Aetna CDHP with a PPO Network
Click on a question. Get an answer.About the Plan
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The CDHP is an innovative health plan that gives you more control over how you spend your health care dollars. Plan features include:
- Annual Medical Fund of $1,000 Self Only or $2,000 Self Plus One or Self and Family available when you enroll during the annual Open Enrollment. It pays for your covered services first, before you pay out-of-pocket
- Annual Dental Fund of $300 Self Only or $600 Self Plus One or Self and Family available in full on your effective date of coverage
- 100% coverage for in-network preventive care (medical, dental and vision) that does not reduce your Fund balances
- Unused Medical and Dental funds roll over from year to year if you remain in the CDHP (medical rollover maximum of $5,000/Self Only or $10,000/ Self Plus One or Self and Family)
- Freedom to choose the providers you wish to see for covered services (in and out-of-network) with no referrals
- Nationwide coverage
- Traditional medical plan coverage for in- and out-of-network expenses once the annual deductible has been met
- An out-of-pocket cap that limits the total amount you pay annually for eligible expenses
- Online tools to help you manage your money and your health
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To understand how the plan works, let's review its components:
- Preventive Care
- Covered at 100% in network – medical/dental/vision (does not reduce your Funds)
- The Funds
- Annual Medical Fund - $1,000 Self Only; $2,000 Self Plus One or Self and Family
- Annual Dental Fund - $300 Self Only; $600 Self Plus One or Self and Family
- Funds pay for eligible expenses in network or out of network, up to the Fund balance.
- You can visit any licensed health care professional or hospital for covered services (in and out of network) – without a referral.
- Unused Medical and Dental Fund balances roll over to the next year as long as you remain enrolled in the CDHP.
- The Medical and Prescription Drug Plan
- The Annual Deductible – After you have used your Medical Fund and before traditional plan coverage begins, you have an annual deductible of $1,000 Self Only; $2,000 Self Plus One or Self and Family in-network. Under the Self Plus One or Self and Self and Family enrollment, once an individual meets the Self Only deductible, traditional medical coverage begins for that individual. The remaining balance of the Self Plus One or Self and Self and Family deductible can be satisfied by one or more Self and Family members.
- Medical Coverage - When the annual deductible is satisfied, the traditional medical coverage begins. See the Federal Plan brochure for details.
- Out-of-Pocket Maximum – Once an individual meets the Self Only out-of-pocket maximum under the Self Plus One or Self and Self and Family enrollment the plan will begin to cover eligible medical expenses at 100%. The remaining balance of the Self Plus One or Self and Self and Family out-of-pocket maximum can be satisfied by one or more Self and Family members. The in-network out-of-pocket maximum is $5,000 Self Only enrollment and $10,000 Self Plus One or Self and Self and Family enrollment.
- Prescription Drug Coverage - When you fill a covered prescription, the cost of the prescription will be paid from your Medical Fund if Fund dollars are available. If Fund dollars are not available, you pay for the covered prescription until your annual deductible has been met. After that, you pay a copayment or coinsurance for covered prescriptions.
- Preventive Care
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If you are searching for a plan with a national PPO network, the Aetna CDHP might be right for you. The plan uses the Medical Fund to pay the covered claims before the fund is depleted. This ensures that during this time you would not have any out-of-pocket expenses. When the fund is depleted, you'll be responsible for the deductible, and then for the coinsurance.
To determine whether this plan is right for you, review your medical services 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. This will help you estimate your out-of-pocket expenses for the year.
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You have several options:
- Review the Federal Plan brochure and other information on this website
- Chat live with a health plan specialist or schedule an appointment for a one-on one phone consultation at AetnaFedsLive.com
- Call Aetna at 1-855-277-4356 (TTY:711)
Doctors and Networks
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No. You can use any provider who participates with Medicare or accepts Medicare Assignment. This means that even though you may be switching plans, chances are you may be able to continue seeing your same doctors.
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The Aetna CDHP 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% of our Plan allowance and any difference between our allowance and the billed amount once your Medical Fund has been used and your deductible has been met. The annual out-of-network deductible is $1,500 Self Only and $3,000 Self Plus One or Family.
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Use our provider search tool. You can access information about our extensive network of providers as well as individual physicians' board certification status, medical school attended, the year he or she graduated, languages spoken, etc.
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Yes, you can visit a MinuteClinic® for urgent care with a $0 copay after your deductible has been met.
What will I pay?
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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 the equivalent of two retail copays.
You can also get your 90-day prescription at a CVS Pharmacy® for the same cost as mail-order.
Go to our member website and click on "pharmacy benefits" for details and forms.
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Yes, your calendar year In-Network deductible is $1,000 for Self Only coverage and $2,000 for Self Plus One or Self and Family Coverage
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Once you pay your deductible, you pay a coinsurance for most services. 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 you have exhausted your medical fund, the annual deductible of $1,000 for Self Only, $2,000 for Self Plus One and $2,000 for Self and Self and Family in-network and $1,500 for Self Only, $3,000 for Self Plus One and $3,000 for Self and Self and Family out-of-network, must be met before Traditional Medical Plan benefits are paid for care other than preventive care services. Once an individual meets the Self Only deductible under the Self Plus One or Self and Self and Family enrollment, the Plan will begin to cover eligible medical benefits. The remaining balance of the Self Plus One or Self and Self and Family deductible can be satisfied by one or more Self and Family members. In-network and Out-of-network deductibles do not cross apply and will need to be met separately for traditional benefits to begin.
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In most instances, 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 towards 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 which is based on the negotiated rate with the in-network provider.
While many out-of-network providers will submit claims for covered care to Aetna 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.
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Once your Medical Fund has been used, and until you meet your deductible, you will pay the entire cost of the negotiated rate for the prescription at an in-network pharmacy. It is important for you to identify yourself as an Aetna member and show your Aetna ID card to get the negotiated rate. Once you meet your deductible, you will be subject to a prescription copay or coinsurance for covered drugs. See Aetna HealthFund® CDHP federal brochure for more details.
About the Fund
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Aetna sets up different annual Medical and Dental Funds for you that pay for eligible expenses in-network or out-of-network at 100%, so you pay nothing for covered services until your Funds are exhausted.
Annual Medical Fund - You get $1,000 Self Only; $2,000 Self Plus One or Self and Family. It is available on your effective date of coverage if you enroll during the annual Open Season. If you enroll outside of the annual Open Season (e.g., within 60 days of new hire), your Fund will be prorated.
You can earn additional credits to your Medical Fund. Get $50 per enrollee and/or spouse when you complete an online health risk assessment, online wellness program and a post-program assessment. Get another $50 credit per enrollee and/or spouse for completing a biometric screening. See biometric screenings for more details.
Annual Dental Fund - You get $300 Self Only; $600 Self Plus One or Self and Family. It is available on your effective date of coverage.
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You can view your Fund balance, check claims transactions and more on our member website. Or, you can call Member Services at 1-888-238-6240 (TTY:711). If you have claim activity in a given month, you will receive an Explanation of Benefits that lists your Fund balance and annual deductible.
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Remaining Medical and Dental Fund dollars roll over from year to year if you remain in the CDHP, up to the maximum rollover amount (medical rollover maximum of $5,000/Self Only or $10,000/Self Plus One or Self and Family).
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Your annual Fund amount is $1,000 for Self Only coverage and $2,000 for Self Plus One and Self and Family coverage.
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No. Payments from the Funds are benefits and not considered taxable income.
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When you receive covered services, expenses are paid first from your Fund—before you pay anything out of pocket. Preventive care services provided by in-network providers (medical, dental, vision) are covered at 100% and are not deducted from your Fund. See the Federal Plan brochure for details on preventive services.
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No. All Self and Family members covered under your plan share the Fund.
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No. While amounts left in the Funds at the end of the year will roll over if you remain enrolled in the CDHP (up to the rollover maximum), the Funds are only available to pay expenses covered under the Plan.
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You lose any remaining Fund balances if you leave our CDHP Plan.
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If the service is covered by both plans, benefits would first be considered under the CDHP and the balance would then be considered under the FSA.
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All eligible portions of the provider's services would be paid by the Fund (up to the remaining Fund balance). However, you are responsible provider's medical fees that exceed our plan allowance. If your Fund is exhausted, you would need to satisfy your annual deductible before the Plan's traditional medical benefits would be available.
Dental and Vision
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Dental benefits are built in to the CDHP at no added cost.
100% coverage for dental cleanings and X-rays received from in-network dentists
A Dental Fund to use in or out of network for covered dental services ($300 Self Only, $600 Self Plus One or Self and Family)
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Vision benefits are built in to the CDHP at no added cost.
100% coverage for routine eye exams in network
Use your Medical Fund, if available, for prescription glasses or contacts, plus get special discounts on eyewear
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The Plan only covers in-network preventive dental care at 100%. Find participating providers by using the Provider Search online provider directory.
You may choose to use your Dental Fund for care with out of network dentists.
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One routine eye refraction every 12-month period is covered at 100% when you visit a participating provider. Your provider would submit the claim to Aetna and you would pay nothing. Members can use their Medical Fund, if available, for prescription glasses or contacts, and are eligible for discounts on frames, lenses, LASIK laser eye surgery, etc., through the Aetna VisionSM Discount program. 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 the provider search tool.
If you use a nonparticipating provider, you may have to submit a claim. Claim forms are available on your member website.
Enrollment
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Enrollment procedures vary by agency. Detailed instructions and information on the Federal Employees Health Benefits Program enrollment process is available at Enroll Now link on the website. You will need to know the enrollment code for the Aetna CDHP. 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 new 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 a Federal Employees Health Benefits (FEHB) plan. Your enrollment will become effective the beginning of the pay period after your enrollments 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 click on "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.
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, 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 tool – 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 Mobile App™ - 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). The app is available on the App Store® and Google Play. Just type Aetna.com into your mobile web browser.
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Members have access to Teladoc, a convenient, lower-cost alternative to urgent care or the emergency room. Teladoc 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 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 & 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 $49 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 homepage to find plans available in your area. Once 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.
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Log in to your member website member website and fill out a health assessment. Then complete one online wellness program to earn $50. You can also earn an additional $50 for completing your biometric screening.
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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. Is 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. Aetna and CVS Pharmacy® are part of the CVS Health® family of companies.
External website 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.
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.
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.
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