Medical

Brookfield offers a choice of three medical plans. While the plans differ in some respects, they have one important similarity — a focus on prevention.

All three plans are administered by Aetna and offer preventive care at no cost (in-network only) for prescription and vision coverage, help for plan participants managing chronic conditions and wellness-focused features. You can locate a doctor or facility through Aetna’s Find A Doctor Online Directory: aetna.com/docfind/home.do. Please keep in mind that the availability of any particular provider cannot be guaranteed.

HIGH-DEDUCTIBLE HEALTH PLAN

This plan is covered in two sections, the High-Deductible Health Plan (HDHP) and the Health Savings Account (HSA).

The HDHP is similar to the PPO in that you have the option to choose any provider when you need care. However, in exchange for a lower per-paycheck cost, you must satisfy a higher deductible that applies to almost all health care expenses, including those for prescription drugs.

With lower premiums and an out-of-pocket cap mandated by federal law, HSA-compatible health insurance like the Brookfield HDHP typically saves money compared to a PPO for both high- and low-frequency users of health care.

HDHP at a Glance
  • Lower monthly contribution
  • Allows for participation in an HSA
  • Freedom to go out-of-network
  • Participants responsible for amounts up to deductible and out-of-network charges in excess of Aetna contracted rates
  • The HDHP utilizes the Aetna Choice POS II network

If you select the High-Deductible Health Plan, you may be eligible to participate in a Health Savings Account.

EXCLUSIVE PROVIDER ORGANIZATION

With the Exclusive Provider Organization (EPO) option, you receive comprehensive coverage for a range of services. You must use in-network providers. There are no out-of-network benefits.

EPO at a glance
  • Moderate monthly contribution
  • Low deductible and coinsurance
  • No claim forms
  • No out-of-network benefits
  • The EPO utilizes the Open Access Aetna Select network

PREFERRED PROVIDER ORGANIZATION

The Preferred Provider Organization (PPO) option offers the freedom to see any provider when you need care. When you use providers from within the Aetna PPO network, you receive benefits at the discounted network cost.

PPO at a Glance
  • Higher monthly contribution
  • Freedom to go out-of-network
  • No claim forms for in-network services
  • Participants responsible for amounts up to deductible and out-of-network charges in excess of Aetna contracted rates
  • The PPO utilizes the Aetna Choice POS II network

PRESCRIPTION DRUG COVERAGE

If you enroll in one of the medical plan options, your prescription drug coverage will be administered by CVS Caremark. Note: CVS Caremark, along with Aetna, are part of the CVS Health company. To use your prescription benefits, simply present your Aetna identification card to a participating pharmacist. Your pharmacist will notify you of the amount you need to pay. Most major drug store chains accept your Aetna card. If you have a question about participating pharmacies near you, call CVS Caremark at 888-792-3862 or visit their website at www.caremark.com.

You can fill prescriptions at:

  • Retail (up to 30-day supply): At participating pharmacies; one refill is allowed at retail.
  • Mail order or CVS Pharmacy (up to 90-day supply): Through a CVS Caremark mail-order program or your local CVS Pharmacy for maintenance medications and supplies. Specialty Drugs (that typically require a signature), can be delivered and received at a CVS Pharmacy. Newly prescribed specialty medications are subject to CVS Caremark’s step-therapy program. If you are taking a maintenance medication for 60 or more days, you are required to use mail order or a CVS Pharmacy.

Your prescription drug costs are determined based on where you fill your prescription and whether the prescription you are purchasing is a:

  • Generic drug: A chemical equivalent to a brand-name drug that contains the same active ingredients.
  • Formulary brand: A group of preferred brand-name drugs selected by CVS Caremark pharmacists; usually cost less than similar drugs not on the formulary list. The formulary list is available on www.aetna.com.
  • Non-formulary brand: Brand-name drugs that are not on the formulary list.
SPECIALTY PHARMACY

Members enrolled in the PPO and EPO plans and taking certain specialty medications may be eligible for pharmaceutical assistance programs. CVS will reach out to you or your family member if applicable.

MEDICAL PLAN ENHANCEMENTS

Brookfield’s benefits program includes covered medical procedures and health aids designed to meet the diverse needs of employees.

Calibrate

Your metabolic health affects everything from your immune function and mood to your inflammation levels and risk for chronic disease — not to mention your ability to lose weight. Calibrate is designed to reprogram your metabolic system with clinically-proven medication and lifestyle changes to your existing habits. Calibrate’s unique Two-Year Metabolic Reset approach includes doctor-prescribed GLP-1 medication, 1:1 video coaching and a holistic curriculum for meaningful improvements to the food you eat, how you sleep, how much you exercise, and how your emotional health is supported. Visit www.joincalibrate.com to get started. To be eligible for Calibrate, you must be enrolled in a Brookfield Aetna medical plan and have a BMI that is ≥ 30.

Memorial Sloan Kettering (MSK)
World-Class Cancer Center

MSK Direct gives you accurate and comprehensive diagnoses and treatment plans, clinical trials access and MSK-IMPACT genomic testing, if clinically appropriate. You will receive personalized treatment planning and care, plus continuous support through the cancer journey, including:

  • Screening
  • Generic, emotional and social counseling
  • Oncology nursing
  • Integrative medicine
  • Medical nutrition therapy
  • Pain management
  • Palliative care
  • Survivorship programs

These programs are available to you on-site at MSK or remotely through video or phone. So you can choose what works best for your care. To learn more about MSK Direct, visit www.mskcc.org.

Hinge Health

Brookfield is offering Hinge Health at no additional cost for those enrolled in a Brookfield medical plan. Hinge Health is a digital exercise therapy program for back, knee, hip, neck or shoulder pain. It features wearable motion sensors to guide you through the program, a library of educational resources and a personalized health coach who will be there to support you every step of the way. To learn more, call 855-902-2777 or email help@hingehealth.com.

Teladoc

Teladoc allows you to get 24/7 access to board-certified doctors and pediatricians by online video, phone or mobile app. Register now so you can see a doctor right in your own home — and even get prescriptions. Use Teladoc for things like:

• Cold and flu symptoms
• Ear infections
• Respiratory infections
• Allergies
• Pinkeye, and more…

Teladoc is perfect for non-emergency issues when you can’t see your primary doctor. There’s no need to hassle with waiting rooms, and it’s a fraction of the cost of an urgent care visit. You can also receive behavioral health care through Teladoc at no cost to you if you’re in the EPO or PPO plan; subject to deductible, no coinsurance, in the HDHP per IRS guidelines. To get started, go online to www.teladoc.com/Aetna and register. You can also use Teladoc when you’re on the go. Download the Teladoc mobile app (available for Android and Apple iOS in the app store) and start scheduling appointments from anywhere.

Aetna Concierge Services

If you ever need help with your health plan, Aetna Concierge Services can act as your personal assistant for health care. From finding a specialist to understanding different coverages and costs, your concierge can answer questions, assist with scheduling appointments and help you calculate your costs before you go to the doctor or into surgery. Made specifically to support you, you can contact Concierge Services to help you:

• Choose the right doctor
• Understand your coverage
• Get more information about a diagnosis
• Plan for upcoming treatment

Speak with your concierge by calling 888-655-5327, Monday through Friday from 8:00 am to 6:00 pm.

Lyra Mental Health Resources

Lyra is designed to help you with life’s challenges, whether you need mental health coaching (seven free sessions for employees and adult dependents), mental health therapy or medication management support, Lyra will help you quickly find the right provider.

This benefit is available to members and their dependents enrolled in a Brookfield Aetna medical plan.

You can create your profile, complete a wellness questionnaire and select your appropriate care path — digital tools, coaching, therapy or medication management — at brookfield.lyrahealth.com. Enter your health plan information and a payment card to cover any related costs for therapy and/or medication management services (out-of-pocket cost-share may apply consistent with other mental health services through Aetna). Schedule any coaching or therapy appointments, if recommended, and sessions may begin within six days.

If you have questions, contact the Lyra Care Team 24/7 by phone at 877-424-1860 or email at care@lyrahealth.com.

Progyny Fertility Benefits

With Progyny, you have access to the most advanced, effective fertility treatment possible. Progyny fertility benefits are available to all employees and covered spouses or domestic partners who are enrolled in a Brookfield Aetna medical plan. Progyny adoption and surrogacy benefits are available to all benefit eligible employees.

Brookfield’s benefit includes three Smart Cycles. Each Smart Cycle is a bundle of all services (appointments, tests, diagnostics, labs, anesthesia, etc.) used for comprehensive fertility treatments. You can utilize your Smart Cycles for whichever treatments you and your doctor determine are right for you, until you exhaust your Smart Cycle balance.

You’ll have a dedicated Patient Care Advocate (PCA) who will guide you throughout the entire process. You can manage your Smart Cycle balance by contacting your PCA, who will provide access to the Progyny member portal. To get started, call 844-930-3356.

WORKING SPOUSE SURCHARGE POLICY

Brookfield assesses a $1,200 per year or $46.15 per pay period Spousal Surcharge fee on medical plan premiums for employees whose spouses are enrolled in Brookfield’s medical plan. The Spousal Surcharge will apply if the covered spouse is currently employed elsewhere and is offered medical and prescription drug coverage through their employer.

If your covered spouse is unemployed, self-employed or employed but not offered medical/prescription coverage, you may request to have the Surcharge waived by completing and returning a Working Spouse Surcharge Waiver Affidavit form to the Benefits Department. The form and instructions are located in several locations: on the documents page here, the Policies and Forms section of the Human Resources intranet page or by contacting the Benefits Department.

Once the Waiver is approved, the Surcharge is waived for as long as your spouse’s employment situation remains the same. You do not need to re-submit a new Waiver every year. You are required to contact the Benefits Department in the event your spouse becomes eligible for medical/prescription benefits through their employer.