Medical Plans

You have options when it comes to your medical and pharmacy benefits, each with different levels of coverage. When you visit providers within the Aetna OA PPO or Aetna Value Network HMO network, your cost is less. When seeking care outside of the Aetna OA PPO network, you will pay an increased portion of the costs.

Understanding Your Options

AETNA (AETNA WHOLE HEALTH AND AETNA FULL NETWORK) HMO

A Health Maintenance Organization (HMO) is a group of medical providers that work together to keep the cost of medical services down. In Network Coverage Only— Aetna contracts with private physicians and hospitals. The AWH HMO plan maintains a network of preferred physicians, specialists, and hospitals that have agreed to contracted rates and will also complete and submit your benefit claims. You will need to specify who your PCP or IPA/Medical Group is.

PRIMARY CARE PHYSICIAN (PCP)

The Primary Care Physician (PCP) is a doctor you select from the provider directory to be the single source for all of your medical needs. Whenever you have a medical need (including emergencies, if you are able), your PCP should be contacted on a HMO. This doctor or office will determine the proper course of action and handle your medical needs within their facility or refer you to another doctor or specialist. If you need to be hospitalized, your PCP will assist you in facilitating your care during the entire hospitalization. In the event of an emergency, contact your PCP who will determine proper treatment, except in the case of dire emergency, where you are incapacitated, or a life- threatening situation has occurred.

INDEPENDENT PHYSICIANS’ ASSOCIATION (IPA OR MEDICAL GROUP)

The IPA is a medical group or organization that acts like a PCP on a HMO. However, instead of a single physician, you have a group of physicians available to handle your medical needs. The same criteria apply under an IPA that applies when you choose a PCP. You will simply contact the medical group’s main offices to schedule appointments or referrals, and in emergencies.

AETNA OA MANAGED CHOICE POS PPO

This stands for Open Access Managed Choice. An Open Access Managed Choice acts like a PPO plan and allows you to seek care outside the Aetna OA provider network. You do not need a referral and are not required to select a Primary Care Provider (PCP). You or your covered dependents will pay less out of your pocket by obtaining care in the Aetna provider network.

Comparing the Options

Before you review your medical plan options, you should understand how they work. Start with these terms:

A set percentage you pay of the cost of the care you receive, for example 20%.

A set dollar amount you pay when you receive health care, for example $35 when you see a specialist.

A set amount you must pay out of your pocket before the plan starts paying part of the cost unless a copay applies.

The most you will pay in a calendar year for provider visits, prescriptions, etc., for covered expenses and includes your deductible, copays, and coinsurance. This “safety net” provides peace of mind for those who have a serious condition or illness.

 

Aetna AWH HMO



Aetna HMO


 Narrow NetworkFull Network
General Plan Information DeductibleIn NetworkIn Network
Deductible
Individual Deductible (ded)NoneNone
Family Deductible (ded)NoneNone
Out of Pocket Maximum
Individual$4,000$4,000
Family$8,000$8,000
Copays
Physician Visits$30 copay$30 copay
Specialist$45 copay$45 copay
Teladoc Visit$30 copay100%
Preventative Care Services100%100%
Emergency & Ambulatory
Urgent Care$60 copay$60 copay
Emergency Room
(waived if admitted)
$300 copay$300 copay
Hospital Services
Inpatient$500 per day, up to 5 days
then 100% covered

$500 per day, up to 5 days
then 100% covered

Outpatient$200 copay$200 copay
Diagnostic Services
Lab and X-rayLab: $30
X-ray: $45
Lab: $30
X-ray: $45
Complex imaging$200 copay$200 copay
Therapy Visits
Mental Health/Substance Abuse
Inpatient$500 per day, up to 5 days
then 100% covered

$500 per day, up to 5 days
then 100% covered

Mental health office visits$45 copay$45 copay
Durable Medical Equipment$30 copay$30 copay
Chiropractic Care
(20 visits per year)
$15 copay$15 copay
Acupuncture
(20 visits per year)
$30 copay$30 copay
Prescription Drugs
Retail30 days30 days
Generic$10 copay$10 copay
Preferred (Preferred Brand)$30 copay$30 copay
Non-Preferred Brand$50 copay$50 copay
Preferred Specialty30%, $250 max30%, $250 max
Mail Order90 days90 days
Preferred (Generic)$20 copay$20 copay
Preferred (Preferred Brand)$60 copay$60 copay
Non-Preferred Brand$100 copay$100 copay
Preferred SpecialtyN/AN/A
 

Aetna PPO 3000



Aetna PPO 500


General Plan InformationIn NetworkOut of NetworkIn Network

Out of Network


Deductible
Individual Deductible (ded)$3,000$6,000$500$5,000
Family Deductible (ded)$6,000$12,000$1,000$10,000
Out of Pocket Maximum
Individual$6,000$12,000$4,000$10,000
Family$12,000$24,000$8,000$20,000
Coinsurance & Copays
Coinsurance20%50%20%50%
Physician Visits$40 copay
no ded
50%
after ded
$30 copay
no ded


50%
after ded


Specialist$60 copay
no ded
50%
after ded
$40 copay
no ded


50% after ded


Teladoc Visit$30 copay
no ded
N/A100%
no copay
N/A
Preventative Care Services100%
no ded
50%
after ded
100%

50%
after ded


Emergency & Ambulatory
Urgent Care$75copay
no ded
50%
after ded
$50 copay
no ded


50% after ded


Emergency Room (waived if admitted)$300
copay no ded
 

$300 copay,
after ded


 
Hospital Services
Inpatient$0
after ded
50%
after ded
$750 per day for first 3 days, then 100%,
after ded


50%
after ded


Outpatient$0
after ded
50%
after ded
$750
after ded


50% after ded


Diagnostic Services
X-ray and Lab$0
after ded
50%
after ded
Lab: $25
no ded
X-ray $50 copay
no ded


50%
after ded


Complex imaging$0
after ded
50%
after ded
$500 copay
no ded


50%
after ded


Therapy Visits
Mental Health/Substance Abuse
Inpatient$0
after ded
50%
after ded
$750 per day for first 3 days, then 100%,
after ded


50%
after ded


Mental health office visits$60 copay
no ded
50%
after ded
$40 copay
no ded


50%
after ded


Durable Medical Equipment$0
after ded
50%
after ded
20%
after ded


50%
after ded


Chiropractic Care
(20 visits per year)
$60 copay
no ded
50%
after ded
$40 copay
no ded


50%
after ded


Acupuncture
(20 visits per year)
$25 copay
no ded
50%
after ded
$30 copay
no ded


50%
after ded


Prescription Drugs
Retail30 days 30 days 
Generic$10 copayNot Covered$10 copay

Not Covered


Preferred (Preferred Brand)$30 copay Not Covered

$30 copay


 Not Covered
Non-Preferred Brand$50 copay Not Covered

$50 copay


 Not Covered
Preferred Specialty30%, $250 max Not Covered

30%, $250 max


 Not Covered
Mail Order90 days 90 days 
Preferred (Generic)$20 copayNot Covered$20 copay

Not Covered


Preferred (Preferred Brand)$60 copay Not Covered

$60 copay


 Not Covered
Non-Preferred Brand$100 copay Not Covered

$100 copay


 Not Covered

Questions?