Medical
Segal offers a choice of two Aetna medical plans: the Aetna High Deductible Health Plan (HDHP) with Health Savings Account (HSA) and the Aetna PPO. Depending on your location, you may also have access to regional managed care plans (HMOs and EPOs).
Aetna HDHP with HSA
The Aetna HDHP with HSA is a high deductible medical and prescription plan. Contributions are lower than other medical plans, but deductibles generally are higher. What sets this plan apart from traditional medical plans is the Health Savings Account (HSA), which allows you to save and pay for qualified healthcare expenses on a tax-advantaged basis. Segal contributes to your HSA, and the money is yours to use now or in the future.
How the plan works
- In-network preventive care is covered at 100%, with no deductible, coinsurance or copays.
- For other covered services, including prescription drugs, you pay out of pocket until you meet the deductible, then share in the cost through coinsurance or copays. If you reach the out-of-pocket maximum, the plan pays 100% of covered expenses for the remainder of the calendar year.
- You can use in-network or out-of-network providers, but you pay less when you use providers in the Aetna Choice® POS II (Open Access) network. If you call a provider to check their network status, be sure to ask specifically if they are in-network, rather than if they accept the coverage. Some providers accept the coverage but on an out-of-network basis, which generally costs more.
- Prescription drug coverage is provided through Optum Rx.
- The plan covers three lifetime attempts for Advanced Reproductive Technology (ART), subject to plan guidelines.
- The plan covers a variety of transgender transition assistance services, subject to plan guidelines and federal laws.
Coverage overview
(Employee Only / Employee Plus Family)
(Employee Only / Employee Plus Family)
* For Employee Plus Family coverage, once you meet the family deductible, then all family members have met it for the rest of the year. There are no individual deductibles for members of a family.
Resources
2026 Aetna HDHP Summary of Benefits and Coverage (SBC)
2026 Aetna HDHP Summary of Benefits
2026 Aetna HDHP Booklet Certificate
2026 Aetna HDHP Schedule of Benefits
Aetna PPO
The Aetna PPO, which is also known as the Aetna Choice POS II, offers comprehensive medical and prescription coverage. There is no Health Savings Account (HSA) with this medical plan.
How the plan works
- In-network preventive care is covered at 100% with no deductible, coinsurance or copays.
- For other covered services, including prescription drugs, you pay out of pocket until you meet the deductible, then share in the cost through coinsurance or copays. If you reach the out-of-pocket maximum, the plan pays 100% of covered expenses for the remainder of the calendar year.
- You can use in-network or out-of-network providers, but you pay less when you use providers in the Aetna Choice® POS II (Open Access) network. If you call a provider to check their network status, be sure to ask specifically if they are in-network, rather than if they accept the coverage. Some providers accept the coverage but on an out-of-network basis, which generally costs more.
- Prescription drug coverage is provided through Optum Rx.
- The plan does not cover Advanced Reproductive Technology (ART).
- The plan covers a variety of transgender transition assistance services, subject to plan guidelines and federal laws.
Coverage overview
(Employee Only / Employee Plus Family)
(Employee Only / Employee Plus Family)
* For Employee Plus Family coverage, your family will have one deductible. You will meet it when the expenses of all family members add up to the family deductible; however, no one person will have to pay more than the individual deductible.
Resources
2026 Aetna PPO Summary of Benefits and Coverage (SBC)
2026 Aetna PPO Summary of Benefits
2026 Aetna PPO Booklet Certificate
2026 Aetna PPO Schedule of Benefits
Aetna medical plan resources
When you enroll in Segal’s Aetna HDHP with HSA or Aetna PPO medical plan, you have access to a variety of specialized support programs and resources:
- Aetna concierge. Aetna’s concierge team can help you navigate your medical benefits, find in-network doctors and understand claims.
- Aetna 24-hour nurse line. For 24/7 health support, Aetna’s nurse line offers free, confidential medical guidance from registered nurses.
- Teladoc telemedicine. Teladoc offers 24/7 virtual access to board-certified doctors to diagnose and prescribe medications for minor health conditions, as well as virtual behavioral health, all from the comfort and convenience of home. Visit Teladoc or call 855-TELADOC (855-835-2362).
- Hinge Health virtual physical therapy. Hinge Health provides virtual support for back, joint and other musculoskeletal pain and women’s pelvic health through personalized digital exercise therapy and one-on-one access to a physical therapist, all delivered through the Hinge Health app at no cost to you.
- Reproductive care. Aetna offers complete reproductive care for every life stage of life, including family-building support for both men and women, comprehensive maternity support and guidance, men’s health support, and midlife support for menopause and healthy aging. In addition, Aetna’s 24-hour dedicated women’s health nurse line offers expert support for maternity or other women’s health concerns at no cost.
- Lifestyle and condition coaching. Aetna’s lifestyle and condition coaching offers personalized support and actionable advice for a wide range of focus areas, such as nutrition, sleep, diabetes, chronic condition management, weight management and more.
- Aetna discount programs. You have access to Aetna discount programs for saving money on health-related products, including eyewear, healthy lifestyle choices, natural products and services, and hearing aids.
- Transform Oncology cancer care. The program pairs you with a dedicated advocate who will work alongside your cancer care team to help you and your family navigate treatment, benefits and next steps. Services may include access to genetic counseling and testing, which can help guide treatment decisions and assess the risk of developing other forms of cancer, as well as access to Aetna’s centralized hub of cancer information and resources. Visit Aetna to learn more.
Regional managed care plans: HMOs and EPOs
Health Maintenance Organizations (HMOs) and Exclusive Provider Organizations (EPOs) may be available if you live in certain geographic areas. These plans emphasize coordinated care and typically require you to use in-network providers. With an HMO or EPO, you generally must choose a primary care physician (PCP) who coordinates your care and provides referrals to specialists, when required by the plan. Preventive care is covered at 100% in-network, while other services may be subject to copays, deductibles and/or coinsurance. Note: If enrollment in a managed care plan falls below 10 employees, the managed care plan may not be offered going forward.
Resources
Aetna EPO in CA, GA, NJ, NY, DC (including NY collectively bargained employees)
2026 Summary of Benefits
2026 Summary of Benefits and Coverage (SBC)
2026 SBC Supplement
Note: Once you’re enrolled in the Aetna EPO, log in to your member website and select “Coverage & Benefits” to find your Summary of Coverage/Schedule of Benefits and your booklet with the details of your healthcare benefits, your share of the costs and information about covered services.
Emblem Health – HIP HMO in NY (including NY collectively bargained employees)
2026 Summary of Benefits and Coverage (SBC)
2026 Summary of Benefits
Kaiser Northern CA HMO
2026 Summary of Benefits and Coverage (SBC)
2026 Summary of Benefits
2026 Fertility Coverage
Kaiser Southern CA HMO
2026 Summary of Benefits and Coverage (SBC)
2026 Summary of Benefits
2026 Fertility Coverage
Contacts
Aetna HDHP with HSA
aetna.com
Aetna Concierge: 866-335-1408
24-Hour Nurse Line: 800-556-1555
Mental/Behavioral Health: 800-424-4047
Aetna PPO
aetna.com
General: 800-962-6842
Mental/Behavioral Health: 800-424-4047
Kaiser Permanente
kp.org/memberservices
800-278-3296 (TTY: 711)
EmblemHealth
emblemhealth.com
877-411-3625 (TTY/TDD: 711)
Aetna EPO
aetna.com
888-982-3862