Medical, Vision, and Dental Plan Information

 

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Aetna

Aetna Deductible Plan

2024:

• 2024 Summary of Benefits and Coverage (SBC) (PDF)
• 2024 Summary Plan Descriptions (SPD) (PDF)

2023:

• 2023 Summary of Benefits and Coverage (SBC) (PDF)
• 2023 Summary Plan Descriptions (SPD) (PDF)

Aetna High Deductible Health Plan

2024:

• 2024 Summary of Benefits and Coverage (SBC) (PDF)
• 2024 Summary Plan Descriptions (SPD) (PDF) 

2023:

• 2023 Summary of Benefits and Coverage (SBC) (PDF)
• 2023 Summary Plan Descriptions (SPD) (PDF)

LEOFF Retiree Plan

• 2024 Summary of Benefits and Coverage (SBC) (PDF)
• 2023 Summary of Benefits and Coverage (SBC) (PDF)

General Resources

• 2024 Aetna Overall Summary and Plan Descriptions (Deductible and HDHP) (SPD) (PDF)
• 2023 Aetna Overall Summary and Plan Descriptions (Deductible and HDHP) (SPD) (PDF)
• Behavioral Health AbleTo Support (PDF)
• Hinge Health Flyer (PDF)
• Transform Oncology (PDF)
• Find A Provider | Instructions (PDF)
• Transition of Care Form (PDF)

Pharmacy Resources

• 2021 Pharmacy Drug Guide (PDF)
• Find A Medication | Instructions (PDF)
• Pharmacy FAQ
• Drug Exclusion List (PDF)
• Specialty Drug List (PDF)

Preventive Services

The plan pays 100% of the cost of qualified preventive services provided in-network, and some generic preventative drugs are available with no copay, deductible, or coinsurance. Please refer to Aetna.com for a complete and up-to-date drug listing.

• Quick Guide to Preventive Care

Teledoc Resources

• Teledoc - Talk to a Doctor Anytime, Anywhere by Phone or Video
• Set Up Teledoc in 4 Easy Steps (PDF)
• Teledoc – Now Including Behavioral Health and Dermatology (PDF)
• Teledoc FAQ (PDF)

Consolidated Appropriation Act – Transparency in Coverage

In compliance with the Consolidated Appropriations Act, 2021 (CAA), Aetna is providing machine-readable files with in-network rate and allowed amount data. The file is updated monthly.

• Aetna Machine Readable Files (MRFs)

Kaiser Permanente Core Plan

2024:

• 2024 Summary of Benefits and Coverage (SBC) (PDF)
• 2024 Summary Plan Descriptions (SPD) (PDF) 

2023:

• 2023 Summary of Benefits and Coverage (SBC) (PDF)
• 2023 Summary Plan Descriptions (SPD) (PDF)

Mental Health and Wellness

• Mental Health and Wellness Brochure (PDF)
• Mental Health and Wellness FAQ (PDF)

Delta Dental

2024:

• 2024 Legacy Plan 00201 Summary (PDF)
• 2024 Core and Enhanced Plan 09201 Summary (PDF)

2023:

• Legacy Plan 00201 Summary (PDF)
• Core and Enhanced Plan 09201 Summary (PDF)

Notice: Starting in 2022, only the Enhanced Plan will cover orthodontia: LEOFF Plan 09521 Summary (PDF)

1-800-877-7195
VSP

VSP Vision Care

2024:

• 2024 Summary of Benefits (PDF)

2023:

• 2023 Summary of Benefits (PDF)

VSP Flyers

• Exclusive Member Extras (PDF)
• Browse with Benefits (PDF)
• What to Expect during an Eye Exam (PDF)

PayFlex (Flexible Spending Accounts and Health Savings Accounts)

• Information about Flexible Spending Accounts, including common eligible expenses
• Information about Dependent Care Flexible Spending Accounts, including common eligible expenses
• Information about Health Savings Accounts, including common eligible expenses
• IRS Publication 969, Health Savings Accounts

Info Sheets

• Flexible Spending Accounts (PDF)
• Health Savings Accounts (PDF)
• Limited Flexible Spending Accounts (PDF)
• HSA Custodial Agreement (PDF)