Medical
Benefits

Employees can choose from two medical plans administered by Aetna®. All of our medical plan options include free* care within the RWJBarnabas Health system.

Aetna® Medical Plan Options

Click on the plan name to see what’s covered!

  • Core Plan – The lowest-cost medical option for employees who primarily use care within the RWJBarnabas Health system and our partner systems through the HTC. Care received within the Premier tier is free* for Core Plan members.
  • Flex Plan – Designed for employees who live in New Jersey, but want to pay less out-of-pocket when receiving care outside the RWJBarnabas Health system or in other states. Payroll contributions are higher for this plan. This plan also includes free* care within the RWJBarnabas Health system.
  • Out-of-Area Plan – Designed for employees who live outside of New Jersey. Employees can still access free* care within the RWJBarnabas Health System, and will also have lower out-of-pocket costs when accessing care outside of New Jersey.

You can view the Summary of Benefits and Coverage for additional plan design details, found on the Aetna website.

*Payroll deductions and Emergency Room copay ($200) still apply.

Finding Care

To search for a provider or facility, you can:

  • Visit the Aetna resource page or call the Aetna Concierge at 855.546.5415.
  • Call our Care Navigation team at 844.424.2628 for assistance with finding a provider or booking an appointment.
  • Check out the list of frequently used providers by visiting “Explore Your Care Network.”

Looking for Urgent Care? 

RWJBarnabas Health has many urgent care partner practices across New Jersey. Click here to view a listing of urgent care locations available at no cost* for employees and their family members enrolled in our health benefit plans through Aetna.

Accessing Your Member ID Card
  • Access a digital version of your Aetna ID card by logging in to the Aetna portal here or by downloading the Aetna mobile app. You can also find a “Prescription drug only” ID card in the CVS Caremark portal or mobile app.
  • Call the Aetna Concierge at 855.546.5415 for assistance in getting a physical ID card mailed to your home. 
How much will I pay for care?

Your out-of-pocket costs depend on the plan you choose and the provider’s network tier. You can use providers in any tier throughout the year.

Note: Office visits in the Extended Tier are subject to copays only – the deductible and coinsurance do not apply to those visits. Services rendered at a Premier facility (Inpatient/Outpatient) will be covered at 100%*. Lab services in the Extended Tier (including LabCorp and Quest) are covered at 100%*.

 

Premier (Tier 1)

“Maximum Savings”

Extended (Tier 2)

“Standard Plus Savings”

Aetna Network (Tier 3)

“Standard Savings”

Out-of-Network

Care within the Premier Tier will be at no cost* to you. The following are in the Premier Tier:

  • RWJBH facilities
  • RWJBH employed doctors
  • RWJBH Joint Venture Facilities and practices
  • RWJBH Clinically Integrated Network Practices

Office visits in the Extended Tier typically have copays. This tier includes many large provider groups as well as health systems that are part of the Healthcare Transformation Consortium (HTC). Learn more about the HTC here.

  • Large provider groups such as Summit Health, Axia, Lifeline, and Advocare
  • Certain RWJBH-affiliated doctors
  • AtlantiCare
  • Atlantic Health System
  • CentraState Healthcare System
  • Holy Name
  • Hunterdon Health
  • Saint Peter’s Healthcare System
  • Valley Health System

Most services in the Aetna Network Tier are subject to deductible and coinsurance. This tier includes providers in the Open Access Aetna Select Network (Core Plan) or Aetna Choice POS II Network (Flex/Out-of-Area Plans).

  • Includes providers in New Jersey who are not in the Premier or Extended Tiers (such as Hackensack Meridian Health)
  • Includes providers outside of New Jersey (such as CHOP, Memorial Sloan Kettering and New York-Presbyterian)

    Out-of-Network providers do not participate in Aetna’s provider network.

    • If you’re enrolled in the Core Plan, there is no coverage for out-of-network providers; you are responsible for 100% of the cost.
    • If you’re enrolled in the Flex or Out-of-Area medical plans, you’ll experience significant costs with out-of-network providers.
    • Note: Office visits in the Extended Tier are subject to copays only – the deductible and coinsurance do not apply to those visits. Services rendered at a Premier facility (Inpatient/Outpatient) will be covered at 100%*. Lab services in the Extended Tier (including LabCorp and Quest) are covered at 100%*.
    • *Payroll deductions and Emergency Room copay ($200) still apply.

    Questions?

    Care Navigation
    (Provider Search and Appointments)
    Call: 844.424.2628
    Monday – Friday from 8 a.m. to 7 p.m. ET

    Aetna® Concierge
    (Claims and Coverage Questions)

    Call: 855.546.5415
    Monday-Friday from 8 a.m. to 6 p.m. ET
    Website: Aetna® Website

    RWJBarnabas Health Benefits Center
    (Enrollment Questions)
    Call: 844.690.0920

    Monday – Friday from 8:30 a.m. to 7 p.m. ET
    Benefits Enrollment Portal

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