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Aetna Open Access® Plan - HMO Network

  • No referrals to network specialists*
  • Dental and vision benefits included
  • See doctors in any Aetna HMO network

Available in these areas DC, MD, VA AZ, CO, CT, DE, GA, IL, IN, KS, KY, MO, NC, NJ, NY, NV, OH, OK, PA, TN, TX, WA CO, CT, DE, NJ, NY, OK, PA, TX

(These markets also have a high option. See column to left)
CA
Aetna HMO Options Open Access HMO Open Access HMO Open Access HMO HMO
  HIGH OPTION BASIC OPTION HIGH OPTION BASIC OPTION HIGH OPTION
Benefit Features No Referrals! No Referrals! No Referrals! No Referrals!  
Primary care office visit copay
(When using your designated PCP)
$15 $20 $20 $15 $20
Preventive care
Routine well-child exams w/PCP (through age 17)
Routine physicals w/PCP
Routine gynecological exam
Immunizations with PCP office visit

$0

$15
$25
$15

$0

$20
$30
$20

$0

$20
$30
$20

$15

$15
$30
$15

$0

$20
$30
$20
Hospital copay $150/day
$450 max/stay
90%
(Aetna pays)
$150/day
$750 max/stay
80%
(Aetna Pays)
$150/day
$750 max/stay
Outpatient surgery copay $175 90%
(Aetna pays)
$175 80%
(Aetna pays)
$175
Emergency room copay $100 $100 $100 $200 $100
Urgent care center copay $50 $50 $50 $100 $50
Dental See below for dental benefits
Vision
Routine refraction

Prescription eyewear reimbursement

Aetna VisionSM Discounts
$25

$100/24 months

included
$30

$100/24 months

included
$30

$100/24 months

included
$30

$200/24 months

included
$30

$100/24 months

included
Prescription copays
(up to 30 days)

Generic formulary
Brand-name formulary
Non-formulary
Mail order available for maintenance prescriptions


$5
$25
$50


$10
$25
$50


$10
$25
$50


$5
$30
$50


$10
$25
$50

Dental benefits include:
You are automatically enrolled for dental benefits in our Basic Dental option. To get more choice in dentists, switch to the dental PPO option, at no extra cost by filling out our online form online form or by calling at 1-800-537-9384.

YOU ARE AUTOMATICALLY
ENROLLED IN THE
BASIC DENTAL OPTION
YOU MAY SWITCH TO THE
DENTAL PPO OPTION
  In-network Out-of-network
Annual Deductible None $20 $20
Diagnostic x-rays $5 $0 50%**
Preventive Care $5 $0 50%**
Amalgam Fillings $5 $0 50%**
Other Services Reduced Fee Reduced Fee You pay 100%

*In California only the standard HMO plan is available, where referrals are required.

**You pay 50% of our negotiated rate and any other difference between our allowance and the billed amount.

 

Open Access Features

  • PPO dental network option at no extra cost
  • No referrals
  • No claim forms
  • Nationwide access to the Aetna Open Access and HMO network of doctors.
  • Online provider directory
  • Aetna Navigator website features personal benefits information






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