Endowed Health Plan Comparison Chart
Use this chart to compare benefits coverage between Cornell's three endowed health plans, provided by Aetna.
- CPHL = Cornell Program for Healthy Living Plan
- WCM-PPO = Weill Cornell Medicine PPO Plan
- HDHP = High Deductible Health Plan
New changes for 2027 are highlighted in yellow below. See this chart to compare with 2026 coverage.
The Fine Print
You may visit any provider for eligible medical necessary services, and will receive the greatest benefit by seeing an Aetna participating provider (in-network coverage). You will pay more when providers are non-participating with Aetna (out-of-network).
The out-of-network reimbursement limit for the Aetna CPHL Plan, Weill Cornell Medicine PPO Plan, and Aetna HSA Plan is 275% of the Medicare allowable rate, amounts over this are not applicable to the deductible and out-of-pocket maximums. Please contact Aetna at 877-371-2007 for coverage or claims questions.
While every attempt has been made to ensure the accuracy of this Summary, in the event of any discrepancy the Summary Plan Description and Plan Document will prevail. Please visit the endowed health plan webpages for more detail and contact information if you have questions.
Plan summary does not guarantee coverage.
Please contact Aetna (877-371-2007) or OptumRx (866-533-6977) for specific coverage details.
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Plan Features
Deductible
Per calendar year
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | $200 Individual $400 Family | $300 Individual $600 Family | $1,750 Individual $3,500 Family |
| Out-of-Network | $1,250 Individual $2,500 Family | $750 Individual $1,500 Family | $3,000 Individual $6,000 Family |
Lifetime Maximum
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | Unlimited | Unlimited | Unlimited |
| Out-of-Network | Unlimited | Unlimited | Unlimited |
Out of Pocket Maximum
Per calendar year (includes deductible and medical and Rx copays)
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | $3,000 Individual $6,000 Family | $2,300 Individual $4,600 Family | $3,250 Individual $5,500 Family |
| Out-of-Network | $3,750 Individual $7,500 Family | $3,750 Individual $7,500 Family | $4,250 Individual $7,500 Family |
2027 Account-Based Cornell Contribution (HDHP only)
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| Health Savings Account Employer Contribution | n/a | n/a | $1,000* |
*pro-rated if not enrolling during open enrollment
2027 Contribution Maximum (HDHP only)
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| Health Savings Account Maximum Contribution | n/a | n/a | $4,500* Individual $9,000* Family |
Includes Cornell's contribution. Employees age 55 and older can contribute an additional $1,000.
Physician Services
Allergy Testing, Treatments, Shots
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | Testing & treatment: 100% after $25 copay Shots: 90% after deductible | Testing & treatment: 100% after $10 copay within Weill network; 100% PCP copay/$30 Specialist in Aetna Network Shots: 100%, no deductible | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Chiropractic Visits
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% after $25 copay | 100% after $10 copay within Weill network; 100% after $30 copay Aetna network. 36 visit max. | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible. 36 visit max. | 80% after deductible |
Diagnostic X-Ray/Laboratory
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible (except in physician office when it is 100% after $25 copay) | X-ray: 100% after $10 copay Weill network 90% after deductible Aetna network (except in physician office when office visit copay applies). Lab: 90% after deductible. | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible. | 80% after deductible |
Eye Exam (routine)
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% after $25 copay (1 exam per calendar year) | 100% after $10 copay Weill network; 100% after $30 copay Aetna network. (1 exam per calendar year) | No deductible, $20 copay (1 exam per calendar year) |
| Out-of-Network | 80% after deductible (1 exam per calendar year) | 70% after deductible. (1 exam per calendar year) | 80% after deductible (1 exam per calendar year) |
Preventive/Routine Vaccinations
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% | 100% | No deductible, 100% |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Gynecological Exams (routine)
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% (1 gyn exam and pap test per calendar year) | 100% (1 gyn exam and pap test per calendar year) | No deductible, 100% (1 gyn exam and pap test per calendar year) |
| Out-of-Network | 80% after deductible (1 gyn exam and pap test per calendar year) | 70% after deductible (1 gyn exam and pap test per calendar year) | 80% after deductible (1 gyn exam and pap test per calendar year) |
Hearing Exams (routine)
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% after $25 copay (1 exam every 2 yrs) | 100% after $10 copay Weill network 100% after $30 copay Aetna network (1 exam per calendar year) | No deductible, $20 copay (1 exam every 2 yrs) |
| Out-of-Network | 80% after deductible (1 exam every 2 yrs) | 70% after deductible (1 exam per calendar year) | 80% after deductible (1 exam every 2 yrs) |
Hearing Aid Equipment
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | Adults & children 13 and older: reimbursed at 100% no copay or deductible up to $3,000 per hearing aid per ear once every 3 yrs. Children age 12 and under: Reimbursed at 100% no copay or deductible up to $3,000 per hearing aid per ear, once every 2 years. Excludes batteries. | Adults & children: reimbursed at 100% no copay and no deductible, max $3,000 total every 3 years. Excludes batteries. | Adults & children 13 and older: Deductible, reimbursed at 100% up to $3,000 per hearing aid per ear once every 3 yrs. Children age 12 and under: Deductible, reimbursed at 100% up to $3,000 per hearing aid per ear, once every 2 years. Excludes batteries. |
| Out-of-Network | Adults & children 13 and older: reimbursed at 100% no copay or deductible up to $3,000 per hearing aid per ear once every 3 yrs. Children age 12 and under: Reimbursed at 100% no copay or deductible up to $3,000 per hearing aid per ear, once every 2 years. Excludes batteries. | Adults & children: reimbursed at 100% no copay and no deductible, max $3,000 total every 3 years. Excludes batteries. | Adults & children 13 and older: Deductible, reimbursed at 100% up to $3,000 per hearing aid per ear once every 3 yrs. Children age 12 and under: Deductible, reimbursed at 100% up to $3,000 per hearing aid per ear, once every 2 years. Excludes batteries. |
Mammography Exam (routine)
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% | 100% | No deductible, 100% |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Office Visit
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% after $25 copay | 100% after $10 copay Weill network; 100% after $20 copay Aetna network. Does not include ob/gyn (refer to specialist) | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible. Does not include ob/gyn (refer to specialist) | 80% after deductible |
Telemedicine Office Visit
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% after $25 copay | 100% after $10 copay Weill network; 100% after $20 copay Aetna network. Does not include ob/gyn (refer to specialist) | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible. Does not include ob/gyn (refer to specialist) | 80% after deductible |
Routine Physical/Wellness Exam
Age 3 onward, 1 per calendar year.
Birth through age 3 subject to any age and visit limits provided in the comprehensive guidelines supported by the American Academy of Pediatrics.
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% | 100% | No deductible, 100% |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Physician Hospital Services
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible | 90% after deductible | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Specialist Office Visits
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% after $25 copay | 100% after $10 copay Weill network; 100% after $30 copay Aetna network. Includes ob/gyn | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible Includes ob/gyn | 80% after deductible |
Surgery
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible (except in physician office when office visit copay applies) | 90% after deductible (except in physician office when office visit copay applies) | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Hospital
Inpatient Coverage
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible | 90% after deductible | 90% after deductible |
| Out-of-Network | 80% after deductible Pre-certification required | 70% after deductible Pre-certification required | 80% after deductible Pre-certification required |
Outpatient Coverage
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible | 90% after deductible | 90% after deductible |
| Out-of-Network | 80% after deductible Pre-certification required for certain procedures | 70% after deductible Pre-certification required for certain procedures | 80% after deductible Pre-certification required for certain procedures |
Emergency Room
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible | 90% after deductible | 90% after deductible |
| Out-of-Network | 90% paid as in-network | 70% after in-network deductible | 80% after deductible Paid as in-network |
Non-Emergency Use of Emergency Room
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 50% after deductible | 50% after deductible | Deductible, then 50% |
| Out-of-Network | 50% after deductible | 50% after deductible | Deductible, then 50% |
Other Covered Services
Ambulance
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible | 90% after deductible | 90% after deductible |
| Out-of-Network | 90% after deductible | 90% after deductible | 90% after deductible |
Artificially Assisted Fertilization
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible $30,000 lifetime max per family for all covered services | 90% after deductible $30,000 lifetime max per family for all covered services | 90% after deductible $30,000 lifetime max per family for all covered services |
| Out-of-Network | 80% after deductible $30,000 lifetime max per family for all covered services | 70% after deductible $30,000 lifetime max per family for all covered services | 80% after deductible $30,000 lifetime max per family for all covered services |
Durable Medical Equipment
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible | 90% after deductible | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Home Health Care
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible Up to 120 visits per calendar year | 90% after deductible Up to 200 visits per calendar year | 90% after deductible Up to 120 visits per calendar year |
| Out-of-Network | 80% after deductible Up to 120 visits per calendar year | 70% after deductible Up to 200 visits per calendar year | 80% after deductible Up to 120 visits per calendar year |
Hospice Care
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% | 100% | Deductible, then 100% |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Maternity
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | Prenatal Care: 100% (excludes lab work and ultrasounds; covered at 90% after deductible) Delivery and routine nursery care: 90% after deductible | Prenatal Care 100% (excludes lab work and ultrasounds; covered at 90% after deductible) Delivery and routine nursery care: 90% after deductible | Prenatal Care no deductible, 100% (excludes lab work and ultrasounds; covered deductible, then 90%) Deductible, then 90% delivery and routine nursery care |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Breastfeeding Supplies and Counseling
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% | 100% | No deductible, 100% |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Oral Surgery
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% after $25 copay in physician office (for accidental injuries, certain surgical extractions, periodontal surgery), otherwise 90% after deductible | 100% after $10 copay in Weill network physician office and $30 copay in Aetna network physician office; 90% after deductible if performed inpatient/outpatient hospital (for accidental injuries, certain surgical extractions, periodontal surgery) | 90% after deductible (for accidental injuries, certain surgical extractions, periodontal surgery) |
| Out-of-Network | 80% after deductible (for accidental injuries, certain surgical extractions, periodontal surgery) | 70% after deductible (for accidental injuries, certain surgical extractions, periodontal surgery) | 80% after deductible (for accidental injuries, certain surgical extractions, periodontal surgery) |
Physical/Occupational/Speech Therapy & Cardiac Rehab
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible | 90% after deductible | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Habilitative Services (PT/OT/ST)
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% | 100% | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Private Duty Nursing
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible; up to 70, 8-hour shifts per calendar year. | Not covered unless part of Home Health Care. | 90% after deductible; up to 70, 8-hour shifts per calendar year. |
| Out-of-Network | 80% after deductible; up to 70, 8-hour shifts per calendar year. | Not covered unless part of Home Health Care. | 80% after deductible; up to 70, 8-hour shifts per calendar year. |
Skilled Nursing Facility
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible; up to 120 days per calendar year. | 90% after deductible; up to 120 days per calendar year. | 90% after deductible; up to 120 days per calendar year. |
| Out-of-Network | 80% after deductible; up to 120 days per calendar year. | 70% after deductible; up to 120 days per calendar year. | 80% after deductible; up to 120 days per calendar year. |
Behavioral Health Care
Telemedicine for Behavioral Health
Telemedicine for Behavioral Health received through Teladoc is subject to a $25 copay per visit for the Aetna CPHL Plan and Weill Cornell Medicine Plan; whereas, the HDHP is covered at 90% after deductible per visit.
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% | 100% | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Mental Health
Inpatient Care
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible | 90% after deductible | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Partial Hospitalization/Intensive Outpatient
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible | 90% after deductible | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Outpatient Other
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% | 100% | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Outpatient Office Visit
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% after $25 copay | 100% after $10 copay | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Substance Disorder
Inpatient Care
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible | 90% after deductible | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Partial Hospitalization/Intensive Outpatient
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible | 90% after deductible | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Halfway House
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 90% after deductible | 90% after deductible | 90% after deductible |
| Out-of-Network | Not covered | Not covered | Not covered |
Outpatient Care
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | 100% after $25 copay | 100% after $10 copay | 90% after deductible |
| Out-of-Network | 80% after deductible | 70% after deductible | 80% after deductible |
Prescription Drug Administered by OptumRx
Retail Pharmacy (30 day supply only)
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | Tier 1: $5 Tier 2: $30 Tier 3: $50 Up to 30 day supply | Tier 1: $5 Tier 2: $30 Tier 3: $50 Up to 30 day supply | Deductible, then Tier 1: $5 Tier 2: $30 Tier 3: $50 Up to 30 day supply |
| Out-of-Network | Contracted rate less applicable copay | Contracted rate less applicable copay | Deductible, contracted rate less applicable copay |
Home Delivery (90 day supply)
Choose delivery to home address or Cornell Health Pharmacy; or fill 90 day exclusively at Cornell Health Pharmacy on Cornell campus.
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | Tier 1: $10 Tier 2: $60 Tier 3: $90 Up to 90 day supply renewable up to a year for maintenance/specialty meds | Tier 1: $10 Tier 2: $60 Tier 3: $90 Up to 90 day supply renewable up to a year for maintenance/specialty meds | Deductible, then Tier 1: $10 Tier 2: $60 Tier 3: $90 Up to 90 day supply renewable up to a year for maintenance/specialty meds |
| Out-of-Network | Not covered | Not covered | Not covered |
Prescription Contraceptives
Choose delivery to home address or Cornell Health Pharmacy; or fill 90 day exclusively at Cornell Health Pharmacy on Cornell campus.
| CPHL | WCM-PPO | HDHP | |
|---|---|---|---|
| In-Network | Oral contraceptives and barrier methods (i.e. diaphragm): $0 copay for generic or single source brand | Oral contraceptives and barrier methods (i.e. diaphragm): $0 copay for generic or single source brand | Oral contraceptives and barrier methods (i.e. diaphragm): $0 copay for generic or single source brand |
| Out-of-Network | Contracted rate less applicable copay | Contracted rate less applicable copay | Deductible, contracted rate less applicable copay |