Aetna CDHP with a PPO Network FAQs
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It means that it is a benefits plan that gives you more purchasing power. You can visit any licensed provider (in and out of network), and you are given Medical and Dental Funds to help pay for services that are covered under your Plan. You pay nothing for covered services until you use up the funds. You can stretch your funds by seeking the most cost-effective care. When you use Aetna participating providers for covered services, you get the advantage of Aetna's negotiated rates.
The CDHP is an innovative health plan that gives you more control over how you spend your health care dollars. Plan features include:
- Affordable premiums
- Annual Medical Fund of $1,000 Self Only or $2,000 Self Plus One or Family available in full, when you enroll during the annual Open Enrollment. It pays for your covered services first, before you pay out of pocket.
- Annual Dental Fund of $300 Self Only or $600 Self Plus One or Family available in full on your effective date of coverage
- 100% coverage for in-network preventive care (medical, dental and vision) that does not reduce your Fund balances
- Unused Medical and Dental funds roll over from year to year as long as you remain in the CDHP (medical rollover maximum of $5,000/Self Only or $10,000/ Self Plus One or Family)
- Freedom to choose the providers you wish to see for covered services (in and out of network)– with no referrals
- Nationwide coverage
- Traditional medical plan coverage for in and out of network expenses once the annual deductible has been met
- An out-of-pocket cap that limits the total amount you pay annually for eligible expenses
- Online tools to help you manage your money and your health
To understand how the plan works, let's review its components:
- Covered at 100% in network – medical/dental/vision (Does not reduce your Funds)
- Annual Medical Fund - $1,000 Self Only; $2,000 Self Plus One or Family
- Annual Dental Fund - $300 Self Only; $600 Self Plus One or Family
- Funds pay for eligible expenses in network or out of network up to the Fund balance.
- You can visit any licensed health care professional or hospital for covered services (in and out of network) – without a referral.
- Unused Medical and Dental Fund balances roll over to the next year as long as you remain enrolled in the CDHP.
- The Annual Deductible – After you have used your Medical Fund and before traditional plan coverage begins, you have an annual deductible of $1,000 Self Only; $2,000 Self Plus One or Family. The Self Plus One and the Family deductible may be satisfied by one (or more) family members.
- Medical Coverage - When the annual deductible is satisfied, the traditional medical coverage begins. The medical plan also includes an out-of-pocket maximum to limit the amount you pay out of pocket in a given year – meaning once you hit your out of pocket maximum, Aetna covers 100% of your eligible medical expenses for the remainder of the calendar year.
- Prescription Drug Coverage - When you fill a covered prescription, the cost of the prescription will be paid from your Medical Fund if Fund dollars are available. If Fund dollars are not available, you pay for the covered prescription until your annual deductible has been met. After that, you pay a copayment or coinsurance for covered prescriptions.
If you are looking for a benefits plan with nationwide coverage in and out of network, and a plan that comes with dental and vision coverage built in, the CDHP could be right for you. Consider the following to be sure:
- Review your past year's medical services use and expenses. Be sure to include the cost of your prescription medications in your review.
- Estimate any expected changes in your medical expenses for the coming year.
- Compare the out-of-pocket costs (what you pay for your health plan, annual deductible, coinsurance, etc.) for the CDHP and other health benefits plans available to you. Don't forget to factor in the Medical and Dental Funds built into Aetna's CDHP, since you don't pay any money out of your pocket for covered services until you have exhausted those funds first.
- Compare dental and vision benefits available with the CDHP and other health benefits plans available to you.
Aetna sets up different annual Medical and Dental Funds for you that pay for eligible expenses in network or out of network at 100% so you pay nothing for covered services until your Funds are exhausted.
- Annual Medical Fund - You get $1,000 Self Only; $2,000 Self Plus One or Family. It is available in full on your effective date of coverage if you enroll during the annual Open Season. If you enroll outside of the annual Open Season (e.g. within 60 days of new hire) your fund will be prorated.
- You can earn additional credits to your Medical Fund. Get $50 per enrollee and/or spouse when you complete an online health risk assessment, online wellness program, and a post-program assessment. Get another $50 credit per enrollee and/or spouse for completing a biometric screening. See http://aetnafeds.com/cdhp-biometric-screenings.php for more details.
- Annual Dental Fund - You get $300 Self Only; $600 Self Plus One or Family. It is available in full on your effective date of coverage.
Remaining Medical and Dental Fund dollars roll over from year to year as long as you remain in the CDHP, up to the maximum rollover amount (medical rollover maximum of $5,000/Self Only or $10,000/Self Plus One or Family)
No. Payments from the Funds are benefits and not considered taxable income.
First, preventive care services provided by in-network providers (medical, dental, vision) are covered at 100% and nothing is deducted from your Fund. See the Federal Plan brochure for details on preventive services. When you receive other types of covered services, expenses are paid first from your Fund—before you pay anything out of pocket.
All eligible portions of the provider's services would be paid by the Fund (up to the remaining Fund balance). However, you are responsible for provider's medical fees that exceed our Plan allowance. If your Fund is exhausted, you would need to satisfy your annual deductible before the Plan's traditional medical benefits would be available.
No. All family members covered under your plan share the Fund and the annual deductible.
No. While amounts left in the Funds at the end of the year will roll over as long as you remain enrolled in the CDHP (up to the rollover maximum), the Funds are available only to pay expenses covered under the Plan.
You lose any remaining Fund balances if you leave our CDHP Plan.
If the service is covered by both plans, benefits would first be considered under the CDHP and the balance would then be considered under the FSA.
The pharmacy has access to Aetna's claim system and can determine at the point of sale what payment you owe for your covered prescription drug. If you have a Medical Fund balance, the cost of the covered prescription will be automatically deducted. If you have exhausted your Medical Fund but not met your annual deductible, the pharmacy will let you know the correct amount to pay. If you have exhausted your Medical Fund balance and met your deductible, then the pharmacy will let you know the appropriate copayment or coinsurance amount.
When you enroll in the CDHP, you have access to valuable online resources. Aetna Navigator® - Your personalized and secure, self-service website packed with health and benefits information. When you register, you can print temporary ID cards, check eligibility or claim status, check Fund balances and much more. Here are just a few of the highlights:
- Cost of Care - compare in-network and out-of-network provider fees, the cost of brand-name drugs vs. their generic equivalents, and the costs for services such as routine physicals, emergency room visits, lab tests, X-rays, MRIs, etc.
- Member Payment Estimator- provides real-time, out-of-pocket estimates for medical expenses based on your Aetna health plan. You can compare the cost of doctors and facilities before you make an appointment, helping you budget for and manage health care expenses.
- Hospital Comparison Tool – see how hospitals in your area rank by factors important to you.
- Simple Steps To A Healthier Life® Program – assess your potential health risks, develop a personalized action plan for better health, track your progress and participate in wellness programs. In addition, a wellness credit of $50 for Self Only enrollment will be added to your CDHP Medical Fund when you complete a Simple Steps to a Healthier Life Health Assessment and at least one online Healthy Living program. You can also receive an additional $50 wellness credit ($100 total) if your covered spouse also completes the Assessment and one online Healthy Living program under Self Plus One or Family enrollment.
- DocFind® online provider directory – lists participating physicians, hospitals and other health care providers. Using doctors that participate in the Aetna network gives you the most value. DocFind® also includes important provider credentials like education, board certification and languages spoken.
- Aetna Mobile - Puts your health in your hands. Anywhere you are you have the health plan info you need. You can pull up your ID card, find a doctor, look up any claim, check benefit details and access your Personal Health Record (PHR). It's available for Android and iPhone® mobile devices. Just type Aetna.com into your mobile web browser.
You can view your Fund balance, check claims transactions and more on Aetna Navigator® – your secure member website. Or, you can call Member Services at 888-238-6240. If you have claim activity in a given month, you will receive an Explanation of Benefits that lists your Fund balance and annual deductible.
Enrollment procedures vary by agency. Detailed instructions and information on the Federal Employees Health Benefits Program enrollment process is available at Enroll Now. Enrollment procedures vary by agency.
You have several options:
- Review the Federal Plan brochure and other information on this website
- Visit Aetna Navigator® to see the resources and information available to you when you enroll. Enter the following user name and password:
User name: federal3
- Call Aetna at 877-459-6604
- Chat live with a health plan specialist or schedule an appointment for a one-on one phone consultation
All members have access to Teladoc®, a convenient, lower cost alternative to urgent care or the emergency room. Teladoc® lets you speak to a licensed doctor by web, phone or app in under 10 minutes. It's perfect for when youre traveling or when your doctor isn't available. Members simply visit www.teladoc.com/aetna or call 855-Teladoc to get started.
Teladoc doctors diagnose non-emergency medical problems, like cold & flu, pink eye, skin rash, stress/anxiety, and recommend treatment. They can even call in a prescription to your pharmacy of choice, when necessary. All Teladoc doctors:
- Are U.S. board-certified in internal medicine, family practice, emergency medicine or pediatrics.
- Are U.S. residents and licensed in your state.
- Average 15 years of practice experience.
Please note: Teladoc is not available to all members and operates subject to state regulations. Teladoc and Teladoc physicians are independent contractors and are neither agents or employees of Aetna or plans administered by Aetna. For complete descriptions of the limitations of Teladoc services, visit Teladoc.com/Aetna.com
You must live or work in our service area to enroll in our plan. Return to the homepage to find plans available in your area. Once enrolled in the CDHP plan, covered medical services received overseas would be considered out-of-network. The cost of covered medical expenses would first be deducted from your Medical Fund to pay for services. Once the Medical Fund is exhausted, you would have to satisfy your deductible. After your deductible has been met, we pay 60% for out of network covered medical expenses. See Section 7 of our federal brochure for more information on how to submit overseas claims.
Dental and vision benefits are built in to the CDHP at no added cost.
- 100% coverage for dental cleanings and x-rays received from in network dentists
- A Dental Fund to use in or out of network for covered dental services ($300 Self Only, $600 Self Plus One or Family)
- 100% coverage for routine eye exams in network
- Use your Medical Fund, if available, for prescription glasses or contacts, plus get special discounts on eyewear
Yes. You get access to great discounts on prescription eyewear, vision services, gyms, weight loss programs, chiropractic, acupuncture, massage, vitamins, electric toothbrushes, gum, mints, and more! Visit aetnafeds.com/perks.php for more information.
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