1. CDHP is described as a "consumer driven" health plan. What does that mean?
A benefits plan that gives you more purchasing power. You can visit 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 pay nothing for covered services until you use up the funds. You can stretch your funds by seeking the most cost-effective care. When you use Aetna participating providers for covered services, you get the advantage of Aetna's negotiated rates.
The 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 that pays for your covered services at 100% until exhausted.
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 CDHP (medical rollover maximum of $5,000/single or $10,000/family)
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 deductible 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
Funds pay for eligible expenses in network or out of network at 100% up to the Fund balance.
You can visit 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 as long as you remain enrolled in the CDHP.
The Medical and Prescription Drug Plan
The Annual Deductible After you have used your Medical Fund and before traditional plan coverage begins, you have an annual deductible of $750 Single; $1,500 Family.
Medical Coverage - When the annual deductible is satisfied, the traditional medical coverage (90% coverage for in-network care and 60% coverage for out-of-network care) begins. 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 deductible) 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 deductible has been satisfied. Once the annual deductible has been satisfied, you pay a copayment of $10/$30/$50 for covered in-network prescriptions.
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, and a plan that comes with dental and vision coverage built in, the 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 deductible, coinsurance, etc.) for the CDHP and other health benefits plans available to you. Don't forget to factor in the Medical and Dental Funds built into Aetna's CDHP, since you don't pay any money out of your pocket for covered services until you have exhausted those funds first.
Compare dental and vision benefits available with the CDHP and other health benefits plans available to you.
Aetna sets up different annual Medical and Dental Funds for you that pay for eligible expenses in network or out of network at 100% so you pay nothing for covered services until your Funds are exhausted.
Annual Medical Fund - You get $1,250 Single; $2,500 Family. It is available in full on your effective date of coverage.
Annual Dental Fund - You get $300 Single; $600 Family. It is available in full on your effective date of coverage.
6. What happens to any remaining balances in my Fund at the end of the year?
Remaining Medical and Dental Fund dollars roll over from year to year as long as you remain in this Plan, up to the maximum rollover amount (medical rollover maximum of $5,000/single or $10,000/family)
First, covered 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 Fundbefore 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 deductible before the Plan's traditional medical benefits would be available.
11. 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 as long as you remain enrolled in the CDHP (up to the rollover maximum), the Funds are available only to pay expenses covered under the Plan.
The pharmacy has access to Aetna's claim adjudication system and can determine at the point of sale what payment you owe for your covered prescription drug. If you have a Medical Fund balance, the cost of the covered prescription will be automatically deducted. If you have exhausted your Medical Fund but not met your annual deductible, the pharmacy will let you know the correct amount to pay. If you have exhausted your Medical Fund balance and met your deductible, then the pharmacy will let you know the appropriate copayment amount ($10/$30/$50).
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.
16. What online resources are available to help me use my plan?
When you enroll in the CDHP, you have access to valuable online resources.
Aetna Navigator™ - Your personalized and secure, self-service website packed with health and benefits information. When you register, you can print temporary ID cards, check eligibility or claim status, check Fund balances and much more. Here are just a few of the highlights:
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.
Aetna SmartSourceSM - Type in your condition or symptom and get custom-fit information, including a list of doctors that may be able to treat your condition, common medications, cost estimates and helpful Aetna programs and discounts.
You can view your Fund balances, check claims transactions and more on Aetna Navigator® your personalized and secure self service website. Or, you can call Member Services at 1-888-238-6240. If you have claim activity in a given month, you will receive an Explanation of Benefits that lists your Fund balance and annual deductible.
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 deductible. After your deductible has been met, we pay 60% for out of network covered medical expenses. See Section 7 of our federal brochure for more information on how to submit overseas claims.
Yes. You get great discounts on prescription eyewear, vision services, gyms, weight loss programs, chiropractic, acupuncture, massage, vitamins, electric toothbrushes, gum, mints, and more!
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:
Medical Fund of $1,250 (single)/$2,500 (family)
Aetna provides a benefit which includes Medical and Dental Funds available on the first day of coverage
Nothing is paid out of your pocket until the Funds are exhausted
Unused Fund amounts roll over to the next year
Dental and vision benefits included
Nationwide coverage both in and out of network
100% preventive care coverage when you use participating providers
