About the plan:
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The Aetna 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.
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Preventive care is covered at 100% 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.
- PCP: $25 copay in network* (40% coinsurance out of network)
- Specialist visit: $40 copay in network* (40% coinsurance out of network)
- Prescriptions:*
- $10 per generic formulary drug for a 30-day supply
- 30% per covered brand formulary drug, $600 maximum per prescription for a 30-day supply
- 50% per covered non-formulary (generic or brand name) drug, $600 maximum per prescription for a 30-day supply
- 50% per covered specialty drug up to a $600 maximum per prescription for preferred or $1,200 maximum per prescription for non-preferred for a 30-day supply
- Mail-order delivery is also available for a 90-day supply (we do not offer a 90-day supply for specialty drugs)
- $700 Self Only/$1,400 Self Plus One or Self and Family, in network
- $1,400 Self Only/$2,800 Self Plus One or Self and Family, out of network
Once your deductible has been satisfied, you pay a coinsurance depending on whether you stay in or go out of network. The coinsurance for in network is 20%. The coinsurance for out of network is 50%.
*For in-network copay and prescriptions: Primary care visits, specialist visits and prescriptions are not subject to the deductible.
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If you are looking for a plan with 100% coverage for in-network preventive care and nationwide coverage in and out of network, the Aetna Value plan could be right for you. Consider the following:
- 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 (employee contributions, deductibles, coinsurance, etc.) for the Aetna Value plan and other health insurance plans available to you.
- Assess discounts on things like gym memberships, massage and weight-loss programs.
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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)
Doctors and networks:
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While you can save money by visiting in-network providers, you have coverage in and out of network.
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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 50% of our plan allowance and any difference between our allowance and the billed amount once your deductible has been met. The annual out-of-network deductible is $1,400 for Self Only and $2,800 for Self Plus One or Self and Family.
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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 for urgent care with a $0 copay after you meet your deductible.
What will I pay?
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Yes, mail-order pharmacy is available for maintenance medications. Your share of the cost for a 90-day prescription will be equal to two retail copays. 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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Your calendar year in-network deductible is $700 for Self Only coverage and $1,400 for Self Plus One or Self and Family Coverage. With the Value Plan, some services are not subject to the deductible.
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Once you pay your deductible, you pay a copay for some services, such as office visits. You pay coinsurance for others, such as hospital benefits and specialty pharmacy. 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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The in-network annual deductible is:
- $700 for Self Only
- $1,400 for Self Plus One
- $1,400 for Self and Self and Family
- $1,400 for Self Only
- $2,800 for Self Plus One
- $2,800 for Self and Self and Family
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When you visit your in-network PCP or specialist, you will pay a copay when you go to the office. This does not count toward your deductible.
In most other cases, you will not make a payment at the time you receive services at an in-network provider. Instead, you should wait for the medical claim to be processed through our claim system. We will process the claim and apply the applicable amount toward your deductible. The doctor's office will send you a bill requesting payment. If you have already met your deductible, you will be billed for the coinsurance amount. This is based on the negotiated rate with the in-network provider.
While many out-of-network providers will submit claims for covered care to us on your behalf, some may not. In that case, you may have to pay the cost of the visit up front and then submit a claim.
Dental and vision:
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The Value plan does not include dental coverage.
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Routine eye refraction is covered at 100% under the Value plan.
Enrollment:
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Enrollment procedures vary by agency. Detailed instructions and information on the Federal Employees Health Benefits (FEHB) Program enrollment process is available at the Enroll Now link on the website. You will need to know the enrollment code for the Aetna Value plan. Please return to the home 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 begin on January 1, 2025. Coverage for active employees 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 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.
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. It can help 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 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 today 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 home page to find plans available in your area. Once enrolled in the plan, covered medical services received overseas would be considered out of network. 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.
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You can earn wellness incentive credits for completing any combination of the activities listed below. Each activity lets you or a covered family member earn a $50 credit for completion. You can earn a maximum of $250 for Self Only or $500 for Self Plus One or Self and 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
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, 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. Pharmacy benefits are administered through an affiliated pharmacy benefit manager, CVS Caremark.
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.
Includes select MinuteClinic services. Not all MinuteClinic services are covered. Please consult benefit documents to confirm which services are included. Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered non-preventive MinuteClinic services at no cost-share. However, such services are covered at negotiated contract rates. This benefit is not available in all states and on indemnity plans.
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.
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