Health Care 101

Understanding your health care choices just got easier at AllTrails

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Medical Plans, Plain and Simple

If you find health insurance terms confusing, you're not alone. That's why we made this handy guide. No more jargon or complicated descriptions. Just straightforward explanations about plans, payments and easy ways to save.

Covered Services

"Covered" doesn't mean free. A covered health care service is one that your plan recognizes and pays for after you've met the deductible, coinsurance or copay.

Referrals

A referral is like a permission slip from your primary care physician (PCP) to see a specialist or another provider. Many doctors can send referrals electronically.

Network Providers

Network providers participate in our network and offer special lower rates for our members, helping you save money on care.

Paying for Care: An Overview of Terms

Understanding Your Costs

  • Claims are requests for your plan to pay for services you receive. We use these to check what your plan will cover and the amount we'll pay. You can find the status and amounts billed for your claim on your member website or the Aetna Health app.
  • Explanation of Benefits (EOB) statements show a breakdown of how we process claims. It's not a bill and may not show the current balance you owe.
  • Provider bills show the amount you actually owe for services. Your provider will give this to you, and you can make payments directly to them.

Cost Sharing Breakdown

  • Deductible: The amount you pay for out-of-pocket costs before your plan begins to pay. Each year, you pay 100% of covered expenses until you meet your deductible amount.
  • Coinsurance: A fixed percentage you pay after meeting your deductible. For example, if your care is $100 and your coinsurance is 20%, you pay $20.
  • Copay: A fixed dollar amount. For example, you may pay $25 per doctor office visit.
  • Out-of-pocket maximum: The maximum you pay each year for covered expenses. Once you hit your maximum, the plan pays 100% of covered expenses for the rest of the year.

Three Plans, Three Choices

AllTrails offers three Aetna PPO plans designed for different needs and budgets. Here's how to choose the right one for you.

PPO $0 Plan

Maximum coverage, minimal out-of-pocket

PPO $1000 Plan

Balanced coverage with moderate costs

PPO HSA Plan

Lower premiums, tax-advantaged savings

PPO $0 Plan: Best for Frequent Healthcare Users

This plan can be ideal if you visit doctors regularly, have ongoing medical needs, or want predictable costs.

Why Choose This Plan?

  • You pay a low per paycheck cost
  • No deductible to meet before coverage starts
  • Low copays: $15 PCP, $30 specialist
  • Predictable costs for regular care

Key Numbers

  • Individual Out-of-Pocket Max: $2,500
  • Family Out-of-Pocket Max: $5,000
  • Emergency Room: $300 copay
  • Prescription Drugs: $10-$50 copays

Perfect for: People who see doctors frequently, families with kids, anyone managing chronic conditions

PPO $1000 Plan: The Balanced Choice

This middle-ground option balances monthly costs with reasonable out-of-pocket expenses.

Why Choose This Plan?

  • No cost out of your paycheck
  • Low copays after deductible: $25 PCP, $50 specialist
  • Good for generally healthy people
  • Protection against major expenses

Key Numbers

  • Individual Deductible: $1,000
  • Family Deductible: $2,000
  • Individual Out-of-Pocket Max: $4,000
  • Family Out-of-Pocket Max: $8,000
  • Emergency Room: $300 copay + 20%

Perfect for: Healthy individuals, people who want no cost premiums but still have solid coverage

PPO HSA Plan: Save Money, Build Wealth

This high-deductible plan offers the lowest premiums and lets you save tax-free money in a Health Savings Account.

Why Choose This Plan?

  • No cost out of your paycheck
  • Tax-free HSA contributions (you keep forever)
  • Great for healthy people who rarely need care
  • HSA contributions grows tax-free for retirement

Key Numbers

  • Individual Deductible: $2,000 (in-network)
  • Family Deductible: $4,000 (in-network)
  • Individual Out-of-Pocket Max: $4,000
  • Family Out-of-Pocket Max: $8,000
  • After deductible: 20% coinsurance

Perfect for: Healthy individuals, high earners wanting tax savings, people who can afford to pay upfront and want to build long-term savings

Quick Comparison: Which Plan Saves You Money?

Remember: All three plans use the same Aetna network, cover preventive care 100%, and include prescription drug coverage. The difference is how much you pay upfront versus over time.

In-Network vs. Out-of-Network Care

Choosing in-network providers may help save you money. These providers contract with us to offer rates that are often lower than their regular fees. They also work directly with us and send us claims for services you receive.

In Network

Cost You Less

  • Lower out-of-pocket costs with negotiated rates
  • No balance billing
  • Less paperwork
  • Provider files your claim
  • Plan pays provider directly based on negotiated rate
Out of Network

Cost You More

  • Higher costs without contracted rates
  • Providers charge more for services
  • You may pay the difference between plan payment and provider charges
  • You may need to file your own claims
  • More paperwork to handle

Your Healthcare Journey: Three Simple Steps

01

Doctor Visit

Visit your doctor and show your Aetna member ID card. There's no need to pay at your visit unless you have a copay.

02

Claims Processing

Your doctor files your claim and the plan pays your doctor any amount it owes based on the negotiated rate.

03

Final Billing

Your doctor bills you for any amount you owe after the plan has paid their portion.

Know more, get more.

Now you know how health plans work. So you can choose confidently and use yours wisely — all year long. Happy Hiking!