2025 Plan Coverage Documents
Review these plan documents for a detailed explanation of coverage. Contact the plan administrator with coverage questions.
Documents will be posted as they become available from the plans.
Health care program
Medical
All enrollees
Aetna Medicare Plan
All enrollees
PPO enrollees
- Annual Notice of Changes (Medicare Parts A & B)
- Schedule of Cost Sharing & Evidence of Coverage (Medicare Parts A & B)
- Annual Notice of Changes (Medicare Part B-Only)
- Schedule of Cost Sharing & Evidence of Coverage (Medicare Part B-Only)
ESA PPO enrollees
- Annual Notice of Changes (Medicare Parts A & B)
- Schedule of Cost Sharing & Evidence of Coverage (Medicare Parts A & B)
- Annual Notice of Changes (Medicare Part B-Only)
- Schedule of Cost Sharing & Evidence of Coverage (Medicare Part B-Only)
Aetna Basic Plan
- PPO Summary of Benefits and Coverage
- Indemnity Summary of Benefits and Coverage
- Transform Oncology Program
Aetna Basic Health Care Assistance Plan (HCAP)
Prescription
All enrollees
SilverScript (Medicare enrollees)
- Annual Notice of Changes
- Evidence of Coverage
- Formulary
- Summary of Benefits
- Notice of Medicare Part D Creditable Coverage
CVS Caremark (non-Medicare enrollees)
Dental and vision
Delta Dental
Vision Service Plan (VSP)
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