About the plan:
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The Altius health plan, high and standard options, are health maintenance organization (HMO) plans. Members have the freedom to visit any in-network provider, including primary care physicians (PCPs) or specialists, for covered services without a referral. You can find in-network providers by using our provider search. We suggest that members select a PCP, but it is not required. You can find more information in the Federal Plan brochure.
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Altius plan features include:
- No referrals
- 100% coverage in-network for preventive medical care
- No requirement to choose a PCP
- Built-in dental benefits for the high option
- 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
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The Altius health plan, high and standard, gives you access to an extensive network of providers. And the freedom to see in-network specialists without a referral.
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You have several options:
- Chat live with a health plan specialist or schedule an appointment for a one-on-one phone consultation at AetnaFedsLive.com
- Review the Federal Plan brochure and other information on this website
- Call Aetna at 1-855-277-4356 (TTY: 711)
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Please visit our Altius HDHP page for information on the Altius HDHP.
Doctors and networks:
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Yes. You may visit any PCP or specialist in the Altius network service area. You do not need a referral to see a specialist in the network. You can find network providers by using our provider search.
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No. You do not need to get a referral to see a specialist in the Altius High and Standard HMO.
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Out-of-network services and supplies are not covered under this plan. However, eligible expenses for emergency care are covered. See section 5(d) Emergency Services/Accidents in the Federal Plan brochure.
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No. While you do not have to select a PCP, we encourage you to establish a relationship with one. 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 in-network providers or specialists, if required.
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Yes, you may choose a different PCP for each member of your family. You may also request to change your PCP at any time.
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Use our provider search. You can access information about our extensive network of providers, as well as individual physicians' board certification status, medical school attended, the year they graduated, languages spoken, etc.
What will I pay?
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A copay is a flat fee you must pay to a health care professional, facility or pharmacy when you receive covered services. The copay will vary, depending on where you get services and who you get them from. For example, a selected PCP, specialist, inpatient hospital stay, emergency room, outpatient hospital or pharmacy. Please see the Federal Plan brochure for copay amounts.
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Members usually do not need to file claim forms except in some out-of-network emergency care situations.
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Yes, mail-order pharmacy is available for maintenance medications. See the Altius health plan brochure for details. You can also get your 90-day prescription at a CVS Pharmacy® location for the same cost as mail-order. For a complete list of other participating pharmacies, log in to Aetna.com and use our provider search tool.
Go to our member website and select "pharmacy benefits" for details and forms.
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Yes. Altius health plans, high and standard, each include an annual deductible. That’s the amount you pay out of pocket before the medical coverage begins payment for covered expenses. The annual deductibles are:
- $50/Self Only for the high option
- $100/Self Plus One or Self and Family for the high option
- $100/Self Only for the standard option
- $200 Self Plus One or Self and Family for the standard option
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Once you pay your deductible, you pay a copay for most services. You won’t pay a copay for inpatient hospital benefits on the standard option, or for specialty pharmacy on both high and standard options. These services will require coinsurance. The copay and coinsurance amounts are listed in the Federal Plan Brochure and will apply until you meet your out-of-pocket maximum.
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Once an individual meets the Self Only deductible under the Self Plus One or Self and Family enrollment, they will then be covered under plan benefits. One or more family members can satisfy the remaining balance of the Self Plus One or Self and Family deductible.
The deductibles are:- $50 for Self Only for the high option
- $100 for Self Plus One or Self and Self and Family for the high option
- $100 for Self Only for the standard option
- $200 for Self Plus One or Self and Family for the standard option
Dental and vision:
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Dental benefits are included with the high option. The dental plan is available with our preferred provider organization (PPO) network and allows you to visit any licensed dentist nationwide.*
You'll get preventive care (like cleanings and X-rays) covered at 100%, minor services (like fillings) covered at 60% and major services (like crowns) covered at 40% when you visit network dentists.*
Plus, there's no deductible or waiting period.
There are no dental benefits under the Altius standard option.
*FOR IN-NETWORK PREVENTIVE CARE: If you use an out-of-network dentist, you are responsible for the difference between our plan allowance and the dentist's charges.
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While you will usually save money visiting in-network providers, the dental plan is available with our PPO network. It lets you visit any licensed dentist nationwide.
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Routine eye exams are covered under the medical plan. Members are also eligible for an eyewear reimbursement every 24 months. See your Federal Plan brochure for details.
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The plan covers one routine eye refraction every 12-month period at 100% when you visit a participating provider. Your provider will submit the claim to Aetna, and you won’t pay anything. Members are also eligible for a $100 eyewear reimbursement every 24 months and discounts on frames, lenses, LASIK procedure, etc., through the Aetna VisionSM discount program. If you use a participating location, they will take the $100 eyewear reimbursement off at the point of sale. If you use another eyewear provider, simply mail the receipt along with your member ID number to:
Aetna
PO Box 14089
Lexington, KY 40512-4089You can find participating locations by using our provider search.
If you use a nonparticipating provider, you may have to submit a claim. Claim forms are available on our member website.
Enrollment:
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Detailed instructions and information on the Federal Employees Health Benefits (FEHB) Program enrollment process are available on our website at Enroll Now. Enrollment procedures vary by agency. You will need to know the enrollment code for the Altius high or standard plan. Please refer to the rate calculator for the plans available in your area and the federal enrollment codes.
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Coverage and 2023 benefit changes for current members and annuitants begins on January 1, 2023. Coverage for Aetna® members joining during Open Season becomes effective on the first day of the first pay period in January 2023.
If you enroll as a newly hired Federal Employee, you have 60 days to enroll in an FEHB plan. Your enrollment will become effective the beginning of the pay period after your enrollment is received.
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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 our member website and print an ID card. After you register, simply select "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.
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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.
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Eligible out-of-area dependents, such as children who are away at college, can be covered through the Aetna HMO or Aetna Open Access® HMO networks. To find out whether we have an Aetna HMO or Aetna Open Access HMO network in their area, go to our provider search. If we do not have an Aetna HMO or Aetna 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.
Member perks:
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Our member website is 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 estimator tools — Provides personalized cost information. You can estimate how much you’ll pay out of pocket for medical tests, office visits and procedures ahead of time. If Medicare is your primary coverage, these estimates may not be representative of your actual costs.
- Hospital Comparison Tool — See how hospitals in your area rank by factors important to you.
- Personal Health Record — A private and secure online tool that 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.
- Our provider search — Helps you find doctors, dentists, hospitals and other providers that accept your plan. Using in-network providers will help you save money. The provider search also includes important provider credentials like education, board certification and languages spoken.
- Aetna HealthSM app — Puts our 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). The app is available on the App Store® or the Google Play™ store. Just type Aetna.com into your mobile web browser.
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All members have access to Teladoc Health, a convenient, lower-cost alternative to urgent care or the emergency room. It lets you access board-certified doctors 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 can simply visit Teladoc.com/aetna or call 1-855-Teladoc to get started.
Teladoc doctors prescribe medical treatment for a wide range of conditions including cold and flu, pink eye, skin rash and stress/anxiety. They can even call in a prescription to your pharmacy of choice, when necessary. All Teladoc doctors:- Are U.S. board certified internists, state-licensed family practitioners, and pediatricians licensed to practice medicine in the U.S.
- Are U.S. residents
Consultations are $40 or less for most services, depending on your plan, and do not require a referral.
Please note: Teladoc is not available to all members. Teladoc and Teladoc physicians are independent contractors and are not agents of Aetna. Visit Teladoc.com/Aetna for a complete description of the limitations of Teladoc services. Teladoc, Teladoc Health and the Teladoc Health logo are registered trademarks of Teladoc Health, Inc.
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You must live or work in our service area to enroll in our plan. Return to the home page to find plans available in your area. Once enrolled in the plan, only emergency care is covered overseas. See Section 7 of our federal brochure for more information on how to submit overseas claims.
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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 for more information.
DISCLAIMERS
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).
Aetna, CVS Caremark® Mail Service Pharmacy and CVS Pharmacy® are part of the CVS Health® family of companies.
External websites links are provided for your information and convenience only and do not imply or mean that Aetna endorses the content of such linked websites or third-party services. Aetna has no control over the content or materials contained therein. Aetna therefore makes no warranties or representations, express or implied, about such linked websites, the third parties they are owned and operated by, and the information and/or the suitability or quality of the products contained on them.
Estimated costs are not available in all markets or for all services. We provide an estimate for the amount you would owe for a particular service based on your plan at that very point in time. It is not a guarantee. Actual costs may differ from an estimate for various reasons including claims processing times for other services, providers joining or leaving our network or changes to your plan. Health maintenance organization (HMO) members can only get estimated costs for doctor and outpatient facility services.
DISCOUNT OFFERS ARE NOT INSURANCE. They are not benefits under your insurance plan. You get access to discounts off the regular charge on products and services offered by third party vendors and providers. Aetna makes no payment to the third parties — you are responsible for the full cost. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts.
Discount vendors and providers are not agents of Aetna and are solely responsible for the products and services they provide. Discount offers are not guaranteed and may be ended at any time. Aetna may get a fee when you buy these discounted products and services.
For a complete list of other participating pharmacies, log in to Aetna.com and use our provider search tool.
Vision care providers are contracted through EyeMed Vision Care. LASIK surgery discounts are offered by the U.S. Laser Network and Qualsight.
Natural products and services are offered through ChooseHealthy®, a program provided by ChooseHealthy, Inc. which is a subsidiary of American Specialty Health Incorporated (ASH). ChooseHealthy is a registered trademark of ASH and is used with permission.
Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional.
Incentive-based activity awards will only be given for completing select wellness programs as determined by the plan sponsor.
Google Play and the Google Play logo are trademarks of Google LLC.
Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple, Inc. All trademarks and logos are the intellectual property of their respective owners.
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