Aetna Open Access® HMO Plan FAQs
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The Aetna Open Access HMO plan is an HMO that gives members more freedom. Members can visit any in-network provider (PCP or specialist) for covered services without a referral.* You can find Aetna network providers by using the DocFind® online provider directory. We recommend that members select a primary care physician, but it is not required.** Members pay a copayment for covered services. The copayment amounts for specific services vary and are listed in the Federal Plan brochure.
*Except in our California HMO plan.
**Members in our California HMO plan must select a PCP.
The Aetna Open Access Plan is an easy to use medical plan with predictable costs, plus it has dental and vision benefits built in. You get access to an extensive network of providers, and the freedom to see Aetna network specialists without a referral.
Plan features include:
- No referrals*
- No deductible**
- 100% coverage in network for preventive medical care
- No requirement to choose a primary care physician (PCP) ***
- Basic Dental included or you may select our Dental PPO network option at no extra charge****
- Out-of-area dependent coverage – visit network providers in any Aetna HMO service area nationwide
- Vision benefits including an eyewear reimbursement every 24 months
- Lots of perks like discounts on eyewear, gyms, weight loss programs, acupuncture, massage therapy, vitamins, electric toothbrushes, gum, mints, and more!
- Online tools to help you manage your health
*Except in our California HMO plan.
**Except in our Kansas HMO plan.
***Members in our California HMO plan must select a PCP.
****Members in our Kansas HMO plan have only a Dental PPO.
Yes. You may visit any PCP or specialist in your Aetna Open Access HMO network service area. You may also use any Aetna HMO provider when you travel outside your service area and dependent children away at school may also use Aetna HMO providers while at school. You can find Aetna network providers by using the DocFind® online provider directory.
Out-of-network services and supplies are not covered under this Plan. However, eligible expenses for emergency care and urgent care services are covered. See section 5(d) Emergency Services/Accidents in the Federal Plan brochure.
No. While you do not have to select a PCP, except in our California HMO plan, we encourage you to establish a relationship with one as it can help you better manage your health. Your PCP can provide routine care, treat you for illnesses and injuries, or recommend that you see participating providers or specialists, if required.
Yes, you may choose a different PCP for each member of your family. You may also request to change your PCP at any time.
Use our DocFind® online directory. You can access information about our extensive network of providers as well as individual physicians' board certification status, medical school attended, the year he or she graduated, languages spoken, etc.
You have two different dental options, Basic Dental or Dental PPO.* New members are automatically enrolled in the Basic Dental option. With the Basic Dental, you must select a participating primary care dentist (PCD) and call Member Services at 800-537-9384 to register your selection. You may then contact the dentist to make an appointment. You pay a $5 office visit copayment for cleanings, composite (white) fillings and X-rays.* See your Federal Plan brochure for details.
If you would like to switch to our Dental PPO network option, at no additional cost, you must call or submit your online request.* If you switch to our Dental PPO Network option on or before the 15th of the month, your coverage in the Dental PPO option will be effective on the first of the following month (e.g.., call on 1/8 and your coverage is effective on 2/1, but if you call on 1/17, your coverage will not be effective until 3/1). The Dental PPO network option gives you access to over 96,000 provider locations.
With the Dental PPO network option, each member pays a $20 annual deductible after which cleanings, composite (white) fillings and X-rays are covered at 100% when using participating providers. With the Dental PPO network option, each member pays a $20 annual deductible after which cleanings, composite (white) fillings and X-rays are covered at 100% when using participating providers. You may also choose to go out of network. If you visit an out of network dentist, you are subject to the $20 annual deductible per member and cleanings, composite (white) fillings and X-rays are covered at 50% of our negotiated rate and the difference between our plan allowance and the billed amount.. There are no benefits for additional services provided by an out-of-network provider.
You can find network providers by using the DocFind® online provider directory.
The advantages of switching to the Dental PPO network option are that you will have access to more dentists and you will also have a limited out-of-network benefit. See Federal Plan brochure for details.
*Members in our Kansas HMO plan have Dental PPO only. You’ll have coverage for cleanings and x-rays at a $0 copay when you use the dental preferred provider organization (PPO) network. Please note fillings are not covered.
Routine eye exams are covered under the medical plan. See your Federal Plan brochure for details. Members are also eligible for an eyewear reimbursement every 24 months and discounts on frames, lenses, LASIK procedure, etc., through the Aetna Vision℠ Preferred Discounts program.
A copayment is the fixed dollar amount or percentage you must pay to a health care professional, facility or pharmacy when you receive covered services.
You pay a copayment at the time of service. The copayment will vary, depending on where the services are delivered and by whom (e.g., selected PCP, specialist, inpatient hospital stay, emergency room, outpatient hospital and pharmacy). Please see the Federal Plan brochure for copayment amounts.
When you enroll in the Aetna Open Access HMO Plan, you have access to valuable online resources. Aetna Navigator® your secure member website is packed with health and benefits information. When you register, you can print temporary ID cards, check eligibility or claim status, e-mail customer service and much more. Here are just a few of the highlights:
- Estimate the Cost of Care - compare the cost of brand-name drugs versus their generic equivalents. 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.
- DocFind® - Aetna's online provider directory that lists participating physicians, hospitals and other health care providers. DocFind® also includes important provider credentials like education, board certification and languages spoken.
- Aetna Mobile - Puts Aetna online features at your finger tips, it allows you to view your member ID card, find a doctor, look up claims, 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.
Enrollment procedures vary by agency. Detailed instructions and information on the Federal Employees Health Benefits Program enrollment process is available on our website at Enroll Now. Enrollment procedures vary by agency. You will need to know the enrollment code for the Aetna Open Access Plan. Please refer to the rate calculator for the plans available in your area and the federal enrollment codes.
If you do not receive your ID card by your effective date, you may use a copy of your SF2809 Form or electronic enrollment (e.g. Employee Express, PostalEase, etc.) confirmation. If you are enrolled in our system, you may register on Aetna Navigator® and print an ID card. After you register, simply click on "Get an ID card" and follow the instructions. You may use this printable version of your personal ID card if you need medical or dental care.
Coverage and 2018 benefit changes for current members and annuitants begins on January 1, 2018. Coverage for new Aetna members (joining during Open Season) becomes effective on the first day of the first pay period in January 2018.
If you enroll as a newly hired Federal Employee, you have 60 days to enroll in a Federal Employees Health Benefits (FEHB) plan. Your enrollment will become effective the beginning of the pay period after your enrollment is received.
You will need to work with your personnel office to complete a new enrollment form to change plans. Please refer to the rate calculator for the plans available in your area and the federal enrollment codes.
Eligible out-of-area dependents, such as children who are away at college, can be covered. To find out whether we have an Aetna HMO or Open Access HMO network in their area, go to the DocFind® online provider directory. If we do not have an Aetna HMO or Open Access HMO network in their area they would be covered for emergencies and urgent care, but would need to return home for routine care.
Members usually do not need to file claim forms except in some out-of-network emergency care situations.
No, California members are covered under Aetna's HMO Plan and must continue to get referrals from their PCP in order to see network specialists.
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 mobile appin under 10 minutes.It's perfect for when you're traveling or when your doctor isn't available. Members simply visit 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.
Consultations are $40 or less, depending on your plan, and do not require a referral.
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 nor employees of Aetna or plans administered by Aetna. For complete descriptions of the limitations of Teladoc services, visit Teladoc.com/Aetna
You must live or work in our service area to enroll in our plans. Once enrolled in the plan, medical services received overseas would be covered for emergency or urgently needed care only. If you receive covered services overseas, you will need to submit your claims to Aetna for reimbursement of those services.
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