Your Benefits

Aetna Choice® POS II Plan Overview

 

How It Works
Benefits and Advantages
Aetna Medical Highlights Brochure [PDF]

The Aetna Choice POS II plan offers comprehensive health care both inside and outside the extensive Aetna network. With your Aetna Choice POS II plan, you are free to visit any doctor whenever you need care, but you save money when you use in-network providers because they charge a lower, negotiated fee, and the plan pays a higher percentage of covered charges (called coinsurance).


How It Works


Option 1: Use the Aetna network

Network doctors contract with us to offer rates that are often much lower than their regular fees. So choosing a PCP or another network doctor will help you save money.

Your PCP and network doctors also work directly with us. They will send us claims for the services you receive. And get approval for coverage of some services when it’s needed.

This is all behind-the-scenes work that you don’t have to worry about when you choose network doctors.

Plus, they’re easy to find. Just visit www.aetna.com.

This network option typically costs you less.

Option 2: Go outside the network
You can also visit licensed providers who are not in our network. Out-of-network doctors and hospitals do not contract with us. So that means:

They also do not work with us like network providers do. They generally don’t send us claims or get approval for coverage when needed. So you may need to handle these details on your own.

 

You must pay the full cost of the service until you meet the plan’s annual deductible, a set dollar amount that you must pay out of your pocket before the plan begins to pay.

2018 HDHP Gold Plan Deductible
  In-Network Out-of-Network
Per person $1,500 $3,000
Per family $3,000 $6,000

 

2018 HDHP Silver Plan Deductible
  In-Network Out-of-Network
Per person $3,000 $6,000
Per family $6,000 $12,000

 

After you meet the deductible, coinsurance (copayment) starts: The plan will pay a percentage of the covered expense and you will pay the balance. 

2018 HDHP Gold Plan Coinsurance
  In-Network Out-of-Network
Plan pays 90% 70%
You pay 10% 30%

 

2018 HDHP Silver Plan Coinsurance
  In-Network Out-of-Network
Plan pays 75% 55%
You pay 25% 45%

For out-of-network charges, the plan will only pay up to the reasonable and customary charges for the service, and you will need to pay anything above the reasonable and customary charge as well as your coinsurance.

 

There is a cap on the amount of coinsurance you will have to pay, called out-of-pocket maximum. When you reach that amount, the plan pays 100% of the reasonable and customary charges.

2018 HDHP Gold Plan Out-of-Pocket Maximum
  In-Network Out-of-Network
Per person $4,000 $8,000
Per family $8,000 $16,000

 

2018 HDHP Silver Plan Out-of-Pocket Maximum
  In-Network Out-of-Network
Per person $6,000 $12,000

Per family

$12,000

$24,000

In-network wellness visits are covered at 100% and are not subject to the deductible.


Benefits and Advantages

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 HDHP Gold Plan and HDHP Silver Plan, 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.