Aetna Open Access® HMO Plan
Click on a question. Get an answer.About the Plan
-
The Aetna Open Access Plan is an HMO that gives members more freedom. Members can visit any in-network provider (PCP or specialist) for covered services without a referral.* You can find Aetna network providers by using our provider search tool. We recommend that members select a primary care physician, but it is not required.** Members pay a copay for covered services. The copay amounts for specific services vary and are listed in the Federal Plan brochure.
*Except in our California Plan.
**Members in our California Plan must select a PCP.
-
Aetna Open Access HMO features include:
- No referrals*
- No deductible**
- 100% coverage in-network for preventive medical care
- No requirement to choose a primary care physician (PCP) ***
- Basic Dental included or you may select our Dental PPO network option at no extra charge****
- Out-of-area dependent coverage – visit network providers in any Aetna 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
*Except in our California Plan.
**Except in our Kansas Plan.
***Members in our California Plan must select a PCP.
****Members in our Kansas Plan only have the Dental PPO network option.
-
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 Aetna network specialists without a referral.
-
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 855-277-4356
Doctors and Networks
-
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 and dependent children away at school may also use Aetna HMO providers while at school. You can find in- network providers by using our provider search tool.
-
No. You do not need to get a referral to see a specialist in the Aetna Open Access HMO unless you live in California. California members covered under Aetna's Plan and must continue to get referrals from their PCP in order to see network specialists.
-
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.
-
No. While you do not have to select a PCP, except in our California Plan, we encourage you to establish a relationship with one as 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.
-
Yes, you may choose a different PCP for each member of your family. You may also request to change your PCP at any time.
-
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.
What will I pay?
-
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.
-
Members usually do not need to file claim forms except in some out-of-network emergency care situations.
-
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.
Go to our secure member website and click on "pharmacy benefits" for details and forms.
Dental and Vision
-
You have two different dental options, Advantage Dental or Dental PPO.* Upon enrollment members are 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 800-537-9384 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 (e.g., call on 1/8 and your coverage is effective on 2/1, but if you call on 1/17, your coverage will not be effective until 3/1). The Dental PPO network option gives you access to over 300,000 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 and 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 tool.
The advantages of switching to the Dental PPO network option are that you will have access to more dentists and you will also have a limited out-of-network benefit. See Federal Plan brochure for details.
*Members in our Kansas Plan have Dental PPO only. You’ll have coverage for cleanings and X-rays at a $0 copay when you use the dental preferred provider organization (PPO) network. Please note fillings are not covered.
-
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 procedure, etc., through the Aetna VisionSM Preferred Discounts program.
-
Yes. The Plan covers in-network preventive dental care. Find participating providers by using the provider search tool.
-
One routine eye refraction every 12-month period is covered when you visit a participating provider. Your provider would submit the claim to Aetna and you would pay nothing. Members are also eligible for an 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 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 the provider search tool.
If you use a nonparticipating provider, you may have to submit a claim. Claim forms are available on your secure member website.
Enrollment
-
Detailed instructions and information on the Federal Employees Health Benefits 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.
-
Coverage and 2021 benefit changes for current members and annuitants begins on January 1, 2021. Coverage for Aetna members joining during Open Season becomes effective on the first day of the first pay period in January 2021.
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.
-
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 secure 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.
-
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.
-
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
-
Our secure 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). It's available for Android™ and iPhone® mobile devices. * Just type Aetna.com into your mobile web browser.
* Apple, the Apple logo, iPad and iPhone are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Android and Google Play are trademarks of Google Inc.
-
All 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 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 $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.
-
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.
-
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.php for more information.
Trademarks included in this material are the intellectual property of their respective owners.
External websites links are provided for your information and convenience only and does 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. The tool gives you an estimate of what you would owe for a particular service based on your plan at that point in time. Actual costs may differ from the estimate if, for example, claims for other services are processed after you get your estimate but before the claim for this service is submitted, or if the doctor or facility performs a different service at the time of your visit.
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.
