Aetna Open Access® Plan
National network of doctors, predictable costs, no referrals
2023 Biweekly rates for zip code
These rates do not apply to all Enrollees. If you are in a special enrollment category, please refer to the FEHB Program website or contact the agency or Tribal Employer which maintains your health benefits enrollment.
| Aetna Open Access® HMO Plan | Code | Biweekly Premium |
|---|
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Your 2023 benefits - DC, MD, Northern VA
| Plan Details | Basic Option |
|---|---|
| Preventive care copay | $0 |
| Primary care visit copay | $25 |
| Specialist visit copay | $55 |
| Teladoc® telehealth services | $40 |
| MinuteClinic® or Walk in Clinic | $0 |
| Prenatal Care | $0 |
| Inpatient hospital care | You pay 20% |
| Outpatient facility copay | $350 |
| Emergency room copay | $200 |
| Urgent care center copay | $50 |
| Lab/X-ray/diagnostic services | $25 PCP / $55 specialist ($100 for certain tests) |
| Prescription drug copays
(for a 30-day supply at a retail pharmacy) See Aetnafeds.com/pharmacy for a list of participating pharmacies. |
|
| Preferred Generic formulary* | $10 |
| Preferred Brand-name formulary* | 50% up to $200 maximum |
| Non-preferred (generic or brand name through our mail order drug program or at CVS Pharmacy®)* | 50% up to $300 maximum |
For specialty drug information, see the federal plan brochure.
|
|
| Built-in Vision | |
| Routine eye exam copay | $55 |
| Money toward prescription eyewear | You get $100 every 24 months |
| Discounts on eyeglasses, contacts, eye exams and more | Included |
Built-in dental, too
Use our Advantage Dental Network. Call 800-537-9384 (TTY:711) to select a dentist OR to switch to our larger PPO network at no additional cost. It's your choice!
Basic - Pay a $5 copay for cleanings, fillings and X-rays when you visit your primary care dentist (PCD).
PPO - After a $20 deductible per member, cleanings, fillings, and X-rays are covered at 100% with network dentists.***
Why choose the Aetna Open Access plan?
- Large nationwide Aetna Network
- 24 hours a day / 7 days a week access to doctors via phone or video with Teladoc®† telehealth services
- Built-in dental and vision coverage
- Predictable costs
- No referrals to network specialists
- Discounts on eyewear, LASIK laser eye surgery, gym memberships, massage, acupuncture, weight-loss programs and more
*A formulary is a list of generic and brand-name drugs your health plan prefers.
** If you choose the brand name drug over the generic equivalent, you will owe the corresponding copay plus the difference between the generic and brand name costs. Please see the plan brochure for details.
*** Out of Network for cleanings, composite fillings and X-rays – you pay 50% of negotiated rate plus any difference between our allowance and the billed amount.
†Teladoc® is covered at the member cost share.
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).
This is a brief description of the features of this Aetna health benefits plan. Before making a decision, please read the Plan's applicable Federal brochure(s). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. 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. 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.
Pharmacy clinical programs such as precertification, step therapy, and quantity limits may apply to your prescription drug coverage. Aetna's Drug Guide is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change.
