Visit any licensed doctor nationwide in the Aetna HMO network
Dental and vision benefits built in
No referrals to network specialists for covered services (except in California)
Check out the 2010 Aetna Federal Brochure for service area details.
Available in these areas
DC, MD, VA
AZ, DE, GA, IL, NJ, NY, OH, PA, TN, TX
DE, NJ, NY, PA
(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
Specialist office visit copay
$25
$30
$30
$30
$30
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% (We pay)
$150/day $750 max/stay
80% (We pay)
$150/day $750 max/stay
Outpatient surgery copay
$175
90% (We pay)
$175
80% (We pay)
$175
Emergency room copay
$100
$100
$100
$200
$100
Urgent care center copay
$50
$50
$50
$100
$50
Vision Routine refraction
Prescription eyewear reimbursement
Discounts on eyewear
$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 drug copays (up to 30 days) Generic formulary Brand-name formulary Non-formulary Mail order available for maintenance prescriptions (90 days for only 2 copays)
$5 $30 $60
$10 $30 $60
$10 $30 $60
$5 $30 $60
$10 $30 $60
These plans come with built-in dental! You're automatically enrolled in our Basic Dental option. To get more choice in dentists, simply switch to the dental PPO option, at no extra cost by filling out our online form or by calling at 1-800-537-9384.
Dental
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%
*You pay 50 percent of our Plan allowance 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
