and generic prescriptions.
  • American pays 100% of preventive care if you use an in-network provider.

Annual deductible (in-network)
Single: $300
Family: $900

?   TIP: You can use your HIA or HCFSA to help pay for out of pocket expenses.
Share the health care cost once you reach your deductible. Your share is called co-insurance:
  • 20% for most in-network care
  • 40% for most out-of-network care
You continue to pay co-insurance until you reach the out-of-pocket maximum.
  • Medical and prescription co-insurance apply toward the out-of-pocket maximum.
  • Co-pays and expenses applied toward the deductible are not included in the out-of-pocket maximum.
Out-of-pocket maximum (in-network)
Single: $1,750
Family: $4,375

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 HIA Works
The Value option includes a Health Incentive Account (HIA) which is funded when you earn Healthmatters Rewards. If you don’t earn Rewards, you will not have an HIA.

Your HIA can be used to pay eligible medical and prescription drug out-of-pocket expenses for you, your spouse and children who are covered by the Value option.

The HIA is compatible with the Health Care Flexible Spending Account (HCFSA). If you have both, the HCFSA pays first because FSAs have a “use it or lose it” rule and they do not roll over year to year.

PayFlex administers your HIA and you can track your account at the HealthHub website. Any unused HIA funds will roll over from year to year. HIA funds may only be used when you’re enrolled in the Value option. You keep your HIA as long as you remain enrolled or until you retire or change medical options. HIA funds are forfeited when you leave the Company.

Contribution Costs
Contribution Costs
Monthly contribution costs for the Value option:
 Employee OnlyEmployee +
Spouse/Domestic Partner
Employee + Child(ren)Family
Tier 1$140.63$365.63$253.13$492.19
Tier 2$168.75$438.75$303.75$590.63
American offers access to three different administrators for each state. The Preferred Administrator, Tier 1 and Tier 2. The preferred administrator has a large selection of providers, hospitals and facilities in-network. However, we realize that some people prefer to continue using their same doctors, providers and facilities which may not be in each administrator's network. For this reason, we offer a choice between Blue Cross & Blue Shield, UnitedHealthcare and Aetna. During your decision-making process, you may want to keep in mind the additional cost for the tier 1 and tier 2 administrators.

Summary of Benefits

Summary of Benefits - Value Option (PDF)

Uniform Benefit Glossary (PDF)