Getting to Know Your Benefits
We recognize the importance of making sure you fully understand our health care plans plans so you can select the one that best meets your needs. To help, we’ve come up with a cheat sheet of key benefits jargon, as well as, answers to some of our most frequent questions about covered services.
Key Benefits Terms Explained
The annual amount an employee or covered dependent must pay for services before the plan pays a benefit. Preventive care is covered at 100% with no deductible required.
This is the percentage of the cost employees/covered dependents pay for certain services after the deductible has been met.
You can think of this as “cost sharing”. For example, once your deductible has been met you could pay 20% for the cost of certain services and the plan could pay 80%.
The flat fee paid by the member when a service is received, i.e. $20 for a doctor's visit or $20 for a prescription. Co-pays do not apply to the deductible but do apply to your out-of-pocket maximum.
An in-network provider is a hospital, doctor, medical group, and/or other healthcare provider contracted with Aetna provide services to customers for a discounted fee.
Using these providers will lessen your medical expenses when using your benefits.
Click HERE to locate an in-network provider
An out of network provider is a hospital, doctor, medical group, or other healthcare provider who are not contracted with Aetna provide services to customers. Because the fees are not negotiated in advance with the Aetna, the provider can charge the member as much as they wish.
The maximum amount a employee/covered dependent would have to pay out of their pocket for medical expenses for the year, with the exception of benefit premiums (which come out of your paycheck).
Your out-of-pocket maximum includes your deductible, any coinsurance paid and all co-payments.
Preventive Routine Physicals
Covered expenses include charges made by your primary care physician (PCP) for routine physical exams. This includes routine vision and hearing screenings given as part of the routine physical exam. A routine exam is a medical exam given by a physician for a reason other than to diagnose or treat a suspected or identified illness or injury.
Routine physical exams may also include:
- Evidence-based items that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force.
- Services as recommended in the American Academy of Pediatrics/Bright Futures Guidelines for Children and Adolescents.
- Screenings and counseling services as provided for in the comprehensive guidelines recommended by the Health Resources and Services Administration.
- X-rays, lab and other tests given in connection with the exam.
- For covered newborns, an initial hospital check up.
Not covered under this Preventive Care benefit are charges for:
- Services which are covered to any extent under any other part of McClatchy health care plans;
- Services which are for diagnosis or treatment of a suspected or identified illness or injury;
- Exams given during your stay for medical care;
- Services not given by a physician or under his or her direction;
- Psychiatric, psychological, personality or emotional testing or exams;
No. Any charges associated with a physical received beyond the plan frequency will be denied and you will be responsible for the full amount associated with the visit.
Negotiated rates cannot be applied to services when they are denied.
Physicians may recommend a physical frequency that exceeds the number of visits McClatchy medical will cover has preventive.
If you are unsure of the date your last routine physical was received or if you have questions about what services are considered preventive, contact Aetna Member Services 888-492-3862.
Well-Woman Preventive Care
Covered expenses include charges made by your physician obstetrician, or gynecologist for:
- A routine well woman preventive exam office visit, including Pap smears. A routine well woman preventive exam is a medical exam given by a physician for a reason other than to diagnose or treat a suspected or identified illness or injury; and
- Routine preventive care breast cancer genetic counseling and breast cancer (BRCA) gene blood testing. Covered expenses include charges made by a physician and lab for the BRCA gene blood test and charges made by a genetic counselor to interpret the test results and evaluate treatment.
Still Have Questions?
McClatchy's new Total Rewards team is here to help you get the most out of our benefits programs! If you have specific plan questions or need assistance resolving claim issues contact the Total Rewards team by phone, email or using the online form below:
- Phone: 800-852-2802, Opt. 1
- Email: email@example.com