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FAQs about Open Enrollment
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 U.S. can choose the Aetna Public Employees Plan for his or her medical coverage.
Is Aetna a managed care plan?
Aetna Public Employees Plan is technically a preferred provider organization 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).
Like the PEBB managed care plans, enrollees pay flat copays ($25 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.)?
Aetna Public Employees Plan enrollees get the same freedom as UMP enrollees to choose from a large network of providers without a referral. Unlike UMP enrollees who pay a percentage of the charges (coinsurance) per service, Aetna enrollees pay a flat copay per service. Some other key comparisons with UMP:
- The benefits are basically the same for all PEBB plans.
- There is no annual prescription drug deductible with Aetna PEP. UMP enrollees must pay a $100 prescription drug deductible before UMP begins paying for preferred and nonpreferred drugs. There is no prescription drug deductible for generic drugs for either plan.
- UMP premiums are less expensive. See rates at www.pebb.hca.wa.gov.
- Aetna PEP 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 PEP does not cover services from non-contracted providers, so the claim would be denied (except in an emergency).
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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 PEP 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 PEP 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, the plan will cover the rest of the charges and the enrollee will owe nothing or very little.
However, enrollees not covered by Medicare 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. If you are covered by Medicare, you are not limited to the Aetna network for services covered by Medicare.
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Is there a conversion plan for Aetna enrollees whose COBRA period expires?
Aetna PEP enrollees have the right to switch to an individual conversion plan when they are no longer eligible to continue their Aetna PEP coverage and are not eligible for Medicare or other group insurance coverage. Enrollees must apply for conversion coverage within 31 days after their group medical plan ends.
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