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The Benefits Center For Inova Health System

A summary of benefits is available for the Aetna Open Choice PPO 1 plan and the PPO 2 plan.

Aetna Open Choice (PPO 1 and PPO 2) Plans

The Open Choice PPO Plans give you the freedom to select any licensed provider when you need care. These plans offer both in-network and out-of-network benefits, but the plan's reimbursement is higher when you use a network provider. You do not have to select a primary care physician (PCP) and no referrals are needed for specialty care and other medical services.

The main difference between the Aetna Open Choice PPO 1 and PPO 2 is the out-of-pocket expenses for coinsurance and copays. Please see the Aetna Open Choice PPO 1 and the Aetna Open Choice PPO 2 summary of benefits charts for more details.

You should choose an Open Choice PPO plan if:

  • You need open access to any licensed health care provider.
  • You are open to controlling your health care costs by using network providers and receiving higher benefits.
  • You want to be able to visit specialists without getting referrals from a PCP.
  • You are willing to pay higher out-of-pockets costs in exchange for more choice.

How Open Choice Works

Under the Open Choice PPO plan, you may receive care from any licensed, qualified doctor or other health care provider. You are not required to select a PCP and no referrals are required for specialty care. When you need care, simply choose the appropriate doctor and make an appointment.

While you are free to use any provider, you save money when you use providers who belong to the provider network. The network consists of more than 472,000 providers and includes both primary care physicians and specialists ranging from cardiologists, podiatrists, and OB/GYNs to oncologists, ophthalmologists and orthopedists. Facilities such as hospitals, urgent care centers and labs also belong to the network.

The PPO plan has two levels of benefits:

  • In-network benefits. When you use in-network providers, you pay a fixed dollar amount, called a copayment (or copay), for doctor's office visits and routine exams. For other services, you pay a lower deductible and the plan pays a larger share of your expenses. In addition, the network provider files claims for you and takes care of the plan's precertification requirement.

  • Out-of-network benefits. If you decide to use an out-of-network provider, you must meet a higher deductible and the plan pays a smaller share of your expenses. In addition, you must file your own claims and call Aetna when your doctor recommends care that must be precertified.

View the in-network and out-of-network costs associated with the Aetna Open Choice PPO 1 and PPO 2 plans.

In-Network Provider? Or Not? Remember to ASK!

You save money when you use in-network providers - doctors, hospitals and other care providers who belong to Aetna's network.

If your doctor refers you to another provider (such as a specialist), be sure to ASK whether or not the provider belongs to the network. If he or she doesn't, benefits will be paid at the lower, out-of-network level AND only up to what Aetna determines to be the reasonable charge for the service. You'll be billed for any amount that exceeds the reasonable charge.