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Aetna Value Plan

National PPO network, wellness credits, low rates and 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.

Table of rates.
Aetna Value Plan Code Biweekly Premium

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Your 2023 benefits

Table of plan details.
Plan Details What you pay
In the network
What you pay
Out of network
Preventive Care $0

(no deductible)

Primary care visit $25

(no deductible)

Specialist visit $40

(no deductible)

Teladoc® telehealth services $40 50%
Walk in clinic or MinuteClinic® $0

Maternity 20% of plan allowance 50%
Prenatal Care $0 50%
Hospital Care 20% 50%
Yearly Deductible $700 Self Only
$1,400 Self Plus One or Family
$1,400 Self Only
$2,800 Self Plus One or Family
Other services

(Like inpatient and outpatient hospital procedures)

20% of plan allowance 50% of plan allowance

Prescription drug benefits

See for participating pharmacies.
Table of prescription drug benefits. See for participating pharmacies.
Prescription drugs

(for a 30-day supply at a retail pharmacy)

What you pay
In the network
What you pay
Out of network
Preferred Generic* $10

(no deductible)

Preferred Brand-name*

(no generic available)

30% up to $600

(no deductible)

Non-preferred (generic or brand)* 50% up to $600

(no deductible)

Preferred specialty drugs**
Non-preferred specialty drugs****
50% up to $600
50% up to $1,200

(no deductible)


Note: You don’t need to meet a deductible for prescription drugs. Just pay your copay or coinsurance (as noted below).***

30-day supply at a retail pharmacy¹:

$10 for generics, 30% of cost of brand name up to a $600 maximum, 50% of cost of non-formulary up to a $600 maximum†

90-day supply through mail-order service:

You’ll generally pay less for a 3-month supply than for 3 separate 1-month supplies.

Earn Wellness Incentive Credits

  • Step 1: Get preventive care like routine physicals, flu shots and biometric screenings.
  • Step 2: Earn $50 in wellness credits for each activity (up to $250 for Self Only or $500 for Self Plus One or Family coverage).
  • Step 3: Use those credits to pay your deductible or medical coinsurance costs.

Why choose the Aetna Value Plan?

  • Large nationwide Aetna PPO Network
  • Low monthly premium costs
  • Deductible does not apply to office visits or for prescriptions.
  • Earn up to $250/self or $500/self plus one and family in wellness credits
  • Acupuncture and chiropractic care are covered!
  • 24 hours a day / 7 days a week access to doctors via phone or video with Teladoc®† health services
  • Healthy ways to reduce your out-of-pocket costs — complete wellness activities and earn wellness credits toward your medical deductible or coinsurance
  • Discounts on eyewear, LASIK laser eye surgery, gym memberships, massage, acupuncture, weight-loss programs and more

*Formulary is a list of generic and brand-name drugs your health plan prefers.
**Plus the difference between the plan allowance and billed amount.
*** Your plan requires the use of generic medication when a generic equivalent exists. 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.
****For specialty drug information, see the federal plan brochure.

¹†If you use an out-of-network retail pharmacy, you pay 50 percent of the negotiated rate for all types of drugs, plus any difference between our allowance and the billed amount.

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 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. 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. 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.

New Hires have 60 days to choose benefits.

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