Aetna Open Access® HMO Plan - High Option
National network of doctors, predictable costs, no referrals
2024 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.
| Open Access® HMO - High Option | Code | Biweekly Premium |
|---|
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Your 2024 benefits
| Plan Details | High Option - YOU PAY |
|---|---|
| Preventive care copay | $0 |
| Primary care visit copay | $20 |
| Specialist visit copay | $35 |
| CVS Virtual Care | General medical: $0 |
| Teladoc® telehealth services | $35 |
| MinuteClinic® or Walk in clinic | $0 |
| Prenatal Care | $0 |
| Inpatient hospital care | $250 per day, $1,000 max per stay |
| Outpatient facility copay | $175 |
| Emergency room copay | $125 |
| Urgent care center copay | $50 |
| Lab/X-ray/diagnostic services | $20 PCP / $35 specialist ($75 for certain tests) |
| Prescription drug copays
(for a 30-day supply at a retail pharmacy) See Aetnafeds.com/pharmacy for list of participating pharmacies. | |
| Preferred Generic formulary* | $10 |
| Preferred Brand-name formulary* | $35 |
| Non-Preferred (generic or brand)* | $100 |
| Or get a 90-day supply for 2 copays through mail-order service or available at a CVS Pharmacy®. For specialty drug information, see the federal plan brochure. Your plan requires the use of generic medication when a generic equivalent exists. ** |
|
| Built-in Vision | |
| Routine eye exam copay | $35 |
| 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.*** |
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Why choose Aetna Open Access HMO?
- Large nationwide Aetna HMO Network
- 24 hours a day / 7 days a week access to doctors via video with CVS Virtual Care
- 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
For information about our plans available through the Federal Employees Dental and Vision Insurance Program (FEDVIP), please visit our Dental PPO Plan site or our Aetna Vision™ Preferred site.
*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.
†Referrals are required in our California HMO plan
Aetna, 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.
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. 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. Information is believed to be accurate as of the production date; however, it is subject to change.
