Health Insurance
 Aetna Health Insurance
ACE, APA, Exempt, Food Service,
Maintenance, Non-Represented, and TOTEM employees are
covered by Aetna's Open Choice PPO Plan (Group #658742). For more information contact
Member Services or visit Aetna Navigator online.
 Resources from Aetna
Medical and Prescription Plans
| Low Option Plan
Benefits |
 |
Standard Option Plan Benefits |
| Medical Plan Benefits |
|
Medical Plan Benefits |
| » |
$1,500 individual/$4,500 family deductible |
| » |
pays 80% of the next $25,000 of covered charges |
| » |
once your 20% out of pocket expenses reaches $5,000,
the plan will pay 100% of covered charges |
| » |
$30 general office visit co-pay |
|
|
| » |
$500 individual/$1,500 family deductible |
| » |
pays 80% of the next $12,500 of covered charges |
| » |
once your 20% out of pocket expenses reaches $2,500, the plan will pay 100% of covered charges |
| » |
$20 general office visit co-pay |
|
| Prescription Plan Benefits |
|
Prescription Plan Benefits |
| Type of Drug |
Retail |
Mail Order |
| Generic Drugs |
» |
$15 co-pay for each 30-day supply (or
cost of prescription if less than co-pay) |
» |
$30 co-pay for each 90-day supply (or
cost of prescription if less than co-pay) |
| Brand Name Formulary
Drugs |
» |
20% coinsurance (up to $120 cap) |
» |
20% coinsurance (up to $80 cap) |
| Brand Name Non-Formulary
Drugs |
» |
20% coinsurance (up to $240 cap) |
» |
20% coinsurance (up to $160 cap) |
|
|
| Type of Drug |
Retail |
Mail Order |
| Generic Drugs |
» |
$15 co-pay for each 30-day supply (or cost of prescription if less than co-pay) |
» |
$30 co-pay for each 90-day supply (or cost of prescription if less than co-pay) |
| Brand Name Formulary Drugs |
» |
20% coinsurance (up to $75 cap) |
» |
20% coinsurance (up to $50 cap) |
| Brand Name Non-Formulary Drugs |
» |
20% coinsurance (up to $120 cap) |
» |
20% coinsurance (up to $80 cap) |
|
| Mandatory Generic (MG) - If the member requests a brand prescription when a generic prescription is available, the member will be responsible for paying the applicable copay, plus the difference between the generic price and the brand price. The physician may state "dispensed as written" for the tiers above to apply. |
Newborns
Please come to the Benefits Department to enroll your newborn within 31 days of birth with a state or hospital birth certificate. Failure to enroll your child within this period will result in loss of medical coverage. You will need to enroll your dependent during the next open enrollment period for coverage to begin the following fiscal year.
Dental Plan
The benefits below are based on plan allowance for the service provided. Pre-authorization of major treatments is not required, but is recommended.
| » |
100% of diagnostic and preventative care within UCR (Usual Customary Rates) |
| » |
80% of basic care |
| » |
50% of major care |
| » |
$3,000 maximum per enrollee per calendar year (January-December) |
| » |
$25 annual deductible on basic and major care |
|
Eligible employees under the district's health insurance should register on the Aetna Navigator. Below are some great features available on their Web site and instructions on how to access them.
Aetna Navigator Features |
|
How to… |
-
Use DocFind to locate a physician, specialist or medical facility
-
View who is covered on your plan
-
Print a temporary medical ID card or order a new card if your card has been lost or stolen
-
View Explanation of Benefits for Claim Status
-
E-mail Customer Service in a secure environment with questions about benefits or claims
-
Access the Prescription Drug Formulary
-
Print forms to begin the Pharmacy Mail Order process
-
Access Aetna InteliHealth featuring Harvard Medical School's Consumer Health Information
|
|
Register for Aetna Navigator
- Go to www.aetna.com and look for the "Members: Secure Information" heading
- Click "Register Now" and follow the instructions for a first-time user to register as an Aetna member.
- Please note the user name and password you created for your records
Print a temporary card (after you are logged in)
- Click the "ID Card" link under the "Shortcuts" menu on the left side
- OR place your cursor over the "Requests & Changes" option at the top of your home page and choose "ID Card" from the list of options.
- Click on the "Medical Temporary Identification" link
- Select the covered member you wish to view, click "Continue" and use the print function of your browser
|
 Download a PDF version of this information |
DocFind Provider Directory & Medication Formulary Guides
The Aetna web site is also a great way to search the "DocFind Provider
Directory" and "Medication Formulary Guides," which are
now available.
| To access "DocFind" use the "Find a Doctor" link under Shortcuts. Follow the steps on the next screens: |
|
To access Prescription Drug Search
(Pharmacy plan type is Three Tier Open Formulary – use this to search) |
-
Enter City, County or Zip code, depending upon your search preference
-
Select a Type of Provider
-
Select a Plan – The category is Aetna Standard Plans. Then, select Open Choice PPO for the type of plan.
-
Select Search Criteria – you can narrow your results further or choose to view results for all providers.
|
|
-
On the Shortcuts menus follow the "Look up a Drug link or the "Is Your Drug Covered? (Preferred Drug List) link.
OR
From the www.aetna.com home page, follow the "Members: Public Information" link
-
Place your curser over the "Health Coverage Info" option at the top & choose "Drugs & Prescriptions" from the list of options.
-
Click on "Preferred Drug List (Formulary)" and then follow the "Preferred Drug Guides" links to get to the Search box.
-
To search, make sure you are under Non-Medicare Plans, then select Three Tier Open Formulary in the drop-down box.
|
|
Contacting Aetna
Please contact the appropriate Aetna Service Centers with any questions:
Medical Member Services
P.O. Box 14089
Lexington, KY 40512-4089
1-877-204-9186
www.aetna.com
|
|
Dental Member Services
P.O. Box 14094
Lexington, KY 40512-4094
1-877-238-6200
www.aetnadental.com
|
|
Aetna Pharmacy
Attn: Claim Processing
P.O. Box 14024
Lexington, KY 40512-4024
1-800-238-6279
www.aetnapharmacy.com |
| This is an AETNA Standard "Open Choice PPO Plan" and the Group Number is 658742 |
| Please note |
|
The plan booklet files provided on this site are solely to facilitate the
Group’s review of available benefits. The electronic text is in a “Read Only”
format. Alterations, additions, or deletions to the text are prohibited. Any
unauthorized review, use disclosure, or distribution of this text is
prohibited.
Efforts have been made to ensure this Web site contains accurate information. In
the event of a discrepancy between the electronic text and the hard copy plan
document, the hard copy plan document will prevail.
| PDF Forms |
Forms on this site are designed to be filled out by hand or on your computer, printed out, and mailed to the appropriate office. Due to the limitations of the free Adobe Acrobat Reader software you will be unable to save your changes unless you have a full version of Adobe Acrobat. |
|
|
|
|
|
