Aetna Open Choice PPO

 

Open Choice PPO/POS II

Plan Outline

The Aetna Open Choice PPO/POS II offers worldwide coverage for hospitalization and surgical, medical 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.

Participants can choose, if they wish, to go to a doctor who is in-network and pay $15 per visit to a PCP or $20 per visit to a specialist or treatment without any further need to file a claim with Aetna. Alternatively, participants may elect to receive treatment from any physician not in the network and obtain reimbursement by filing a claim with Aetna, subject to the annual deductible, the normal co-insurance and subject to the providers' fees falling within reasonable and customary norms.

The premiums for the Aetna Open Choice PPO plan increase by 3.28 % this year. The premium rates and related percentages of salary contribution are shown on the schedule of premiums.

For out-of-network services, when a participant has met the annual deductible of $250 per individual ($750 per family) and a further $1,250 in coinsurance per covered individual (limited to $3,750 per family), Aetna will reimburse at 100 per cent all further covered expenses incurred in the year, subject to the requirement that they be medically necessary and "reasonable and customary" as determined by Aetna. The deductible and co-insurance requirement must be met each calendar year. There is no lifetime reimbursement limit under the Aetna plan. When a participant is treated by a network physician, paying the fixed $15 or $20 co-payment for each visit, it is important to note that those $15 or $20 amounts do not count towards meeting the deductible or the out-of-pocket expense limit referred to above.

Aetna Global Benefits

Aetna Global Benefits provides claim services for active and retired staff who meet the following eligibility requirements:

  • Participate in the Aetna Medical programme, and
  • Have an established principal residence outside the United States or
  • Are on mission assignment of six months or more outside the United States.

The Aetna Global services are fully described in ST/IC/2012/16, including instructions for filing claims and obtaining reimbursement for covered expenses.

Aetna members who are eligible for Aetna Global services are automatically issued the Aetna Global ID card and have toll-free access to Aetna's Tampa, Florida service center 24 hours a day, 7 days a week, 365 days a year. The Tampa service center is solely dedicated to serving programme participants who reside outside of the United States. It is staffed by Aetna personnel who are knowledgeable of international health care, including multiple language capability on-site.

The Aetna Global ID cards contain a logo identifying the holder of the card to hospitals outside the U.S. with which Aetna has negotiated direct-payment arrangements and, in many cases, discounted prices. There are presently more than 600 such hospitals and the contracted hospitals in each country and city can be found at the Aetna Global website. Aetna Global Benefits is an Aetna subsidiary. The services provided by Aetna Global are administrative only. There is no effect on your, or your family's, benefits or contributions as participants in the Aetna programme including the appropriate reimbursement based on whether the individual receives health-care services "in-network" (from a provider on Aetna's list) or "out-of-network" (from a provider not on Aetna's list).