Have a Question? Here are our 10 most commonly asked questions. See below for additional frequently asked questions for each of the plans.
Please see our rate calculator to determine the plans and rates for your area.
Yes. All of our plans include access to great discounts on eyewear, vision services, gyms, weight loss programs, chiropractic, acupuncture, massage, vitamins, electric toothbrushes, gum, mints, and more!
Implants and related services are not covered except for the crown that goes over the implant. The tooth being replaced must be extracted while covered under the FEDVIP plan.
No. Orthodontia is covered for children up to age 19 after a 24 month waiting period in the Aetna Dental PPO Plan. Although we do not cover adult orthodontia, members in any of our plans for federal employees can access the Aetna negotiated rate on orthodontia from participating dental providers.
Only on Orthodontia coverage. Orthodontia coverage is available for children up to 19 years of age. A member will be eligible to receive orthodontic benefits after they have been continuously covered by the Aetna Dental PPO plan for 24 months.
Basic plan summary:
Annual Benefit Maximum $3,000 in-network/$2,000 out-of-network
Visit any licensed dentist, anywhere without a referral.
No Deductible
Preventive/Basic Services 100% covered*
e.g. Cleanings, X-rays, Sealants, Space Maintainer and Fluoride
Intermediate Services 60% covered*
e.g. Fillings, Theraputic Pulpotomy, Uncomplicated Extractions, Periodontal Scaling, Denture Adjustment and Repair
Major Services 40% covered*
e.g. Inlays, Onlays, Crowns, Root Canal, Full & Partial Dentures, Pontics, General Anesthesia/Intravenous Sedation
Orthodontic Services** 30% covered*
Orthodontic Lifetime Maximum $1,500/member
*Aetna will pay the percentages listed above as follows: In network - percentage of our negotiated fee with the participating provider. Member not responsible for amounts above the negotiated fee. Out of network - percentage of the provider's prevailing charge (usual & customary - 75th percentile). Member may be responsible for amounts about that level. Please see "How we pay out-of-network claims" under the Member tab on our home page.
**Orthodontia is covered for children up to, but not including, 19 years of age. A member will be eligible to receive Orthodontic benefits after they have been continuously enrolled for 24 months.
The Aetna Open Access Plan provides a full range of medical, dental and vision benefits, access to an extensive network of almost 600,000 providers, and the freedom to see Aetna network specialists without a referral*.
Plan features include:
No referrals*
No deductible
No requirement to choose a primary care physician (PCP), although highly encouraged**
Basic dental included or you may select our Dental PPO network option at no extra charge
Out-of-area dependent coverage - see any Aetna HMO provider nationwide.
Vision benefits including an eyewear reimbursement every 24 months
Lots of perks like discounts on eyewear, gyms, weight loss programs, acupuncture, massage, vitamins, electric toothbrushes, gum, mints, and more!
Online tools to help you manage your health
*except in California where referrals are required
** PCP selection required in our California HMO Plan.
To understand how the plan works, let's review its components. This plan includes access to the Aetna PPO Network.
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 Aetna HealthFund CDHP
The Medical and Prescription Drug Plan
The 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 each eligible in-network prescription.
Aetna HealthFund HDHP with HSA is a health plan with a PPO network that provides traditional health care coverage and a tax-advantaged way to help you build savings for future medical needs. An HDHP with an HSA is designed to give greater flexibility and discretion over how you use your health care benefits. As an informed consumer, you decide how to use the dollars in your HSA.
To understand how the Plan works, let's review its components.
The Health Savings Account
The Plan will automatically deposit $62.50 per month/Self Only or $125 per month/Self and Family into your HSA. (That is $750/Self Only or $1,500/Self and Family annually.)
You can make voluntary contributions to your HSA. The annual statutory maximum (plan contributions plus voluntary contributions) for 2010 is $3,050/Self Only or $6,150/Self and Family so you may voluntarily deposit up to $2,300/Self Only or /$4,650 Self and Family. If you or your spouse are age 55 or older, you may make a catch-up contribution of up to $1,000 for 2010.
When you have a qualified expense (e.g., doctor visit, prescription refill, dental procedures), you may withdraw money from your HSA, tax free, to be reimbursed for this out-of-pocket expense. Or, you can choose to pay from other funds and allow your HSA to grow over time and use it for future health-related expenses.
Any unused dollars roll over year after year.
You own your HSA, so you keep it even if you change health plans or jobs.
You may want to make voluntary contributions to your HSA every year. This will lower your taxes and help you build a larger savings for future health care expenses.
The Medical and Prescription Drug Plan
In addition to the HSA, your HDHP Plan provides traditional health benefits after you have met your deductible. You can visit any licensed health care professional or hospital for covered services without a referral. Precertification is required for hospitalization and certain procedures.
Preventive Care - The Plan includes in-network preventive care coverage (e.g. routine physicals, immunizations, screenings and cleanings at the dentist) covered at 100 percent to encourage you to receive these important services
Deductible - The Plan includes an annual deductible the amount you pay out of pocket before the medical coverage begins payment for covered expenses of $1,500/Self Only or $3,000/Self and Family for in-network service and $2,500/Self Only or $5,000 Self and Family for out of network service per year. You may use money from your HSA to pay for covered health care expenses while you are meeting your deductible.
Medical Coverage - When the deductible is met, the medical coverage (90% in network, 70% out of network) begins for covered expenses. The medical plan also includes an annual out-of-pocket maximum to limit the amount you pay out-of-pocket in a given year meaning once you reach the maximum, the Plan pays 100 percent of your covered medical expenses for the remainder of the year.
Prescription Drug Coverage - When you fill a prescription, you will pay the cost of the prescription, until the deductible has been met. At Aetna participating pharmacies, your prescription drug price may be lower because we have negotiated pricing on behalf of our members. Once the deductible has been met, you pay a copayment for covered prescriptions. Refer to your Federal Plan brochure for additional details.
Yes. Our DocFind® online directory lists participating physicians, hospitals and other health care professionals. DocFind® also includes important provider credentials like education, board certification and languages spoken.
This material is for informational purposes only. See your federal brochure for a complete description of benefits, exclusions, limitations and conditions of coverage.
