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Medical Families of Products
Plan Description
Aetna Standard Family of Products

Aetna Standard products encompass the core health benefit plans Aetna offers. These benefit plans offer a range of coverage, from the Open Choice® PPO plan, which does not require any referrals or PCP selection, to our HMO and exclusive provider plans, where the member chooses a primary care physician, who provides guidance when specialist care is required.

Aetna Open Access® Family of Products

Aetna Open Access products offer the benefits similar to our standard suite of products, and encourage, but do not require members to select a primary care physician. Members can go directly to network specialists, without needing to obtain a referral from their PCP.

Aetna HealthFund® Family of Products

Aetna HealthFund offers consumers an innovative health plan alternative that broadens consumer choice. Aetna HealthFund combines the protection of a deductible-based medical plan with an employer-established health fund. Within the plan, consumers have freedom to choose referral-free access to Aetna's expansive network of physicians and hospitals, as well as the ability to seek out-of-network care. With Aetna HealthFund, members are encouraged to become more involved in their own health care decisions, including how and when their health fund dollars are used.

Aetna Aexcel®/Aexcel® Plus Designation

Aexcel is a physician designation within Aetna's Performance Network that includes specialists who have demonstrated effectiveness in the delivery of care based on a balance of measures of clinical performance and efficiency.

Aetna Medicare Advantage Plans

Medicare Advantage Plans are health plans options made available under the guidance of the Centers for Medicare and Medicaid Services (CMS). . These plans cover the benefits under Part A and Part B (Original Medicare) and may also provide additional features such as eyewear and prescription drug benefits. The types of Medicare Advantage plans that Aetna offers includes:

  • Aetna Golden Medicare Plan® is an HMO plan.
  • Aetna Golden ChoiceTM Plan is a PPO plan.
  • Aetna Medicare OpenSM Plan is a Private-Fee-For-Service plan.

  • National AdvantageTM Program (NAP)

    The National AdvantageTM Program (NAP) offers access to contracted rates for many medical claims that would otherwise be paid as billed under many indemnity plans, the out-of-network portion of managed care plans, or for emergency/medically necessary services not provided within the standard network. The NAP Network consists of many of Aetna's directly-contracted hospitals, ancillary providers, and physicians. The Network also includes hospitals, ancillary providers, and physicians accessed through vendor arrangements where Aetna does not have direct contractual arrangements. Aetna does not credential, monitor or oversee those providers who participate through third party contracts. Since there are a number of factors that determine whether a discount will be given, Aetna is unable to guarantee any level of discount under this program.

    Aetna Medical AccessSM/Vital Savings by Aetna®

    Aetna Medical AccessSM/Vital Savings by Aetna® is a medical discount program - it is not an insurance plan. When cardholders need medical care, they may visit any Aetna Medical AccessSM participating provider to receive discounted medical services. At the time the service is performed, the cardholder pays 100% of the discounted rate for the service using their Vital Savings by Aetna® debit card.

    Behavioral Healthcare Program

    The Aetna Behavioral Health Program offers members access to covered behavioral health services provided by a comprehensive network of psychiatrists, psychologists, therapists and other clinical professionals. Covered benefit options may include access to both inpatient and outpatient services. Members can access covered services directly, without referrals from a PCP.

    Employee Assistance Program (EAP)

    An employee assistance program (EAP) is a worksite-based program designed to assist (1) work organizations in addressing productivity issues and (2) "employee clients" in identifying and resolving personal concerns, including, but not limited to, health, marital, family, financial, alcohol, drug, legal, emotional, stress, or other personal issues that may affect job performance.

    Health Maintenance Organization (HMO) Our Exclusive Provider Plans
    HMO**
    • Member chooses primary care physician (PCP) from the network of participating providers.
    • Member visits PCP for routine care or for injury or illness.
    • PCP referral is generally required for specialist care.
    • Member pays copay at time of service.
    • No claim forms or balance bills.
    • Percentage copay options may be available.
    • Except for emergency or out-of-area urgent care, benefits are not covered outside the network.
    • Wellness and preventive programs included.
    **In Washington, the product referred to as HMO is called Primary Choice(SM) and is offered by Aetna Health Inc., a licensed Health Care Service Contractor.
    Aetna Open Access® Elect Choice (EPO)
    • Referrals not required.
    • Member encouraged to choose participating PCP from the network.
    • Member pays PCP copay each time member seeks care from PCP.
    • Member can go directly to network specialists — without PCP referral.
    • Member pays specialist copay each time member goes to network specialist.
    • No claim forms or balance bills.
    • Percentage copay options may be available.
    • Except for emergency or out-of-area urgent care, benefits are not covered outside the network.
    • Wellness and preventive programs included.
    Aetna Open Access® HMO
    • Referrals not required.
    • Member encouraged to choose a PCP from the network of participating providers.
    • Member pays PCP copay each time member seeks care from selected PCP.
    • Member pays specialist copay each time member goes to network specialist.
    • No claim forms or balance bills.
    • Percentage copay options may be available.
    • Except for emergency or out-of-area urgent care, benefits are not covered outside the network.
    • Wellness and preventive programs included.
    Aetna SelectSM
    • Member chooses primary care physician (PCP) from the network of participating providers.
    • Member visits PCP for routine care or for injury or illness.
    • PCP referral is generally required for specialist care.
    • Member pays copay at time of service.
    • No claim forms or balance bills.
    • Percentage copay options may be available.
    • Except for emergency or out-of-area urgent care, benefits are not covered outside the network.
    • Wellness and preventive programs available as an option.
    Aetna Value NetworkSM HMO (available in California only)
    • Member chooses primary care physician (PCP) from the participating providers within the Aetna Value NetworkSM.
    • Member visits PCP for routine care or for injury or illness.
    • PCP referral is generally required for specialist care.
    • Member pays copay at time of service.
    • No claim forms or balance bills.
    • Percentage copay options may be available.
    • Except for emergency or out-of-area urgent care, benefits are not covered outside the Aetna Value NetworkSM.
    • Wellness and preventive programs included.
    HMO Deductible Plan (California members only)
    • HMO deductible plan. Deductible applies to certain services according to the member’s benefit plan.
    • Member chooses a primary care physician (PCP) from the CA providers participating in the network that supports this plan.
    • Member visits PCP for routine care or for injury or illness.
    • PCP referral is generally required for specialist care.
    • Member pays copay at time of service for physician office services.
    • A percentage coinsurance member cost sharing amount may apply for certain services.
    • No claim forms or balance bills.
    • Except for emergency or out-of-area urgent care, benefits are not covered outside the network.
    Elect Choice® (EPO)
    • Member chooses primary care physician (PCP) from the network of participating providers.
    • Member visits PCP for routine care or for injury or illness.
    • PCP referral is generally required for specialist care.
    • Member pays copay at time of service.
    • No claim forms or balance bills.
    • Percentage copay options may be available.
    • Except for emergency or out-of-area urgent care, benefits are not covered outside the network.
    • Wellness and preventive programs available as an option.
    NYC Community PlanSM (available in NYC only)
    • Member chooses primary care physician (PCP) from the participating providers within the NYC Community Network.
    • Member visits PCP for routine care or for injury or illness.
    • PCP referrals are required for specialist care within the NYC Community Network. Co-pay only applies.
    • Member pays copay at time of service.
    • Self-referred care to NYC Community Network participating providers is not covered.
    • Members may self-refer to MC/EC network specialists - without PCP referral - deductible and co-insurance apply.
    • No claim forms or balance bills.
    • Except for emergency or out-of-area urgent care, out-of-network care is not covered.
    • Wellness and preventive programs included.
    Open Access Aetna SelectSM
    • Referrals not required.
    • Member encouraged to choose participating PCP from the network.
    • Member pays PCP copay each time member seeks care from PCP.
    • Member can go directly to network specialists - without PCP referral.
    • Member pays specialist copay each time member goes to network specialist.
    • No claim forms or balance bills.
    • Percentage copay options may be available.
    • Except for emergency or out-of-area urgent care, benefits are not covered outside the network.
    • Wellness and preventive programs included.
    Preferred Provider Organization (PPO) Plan
    Open Choice® (PPO)
    • No referrals required.
    • No PCP required.
    • Member can access any recognized provider for covered services (in or out of network).
      • If participating provider, member pays lower copay/coinsurance.
      • If nonparticipating provider, member pays deductible/higher coinsurance.
    • Some wellness and preventive programs available as an option.
    Indemnity Plan
    Traditional Choice® Indemnity
    • Indemnity health insurance product.
    • No provider network.
    • Member free to choose any recognized provider for covered benefits.
    • Discounted rates may be available through our National Advantage® program for covered services at many hospitals, facilities and physician offices.
    • Member pays deductible and coinsurance.
    • Member submits claim forms for care received.
    • Some wellness and preventive programs available as an option.
    Point-of-Service (POS) Plans
    Aetna Choice® POS
    • Referrals not required.
    • Member encouraged to choose a PCP from the network of participating providers.
    • Member pays PCP copay each time member seeks care from selected PCP.
    • Member pays specialist copay each time member goes to network specialist.
    • Member may visit any out-of-network, licensed provider for a covered benefit. Member shares the cost of care through deductible and coinsurance.
    • Wellness and preventive programs included.
    Aetna Choice® POS II
    • Referrals not required.
    • Member encouraged to choose a PCP from the network of participating providers.
    • Member pays PCP copay each time member seeks care from selected PCP.
    • Member pays specialist copay each time member goes to network specialist.
    • Member may visit any out-of-network, licensed provider for a covered benefit. Member shares the cost of care through deductible and coinsurance.
    • Wellness and preventive programs available as an option.
    Aetna Open Access® Managed Choice® (POS)
    • Referrals not required.
    • Member encouraged to choose a PCP from the network of participating providers.
    • Member pays PCP copay each time member seeks care from selected PCP.
    • Member pays specialist copay each time member goes to network specialist.
    • Member may visit any out-of-network, licensed provider for a covered benefit. Member shares the cost of care through deductible and coinsurance.
    • Wellness and preventive programs included.
    Managed Choice® (POS)
    • Member chooses primary care physician (PCP) from the network of participating providers.
    • Member visits PCP for routine care or for injury or illness.
    • Member pays applicable copay each time covered benefits are accessed within the network with PCP referral.
    • Member may visit any licensed provider without PCP referral for a covered benefit. Member shares the cost of care through deductible and coinsurance.
    • Some wellness and preventive programs available as an option.
    Quality Point-of-Service® (QPOS®)
    • Member chooses a primary care physician (PCP) from the network of participating providers.
    • Member visits PCP for routine care or for injury or illness.
    • Member pays applicable copay each time covered benefits are accessed within the network with a PCP referral.
    • Member may visit any licensed provider without PCP referral for a covered benefit. Member shares the cost of care through deductible and coinsurance.
    • In network percentage copay options may be available.
    • Wellness and preventive programs included.
    USAccess®
    • One plan, three ways to access care:

      1. Choose network PCP. PCP provides routine and primary care or refers member to network specialists. Member pays copayment at time of service.

      2. Member self-refers to network physician or hospital for covered benefits and shares a higher portion of the cost.

      3. Member goes directly to out-of-network provider without referral, and is subject to deductible and coinsurance.
    • Wellness and preventive programs included.
    Consumer-Directed Plan
    Aetna HealthFund® Aetna Choice® POS
    • Employer paid health fund.
    • High deductible medical plan.
    • Unused health fund dollars roll over to the next year if member remains in plan and with current employer.
    • Referrals not required.
    • Preventative care covered in most plans.
    • Aetna Navigator®, access to personalized tools and reliable consumer health care information.
    • 24-hour Informed Health® Line.
    Aetna HealthFund® HMO (available in CA only)
    • Employer paid health fund.
    • Deductible health plan.
    • Unused health fund dollars roll over to the next year if member remains in plan and with current employer.
    • Member chooses primary care physician (PCP) from the participating providers within the Aetna HealthFund® HMO Network.
    • Member visits PCP for routine care or for injury or illness.
    • PCP referral is generally required for specialist care.
    • Member pays copay at time of service for physician office services.
    • Percentage copayments for other services may apply.
    • No claim forms or balance bills.
    • Except for emergency or out-of-area urgent care, benefits are not covered outside the Aetna HealthFund HMO Network.
    • Wellness and preventive programs included.
    Aetna HealthFund® Open Access Aetna SelectSM
    • Employer paid health fund.
    • High deductible health plan.
    • Unused health fund dollars roll over to the next year if member remains in plan and with current employer.
    • Referrals not required.
    • Member encouraged to choose participating PCP from the network.
    • Member pays PCP copay each time member seeks care from PCP.
    • Member can go directly to network specialists - without PCP referral.
    • Member pays specialist copay each time member goes to network specialist.
    • No claim forms or balance bills.
    • Percentage copay options may be available (only on integrated Rx plans)
    • Except for emergency or out-of-area urgent care, benefits are not covered outside the network.
    • Wellness and preventive programs included.
    Aetna HealthFund® Open Access Elect Choice® EPO
    • Employer paid health fund.
    • High deductible plan.
    • Choice of health fund, deductible and coinsurance amounts from wide dollar ranges.
    • Aetna Navigator®, access to personalized tools and reliable consumer health care information.
    • Unused health fund dollars roll over to the next year if member remains in plan and with current employer.
    • Preventive care covered in most plans.
    • Member can access any network provider for covered benefits, with no referral required.
    • 24-hour Informed Health® Line.
    • Integrated plan administration.
    Aetna HealthFund® Open Access Managed Choice® POS
    • Employer paid health fund.
    • High deductible medical plan.
    • Choice of health fund, deductible and coinsurance amounts from wide dollar ranges.
    • Aetna Navigator®, access to personalized tools and reliable consumer health care information.
    • Unused health fund dollars roll over to the next year if member remains in plan and with current employer.
    • Preventive care covered in most plans.
    • Member can access any recognized provider for covered benefits, with no referral required.
    • 24-hour Informed Health® Line.
    • Integrated plan administration.
    Aetna HealthFund® Open Access POS II
    • Employer paid health fund.
    • High deductible medical plan.
    • Choice of health fund, deductible and coinsurance amounts from wide dollar ranges.
    • Aetna Navigator®, access to personalized tools and reliable consumer health care information.
    • Unused health fund dollars roll over to the next year if member remains in plan and with current employer.
    • Preventive care covered in most plans.
    • Member can access any recognized provider for covered benefits, with no referral required.
    • 24-hour Informed Health® Line.
    • Integrated plan administration.
    Aetna HealthFund® Open Choice® PPO
    • Employer paid health fund.
    • High deductible PPO plan.
    • Choice of health fund, deductible and coinsurance amounts from wide dollar ranges.
    • Aetna Navigator®, access to personalized tools and reliable consumer health care information.
    • Unused health fund dollars roll over to the next year if member remains in plan and with current employer.
    • Preventive care covered in most plans.
    • Member can access any recognized provider for covered benefits, with no referral required.
    • 24-hour Informed Health® Line.
    • Integrated plan administration.
    Medicare Advantage Plans
    Aetna Golden Medicare Plan®
    • Member chooses primary care physician (PCP) from the network of participating providers.
    • Member visits PCP for routine care or for injury or illness.
    • PCP referral is generally required for specialist care.
    • Member pays copay at time of service.
    • No claim forms or balance bills.
    • Percentage copay options may be available.
    • Except for emergency or out-of-area urgent care, benefits are not covered outside the network.
    • Wellness and preventive programs included.
    Aetna Golden ChoiceTM Plan
    • No referrals required.
    • No PCP required.
    • Member can access any licensed provider for covered services (in or out of network).
      • If network provider, member pays lower copay/coinsurance.
      • If non-network provider, member pays deductible/higher coinsurance.
    • Wellness and preventive programs included.
    Aetna Medicare OpenSM Plan
    • No referrals required.
    • No PCP required.
    • Member can access covered services from any provider that is eligible to receive payment from Medicare, agrees to treat them and accepts the Aetna Medicare Open Plan terms and conditions of payment.
    • Member will pay provider the copayment or coinsurance at the time of service.
    • No balance bills unless the provider does not take assignment under Original Medicare.
    • Wellness and preventive programs included.
    To search for doctors participating in the Original Medicare Program please use the link provided:
         • Original Medicare Providers


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