Medical Plan Overview

You have the option to choose one of two plans – the Aetna EPO or Aetna POS plan.

This page describes the Aetna EPO plan.

To learn about the Aetna POS plan, click on the link below.

Aetna POS Plan

Aetna EPO

The Aetna EPO plan lets you work with a Primary Care Physician (PCP) to understand and meet your health care needs. And nothing is better than personal care!

How It Works
Benefits and Advantages
Summary of Benefits Chart [PDF]

The Aetna EPO plan offers comprehensive health care inside the extensive Aetna network. You can find network providers through the Aetna DocFind®.

For more detailed information about this plan, please see the Summary of Benefits Chart.

How It Works

You must stay within the Aetna network for your care to be covered.
You are not required to choose a primary care physician (PCP), but you may want to.
Wellness visits are covered at 100% with no copay.
Most other covered services are paid at 100% after you pay a flat copayment at the time of service. There are no claim forms or deductibles.
Your providers will obtain any precertification you may need.
In case of emergency, call 911 or your local emergency hotline, or go directly to the nearest emergency care facility.

Benefits and Advantages

Extensive network of health care professionals and facilities.
Wellness visits covered at 100%.
Predictable cost-saving copayments for health care services.
No claim forms ever.
Aetna DocFind online directory of health care professionals and facilities.
Aetna Navigator® secure self-service member website, featuring your personal benefits information, cost comparison tools, hospital comparison tool and Healthwise® Knowlegebase, a free health and wellness resource.

Plan Overview

Plan Summary Chart [PDF]

Transition of Care

Transition of Care coverage may allow a member who is receiving treatment to continue the treatment for a limited time at a preferred plan benefit level.

To request coverage, you will need to complete and submit a Transition of Care Request form [PDF].

You will need to complete and submit a separate request form for each provider caring for you.

Submit the completed forms to Aetna by fax to: 1-800-228-1318

Understanding Precertification

Some medical care (for example: Room and Board, miscellaneous expenses for Hospital and Treatment Facilities, Skilled Nursing Facilities, Hospice, Home Health Care, and Private Duty Nursing) require approval from Aetna ("precertification") before you can get coverage.

Under the Aetna EPO, non-emergency admissions or outpatient services must be precertified 14 days prior to the confinement or scheduled date of treatment. Emergency stays should be certified within 48 hours of admission.

If you visit an in-network doctor or facility, the provider will contact Aetna to authorize services on your behalf.

If you visit a doctor or facility outside the network, you must contact Aetna for precertification. See your member ID card for a number you can call to preauthorize your care.

You can check to verify if a procedure requires preauthorization by calling Member Services at 1-866-244-1573.