Aetna Whole Health FAQs
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Aetna Whole Health is a collaboration with regional Accountable Care Organizations (ACO). An ACO is a group of providers (hospitals, doctors and others involved in patient care) who work in partnership to coordinate your care. The goal of the ACO is to provide better quality care, at a lower cost and to enhance the overall patient experience. ACOs are "accountable" for improving the health of their patients. You and your providers are partners in medical decisions concerning your health.
- An ACO includes a team of doctors, nurses and other practitioners who are focused on keeping you healthy.
- Using innovative technology, your information is at your doctor's fingertips, including information about the care you receive outside of his office.
- Your medical team can communicate with one another easily and securely about your treatment plans.
- Duplicative, expensive and, in some cases, invasive tests can be avoided since your medical team works together.
- Your medical team will get alerts for you in cases of adverse drug interactions, missed prescriptions, and medications needed for certain conditions. They will also get reminders when health screenings are needed.
- Interactive online tools give you access to your medical records, tests and lab information, and offer ways to help you lead a healthier life.
An ACC offers a fully integrated medical network, which includes primary care physicians, specialists, lab services, inpatient and hospital services, and home health services. These providers are linked together through an electronic health record that provides a complete picture of a patient's treatment plan. This approach to health care means that your medical team will work together to:
- Define your health care needs
- Research the best ways to meet those needs
- Design a plan of action specifically for you
An Aetna Whole Health ACO collaboration plan may be right for you if you are interested in a more coordinated approach to health care, where your doctors, nurses and other practitioners work together to plan and manage your treatment and care. As a member of an ACO, your role includes being part of the team and using the online resources to help coordinate your care.
In general, if you see doctors that are not part of the ACO then you will have a higher deductible and pay higher coinsurance for these visits. Please see plan details for the ACO available in your area for more information.
When you go to the pharmacy you will pay a copay depending on the medication you are taking. These copays are $5 for generic formulary, $35 for brand formulary and $60 for non-formulary for a 30 day supply. Specialty drugs are also covered at preferred 50% 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. The copays for a 90 day supply of medication are $10 for generic formulary, $70 for brand formulary and $120 for non-formulary.
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.
- Personal Health Record - captures important 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 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). If you have a smart phone we have apps you can use. Just type Aetna.com into your mobile web browser.
- iTriage - allows you to research your symptoms, find a medical provider that best serves your personal needs, and book an appointment – all from your smartphone.
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
- Call Aetna at 1-877-459-6604
All members have access to Teladoc, a convenient, lower cost alternative to urgent care or the emergency room. Teladoc lets you consult with a doctor over the phone or on-line video, day or night. It's perfect for when you're traveling or when your doctor isn't available. Members simply visit https://member2.teladoc.com/aetna or call 1-855-Teladoc to get started.
Teladoc doctors diagnose non-emergency medical problems, like ear infection, colds, pink eye or sore throat, 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 if you are physically located in the states of AR, MO and ID when you place your call. But, if you have a plan from one of these state and are outside of these states when you call, Teladoc is available to you.
Yes. You get great discounts on prescription eyewear, vision services, gyms, weight loss programs, chiropractic, acupuncture, massage, vitamins, electric toothbrushes, gum, mints, and more!