Medical
Aetna Medical Plans
All of the following available medical plan options offer access to high-quality, comprehensive care. They differ largely in the way the cost of care is structured and in the strategies you can use to control your expenses.
Note: All plan deductibles and out-of-pocket maximums reset each year when the new plan year begins, January 1.
OAMC (Open Access Managed Choice) Plans
Visit any doctor, no referrals or primary care physicians needed. The plan has access to Aetna tools, tips, programs and services.
PPO (Preferred Provider Organization) Plans
PPOs have the most freedom. They rely on a network of health care clinics, hospitals and professionals who have agreed to provide their services at discounted rates. These preferred providers are considered “in-network.” In general, you will pay less for in-network services than you would were you go outside the network.
- Note: Employees who are eligible for OAMC plans may not elect a PPO plan. If by chance you are enrolled in a PPO plan but qualify for the OAMC, you may need to switch plans. Eligibility for these plans is based on your home address zip code
EPO (Exclusive Provider Organization) Plans
EPOs are like PPOs, but they don’t cover out-of-network doctors. So, members can go to any doctor, anytime, if they are in-network. This gives the member control over how medical care is accessed, if the doctor is in-network.
HDHP (High Deductible Health Plan) HSA (Health Savings Account) Plans
HDHPs are high-deductible insurance plans that help protect against large claims, and cover preventive care 100% (deductible is waived for preventive services). If you enroll in this plan, you are eligible to open an HSA, which can be used to help pay for qualified medical expenses. Available to all employees.
Contact Aetna
- Phone: 877-204-9186
- Website: aetna.com
- Policy #: 175126
Additional Aetna Resources
- Find a Provider
- How to look up an Aetna provider on Docfind
- 24/7 Nurse Line: 800-556-1555
- Aetna Members Employee Assistance Program:
- 833-721-2315
- resourcesforliving.com
- Username: AspenHR
- Password: eap
Aetna NY/Tri-State Plans 2023-2024
OAMC Plans (175130 and 232275)
Network: Aetna Open Access Plans / Managed Choice POS (Open Access)
- OAMC SBC 2 0 100 15-20 80%
- OAMC SBC $0 100% 15/20
- OAMC $0 100% 15/20 Summary
- OAMC SBC $0 100% 20/30 80%
- OAMC $0 100% 20/30 Summary
- OAMC SBC $0 100% 30/50 80%
- OAMC $0 100% 30/50 80% Summary
- OAMC2 SBC $0 100 15/20 – 80%
- OAMC 2 0 100 15-20 80% Summary
- OAMC SBC $0 100% 5/20 – 80%
- OAMC $0 100% 5/20 – 80% Summary
- OAMC SBC $0 100% 15/20 Medicare
- OAMC $0 100% 15/20 Medicare Summary
- OAMC SBC $0 $100 30/50
- OAMC $0 $100 30/50 Summary
- OAMC SBC $750 90%
- OAMC $750 90% Summary
- OAMC SBC $1000 80%
- OAMC $1000 80% Summary
- OAMC SBC $1250 90%
- OAMC $1250 90% Summary
- OAMC SBC $2000 80%
- OAMC $2000 80% Summary
- OAMC SBC $2000 100%
- OAMC $2000 100% Summary
- OAMC SBC $4500 60%
- OAMC $4500 60% Summary
Aetna PPO Plans (175129)
(Offered in lieu of the OAMC plan in Alaska, Idaho, Montana, South Dakota and Missouri)
Network: Aetna Standard Plans / Open Choice PPO
- PPO SBC $500 80%
- PPO $500 80% Summary
- CMED SBC $1000 80%
- CMED $1000 80% Summary
- PPO HDHP SBC $3000 90%
- PPO HDHP $3000 90% Summary
- PPO SBC $1000 80%
- PPO $1000 80% Summary
EPO Plans (175131)
Network: Aetna Open Access Plans / Elect Choice EPO
- EPO SBC $0/100% 30/65
- EPO $0/100% 30/65 Summary
- EPO SBC $0/100% 45/65
- EPO $0/100% 45/65 Summary (Pending)
- EPO SBC $1000/80%
- EPO $1000/80% Summary
- EPO SBC $3000 80%
- EPO $3000 80% Summary
- EPO SBC $4500 70%
- EPO $4500 70% Summary (Pending)
- EPO HDHP SBC $5000 100%
- EPO HDHP $5000 100% Summary
HDHP Plans (175130)
Network: Aetna Open Access Plans / Managed Choice POS (Open Access)
Aetna Resources
Aetna Quick Video Guides
- Video: Aetna Member Tools and Resources
- Video: Welcome to CVS HealthHub
- Video: Welcome to the Aetna App
Aetna Transition of Care
Aetna Pharmacy Resources
- Aetna Medical Formulary
- Pharmacy Plan Brochure
- Specialty Pharmacy Flyer
- Precertification Request for Rx
- Diabetic Supply Order Form
- Find a Medication (2024 Plan: Advanced Control Plans, Aetna)
- Aetna Advanced Control Rx Plan Summary of Changes
Aetna Additional Resources
- Teladoc Pricing for Members
- 24-Hour Nurse Line
- Maternity Program
- Simple Steps Wellness Program
- Disease Management
- Aetna Discounts
- Aetna Behavioral Health AbleTo Support
- Aetna Health App Member Flyer
- Aetna Member Pre-enrollment Flyer
- Aetna Member Website Presentation
- Aetna Travel Flyer
- Breast Cancer Screening Flyer
- How to File a Claim on the Aetna Member Website
- Traditional EOB Guide
- Minute Clinic Overview and Services Flyer
- Minute Clinic Member Toolkit Flyer
- Preventive Care Brochure
- Disabled Child Attending Physician Statement
- Request for Continuation of Coverage Disabled Child
- Mental Health Discounts
- Fitness Reimbursement Program
- Hearing Discounts
- Find an Aetna Provider Guide
- Authorization for Release of Protected Health Information (PHI)
Aetna Programs
Aetna Resources for Living
You and your household members can find help for personal and family counseling, child/eldercare assistance, legal services, financial help, identity theft recovery and more. Services include 24/7/365 phone support and free short-term counseling (in person or by televideo). We’ll connect you to resources, products and services so you can stress less and live more.
- Website: resourcesforliving.com
- Mobile App: Resources For Living
- Phone: 833-721-2315
- Username: AspenHR
- Password: eap
Aetna Behavioral Health AbleTo Support
Focusing on health conditions and life changes
This eight-week program is available for emotional support after a medical diagnosis or life transition, such as becoming a caregiver or giving birth. It combines counseling and coaching to help you:
- Work through the normal emotions you’re having
- Understand and stick with a treatment plan
- Know the types of changes you need to make
To get started, an Aetna or AbleTo representative will call you to explain more about the program and how it can help.
Retail Walk-in Clinics
When you’re feeling sick and it’s after office hours, try a retail clinic. You don’t need an appointment to visit for minor illnesses, injuries and even vaccines. Walk-in clinics offer convenient hours, with some open seven days a week plus night and weekend hours. You’ll enjoy lower prices, from an average of $81 per clinic visit compared to the $750 to $1,000 average emergency room (ER) price*
- Find a walk-in clinic at aetna.com
- Select “Find a doctor”
*Average retail and ER pricing. Based on Aetna average claims costs. Data accessed July 2017. For illustrative purposes only. Member responsibility may vary based on plan design; for some plans, copays apply. ER copays are typically higher than walk-in clinic copays.
Simple Steps To A Healthier Life
With its health assessment and online coaching programs, this interactive program helps reduce health risks. It helps you stay healthy, productive and connected with Aetna care management support services. The program also includes tailored health reports and easy-to-find wellness information.
Aetna Vision Discounts
Save money with discounts on:
- Eye exams
- Prescription eyewear
- LASIK
- Nondisposable contact lenses
- Designer frame options
You can even save on items that don’t need a prescription, like sunglasses, eyeglass chains, lens cases and cleaners.
Note: Not for use in TX, KS or NY.
Natural Products and Services
Enjoy instant discounts on therapeutic massage, acupuncture and chiropractic visits.* This perk is included with your Aetna benefits and insurance plan.
*Discounts do not apply to visits/claims submitted to your health insurance plan.
Note: Not for use in TX, KS or NY.
Choose Generic Drugs First
When a drug has a generic equivalent but you fill the brand drug prescription, you’ll pay the difference in cost. You’ll also be responsible for your required copay or coinsurance. Talk to your doctor about generic alternatives for your brand drug and if they might work for you. If your doctor feels the brand drug is medically necessary, they can request approval to cover the prescription drug at the brand cost share. For approved medical necessity, you won’t be required to pay the cost difference between the generic and brand drug.
Aetna Pharmacy Solutions
As a part of CVS Health, we’re able to offer you best-in-class pharmacy benefits. These plans can help you balance cost savings with the choices you want. And when you integrate your pharmacy and medical benefits, you provide us with more insights to help you on the path to your best health. Integration keeps your costs in check, too.
Teladoc General Medicine Services
Teladoc connects you with board-certified doctors who offer nonemergency care 24/7, by phone or video call. You can request visits three ways: online, via the Teladoc app or by phone. You can schedule a visit, set up your account and learn more at teladoc.com/aetna.
Note: Teladoc and Teladoc physicians are independent contractors and are not agents of Aetna. For a complete description of the limitations of Teladoc services, visit teladoc.com/aetna.
24-Hour Nurse Line*
Have questions about upcoming medical visits and options? You can talk to a registered nurse for information about tests, procedures and treatment options, 24 hours a day, 7 days a week. And the call is free. You can find the phone number by visiting aetna.com and logging in to your member website.
*While only your doctor can diagnose, prescribe or give medical advice, our 24-Hour Nurse Line nurses can provide information on a variety of health topics. Contact your doctor first with any questions about your health care needs.
Minute Clinic
Access convenient, local care at a MinuteClinic location—at little or no cost to you. MinuteClinics are a walk-in clinic located inside select CVS Pharmacy and Target stores that treat a variety of illnesses, injuries and conditions, including allergies, ear infections, flu, bug stings and more. MinuteClinic providers can also administer vaccines and write prescriptions, when medically appropriate.
Urgent Care Centers
If you have an urgent but not life-threatening medical issue, consider visiting an urgent care center instead of the emergency room.* Urgent care centers can treat sprains, the flu, minor cuts and more, and visits typically cost less than a trip to the ER—and cut your waiting time.
You can visit one of Aetna’s 3,000 participating locations; many are open seven days a week, with no appointments needed.
- Find an urgent care center near you: aetna.com
- Select “Find a doctor” to use the directory, or use the mobile app*
*Standard text messaging and other rates from your wireless carrier may apply.
Aetna Discounts
The Aetna discount program offers instant savings on your favorite healthy-living products and services. You can save on gym memberships, weight-loss programs, vision services, hearing aids and more—with any health plan. These built-in discounts aren’t insurance, so there are no claims, referrals or limits on their use.
Note: Discount vendors and providers are not agents of Aetna and are solely responsible for the products and services they provide. Discount offers are not guaranteed and may be ended at any time. Aetna may get a fee when you buy these discounted products and services. Not for use in TX, KS or NY.
Aetna One Choice
Helping you navigate current health challenges
This industry-leading care management program helps you and your family work with the health system, so you can focus on your health.
This program:
- Offers both digital support and a nurse assigned to your family
- Helps you get the most from your benefits
- Finds health barriers and prioritizes your health goals
- Focuses on real-time interventions
- Manages continuing health issues
Aetna Member Tools
Find A Provider Search Tool
You can search for providers by name, specialty, language and/or location. You’ll also find maps, directions and more. Visit aetna.com to get started.
Aetna Health App and Aetna Member Website
Manage your benefits, connect to care, and handle claims no matter where you are. The Aetna Health app and your Aetna member website are personalized, seamless and easy to use. Once you’re a member, here’s how you can connect:
- Get the Aetna Health app by texting “GETAPP” to 90156 for a link to download the app and create an account.*
- Go to aetna.com to create an account and log in to your member website.
You can also access your digital ID card whenever, wherever you are through the Aetna Health app, or you can print it out through the member website.
*Message and data rates may apply.
Legal Notice: Health benefits and health insurance plans contain exclusions and limitations. This material is for informational purposes only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Not all services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage.
Click here to view or print your medical, dental or vision plan disclosures. Here, you can also find state requirements and information on the Women’s Health and Cancer Rights Act.
Machine Readable Files
Questions? Contact Benefits@AspenHR.com