The Smart Health Plan Easy and Affordable Lower Monthly Premiums Health and Wellness Card The Aqua Deductible Out-of-Pocket Expenses The Aqua Safety Net Pharmacy Benefit What’s Not Included Benefits Packages How Aqua Works Aqua FAQs

 

Aqua Out-of-Pocket Costs.

After meeting their deductible, your employees no longer pay all of the costs for medical services. Depending on the covered service, the employee pays a coinsurance up to an out-of-pocket maximum. Aqua pays the balance.

How it Works.

Once the deductible is met, Aqua pays most of the cost of care for covered expenses and the plan member pays a coinsurance. For most services, this is 20% for services within the Aqua Network and 50% for services provided by an out-of-network provider. To keep your employees’ financial health intact, there is an annual out-of-pocket maximum.

Aqua Network of Providers.

The out-of-pocket maximum is lower when using in-network providers than for using out-of-network providers, but your employees still have full control over where they want to receive their care. There are literally thousands of in-network providers from which to choose.

Cost of Care.

When your employees use Aqua Network providers, they typically will pay 20% of the lower, discounted rate for covered services, and 50% for out-of-network services. The Aqua Allowance and the Aqua Deductible do not count toward the out-of-pocket maximum but all coinsurance payments do count toward the out-of-pocket maximum.

Annual Plan.

At the beginning of the plan year, employees begin with their full Aqua Allowance and must meet their deductible before coinsurance takes effect. The out-of-pocket maximum is an annual maximum.