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. You also get 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. Implant crowns are covered under the major category at 40%. The annual benefit maximum for each member is $1,200.
No. Orthodontia is covered for children up to age 19 after a 24 month waiting period. Although we do not offer 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:
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
Annual Benefit Maximum $1,200/member (inc. preventive)
**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.
*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.
The Aetna Open Access Plan provides a full range of medical, dental and vision benefits, access to an extensive network of over 470,000 providers, and the freedom to see Aetna network specialists without a referral*.
Plan features include:
No referrals*
Low cost
No deductible
No requirement to choose a primary care physician (PCP)
Basic dental included or you may select our Dental PPO network option at no extra charge
Expanded out-of-area dependent coverage
Vision Program including an eyewear reimbursement every 24 months
Emergency coverage
Online tools to help you manage your health
*except in California where referrals are required
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
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.
Aetna HealthFund HDHP with HSA is a health plan product 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 your Plan coverage with a high deductible and out-of-pocket expenses limited by catastrophic protection. And you decide how to spend 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 2008 is $2,900/Self Only or $5,800/Self and Family so you may voluntarily deposit up to $2,150/Self Only or /$4,300 Self and Family. If you or your spouse are age 55 or older, you may make a catch-up contribution of up to $900 for 2008.
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, including what you pay toward the deductible. Or, when you have a claim, 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.
Fund the 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 Aetna HealthFund HDHP Plan provides traditional health benefits after you have met your deductible. You can seek care from 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. Remember, you may use money from your HSA for pay for qualified health care expenses which helps satisfy 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 each prescription you fill that is covered under your Plan. 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.
WHAT DO I GET FOR MY HEALTH PLAN DOLLARS? Access to discounts on eyewear, gyms, massage, weight loss programs and more!
