1. Aetna HealthFund CDHP is described as a "consumer driven" health plan. What does that mean?
Simply put, it is a benefits plan that gives you more purchasing power. You can seek care from any licensed provider (in and out of network), and you are given Medical and Dental funds to help pay for services that are covered under your plan. You can stretch your funds by seeking the most cost-effective care.
2. What are the advantages of the Aetna HealthFund CDHP?
The Aetna HealthFund CDHP is an innovative health plan that gives you more control over how you spend your health care dollars. Plan features include:
Affordable, low premiums
Annual Medical Fund of $1,250 Single or $2,500 Family available in full on your effective date of coverage
Annual Dental Fund of $300 Single or $600 Family available in full on your effective date of coverage
100% coverage for in-network preventive care (medical, dental and vision) that does not reduce your Fund balances
Unused Medical and Dental funds roll over from year to year as long as you remain in the Aetna HealthFund CDHP and rolled over Medical funds can reduce your annual member responsibility.
Freedom to choose the providers you wish to see for covered services (in and out of network)– with no referrals
Nationwide coverage
Traditional medical plan coverage of 90% in network and 60% out of network once the annual member responsibility has been met
An out-of-pocket cap that limits the total amount you pay annually for eligible expenses
Online tools to help you manage your money and your health
To understand how the plan works, let's review its components:
Preventive Care
Covered at 100% in network – medical/dental/vision (Does not reduce your Funds)
The Funds
Annual Medical Fund - $1,250 Single; $2,500 Family
Annual Dental Fund - $300 Single; $600 Family
Pays for eligible expenses in network or out of network at 100% up to the Fund balance.
You can seek care from any licensed health care professional or hospital for covered services (in and out of network)– without a referral.
Unused Medical and Dental Fund balance rolls over to the next year so long as you remain enrolled in the Aetna HealthFund CDHP and rolled over Medical funds can reduce your annual member responsibility
The Medical and Prescription Drug Plan
The Annual Member Responsibility – Before traditional plan coverage begins, and after you have used your annual Medical Fund, you have an annual member responsibility of $750 Single; $1,500 Family. If you rollover Medical funds from the previous year, these funds will help to reduce your annual member responsibility.
Medical Coverage - When the annual member responsibility is satisfied, the traditional medical coverage (90% coverage for in-network care and 60% coverage for out-of-network care) begins. If you still have dollars in your Medical Fund that you rolled over from previous years, those Fund dollars can help you pay your member responsibility under the plan as well as your out-of-pocket expenses (i.e., the 10% under the traditional medical coverage). The medical plan also includes an out-of-pocket maximum of $3,000 Single/$6,000 Family for in-network expenses and $4,000 Single/ $8,000 Family for out-of-network expenses (including annual member responsibility) to limit the amount you pay out of pocket in a given year – meaning at that point, Aetna pays 100 % of your eligible medical expenses for the remainder of the calendar year.
Prescription Drug Coverage - When you fill a covered prescription, the cost of the prescription will be paid from your Medical Fund if Fund dollars are available. If Fund dollars are not available, you pay for the covered prescription until your annual member responsibility has been satisfied. Once the annual member responsibility has been satisfied, you pay a copayment of $10/$25/$40 for each eligible in-network prescription. If you still have dollars in your Medical Fund that you rolled over from previous years, those fund dollars can help you pay your member responsibility under the plan.
Dental Discounts - Available from Aetna participating dentists even if you have used all of your Dental Fund dollars.
If you are looking for an affordable plan with nationwide coverage in and out of network, Aetna HealthFund CDHP could be right for you. Consider the following to be sure:
Review your past year's medical services use and expenses.
Estimate any expected changes in your medical expenses for the coming year.
Compare the out-of-pocket costs (what you pay for your health plan, annual member responsibility, coinsurance, etc.) for Aetna HealthFund CDHP and other health benefits plans available to you.
First, preventive care services provided by in-network providers (medical, dental, vision) are covered at 100% and nothing is deducted from your Fund. See the Federal Plan brochure for details on preventive services. When you receive other types of covered services, expenses are paid first from your Fund—before you or any other component of the plan makes payment.
9. If I receive care from a nonparticipating provider, how is the cost of that care charged against the Fund?
All eligible portions of the provider's services would be paid by the Fund (up to the remaining Fund balance). However, you are responsible for provider's medical fees that exceed our Plan allowance. If your Fund is exhausted, you would need to satisfy your annual member responsibility before the Plan's traditional medical benefits would be available.
11. If I have out-of-pocket expenses in one year, can I carry those claims over and have them paid by my Fund the next year?
No. Claims cannot be carried over from one year to the next. Your Annual Medical Fund and your Annual Dental Fund cannot pay claims incurred in previous years. Your Funds can only be used to pay for covered expenses incurred in the current year.
12. If I have not exhausted my Fund at the end of the year, can I take the balance in cash?
No. While amounts left in the Funds at the end of the year will roll over so long as you remain enrolled in the Aetna HealthFund CDHP, the Funds are available only to pay expenses covered under the Plan.
14. If I am a member of the Aetna HealthFund CDHP and I also have a Flexible Spending Account (FSA), how would a covered service be paid?
If the service is covered by both plans, benefits would first be considered under the Aetna HealthFund CDHP and the balance would then be considered under the FSA.
The pharmacy will know what payment you owe for your covered prescription drug based on your Medical Fund balance, your annual member responsibility balance, or the appropriate copayment amount, as applicable.
Yes, Mail-Order Pharmacy is available for maintenance medications. Go to the Aetna Navigator™ member website and click on "pharmacy benefits" for details and forms.
17. What online resources are available to help me use my plan?
When you enroll in the Aetna HealthFund CDHP, you have access to valuable online resources.
Aetna Navigator™ - Your personalized, self-service website packed with health and benefits information. When you register, you can order ID cards, check eligibility or claim status, check Fund balance and much more. Here are just a few of the highlights:
Estimate the Cost of Care - compare in-network and out-of-network provider fees, the cost of brand-name drugs vs. their generic equivalents, and the costs for services such as routine physicals, emergency room visits, lab tests, X-rays, MRIs, etc.
Hospital Comparison Tool – see how hospitals in your area rank by factors important to you.
Simple Steps To A Healthier Life® Program – assess your potential health risks, develop a personalized action plan for better health, track your progress and much more.
Aetna InteliHealth® and Healthwise® Knowledgebase websites – Health information sources to help you make better decisions about your health care and treatment options.
Personal Health Record - captures important health information in one place, helping you stay healthy with personalized alerts and reminders and allowing you to print and share your health history with your doctors.
DocFind® online provider directory – lists participating physicians, hospitals and other health care providers. Using participating providers will help you save money. DocFind® also includes important provider credentials like education, board certification and languages spoken.
You can view your Fund balances, check claims transactions and more on Aetna Navigator™ – your personalized self service website. Or, you can call Member Services at 1-800-537-9384. If you have claim activity in a given month, you will receive an Explanation of Benefits that lists your Fund balance and annual member responsibility.
Enrollment procedures vary by agency. Detailed instructions and information on the Federal Employees Health Benefits Program enrollment process is available at Enroll Now. You will need to know the enrollment code for the Aetna HealthFund CDHP which is 221 for Self Only coverage and 222 for Self and Family coverage.
You must live or work in our service area to enroll in our plan. See our rate calculator to find plans available in your area. Once enrolled in the CDHP plan, covered medical services received overseas would be considered out-of-network. The cost of covered medical expenses would first be deducted from your medical fund to pay for services. Once the medical fund is exhausted, you would have to satisfy your member responsibility. After your member responsibility has been met, we pay 60% out of network for covered medical expenses. See Section 7 of our federal brochure for more information on how to submit overseas claims.
This material is for informational purposes only. See your federal brochure for a complete description of benefits, exclusions, limitations and conditions of coverage.
CDHP Features:
NEW – Increased medical fund ($1,250 (single)/$2,500 (family)
NEW – Reduced member responsibility.
NEW – In-network coinsurance (Aetna’s share) increased to 90%
Entire Medical and Dental funds available immediately – nothing is paid out of your pocket until Funds are gone
Unused fund amounts roll over to the next year
Dental and vision included
Nationwide coverage both in and out of network
100% preventive care coverage when you use participating providers
