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!