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About the Aetna Public Employees Plan
Where is the Aetna Public Employees Plan available?
Aetna has network providers in all counties in Washington State, as well as a large national provider network. Anyone who has Public Employees Benefits Board (PEBB) benefits and lives in the continental United States can choose the Aetna Public Employees Plan for his or her medical coverage.
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Is Aetna a managed care plan?
Aetna Public Employees Plan is technically a preferred provider organization (PPO) like Uniform Medical Plan, because enrollees do not need to choose a primary care provider to oversee their medical care. However, it has similarities to managed care plans.
Like a PPO, enrollees in the Aetna Public Employees Plan can see any provider in the network without a referral, including specialists. Unlike UMP and many PPOs, Aetna will not cover services from non-network providers (except for emergency care), and has no annual deductible.
Like the PEBB managed care plans, enrollees pay flat copays ($10 for office visits) for most services.
Since PEBB determines the benefits, the Aetna plan will basically cover the same services and supplies as all other PEBB plans.
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How does the Aetna Public Employees Plan compare with UMP (benefits, costs, provider network, etc.)? Why choose one plan over the other?
Enrollees who want the freedom to choose from a large network of providers without having to get a referral AND who prefer to pay flat copays per service instead of coinsurance (or a percentage of the charges) will likely want to choose Aetna.
Some other key comparisons with UMP:
- The benefits are basically the same for all PEBB plans.
- Enrollees pay flat copays with Aetna. UMP enrollees pay coinsurance (a percentage of the charges) for most services.
- There is no annual deductible with Aetna. UMP enrollees must pay a $200 medical deductible before UMP begins paying medical benefits. UMP enrollees must also pay a $100 prescription drug deductible before UMP begins paying benefits for brand name drugs. There is no prescription drug deductible for generic drugs under UMP.
- UMP premiums are less expensive. See rates at www.pebb.hca.wa.gov.
- Aetna does not cover visits to non-network providers, except in emergencies. UMP covers non-network providers as long as they are approved provider types, but at a lower rate.
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Many retirees spend part of the year in sunnier locations. Will they be able to find Aetna providers in Arizona, California, Nevada and other states?
One of the advantages of the Aetna Public Employees Plan is that Aetna has a comprehensive nationwide network of providers. Plan shoppers and enrollees can search for providers by visiting Aetna’s website at www.aetnahca.com or by calling Aetna Member Services at 1-800-222-9205. Aetna does not have a provider network in Hawaii or Alaska.
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If a member goes to a non-contracted provider, will Aetna cover the visit (with the member paying more, as with UMP) or will claims be denied?
Aetna does not cover services from non-contracted providers, except in the case of an emergency, so the claim would be denied.
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Who handles prescription drug benefits for the Aetna Public Employees Plan?
Prescription drug benefits for the Aetna Public Employees Plan are managed by Washington State Rx Services, which contracts directly with the Health Care Authority and is not affiliated with Aetna. Aetna enrollees pay flat copays for prescriptions at retail and mail order. See the Prescription Drug section of the Aetna website at www.aetnahca.com or call Washington State Rx Services at 1-888-361-1612 to find out what your copay would be for your prescription drugs.
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Where can I see the Preferred Drug List for the Aetna Public Employees Plan?
The Preferred Drug List for Aetna Public Employees Plan is available at www.aetnahca.com. Enrollees can request printed copies by calling 1-888-361-1612.
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How does the Aetna Public Employees Plan coordinate benefits for members who have other insurance that is primary (like Medicare, for example)?
Aetna does coordinate benefits with other plans. If you have other coverage that is primary, in most cases, Aetna will cover the rest of the charges and the enrollee will owe nothing or very little.
However, enrollees must see Aetna network providers or Aetna will deny the claim. If you see a provider that contracts with your primary plan but doesn’t contract with Aetna, then Aetna won’t pay anything on the claim.
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Is there a conversion plan for Aetna enrollees whose COBRA period expires?
Yes. Those who live in Washington and most other states can convert to a basic conversion plan offered by Aetna. In a few states where Aetna does not have a basic conversion plan, they will be able to transfer to a conversion plan offered through Uniform Medical Plan. These states are California, Montana, Nevada, New Hampshire, New York, South Dakota and Vermont.
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Will Aetna have a health risk assessment (HRA) in 2009?
The Health Care Authority does offer a health risk assessment to Aetna plan enrollees The HRA can be accessed at www.aetnahca.com. Aetna does not offer a financial incentive to take the HRA.
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