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Aetna High Deductible Health Plan (HDHP) with a Health Savings Account (HSA)

A national PPO network, no referrals and a tax-free account

2026 Biweekly rates for zip code

These rates do not apply to all Enrollees. If you are in a special enrollment category, please refer to the PSHB Program website or contact the agency which maintains your health benefits enrollment.

Table of rates.
Aetna HealthFund® HDHP with HSA Code Biweekly Premium

Looking to save? Check out the MHBP Consumer Option (HDHP with HSA) »

How does your HDHP with a HSA work?

STEP 1: You get a HSA*
Your HDHP comes with an HSA, which you can use to help pay for your qualified health care expenses. The Plan contributes money to your HSA each month. You can contribute pre-tax dollars to the HSA too. All of that money in your HSA earns interest tax-free. And all unused money is yours to keep - even if you leave the plan.

How much do you get in your HSA?
The Plan adds money each month:
Self Only: $800 a year ($66.67 a month)
Self Plus One or Self and Family: $1,600 a year ($133.34 a month)

STEP 2: You have a deductible
A deductible is the amount you need to pay out of your pocket before the Plan starts to pay for covered services. You can use the money in your HSA to pay your deductible or save it for the future.

What is your deductible amount? In network Out of network
Self Only: $1,800 $2,600
Self Plus One or Family: $3,600 $5,200

To lower your costs, use network providers.

STEP 3: You may have coinsurance
Coinsurance is how much the Plan and you pay for health care expenses. It is a shared amount. We pay the larger part. You pay the smaller part.

Coinsurance starts after you have met your deductible.

What is your coinsurance amount? We Pay You Pay
In network: 85% 15%
Out of network: 60% 40%
Plus
  • CVS Health® Virtual Care™ - $0 after deductible

You get in network preventive care at no additional cost to you!
Examples include wellness screenings and exams, dental cleanings and routine eye exams. If you see network providers, nothing comes out of your pocket (or your HSA).

Built-in pharmacy, dental and vision benefits, too

Table of rates.
Type of coverage What you get
Pharmacy Copays after you meet your deductible:
  • 30-day supply at in-network pharmacy:
    • Preferred generic – You pay $10
    • Preferred brand – You pay 50% max of $200
    • Non-preferred generic or brand – You pay 50% max of $300†**
    Your plan requires the use of generic medication when a generic equivalent exists.***
  • 90-day supply Mail-order delivery or at a CVS Pharmacy® location:
    • Preferred generic – You pay $20
    • Preferred brand – You pay 50% max of $400
    • Non-preferred generic or brand – You pay 50% max of $600†
Dental
  • Cleanings and X-rays covered 100% when you see network dentists.
Vision
  • Routine eye exams covered at 100% when you visit network doctors.
  • $100 allowance every 24 months to pay for prescription eyewear.
  • Discounts on eyeglasses, contact lenses and more.

Aetna HealthFund HDHP Prescription drug benefits when you’re enrolled in Medicare Part A and/or B: Aetna Medicare Rx offered by SilverScript

Members with Medicare Part A and/or Part B primary will be automatically enrolled into Aetna Medicare Rx® offered by SilverScript®. This is a Medicare Part D prescription drug option offering significant savings. Your drugs will still be covered, but copays and coinsurance are lower. See benefits below.
Table of rates.
Benefit What you'll pay
30-day Supply through Retail
  • Preferred generic: $0
  • Generic: $4 from a preferred pharmacy ($5 from a standard pharmacy)
  • Preferred brand: $40
  • Non-preferred brand: $100
  • Specialty: 25% up to $150
90-day Supply through Retail or Mail
  • Preferred Generic: $0
  • Generic: $8 from preferred mail order or pharmacy ($10 from standard mail order or pharmacy)
  • Preferred Brand: $80
  • Non-Preferred Brand: $200
  • Specialty Limited to a one-month supply
Out of Pocket Maximum for prescription drugs Once you have paid $2,000 in out of pocket costs for covered prescription drugs, you will pay $0 for covered prescription drugs for the remainder of the calendar year under this Medicare Part D Prescription Drug Plan. This $2,000 will also apply to the medical plan’s total calendar year out-of-pocket maximum.
2026 Aetna HDHP Plan PSHBP Formularies


Download 2026 PSHB Prescription Drug Formulary for Aetna HDHP Plan with Aetna Medicare Rx offered by SilverScript (PDF)

Download 2026 PSHB Prescription Drug Supplemental Benefit (PDF)

2025 Aetna HDHP Plan PSHBP Formularies


Download 2025 PSHB Prescription Drug Formulary for Aetna HDHP Plan with Aetna Medicare Rx offered by SilverScript (PDF)

Download 2025 PSHB Evidence of Coverage for Aetna HDHP Plan with Aetna Medicare Rx offered by SilverScript (PDF)

Download 2025 PSHB Prescription Drug Supplemental Benefit (PDF)

Aetna Medicare Rx Resources and Contact Information

Call Members Services at 1-833-251-9749 (TTY: 711), Monday through Friday, 8 AM to 8 PM ET or go online at Caremark.com

You can get more money in your HSA!

You can earn an additional $75 for Self Only or $150 for Self Plus One or Family (enrollee and spouse only) by completing the Health Risk Assessment, one wellness program and your biometric screening. Log in to your Aetna member website to complete the Health Risk Assessment and enroll in a wellness program. The money goes directly into your HSA when completed!

Why choose Aetna HDHP?

  • Large nationwide Aetna PPO Network
  • Coverage in network or out — and no referrals needed
  • Earn up to $75/self or $150/self plus one and family in wellness credits
  • An HSA that you own — use the tax-free money to pay for qualified health expenses now or save it for future expenses
  • 24 hours / 7 days a week access to doctors via video with CVS Virtual Care
  • Discounts on eyewear, LASIK laser eye surgery, gym memberships, massage, acupuncture, weight-loss programs and more

Need more information about this plan?

Download 2025 plan summary (PDF)

Click here to download the health plan summary

Download 2025 plan brochure (PDF)

Click here to download this plan's OPM brochure

Read plan FAQs

Read the most frequently asked questions about this plan.

Find your doctor

Find your doctor now in Aetna’s large nationwide network.

*To open an HSA, you must meet certain IRS eligibility requirements. If you don't, let us know by calling 1-877-459-6604 (TTY:711). You can enroll in a similar plan called HDHP with HRA. See the official plan brochure for details.
**For specialty drug information, see the official plan brochure
***If you choose the brand name drug over the generic equivalent, you will owe the corresponding copay plus the difference between the generic and brand name costs. Please see the plan brochure for details.

† See Aetna.com

AAetna and CVS Pharmacy® are part of the CVS Health® family of companies. This is a brief description of the features of this Aetna health benefits plan. Before making a decision, please read the Plan's official brochure(s). All benefits are subject to the definitions, limitations, and exclusions set forth in the official brochure.

Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice.

This material does not contain legal or tax advice. You should contact your legal counsel or tax advisor if you have any questions or need additional information. Please read the plan’s applicable federal brochure(s) for more information about your covered benefits. There may be fees associated with a health savings account (“HSA"). These are the same types of fees you may pay for checking account transactions. Please see the HSA fee schedule online.

This is a brief description of the features of this Aetna health benefits plan. Before making a decision, please read the Plan's official brochure(s). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.

Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional.

Incentive-based activity awards will only be given for completing select wellness programs as determined by the plan sponsor. Aetna’s Drug Guide is subject to change.

The Aetna Medicare Rx offered by SilverScript (EGWP) retiree pharmacy coverage is an enhanced Part D Employer Group Waiver Plan that is offered as a single integrated product. The enhanced Part D plan consists of two components: basic Medicare Part D benefits and supplemental benefits. Basic Medicare Part D benefits are offered by Aetna Medicare Rx offered by SilverScript (EGWP) based on our contract with CMS. We receive monthly payments from CMS to pay for basic Part D benefits. Supplemental benefits are non-Medicare benefits that provide enhanced coverage beyond basic Part D. Supplemental benefits are paid for by plan sponsors or members and may include benefits for non-Part D drugs. Aetna Medicare Rx offered by SilverScript (EGWP) reports claim information to CMS according to the source of applicable payment (Medicare Part D, plan sponsor or member).

Aetna Medicare Rx offered by SilverScript is a group standalone Medicare Prescription Drug Plan (PDP). This plan is offered by SilverScript Insurance Company, which has a Medicare contract. SilverScript Insurance Company and Aetna are affiliated companies. Enrollment in the plan depends on Medicare contract renewal.

Due to legislation in Arkansas, effective January 1, 2026, you may not be able to utilize the following services within the state of Arkansas, unless a court takes action: CVS Retail, CVS Caremark Mail Service, CVS Specialty, and OMNI Care long term pharmacies.

For information about our plans available through the Federal Employees Dental and Vision Insurance Program (FEDVIP), please visit our Dental PPO Plan site or our Aetna Vision™ Preferred site.

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