CSC Employee Benefits Plan · CDHP / HDHP

Your health plan, explained

Meritain Health (Aetna network) Coverage Employee + Family Plan year 8/1–12/31/2026

How your plan works

The whole family shares one running total for the year. Where that total is decides what you pay.

  1. Up to $4,000 You pay 100%

    You pay the full price insurance negotiated until the family has spent $4,000 (the deductible).

  2. $4,000 to $6,000 You pay 10%

    The plan pays the other 90% of in-network care.

  3. After $6,000 You pay $0

    Covered in-network care is free for the rest of the year. One person on their own gets here at $3,400.

Hurt or sick right now

Where you go makes the biggest difference. The same stitches can cost a few hundred dollars or a few thousand.

ER: real emergencies only

  • Bleeding that won't stop after 10 minutes of pressure
  • Deep cut showing bone or tendon, or numbness past it
  • Head injury with confusion, vomiting or passing out
  • Chest pain, trouble breathing, stroke signs
  • Badly broken bone

Often thousands of dollars. The plan doesn't cover ER visits that aren't emergencies.

Urgent care (InstaCare): most other things

  • Cuts needing stitches
  • Sprains, possible simple fractures (X-ray)
  • Burns, infections, fevers, ear and throat pain

Usually a few hundred dollars. If unsure, call and ask if they do stitches and X-rays.

Virtual visit: no exam needed

  • Rashes, pink eye, colds
  • Urinary tract infections
  • Refills and quick questions

The cheapest option.

Pay cash or use insurance?

The bill will show a huge "billed" price, but in-network you only owe the lower price insurance negotiated. That negotiated price can still be higher than the clinic's cash price, and until $4,000 you pay all of it. So ask for both.

  1. Is it preventive, or has the family passed $4,000?

    Use insurance. Preventive care is $0, and past $4,000 you only pay 10%.

  2. Otherwise, ask before you hand over your card

    "What's your self-pay price, and what's the price billed to my insurance? If I need stitches or an X-ray, what does that add?"

  3. Pick the cheaper one, with one exception

    Cash usually doesn't count toward the $4,000. If the family will pass $4,000 before Dec 31 anyway (surgery, a baby, a scan), use insurance.

  4. Decide at check-in

    Once they bill insurance, they usually can't switch you to cash. To pay cash, say "I'd like to self-pay and not bill my insurance."

Either way, pay with the HSA card and keep the receipt. Tip: look up your nearest urgent care's prices once, in the Meritain portal and by calling the clinic, so you know before you need it.

Calculator

Compare an insurance price with a cash price
$
$
$
From the Meritain portal. Remembered on this phone.
$
Remembered on this phone.
Provider
Through insurance—
Paying cash—Doesn't count toward deductible

Free preventive care

$0 when in-network, the person fits the "who" line, and it's billed as preventive. Anything that treats a problem is billed normally.

Show

Adults (18+)

Vaccines
ChickenpoxDiphtheriaFluHepatitis AHepatitis BHPVMeaslesMeningococcalMumpsWhooping coughPneumococcalRubellaShinglesTetanus
  • Yearly checkup (annual physical, wellness visit)All adults, usually once a year. Book it as a "preventive" or "annual physical" visit.
  • Blood pressure screeningAll adults
  • Cholesterol screeningCertain ages, or higher risk
  • Colorectal cancer screeningAges 45–75 (colonoscopy, stool tests)
  • Type 2 diabetes screeningAges 40–70 who are overweight or obese
  • Depression screeningAll adults
  • Obesity screening and counselingAll adults
  • Diet counselingHigher risk for chronic disease
  • Alcohol misuse screening and counselingAll adults
  • Tobacco use screening and quitting helpAll adults
  • Hepatitis C screeningAges 18–79
  • Hepatitis B screeningHigh risk
  • HIV screeningAges 15–65, other ages at higher risk
  • PrEP (HIV prevention medication)HIV-negative adults at high risk
  • Syphilis screeningHigher risk
  • STI prevention counselingHigher risk
  • Tuberculosis screeningHigh risk, no symptoms
  • Lung cancer screening (low-dose CT)Ages 50–80, heavy smokers or quit within 15 years
  • Abdominal aortic aneurysm screeningOne time, men of certain ages who have ever smoked
  • Statin medicationAges 40–75 at high risk
  • AspirinAges 50–59 with high cardiovascular risk
  • Fall prevention (exercise, PT, vitamin D)65+ living in the community

Women

  • Well-woman visit (yearly checkup)All women
  • MammogramEvery 1–2 years, age 40+
  • Pap test (cervical cancer screening)Ages 21–65
  • Bone density screeningOver 65, or younger after menopause
  • Birth controlFDA-approved methods, sterilization, counseling, as prescribed
  • BRCA genetic counselingHigher breast cancer risk
  • Breast cancer chemoprevention counselingHigher risk
  • Chlamydia screeningYounger women and others at higher risk
  • Gonorrhea screeningHigher risk
  • HIV screening and counselingAges 15–65, other ages at higher risk
  • PrEP (HIV prevention medication)HIV-negative, high risk
  • STI counselingSexually active women
  • Diabetes screening after gestational diabetesHistory of gestational diabetes, not pregnant, no type 2 diagnosis
  • Domestic and interpersonal violence screeningAll women
  • Urinary incontinence screeningYearly
  • Tobacco use screening and quitting helpAll women

Pregnant or may become pregnant

  • Folic acid supplementsMay become pregnant
  • Breastfeeding support, counseling and supplies (pump)Pregnant and nursing
  • Gestational diabetes screening24+ weeks pregnant, or high risk
  • Hepatitis B screeningFirst prenatal visit
  • Rh incompatibility screeningAll pregnant women; follow-up if higher risk
  • Preeclampsia prevention and screeningPregnant with high blood pressure
  • Syphilis screeningPregnant women
  • Urinary tract or other infection screeningPregnant women
  • Expanded tobacco counselingPregnant tobacco users
  • Maternal depression screeningMothers, at well-baby visits

Children (birth–18)

Vaccines
ChickenpoxDTaPHibHepatitis AHepatitis BHPVPolioFluMeaslesMeningococcalMumpsPneumococcalRotavirusRubella
  • Well-baby and well-child visits (yearly checkup)All children
  • Height, weight and BMIAll children, regularly
  • Blood pressure screeningAll children
  • Vision screeningAll children
  • Eye exam1 every 24 months (from the plan)
  • Hearing screeningNewborns, then as the provider recommends
  • Developmental screeningUnder age 3
  • Autism screening18 and 24 months
  • Behavioral assessmentsAll children
  • Depression screeningAdolescents, from age 12
  • Alcohol, tobacco and drug use assessmentAdolescents
  • Obesity screening and counselingAll children
  • Cholesterol (dyslipidemia) screeningOnce at 9–11, once at 17–21, or higher risk
  • Hematocrit or hemoglobin (anemia) screeningAll children
  • Lead screeningAt risk of exposure
  • Tuberculin (TB) testHigher risk
  • Oral health risk assessment6 months to 6 years
  • Fluoride varnishAll children once teeth come in
  • Fluoride supplementsWater source lacks fluoride
  • Hepatitis B screeningAdolescents at higher risk
  • HIV screeningAdolescents at higher risk
  • PrEP (HIV prevention medication)HIV-negative adolescents at high risk
  • STI counseling and screeningAdolescents at higher risk
  • Newborn blood screeningNewborns
  • Newborn bilirubin, PKU, sickle cell, hypothyroidism screeningNewborns
  • Newborn eye medication (gonorrhea prevention)Newborns
Not free, so ask first
  • Treatment shots: cortisone, B12, allergy shots, travel vaccines
  • COVID and RSV vaccines (not on the list)
  • A colonoscopy or mammogram follow-up because of a symptom or abnormal result
  • Extra labs added at a physical, or a new problem brought up during it
  • A free vaccine given at a sick visit can add an office visit charge

Costs and rules

Almost everything costs 10% in-network or 30% out-of-network, after the deductible. That covers doctor and specialist visits, virtual visits, labs, imaging, urgent care, surgery, hospital stays, mental health, maternity, therapy and equipment.

Exceptions

  • Preventive care: $0
  • ER and ambulance: 10% even out-of-network
  • No referral needed for specialists

Yearly limits

  • PT, OT and speech therapy: 60 visits combined
  • Chiropractor: 30 visits
  • Acupuncture: 30 visits
  • Home health: 120 visits
  • Skilled nursing: 100 days
  • Eye exam: 1 every 24 months

Needs pre-approval

  • Outpatient surgery and hospital stays
  • MRA and PET scans
  • Inpatient or intensive mental health care
  • Home health, skilled nursing, hospice
  • Equipment rentals, or purchases over $1,500
  • Birth stays over 48 hrs (96 for C-section)

Skip it and the penalty is yours. Ask the office if it's approved.

Not covered

  • Dental (adult and child)
  • Glasses (adult and child)
  • Hearing aids, cosmetic surgery, long-term care
  • Non-emergency care outside the U.S.
  • Routine foot care, unless diabetic
  • Weight loss and bariatric surgery, unless morbidly obese

Avoid surprise bills

  • Ask which lab or imaging center they use, and whether it's in-network
  • Wait for Meritain's Explanation of Benefits before paying a bill
  • Ask for an itemized bill on anything big

Prescriptions (CVS Caremark)

Who to call

Meritain Health(866) 871-1072Deductible balance, claims, pre-approval
Find in-network providersCSC.quantum-health.com
Prescriptionscaremark.com
Plan details, cost estimatormeritain.com