How the Plan Works |
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Aetna Public Employees Plan provides comprehensive medical benefits and helpful tools and resources to help enrollees maintain their health and the health of their families.
- Choose from Aetna’s nationwide network of providers
- Pay low copays for most services
- Use online tools to find doctors or check on a claim
- Get covered preventive care screenings free
- Find reliable health information with Aetna InteliHealth®
With Aetna Public Employees Plan, there are no deductibles to satisfy first before using your medical or prescription drug benefits. You can also see any doctor or health care provider, even specialists, as long they’re members of the Aetna provider network. You don’t need to choose a primary care provider first or get a referral for a specialist!
Just be sure to always choose an Aetna network provider for services to be covered. Services provided by non-network providers are not covered, except for emergency care.
| What you pay for medical services |
The chart below briefly highlights what you’ll pay for major services covered by Aetna Public Employees Plan. For more detailed information, check the
Summary of Benefits. |
| Office Visits and Hospital Care |
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| Office visits |
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$10 copay |
| Urgent care services |
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$10 copay |
| Inpatient hospital services |
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$200 copay, up to $600 maximum per year |
| Ground ambulance |
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$75 copay |
| Air ambulance |
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$100 copay |
| Emergency room |
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$75 copay, waived if admitted as an inpatient |
| Outpatient surgery facility services |
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$100 copay |
| Skilled nursing facility services |
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$200 copay, up to $600 maximum per year |
| Routine Screenings |
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| Preventive care (see preventive care schedule) |
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Covered 100% |
| Eye exams |
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$10 copay |
| Glasses, contact lenses, and contact lens fitting fees |
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$150 maximum, every 24 months |
| Annual hearing exams |
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Covered 100% |
| Hearing aids |
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$400 maximum, every three calendar years |
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Annual out-of-pocket maximum
The annual out-of-pocket maximum is $750 per individual and $1,500 maximum per family. Once any individual meets the maximum, the plan will pay all covered services for that person at 100%. If two or more members on the same subscriber account meet the $1,500 maximum, all services received by all family members on the account will be covered at 100%. |
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| For more details, see the Summary of Benefits and Certificate of Coverage pages. |
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Summary of Benefits
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