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Benefits Plan Information and Costs

The REI Access Plan, administered by Aetna, provides comprehensive employee-only medical coverage. This plan allows you to pay lower payroll deductions to have medical coverage and requires you to meet a higher deductible at the time you use health services. Coverage includes:

Preventive care and preventive drugs at no-cost when provided by an in-network doctor or pharmacy
Coverage for doctor and specialist visits
Mental and behavioral health benefits
Coverage for hospitalization and surgery
Access to telehealth visits through Teladoc
Access to a Health Savings Account (HSA)

Here’s what you and REI pay each paycheck for coverage.

Learn about the 2023 benefits plan costs here.

	You Pay	REI Pays
You Only	$29.13	$263.49

Medical Costs

	In-Network	Out-of-Network
Individual Deductible	$1,800 (includes prescription drug costs)	$5,400 (includes prescription drug costs)
Preventive care visits (routine physical exams, screening tests)¹	$0 (no coinsurance or deductible)	Not covered
Physician office visits	20% after deductible	50% of R&C after deductible²
Labs and x-rays	20% after deductible	50% of R&C after deductible²
Emergency room emergency visits	20% after deductible	20% after deductible
Emergency room non-emergency visits	50% after deductible	50% of R&C after deductible²
Hospital inpatient services	20% after deductible	50% of R&C after deductible²
Inpatient behavioral health (chemical dependency and mental health)	10% after deductible	50% of R&C after deductible²
Outpatient behavioral health (chemical dependency and mental health)	10% after deductible	50% of R&C after deductible²
Alternative care (acupuncture, chiropractic, massage therapy; must be medically necessary; combined limit of 60 visits per plan year)	20% after deductible	50% of R&C after deductible²
Short-term rehabilitation (occupational, physical and speech therapy; must be medically necessary; combined limit of 60 visits per plan year)	10% after deductible³	50% of R&C after deductible³
Vision exam (every 12 months)	20% after deductible	50% of R&C after deductible²
Individual out-of-pocket maximum	$3,600 (includes prescription drug costs)	No maximum

¹ Preventive care includes a variety of routine services. See the plan document for limitations and details.
² A reasonable and customary (R&C) charge is the average charge for a procedure in a particular geographic area. If you use out-of-network providers and they charge more than the R&C, you are responsible for your portion of the coinsurance plus any amount above the R&C.
³ Therapy Services – Habilitative physical, occupational and speech therapy for autism and developmental delay will be covered without any visit limits.

Prescription Drug Costs

	In-Network
Individual Deductible	annual combined medical and prescription drug deductible¹
Retail generic²	$8 copay after deductible
Retail preferred brand	25% ($15 minimum/$60 maximum) after deductible
Retail non-preferred brand	40% ($15 minimum/$75 maximum) after deductible
Mail-order generic³	$20 copay after deductible
Mail-order preferred brand	25% ($30 minimum/$120 maximum) after deductible
Mail-order non-preferred brand	40% ($30 minimum/$150 maximum) after deductible
Individual out-of-pocket maximum	annual combined medical and prescription drug out-of-pocket maximum applies⁴

¹ If you’re covering yourself and other family members, the plan does not start paying benefits until the $3,600 family deductible is met, even if one family member meets the $1,800 individual deductible.
² Up to a 30-day supply
³ 31- to 90-day supply

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