Aetna
Quick Facts
- Voluntary for eligible staff, retirees and dependants at headquarters as well as internationally recruited eligible staff, retirees and dependants away from headquarters who plan to seek care in the US
- Covers medically necessary care at reasonable & customary (R&C) cost
- No co-insurance for services provided by an in-network provider
- Annual deductible and coinsurance of 20% to 30% apply for services received from an out-of-network provider
- Teleconsultations available through “Teladoc”
- Health and wellness support available through ActiveHealth
- Emergency medical assistance management through UnitedHealthcare Global Assistance and Risk
- Premium is a percentage on salary. Up to 66% of total premium is subsidized by Member States
Plan Summary
The Aetna PPO offers worldwide coverage for hospitalization and surgical, medical, vision and prescription drug expenses. Under this plan, medically necessary treatment for a covered illness or injury may be obtained at a hospital or from a physician of one’s own choosing, whether an in-network or out-of-network provider. The Aetna PPO includes the posibility to enroll in the Aetna International programme for plan participants who are active staff members at duty stations outside the US and for retirees with a mailing address outside the US. If staff members do not wish to use a provider contracted by Aetna International, they are free to seek medical services from another facility or medical professional of their choice. In that case, direct-pay assistance may not be available.
Information Material - All about Your Plan
Description of Benefits - Aetna PPO Details
The below resources are official outlines of the available Aetna PPO. We kindly advise you to carefully review the plan details before making a decision on which plan is best suited for your needs.
Benefits Booklet for Active staff - Aetna Choice POS II Medical PlanPDF
Schedule of Benefits for Active staff - Aetna Choice POS II Medical PlanPDF
Benefits Booklet for Retirees - Aetna Open ChoicePDF
Schedule of Benefits for Retirees - Aetna Open ChoicePDF
Description of benefits_Aetna PPO detailsPDF
Description of benefits_Aetna PPO summaryPDF
Description of benefits_Aetna PPO vision detailsPDF
Description of benefits_Aetna PPO vision summary PDF
Amendment to Plan - Technology and LanguagePDF
Amendment to Plan - Pre-certification PenaltyPDF
Guidance Material for Plan Participants
Healthcare 101 - Understanding your optionsPDF
ActiveHealth
Both Aetna and Empire Blue Cross offer access to ActiveHealth that provides you with various resources intended to help you take better care of yourself, including coaching and health assessments.
Mental Health
Mental Health Awareness GuidebookPDF
Parent and Caregiver Mental Health GuidebookPDF
Fertility Treatments
Special Care for a Special Time - Aetna Infertility Facility ListPDF
UnitedHealthcare Global Assistance & Risk
UnitedHealthcare Global Assistance & Risk is a facility available to Aetna and Empire Blue Cross subscribers when they are 100 or more miles away from home. UnitedHealthcare Global Assistance & Risk is a programme providing emergency medical assistance management — including coordinating emergency evacuation and repatriation — and other travel assistance services.
FAQs
What is the coverage for fertility treatment under the Aetna plan?
Artificial insemination is limited to six treatments per lifetime; advanced reproductive technology is limited to $25,000 per lifetime for medical expenses and $10,000 per lifetime for pharmacy expenses, including specialty medications covered by the plan.
Does Aetna cover egg freezing?
Egg freezing is covered when medically necessary due to an illness that would result in infertility such as chemotherapy or radiation or as part of in vitro fertilization (IVF) treatments. Advanced Reproductive Technology is subject to a lifetime maximum of $25,000.
Does the Aetna plan provide worldwide coverage, and may I consult out-of-network providers?
Yes, the Aetna plan covers out of network providers. In addition, the plan does cover you around the world.
Does Aetna cover hospitalization in the Dominican Republic?
Yes, hospitalizations abroad (including DR) are covered under Aetna International.
What kind of video consultations are available with Aetna?
Behavioral Health video consults and telemedicine consults are available. In addition, you can use Teladoc which is Aetna’s telemedicine provider for video consultations.
How to contact Aetna
Domestic:
Call +1 800 784 3991 for support with any questions, concerns or issues.
International:
Email aiservice@aetna.com for support with any questions, concerns or issues.
General information:
If you are looking for additional information or specific details related to your individual plan, please log in to the Aetna PPO member page.
Updates
Aetna’s pharmacy prior authorization
Aetna introduces Rx prior authorization status emails to begin on 7th May, 2021. For more information, please visit the more elaborate Update Description.
Aetna's enhanced Explanation of Benefits (EOB)
Aetna is introducing an enhanced digital Explanation of Benefits (EOB). For more information, please visit the more elaborate Update Description.