Aetna Value Plan FAQs

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Aetna's Value Plan is a straightforward, easy to use plan that offers you the flexibility to visit any licensed provider (both in and out of network). You will pay a reasonable deductible and copays or coinsurance once you meet your deductible.

The Value Plan is a simple and easy to use plan with an affordable premium and a reasonable deductible. You have the flexibility to visit any licensed provider (both in and out of network). When you visit an in-network doctor, you pay a flat copay for your primary and specialist care visits. For other services, there is a deductible. Once you pay your deductible, you pay a copay or coinsurance for care until you reach your out of pocket maximum. You also have the ability to earn wellness credits, up to $250 Self Only/ $500 Self Plus One or Family coverage, that would help to reduce your deductible by getting preventive care, engaging in wellness activities and completing an online health risk assessment.

Preventive care is covered at a $0 copay with an in network provider and does not apply to the deductible. You also do not need to meet your deductible first for in network Primary Care Physician (PCP) visits, specialist visits or prescriptions.

  • Primary Care Physician: $25 copay in-network* (40% coinsurance out of network)
  • Specialist Visit: $40 copay in-network*, (40% coinsurance out of network)
  • Prescriptions*: For a 30 day supply, you pay the following:
    • $10 per generic formulary drug
    • 30% per covered brand formulary drug
    • 50% per covered non-formulary (generic or brand name) drug
    • 50% per covered specialty drug up to a $250 maximum per prescription for preferred or $500 maximum per prescription for non-preferred
Mail order delivery is also available for a 90 day supply.

For out of network PCP and Specialist visit, as well as other in and out of network services, you are responsible for meeting your deductible:
  • $600 Self Only/$1,200 Self Plus One or Family, in network
  • $1,250 Self Only/$2,500 Self Plus One or Family, out of network
Once your deductible has been satisfied, you pay a coinsurance depending on which type of service you use:
  • Other covered services: 20% coinsurance in-network, 40% coinsurance out of network
*Primary care visits, specialist visits, and prescriptions are not subject to the deductible.

If you are looking for an affordable, no frills plan with in and out of network coverage, the Value Plan may 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 Value Plan and other health benefits plans available to you.

You can earn wellness incentive credits for completing any combination of the activities listed below. Each activity allows you or a covered family member to earn a $50 credit for completion. You can earn a maximum of $250 Self Only or $500 Self Plus One or Family. Incentive activities include:

  • Online health risk assessment, one online wellness program, post program survey
  • Biometric Screening
  • Routine mammogram
  • Well adult preventive care (includes well adult visits, Prostate Specific Antigen (PSA) test, routine hearing exam and routine x-ray)
  • Well baby/well child preventive care
  • Immunizations
  • Flu Shot
  • Certain well woman preventive care
  • Routine eye exam

Routine eye exams are covered but the Value Plan does not include dental coverage.

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 app in 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

The Aetna Value Plan offers you the flexibility to visit any licensed provider (both in and out of network). When you visit an out of network provider, you will pay a coinsurance of 40% once your deductible has been met. The annual out of network deductible is $1,250 Self Only and $2,500 Self Plus One or Family.

Participating pharmacies have access to Aetna's claim system and can determine at the point of sale what payment you owe for your covered prescription drug. You do not need to meet your deductible first for prescriptions.

  • For a 30 day supply, you pay the following:
    • $10 per generic formulary drug
    • 30% per covered brand formulary drug
    • 50% per covered non-formulary (generic or brand name) drug
    • 50% per covered specialty drug up to a $250 maximum per prescription for preferred or $500 maximum per prescription for non-preferred

Yes, Mail-Order Pharmacy is available for maintenance medications. Go to the Aetna Navigator® secure member website and click on "Aetna Pharmacy" for details and forms.

When you enroll in the Value Plan, you have access to valuable online resources.

  • Aetna Navigator® – Your secure member website 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:
  • 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, one of the ways you can earn wellness incentives is by completing the Simple Steps to a Healthier Life Health Assessment and at least one online Health 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 and Family enrollment. Please see Question 5 for more opportunities to earn wellness incentive credits.
  • Personal Health Record – is a private and secure online tool where you can access your health information in one place, helping you stay healthy with personalized alerts and reminders and allowing you to print and share your health history with your doctors.
  • DocFind® online provider directory – lists participating physicians, hospitals and other health care providers. Using participating providers will help you save money. DocFind® also includes important provider credentials like education, board certification and languages spoken.
  • Aetna Mobile – Puts Aetna's online features at your fingertips, 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 at Enroll Now. You will need to know the enrollment code for the plan you choose.

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
    Password: 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

Yes. You get great discounts on prescription eyewear, vision services, gyms, weight loss programs, chiropractic, acupuncture, massage, vitamins, electric toothbrushes, gum, mints, and more!

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