Your Benefits With the Trust
The Trust is committed to being your partner in health and providing you with the support you need to live a happy and healthier life. Click below to learn more about your benefits and coverage with the Trust, and find out about preventive care and prescription benefits.
The Trust has preferred provider arrangements with Aetna’s Choice POS II network for medical services. This network of hospitals, physicians and other healthcare professionals provides eligible retirees and dependents with efficient, cost-effective services and supplies at discounted rates.
Providers not in the network are reimbursed at a lower level of benefits, and charges are allowed only up to usual, customary and reasonable (UCR) fees.
Although you may see any provider covered by the plan, you receive higher benefits if you use preferred providers—the choice is yours, each time you use your benefits.
- Find a Preferred Aetna’s Choice POS II network provider online, or by asking your doctor if they are in the preferred network.
- Find the details of your medical coverage in your Summary Plan Description booklet in the sidebar at right.
Preferred covered provider—80%
Non-preferred covered provider—50% of UCR charges
Other covered expenses—80% of UCR charges
All covered providers and expenses—when the out-of-pocket maximum is reached, the plan pays 100% for the rest of the calendar year.
Aetna Case Management
The Trust has contracted with Aetna to provide Case Management services in certain health care treatment situations, such as before a scheduled hospitalization, after discharge from the hospital or if you are considering weight-loss surgery. An Aetna case manager will work cooperatively with you and your physician to consider effective alternatives to hospitalizations and other high-cost care to assist you in making the most efficient use of your benefits with the Trust. Aetna Case Management is included in the benefits provided to you by the Trust and is strictly confidential and voluntary. If you qualify, an Aetna case manager will call you to get started. For more information, call the Trust Office at (206) 282-4500 or (800) 225-7620.
The Trust’s prescription plan is designed to promote the use of proven, cost-effective medications. The Trust Custom Pharmacy Network consists of pharmacies owned by employers who participate in the Trust.
Out of Pocket Maximum
(includes the annual deductible as well as 20% and 50% co-payments)
Get More Information in Your Benefits Booklet
Find the details of your prescription drug coverage in your Summary Plan Description in the sidebar at right.
Eligible Sound Health & Wellness Trust PPO plan participants and their covered dependents can receive $0 co-pay flu shots* either at a pharmacy or at the doctor’s office, with coverage subject to plan limitations.
If you use a Trust Custom Network pharmacy you will pay nothing, subject to plan limitations. If you use any other OptumRX pharmacy, you will pay a discounted amount for your shots. You can then submit your claim to the Trust Office for 100% reimbursement, up to the covered limits. If you prefer, you can still go to your doctor for your vaccination, as long as your doctor is an approved Aetna Choice POS II network doctor. However, your office visit will not be covered. Flu shots are not subject to your deductible.
Getting a flu shot is the single best way to protect against the flu. Children from 6 months to 19 years of age, pregnant women, people 50 and older, and people with certain chronic medical conditions are especially encouraged to get a flu shot.
*Note that the flumist is not covered.