About the plan:
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The Aetna Open Access plan is a health maintenance organization (HMO) plan that gives members more freedom. Members can visit any in-network provider, like a primary care physician (PCP) or specialist, for covered services without a referral.* You can find Aetna® network providers by using our provider search. We recommend that members select a PCP, but it is not required.** Members generally pay a copay for covered services. The copay amounts for specific services vary and are listed in the Federal Plan brochure.
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Aetna Open Access HMO features include:
- No referrals*
- No deductible
- 100% coverage in network for preventive medical care
- No requirement to choose a PCP**
- Basic dental included, or you may select our dental preferred provider organization (PPO) network option at no extra charge
- Out-of-area dependent coverage; visit network providers in any Aetna health maintenance organization (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
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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 any Aetna network specialists without a referral.***
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You have several options:
- Chat live with a health plan specialist or schedule a one-on-one appointment at AetnaFedsLive.com
- Review the Federal Plan brochure and other information on this website
- Call Aetna at 1-855-277-4356 (TTY: 711)
Doctors and networks:
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Yes. You may visit any PCP or specialist in the Aetna Open Access HMO network service area. You may also use any Aetna HMO provider when you travel outside your service area. Dependent children may use Aetna HMO providers while they’re away at school. You can find in- 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 Aetna Open Access HMO network, unless you live in California. California members covered under this plan must continue to get referrals from their PCP in order to see network specialists.
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No. Out-of-network services and supplies are not covered under this plan. However, eligible expenses for emergency care services 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, except in our California plan, 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 participating 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.
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Yes, you can visit a MinuteClinic location for urgent care with a $0 copay.
What will I pay?
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A copay is a flat fee or percentage you must pay to a health care professional, facility or pharmacy when you receive covered services. The copay 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 copay amounts.
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Members usually do not need to file claim forms. However, you may need to file a claim form in some out-of-network emergency care situations.
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Yes, mail-order pharmacy is available for maintenance medications. Your share of the cost for up to a 90-day prescription will be equal to two retail copays. You can also get your 90-day prescription at a participating retail pharmacy for the same cost as mail order.
Go to our member website and select "pharmacy benefits" for details and forms.
Medicare Part D Prescription Drug Plan (PDP) coverage included in Aetna Open Access for the MD/DC/VA region:
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The Office of Personnel Management (OPM) worked with health plans to introduce Medicare Part D prescription drug plans to help you save money. If you’re enrolled in Medicare Part A and/or Part B, your Aetna Open Access plan in the MD/DC/VA region will automatically enroll you in Aetna Medicare Rx® offered through SilverScript®, a Medicare Part D prescription drug plan (PDP). This could mean saving on your prescription costs. The same drugs are covered under the Aetna Medicare Rx plan offered through SilverScript, but copays and coinsurance can be lower. So, depending on your prescriptions, this could offer you a great opportunity to save while still enrolled in your current health plan.
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The Medicare Part D PDP is a Medicare approved prescription drug plan that is governed by CMS.
When you have Aetna Medicare Rx offered by SilverScript your prescription costs will generally be lower.
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No. Your FEHB premiums will not increase.
However, some members may be required to pay an extra charge, known as the Part D Income-Related Monthly Adjustment Amount (IRMAA). The extra charge is figured out using your modified adjusted gross income as reported on your IRS tax return from 2 years ago. If this amount is above a certain amount, you’ll pay your FEHB premium and the additional IRMAA. For more information on IRMAA, visit the Medicare website.
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Yes.
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No. Your out-of-pocket costs for prescription drugs should decrease with Aetna Medicare Rx offered by SilverScript.
Please check the formulary to find out what tier your medications will be on.
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View your plan details page for copays.
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Yes. You will receive an additional card for your Medicare Part D PDP coverage. You will need to present your new card at the pharmacy.
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You can use our provider search tool to find standard and preferred pharmacies near you.
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Visit Caremark.com to register for your member portal with the information on your new prescription ID card.
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You can opt out of Aetna Medicare Rx offered by SilverScript at any time by calling Member Services at 1-833-271-9775 (TTY:711),, Monday through Friday, 8 AM to 8 PM ET or go online at AetnaRetireeHealth.com/FEHBP.
Dental and vision:
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You have two different dental options — Advantage Dental or dental PPO.* When you enroll, you’re automatically enrolled in the Advantage Dental option. With the Advantage Dental, you must select a participating primary care dentist (PCD) and call Member Services at 1-800-537-9384 (TTY: 711) to register your selection. You may then contact the dentist to make an appointment. You pay a $5 office visit copay 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. For example, if you call on January 8, your coverage is effective on February 1. But if you call on January 17, your coverage will not be effective until March 1. The dental PPO network option gives you access to over 420,000 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. 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. 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 our provider search.
There are advantages of switching to the dental PPO network option. You’ll have access to more dentists and a limited out-of-network benefit. See the Federal Plan brochure for details.
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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 laser eye surgery, etc., through the Aetna VisionSM Preferred discounts program.
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One routine eye refraction every 12-month period is covered when you visit a participating provider. Your provider will submit the claim to us and you won’t pay anything. Members are also eligible for an eyewear reimbursement every 24 months and discounts on frames, lenses, LASIK laser eye surgery, etc., through the Aetna VisionSM discount program. If you use a participating location, they will take the eyewear reimbursement off at the point of sale. You can find participating locations by using the provider search.
If you use an out of network provider, simply submit a vision claim form:
For vision benefit claims covered under your Medical Plan use vision claim form and mail to: P.O. Box 981106, El Paso, TX 79998
For vision benefit claims covered under your FEDVIP Vision Plan use vision claim form and mail to: P.O. Box 8504, Mason OH 45040-7111
Enrollment:
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Detailed instructions and information on the Federal Employees Health Benefits (FEHB) 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 return to the medical plans page for the plans available in your area and the federal enrollment codes.
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Coverage and 2025 benefit changes for current members and annuitants begins on January 1, 2025. Coverage for Aetna members joining during Open Season becomes effective on the first day of the first pay period in January 2025.
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, 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 click on "ID cards" 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. To find out whether we have an Aetna HMO or Open Access HMO network in their area, go to our provider search tool. 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.
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, 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. It can help you stay healthy with personalized alerts and reminders and lets you 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 tool also includes important provider credentials like education, board certification and languages spoken.
- Aetna HealthSM app — Puts our online features at your fingertips. You can 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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Yes. Members have access to CVS Health Virtual Care™. Virtual care is a convenient, lower-cost alternative to urgent care or the emergency room. And it’s in addition to your traditional network of providers to give you more options. It's perfect for when you're traveling or when your doctor isn't available. With these virtual options, you can get care ASAP for nonemergency conditions such as cold & flu, sinus infections, Pink Eye, allergies and more. You can also take care of your mental well-being by talking with a therapist for anxiety or stress. They can even call in a prescription to your pharmacy of choice, when necessary.
To access CVS Health Virtual Care register and make an appointment at CVS.com/virtual-care
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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 you’re enrolled in the plan, you are only covered for emergency care 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
*For covered services without a referral: Except in our California plan.
**For PCP not required: Members in our California plan must select a PCP.
***For specialists without a referral: Except in our California plan.
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, CVS Pharmacy® and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies.
All trademarks and logos are the intellectual property of their respective owners.
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.
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.
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.
©2023 Aetna Inc.
