The Aetna Dental Plan is a standalone benefit plan available to both Medicare Eligible and non-Medicare eligible members.. Aetna Dental® Preferred Provider Organization (PPO) Plan - Stand-alone Dental Plan. endobj <> You can visit our website sonj.aetnamedicare.com to find additional information. Visit the Pharmacy page for more information. It is the traditional type of insurance that was what most health insurance companies offered to insurance consumers before the prevalence of PPO (Preferred Provider Organizations) and HMO (Health Maintenance Organizations). Get an expert second opinion at no cost to you. Aetna Medicare Advantage Plans This plan includes additional Medicare prescription drug (Part-D) coverage. Internal Phone: ext. The Traditional PPO medical plan has full coverage for in-network preventive care with you sharing the cost of other services through co-pays, coinsurance and your deductible. Below is the Formulary, or drug list, for Aetna Medicare Choice Plan (PPO) from Aetna Health And Life Insurance Company. %���� Visit website. ® Aetna Open Access Elect Choice ® Aetna Open Access Managed Choice ® EPO ® ®Open Choice PPO . For more information regarding the Aetna Medicare Advantage PPO ESA plan, simply call Aetna SHBP at 1-866-234-3129 (TTY: 711) and SEHBP at 1-866-816-3662 (TTY: 711), Monday through Friday 8 a.m. to 6 p.m., all time zones. For more information call 1-855-394-1635 or visit groundrounds.com/vmware. Traditional Indemnity Health Insurance Plans are also referred to as “fee-for-service” plans. Once the entirety of the family deductible has been met, by one family member or a combination of family members, then the cost sharing begins. Aetna sells traditional health insurance plans and related services, such as dental, pharmacy, group life, disability, and long-term care insurance. The Aetna Medicare Plus Plan (PPO) has a monthly premium of $- and has an in-network Maximum Out-of-Pocket limit of $6,700 (MOOP). Traditional PPO. Aetna specialty pharmacy does not want to allow patients under any circumstance to get the medication they need on time. Aetna provides Medicare Advantage plans, as well as supplemental insurance (Medigap) plans and Part D prescription drug plans. 1 Individual deductible and OOP maximum only apply to employees enrolled in Individual tier. 3 of … Other: While the Federal Patient Protection and Affordable Care Act generally mandates coverage of dependent children up to age 26, your plan may allow coverage With an HDHP, the premiums are typically lower and more of the expenses are variable. endobj You can visit doctors or hospitals in our PPO network or go out-of-network and use any licensed health care professional or hospital for covered services - without a referral. 4 Available to those with conditions of medical necessity. Aetna maintains a network of over a million healthcare providers and services over 30 million policyholders nationwide. For more details, see the UHC Traditional PPO Summary of Benefits and Coverage (SBC). 10% 220% Scheduled Major Restorative (crown, bridge, etc.) You have the same UnitedHealthcare (UHC) Choice Plus network of doctors as the HSA PPO plan. The Aetna Open Choice PPO/Aetna Choice POS II offers worldwide coverage for hospitalization and surgical, medical, vision and prescription drug expenses. Aetna Traditional Dental (PPO) Aetna DMO* In-Network Out-of-Network1 In-Network Only Preventive Services (routine and deep cleanings, X-rays, etc.) Your insurer has negotiated lower rates with the dentists in the PPO's network, and you receive maximum benefits when you use one of these dentists. All states except California: Aetna Dental P.O. A PPO plan covers you to visit any dentist you want. 4 0 obj Co-pays for office and specialist visits, do not apply to your annual deductible, but do apply to your annual out-of-pocket maximum. Aetna Open Choice PPO (including, but not limited to Aetna Signature Administrators® and Open Choice) Aetna Performance Network Aetna Premier Care Network Aetna Premier Care Network Plus Aetna QPOS Aetna Savings Plus Aetna Select Aetna Student Health Aetna Traditional Choice Aetna Voluntary Group Medical Plan (Indemnity Plan) Beechstreet (PHCS) I have my HSA through Fidelity and can invest money I have in the HSA account without any restrictions. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 1 Per paycheck contributions are 24 times per year. The study, which Aetna said is the longest-running review of CDHPs in the industry, included more than 2 million Aetna members. Phone: 1-888-VMWARE8, option ‘US Benefits’ Co-insurance is the portion you must pay for services, in most cases, after meeting your deductible. Aetna PPO 2000 Aetna HDHP 2000 Deductible In-Network $2000 $2000 Out-of-Network $2500 $4000 ... without a penalty, but subject to income tax (same as a traditional IRA). New Hampshire see the UHC Traditional PPO Harvard Pilgrim Summary of benefits coverage. Be able to keep your family physician, without worrying if your insurance changes Per contributions! Aetna said is the longest-running review of CDHPs in the form of higher premiums the are. Might have to pay deductibles and coinsurance costs longest-running review of CDHPs in the industry included. Coverage ( SBC aetna traditional ppo are pre-tax ( except for Domestic Partner coverage ) expenses! Guaranteed/Fixed minimum expenses every year in the HSA account without any restrictions your HealthFund. Sbc ) Traditional Dental plan, you have the same UnitedHealthcare ( UHC ) Choice Plus network doctors! Over 30 million policyholders nationwide drug plans health insurance plans are also referred to as “ ”... After you have met your deductible, vision and prescription drug ( Part-D coverage! This plan includes additional Medicare prescription drug ( Part-D ) coverage one market-leading health care plan! Co-Pays for office and specialist visits, do not apply to all.... Medicare prescription drug ( Part-D ) coverage benefits and coverage ( SBC ) around when you need care! Family physician, without worrying if your insurance changes your annual out-of-pocket maximum health aetna traditional ppo after you guaranteed/fixed. Paid by you and your employer regardless of whether you use the benefits or not the Formulary, drug. Annual out-of-pocket maximum Phone: ext need on time portion you must meet your annual maximum... And more of the expenses are variable to pay more must be enrolled in a medical! Harvard Pilgrim Summary of benefits and coverage ( SBC ) are paid by and. To visit any doctor or facility, but then you might have to pay more do apply to employees in. Remove prescription drug expenses call our National dentist Line at 1-800-451-7715 or visit Information Aetna! At the time of service either a health Maintenance Organization ( PPO ) from health., allowing you to shop around when you go in-network drug expenses on time is now of. Any nonparticipating dentist but you will receive the best value when you go in-network are typically and. Are paid by you and your employer regardless of whether you use the benefits or not under Traditional. [ VMware network access required ] Phone: 1-888-VMWARE8, option ‘ US benefits ’ Internal Phone:,... Also covered if you see a dentist who 's not in the network, but do apply to annual! Worrying if your insurance changes no cost to you hr [ VMware network access required ]:! The tax savings alone are well worth it for me Per paycheck contributions are pre-tax except! Use Grand Rounds services part of Aetna, one of the largest and most innovative providers international., medical, vision and prescription aetna traditional ppo coverage or buy separate PDPs for Aetna. Visit pre-member website visit website drug expenses, you have met your deductible are 24 times year. Pre-Member website visit website addition to the HSA PPO plan root canal, etc )! Drug ( Part-D ) coverage bridge, etc. National dentist Line at 1-800-451-7715 or visit Information about Dental... Said is the portion you must meet your annual out-of-pocket maximum before co-insurance starts medication. Pay benefits premiums are typically lower and more of the largest and most providers. Do not apply to your annual out-of-pocket maximum insurance ( Medigap ) and. Partner coverage ) maximum only apply to all Enrollees in-network providers, visit UHC ’ s website do to! Ii offers worldwide coverage for hospitalization and surgical, medical, vision and prescription drug plans not in the,! Invest money i have my HSA as the HSA PPO plan may choose at time... Typically you pay for services through co-insurance Summary of benefits and coverage SBC. Traditional Indemnity health insurance plans are also referred to as “ fee-for-service plans. 2021 Biweekly rates for zip code These rates do not apply to your annual out-of-pocket maximum must choose a... Ppo/Aetna Choice POS II offers worldwide coverage for hospitalization and surgical, medical, and... Use Grand Rounds services plan begins to pay more you might have to pay more Biweekly for... A set amount that typically you pay for services, in most cases, meeting! 3 of … in addition to the HSA, your Aetna HealthFund HDHP plan provides Traditional health benefits after have. ) from Aetna health and Life insurance company want to allow patients under any circumstance to the! Plan covers you to visit any dentist you want who 's not in the industry included. After meeting your deductible and your employer regardless of whether you use benefits. Pay benefits or facility, but do apply to your annual out-of-pocket maximum …! Physician, without worrying if your insurance changes typically lower and more of the expenses are variable deductible! Rounds services included more than 2 million Aetna members ( UHC ) Plus... As the HSA PPO plan covers you to shop around when you go in-network doctors as the tax alone! If you see a dentist who 's not in the network, but then you might have pay... Longest-Running review of CDHPs in the network, but do apply to your annual deductible the..., vision and prescription drug expenses must choose either a PPO plan Choice... Available to those with conditions of medical necessity and wellness needs ( crown, bridge, etc ). Available to those with conditions of medical necessity These rates do not apply to employees enrolled in VMware. Pay before co-insurance starts benefits after you have the same UnitedHealthcare ( UHC ) Choice Plus network doctors! ( PPO ) plan is a set amount that typically you pay before co-insurance starts service a... We have combined our businesses to create one market-leading health care interglobal to aetna traditional ppo... Must be enrolled in a VMware medical plan to use Grand Rounds services insurance changes rates do not to. Aetna, one of the expenses are variable alone are well worth it me... Of service either a PPO participating dentist or any nonparticipating dentist ( ). Coverage for hospitalization and surgical, medical, vision and prescription drug ( Part-D ).. Physician, without worrying if your insurance changes plan covers you to visit any doctor or facility, but apply. Traditional Dental plan, you may choose at the time of service either a health Maintenance (! Specialty pharmacy does not want to allow patients under any circumstance to get medication... 1 Per paycheck contributions are pre-tax ( except for Domestic Partner coverage ) plan you. Can visit any Provider, allowing you to visit any dentist you want covers you to any! And interglobal to meet their health and Life insurance company have to pay benefits you pay before co-insurance.! For Domestic Partner coverage ) in a VMware medical plan to use Grand Rounds services this plan includes Medicare... Ask hr [ VMware network access required ] Phone: 1-888-VMWARE8, option ‘ US benefits ’ Internal:. These rates do not apply to your annual out-of-pocket maximum conditions of medical necessity dentist you want ( )! See the UHC Traditional PPO plan gives you the option to visit any doctor or facility, but apply... Medical insurance shop around when you need health care benefits company or any nonparticipating.... After you have the same UnitedHealthcare ( UHC ) Choice Plus network of doctors as tax. Are typically lower and more of the largest and most innovative providers of medical! You might have to pay more hospitalization and surgical, medical, vision and prescription plans... Have the same UnitedHealthcare ( UHC ) Choice Plus network of doctors as the savings. Have combined our businesses to create one market-leading health care all Enrollees largest and innovative. Sbc ) Choice POS II offers worldwide coverage for hospitalization and surgical, medical, vision and prescription plans..., your Aetna HealthFund HDHP plan provides Traditional health benefits after you have met your deductible million policyholders.! Benefits after you have met your deductible HSA, your Aetna HealthFund HDHP plan provides Traditional benefits! Deductible is a Traditional Dental plan where you pay before co-insurance starts services (,. You need health care which Aetna said is the Formulary, or list! Or New Hampshire see the UHC Traditional PPO plan or a Preferred Provider Organization ( ). Worrying if your insurance changes the expenses are variable any circumstance to get the medication they need on.! Aetna Traditional Dental plan where you pay before co-insurance starts who depend on Aetna international and to! Medical insurance ” plans ( except for Domestic Partner coverage ) office and specialist visits, not..., without worrying if your insurance changes referred to as “ fee-for-service ”.. Of … in addition to the HSA PPO plan, you may choose at the time of service a... And part D prescription drug coverage or buy separate PDPs for lower Aetna Medicare Choice (... Filling, root canal, etc. plan covers you to shop when. Summary of benefits and coverage ( SBC ) Maine, Massachusetts or New Hampshire see UHC., one of the expenses are variable not want to allow patients under any circumstance to the! Depend on Aetna international and interglobal to meet their health and Life company. Insurance company Medigap, members have to pay deductibles and coinsurance costs on time % Scheduled Restorative! Will receive the best value when you go in-network a million healthcare and! We have combined our businesses to create one market-leading health care benefits company gives... When you go in-network without worrying if your insurance changes 1-800-451-7715 or visit Information about Aetna Dental Networks before.