What am I looking at?
These are Summary of Benefits (SBC) documents — the legal sheets every insurer must publish. Here's the short version, decoded.
Quick picker: which medical plan fits you?
Rarely see a doctor
→ H2 (HDHP 6350/100%)
Highest deductible, but once you hit it everything is 100% covered. HSA-eligible. Best if you're healthy and want the cheapest premium + tax-advantaged savings.
Frequent doctor visits, predictable needs
→ F3 or F3 PPO (1000/80%)
Low $1,000 deductible. Copay-based ($25 PCP / $50 specialist) so you pay a flat fee per visit without racing to meet a deductible first.
Middle ground / want HSA
→ G2 or G2 PPO (3300/90%)
Mid deductible, but everything in-network is only 10% coinsurance. HSA-eligible. Good balance if you want HSA tax perks without H2's high deductible.
Only see in-network doctors, want cheap premium
→ D2 (EPO HDHP 3500/80%)
EPO = no out-of-network coverage at all (except emergencies). Lower premium. HSA-eligible. Only pick if your doctors are all in-network.
PPO vs POS vs EPO: PPO = biggest, most flexible network, typically easier referrals for specialists out-of-state. POS = similar but narrower. EPO = in-network only, no out-of-network coverage. Functionally, F3 and F3 PPO have the same costs — pick PPO if you travel or want a wider network.
Key trade-offs, at a glance
Pick whichever dial you care about most.
| If you want… | Pick… | Catch |
|---|---|---|
| Lowest monthly premium | H2 or D2 | High deductible — you pay the first $3,500–$6,350 yourself |
| Predictable copays instead of deductibles | F3 / F3 PPO | Higher premium, no HSA eligibility |
| HSA tax-advantaged savings | D2, G2, G2 PPO, or H2 | Must be an HDHP plan — H2 is the most HSA-friendly (deductible = OOP max) |
| Out-of-network coverage | Any PPO or POS (not D2) | Out-of-network always costs more (50% coinsurance typical) |
| Orthodontics for adults | Aetna DMO or MetLife PPO (non-ET states) | MetLife "ET States" plan excludes adult ortho |
Medical plans — all Aetna
Six options. They differ mostly on deductible size, how you pay (copay vs coinsurance), and whether out-of-network is covered.
D2
EPO HDHP 3500/80%
Aetna Open Access Elect Choice · EPO
HSA-eligible
High deductible
No out-of-network
- Deductible (ind/fam)$3,500 / $7,000
- Out-of-pocket max$6,500 / $13,000
- PCP / Specialist20% after ded
- ER20% after ded
- Generic Rx$10 retail
F3
OAMC 25/50 1000/80%
Aetna Open Access Managed Choice · POS
Copay-based
Low deductible
- Deductible (ind/fam)$1,000 / $2,000
- Out-of-pocket max$4,500 / $9,000
- PCP / Specialist$25 / $50 copay
- ER$350 copay
- Generic Rx$10 retail
F3 PPO
PPO 25/50 1000/80%
Aetna Open Choice · PPO
Copay-based
Low deductible
Wider network
- Deductible (ind/fam)$1,000 / $2,000
- Out-of-pocket max$4,500 / $9,000
- PCP / Specialist$25 / $50 copay
- ER$350 copay
- Generic Rx$10 retail
G2
OAMC HDHP 3300/90%
Aetna Open Access Managed Choice · POS
HSA-eligible
Mid deductible
- Deductible (ind/fam)$3,300 / $6,600
- Out-of-pocket max$5,500 / $11,000
- PCP / Specialist10% after ded
- ER10% after ded
- Generic Rx$10 retail
G2 PPO
PPO HDHP 3300/90%
Aetna Open Choice · PPO
HSA-eligible
Mid deductible
Wider network
- Deductible (ind/fam)$3,300 / $6,600
- Out-of-pocket max$5,500 / $11,000
- PCP / Specialist10% after ded
- ER10% after ded
- Generic Rx$10 retail
H2
OAMC HDHP 6350/100%
Aetna Open Access Managed Choice · POS
HSA-eligible
Highest deductible
$0 after ded
- Deductible (ind/fam)$6,350 / $12,700
- Out-of-pocket max$6,350 / $12,700
- PCP / Specialist0% after ded
- ER0% after ded
- Generic Rx0% after ded
Heads up on H2: The deductible equals the out-of-pocket max. That means after you spend $6,350 (individual), everything is 100% covered — no coinsurance at all. It's the cleanest HSA plan if you can handle the upfront cost.
Full medical comparison
Each cell shows in-network on top, out-of-network below. Scroll right if the table gets cut off.
In-network (what you pay at a contracted provider)
Out-of-network (what you pay at a non-contracted provider)
| D2EPO HDHP | F3POS copay | F3 PPOPPO copay | G2POS HDHP | G2 PPOPPO HDHP | H2HDHP 100% | |
|---|---|---|---|---|---|---|
| Deductible individual | $3,500OON not covered | $1,000$3,000 | $1,000$3,000 | $3,300$6,000 | $3,300$6,000 | $6,350$14,000 |
| Deductible family | $7,000OON not covered | $2,000$6,000 | $2,000$6,000 | $6,600$12,000 | $6,600$12,000 | $12,700$28,000 |
| Out-of-pocket max individual | $6,500OON not covered | $4,500$9,000 | $4,500$9,000 | $5,500$12,000 | $5,500$12,000 | $6,350$21,000 |
| Out-of-pocket max family | $13,000OON not covered | $9,000$18,000 | $9,000$18,000 | $11,000$24,000 | $11,000$24,000 | $12,700$42,000 |
| Primary care visit | 20% after dedNot covered | $25 copay30% after ded | $25 copay30% after ded | 10% after ded40% after ded | 10% after ded40% after ded | $0 after ded30% after ded |
| Specialist visit | 20% after dedNot covered | $50 copay30% after ded | $50 copay30% after ded | 10% after ded40% after ded | 10% after ded40% after ded | $0 after ded30% after ded |
| Preventive care | $0Not covered | $030%* | $030%* | $030%* | $030%* | $030%* |
| Urgent care | 20% after dedNot covered | $85 copay30% after ded | $85 copay30% after ded | 10% after ded40% after ded | 10% after ded40% after ded | $0 after ded30% after ded |
| Emergency room paid same either way | 20% after ded20% after ded | $350 copay$350 copay | $350 copay$350 copay | 10% after ded10% after ded | 10% after ded10% after ded | $0 after ded$0 after ded |
| Hospital stay | 20% after dedNot covered | 20% after ded50% after ded | 20% after ded50% after ded | 10% after ded40% after ded | 10% after ded40% after ded | $0 after ded30% after ded |
| Diagnostic / imaging | 20% after dedNot covered | 20% after ded50% after ded | 20% after ded50% after ded | 10% after ded40% after ded | 10% after ded40% after ded | $0 after ded30% after ded |
| Mental health outpatient | 20% after dedNot covered | $25 / $030% after ded | $25 / $030% after ded | 10% after ded40% after ded | 10% after ded40% after ded | $0 after ded30% after ded |
| Generic Rx retail / mail | $10 / $20Not covered | $10 / $2030% after $10 | $10 / $2030% after $10 | $10 / $2030% after $10 | $10 / $2030% after $10 | 0% after ded30% after ded |
| Brand Rx retail / mail | $45 / $90Not covered | $45 / $9030% after $45 | $45 / $9030% after $45 | $45 / $9030% after $45 | $45 / $9030% after $45 | 0% after ded30% after ded |
| Non-preferred Rx | $70 / $140Not covered | $70 / $14030% after $70 | $70 / $14030% after $70 | $70 / $14030% after $70 | $70 / $14030% after $70 | 0% after ded30% after ded |
| Referrals required? | No | No | No | No | No | No |
| HSA-eligible? | Yes | No | No | Yes | Yes | Yes |
* Out-of-network preventive care: 30% coinsurance, except well-child visits & child immunizations which are $0 (no cost-sharing). For out-of-network Rx on non-HDHP plans, you pay the normal copay plus 30% coinsurance. On D2 (EPO), out-of-network care is not covered at all except for true emergencies.
Extras included on all plans
These apply across every Aetna medical plan listed above.
- Virtual primary care: $0 in-network telemedicine visits (after deductible on HDHP plans).
- Acupuncture: 10 visits/year for injury or chronic pain.
- Chiropractic, bariatric surgery, infertility treatment: covered (limits apply).
- Hearing aids: 1 aid per ear every 3 years.
- Adult routine eye exam: 1/year (but glasses NOT covered — use vision plan).
- Physical/OT/speech therapy: 60 visits/year combined.
Sample real-world costs
From the SBC's standardized "coverage examples." Self-only coverage.
| D2 | F3 / F3 PPO | G2 / G2 PPO | H2 | |
|---|---|---|---|---|
| Having a baby $12,700 total cost | $5,170 | $3,170 | $4,170 | $6,350* |
| Type 2 diabetes $5,600 total cost | $2,320 | $820 | $2,320 | $2,320 |
| Simple fracture $2,800 total cost | $2,800 | $1,200 | $2,800 | $2,800 |
* H2 pays 100% after deductible, so your max exposure = deductible. Estimates exclude monthly premiums — the plans you pay more for upfront (F3) typically have higher premiums.
Dental plans
One DMO option (Aetna — cheapest, restrictive network) and two PPO options from MetLife.
DMO vs PPO in 10 seconds: DMO = HMO for teeth. Lower cost, but you must use a specific primary care dentist in-network, and coverage only works in certain states. PPO = use any dentist; stay in-network for lower cost.
Side-by-side
| Aetna DMODental Maintenance Org | MetLife PPOHigh Plan (most states) | MetLife PPO – ET States"Exempt" states | |
|---|---|---|---|
| Network | Aetna DMO (narrow) | PDP Plus | PDP Plus |
| Deductible | None | $25 ind / $75 fam | $25 ind / $75 fam |
| Annual max benefit | Unlimited | $3,000/person | $3,000/person |
| Office visit copay | $5 | None | None |
| Preventive cleanings, exams | 0% (free) | 100% in / 90% out | 100% in / 100% out |
| Basic fillings | 20% you pay | 90% in / 70% out | 90% in / 90% out |
| Major crowns, dentures | 50% you pay | 50% / 50% | 50% / 50% |
| Orthodontia (child) | 50% you pay | 50% / 50%, $1,500 lifetime max | 50% / 50%, $1,500 lifetime max |
| Orthodontia (adult) | Covered (50%) | Covered (50%) | Not covered |
| Out-of-network | Not covered (with exceptions) | Covered, lower rates | Covered at same rates |
| State restrictions | Only AZ, CA, GA, MA, MD, MO, NC, NJ, TX | Any state | "ET" states only |
What are "ET States"? States where insurance rules require the plan to pay the same rates in- and out-of-network for certain services. If you live in one, you're auto-enrolled in the ET variant — which trades off adult ortho for flatter reimbursement.
Which dental plan should I pick?
Healthy teeth, just cleanings
→ Aetna DMO
Free preventive, no deductible, no annual cap. Cheapest premium. Only works if you live in a DMO state and pick an in-network dentist.
Expect fillings, crowns, or want flexibility
→ MetLife PPO
$3,000/year benefit cap, use any dentist. Better for pre-existing dental work or if you move around.
Adult considering braces/Invisalign
→ Aetna DMO or MetLife PPO (non-ET)
Both cover adult ortho at 50%. MetLife has a $1,500 lifetime cap; Aetna DMO has a 24-month treatment window. Avoid the ET plan — it excludes adults.
Vision plans
Aetna and MetLife vision plans are very similar. Differences mostly come down to network and small lens perks.
Side-by-side
| Aetna Vision Preferredvia EyeMed | MetLife VisionHigh Plan, via VSP | |
|---|---|---|
| Exam frequency | Every 12 months | Every 12 months |
| Eye exam cost | $0 copay | Covered in full |
| Frame allowance | $150 + 20% off balance | $150 ($170 featured, $85 at Costco/Walmart/Sam's) |
| Standard lenses single/bifocal/trifocal | $0 copay | No additional cost |
| Progressive lenses | $65 copay standard | Member-negotiated copay |
| Contact lens allowance elective | $150 + 15% off balance | $150 + $60 max fitting |
| Kids' polycarbonate lenses | Discounted $40 | Covered in full |
| UV coating | Discounted $15 | Covered in full |
| LASIK discount | 15% off retail / 5% off promo (US Laser Network) | ~15% off / 5% off promo |
| Out-of-network exam reimbursement | Up to $45 | Up to $45 |
Practical difference: If you buy from Costco/Walmart, MetLife/VSP gives better frame coverage there. If you prefer LensCrafters, Pearle, or Target Optical, Aetna/EyeMed is native. MetLife also covers kids' polycarbonate lenses in full — useful for households with kids.
Plain-English glossary
Every insurance word that tripped you up, demystified.
- Premium
- What you pay every month just to have the plan — whether you use it or not. Not shown in these SBCs. Comes from Justworks separately.
- Deductible
- The amount you pay out of pocket before insurance starts paying its share. Higher deductible → lower premium, and vice versa.
- Copay
- A flat fee per visit or prescription ($25, $50, etc.). Predictable, no math. Copay plans (F3, F3 PPO) often don't require you to meet the deductible for doctor visits.
- Coinsurance
- A percentage of the bill you pay after your deductible is met. "20% coinsurance" = plan pays 80%, you pay 20%.
- Out-of-pocket max
- The yearly ceiling on what you can pay. After this, insurance covers 100%. Includes deductible + copays + coinsurance. Excludes premiums.
- In-network
- Doctors/hospitals that have a contract with the insurer — cheaper for you. Out-of-network providers bill you their full rate; plan covers less (or nothing).
- PPO
- Preferred Provider Organization. Widest network. Go out-of-network at higher cost without a referral.
- POS
- Point of Service. Similar to PPO but often with a slightly narrower network.
- EPO
- Exclusive Provider Organization. In-network only. No out-of-network coverage except emergencies. D2 is an EPO.
- HMO / DMO
- Health / Dental Maintenance Organization. Narrow network, must pick a primary care provider, referrals needed for specialists. Lowest cost. Aetna DMO = HMO for dental.
- HDHP
- High-Deductible Health Plan. Higher deductible in exchange for lower premium and HSA eligibility. D2, G2, G2 PPO, H2 are all HDHPs.
- HSA
- Health Savings Account. Tax-free savings for medical expenses. Only available with HDHPs. Money goes in pre-tax, grows tax-free, and comes out tax-free for qualified medical spending. Triple tax advantage.
- Preventive care
- Annual checkups, vaccines, screenings. Always free with in-network providers under the ACA. Deductible does NOT apply.
- Balance billing
- When an out-of-network provider charges you the difference between what they billed and what your plan paid. Does not count toward your out-of-pocket max.
- Formulary
- The insurer's list of covered prescription drugs, organized by tier (generic / preferred brand / non-preferred / specialty).
- Pre-authorization
- Getting the insurer's OK before certain procedures. Skipping it can mean a $400 penalty (or 50% of the bill). Applies to non-emergency hospital stays, some imaging, etc.
- SBC
- Summary of Benefits and Coverage. The standardized 6-page legal doc every insurer must publish per ACA. That's what the PDFs you have are.