Aetna Choice® POS II Plan Overview

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

  • You can stay within the Aetna network or go out of network for care.
  • You have the choice of choosing a primary care physician (PCP) or not, and you can change PCPs whenever you like.
  • You never need a PCP referral to see a specialist.
  • Your payment amounts, structure of coverage and need for claim forms will vary depending upon whether you are in-network or out of network.
  • Your responsibility for getting precertification depends on if you go in or out of the network.
  • In case of emergency, call 911 or go to your nearest emergency facility. Otherwise, you have two ways to get care:

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.

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

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.

 

Benefits and Advantages

  • Flexibility to stay in or out of network network without a referral
  • Extensive network of health care professionals and facilities
  • Network wellness visits covered at 100%
  • Lower out-of-pocket costs for network services
  • No claim forms for network services
  • Provider search tool for easy reference any time 
  • With your member website, at Aetna.com, you can easily find network providers, access to your personal benefits information, get cost estimates for services, download your medical ID card, and access to Healthwise® Knowlegebase, a free health and wellness resource
  • Aetna Concierge personalized assistance online or at the toll-free number on your Aetna member ID card