2025 Monthly Plan Costs by Plan, Coverage and Salary
Aetna HDHP
| Coverage | Less than $65,000 | $65,000 – $89,999.99 | $90,000 – $174,999.99 | $175,000 or more |
|---|---|---|---|---|
| Employee Only | $28 | $49 | $59 | $76 |
| Employee + Spouse | $85 | $149 | $181 | $232 |
| Employee + Child(ren) | $69 | $123 | $149 | $192 |
| Employee + Family | $143 | $249 | $303 | $392 |
Note: Salary includes commissions but not overtime or bonus. Arch will use the non-prorated salary for all part-time employees.
Aetna Choice PPO
| Coverage | Less than $65,000 | $65,000 – $89,999.99 | $90,000 – $174,999.99 | $175,000 or more |
|---|---|---|---|---|
| Employee Only | $117 | $203 | $248 | $320 |
| Employee + Spouse | $218 | $382 | $464 | $600 |
| Employee + Child(ren) | $203 | $356 | $433 | $561 |
| Employee + Family | $329 | $578 | $702 | $908 |
Note: Salary includes commissions but not overtime or bonus. Arch will use the non-prorated salary for all part-time employees.
Kaiser HMO (for California Residents Only)
| Coverage | Less than $65,000 | $65,000 – $89,999.99 | $90,000 – $174,999.99 | $175,000 or more |
|---|---|---|---|---|
| Employee Only | $117 | $203 | $248 | $320 |
| Employee + Spouse | $218 | $382 | $464 | $600 |
| Employee + Child(ren) | $203 | $356 | $433 | $561 |
| Employee + Family | $329 | $578 | $702 | $908 |
Note: Salary includes commissions but not overtime or bonus. Arch will use the non-prorated salary for all part-time employees.
Kaiser HMO (for Hawaii Residents Only)
| Coverage | Less than $65,000 | $65,000 – $89,999.99 | $90,000 – $174,999.99 | $175,000 or more |
|---|---|---|---|---|
| Employee Only | $0 | $81.25 | $112.50 | $218.75 |
| Employee + Spouse | $115.96 | $208.74 | $255.12 | $336.30 |
| Employee + Child(ren) | $104.37 | $187.86 | $229.61 | $302.67 |
| Employee + Family | $173.95 | $313.10 | $382.68 | $504.44 |
Note: Salary includes commissions but not overtime or bonus. Arch will use the non-prorated salary for all part-time employees.
Plan Comparison at a Glance
| Plan Feature | Aetna HDHP | Aetna Choice PPO | Kaiser HMO (for CA residents only) |
|---|---|---|---|
| Cost per paycheck | Lower | Higher | Higher |
| Includes an HSA | Yes | No | No |
| Arch contributes to cover expenses | Yes, through the HSA | No | No |
| Includes Accident Plan at no cost | Yes | No | No |
| Deductible | High deductible; all medical and prescription drug | No deductible for in-network care | Low deductible |
Aetna Medical Plan Overview
| Detail by Plan | Aetna HDHP In-Network | Aetna HDHP Out-of-Network | Aetna Choice PPO In-Network | Aetna Choice PPO Out-of-Network |
|---|---|---|---|---|
| Arch HSA Contribution (Pro-rated based on effective date) | $650 Employee Only/$1,300 Employee + One or Family | $650 Employee Only/$1,300 Employee + One or Family | None | None |
| Maximum Annual HSA Contribution (Arch + Employee) | $4,300, Employee Only/$8,550 Employee + One or Family; Employees age 55+ can contribute an additional $1,000 | $4,300, Employee Only/$8,550 Employee + One or Family; Employees age 55+ can contribute an additional $1,000 | None | None |
| Annual Deductible | $1,650 Employee Only/$3,300 Employee + One or Family | $3,000 Employee Only/$6,000 Employee + One or Family | None | $600 Employee Only/$1,200 Employee + One or Family |
| Out-of-Pocket Maximum | $4,500 Employee Only/$6,850 Employee + One or Family | $9,000 Employee Only/$13,700 Employee + One or Family | $4,000 Employee Only/$8,000 Employee + One or Family | $6,000 Employee Only/$12,000 Employee + One or Family |
| Preventive Care | Covered at 100% | Not Covered | Covered at 100% | Covered at 70% after annual deductible |
| All Medical Services, including General Practitioner, Specialist and Virtual Office Visits | Covered at 80% after annual deductible | Covered at 60% after annual deductible | Covered at 90% | Covered at 70% after annual deductible |
| Prescription Type | Aetna HDHP In-Network | Aetna HDHP Out-of-Network | Aetna Choice PPO In-Network | Aetna Choice PPO Out-of-Network |
|---|---|---|---|---|
| Retail – (up to a 31-day supply) Tier-1 | Covered at 80% after annual deductible | Covered at 60% after annual deductible | Covered at 90% of the prescription drug cost, but not less than $5 and not more than $10 per prescription order or refill | Covered at 90% of the prescription drug cost, but not less than $5 and not more than $10 per prescription order or refill* |
| Retail – Tier-2 | Covered at 80% after annual deductible | Covered at 60% after annual deductible | Covered at 80% of the prescription drug cost, but not less than $45 and not more than $75 per prescription order or refill | Covered at 80% of the prescription drug cost, but not less than $45 and not more than $75 per prescription order or refill |
| Retail – Tier-3 | Covered at 80% after annual deductible | Covered at 60% after annual deductible | Covered at 70% of the prescription drug cost, but not less than $60 and not more than $85 per prescription order or refill | Covered at 70% of the prescription drug cost, but not less than $60 and not more than $85 per prescription order or refill |
| Mail Service – (up to a 90-day supply) Tier-1 | Covered at 80% after annual deductible | Not Covered | Covered at 90% of the prescription drug cost, but not less than $15 and not more than $30 per prescription order or refill | Not Covered |
| Mail Service – Tier-2 | Covered at 80% after annual deductible | Not Covered | Covered at 80% of the prescription drug cost, but not less than $135 and not more than $225 per prescription order or refill | Not Covered |
| Mail Service – Tier-3 | Covered at 80% after annual deductible | Not Covered | Covered at 70% of the prescription drug cost, but not less than $180 and not more than $255 per prescription order or refill | Not Covered |
*If you use a non-network pharmacy, you are responsible for any amount over the allowed amount.