Aetna

Quick Facts

  • Voluntary for eligible staff, retirees and dependants at headquarters as well as internationally recruited eligible staff, retirees and dependants away from headquarters who plan to seek care in the US
  • Covers medically necessary care at reasonable & customary (R&C) cost
  • Area of coverage is worldwide; HLIS should be informed to enroll in Aetna International 
  • No co-insurance for services provided by an in-network provider
  • Annual deductible and coinsurance of 20% to 30% apply for services received from an out-of-network provider
  • Teleconsultations available through “Teladoc”
  • Health and wellness support available through ActiveHealth
  • Emergency medical assistance management through UnitedHealthcare Global Assistance and Risk
  • Premium is a percentage on salary. 66% of total premium is subsidized by Member States

Plan Summary

The Aetna PPO offers worldwide coverage for hospitalization and surgical, medical, vision 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. The Aetna PPO includes the posibility to enroll in the Aetna International programme for plan participants who are active staff members at duty stations outside the US and for retirees with a mailing address outside the US. If staff members do not wish to use a provider contracted by Aetna International, they are free to seek medical services from another facility or medical professional of their choice. In that case, direct-pay assistance may not be available.

Overview of Benefit Coverage for Aetna

Information Material - All about Your Plan

Description of Benefits - Aetna PPO Details

The below resources are official outlines of the available Aetna PPO. We kindly advise you to carefully review the plan details before making a decision on which plan is best suited for your needs.

Description of Benefits for Active staff - Aetna PPO

Description of Benefits for Retirees - Aetna PPO

Amendment to Plan - Appendix

Amendment to Plan - Technology and Language

Amendment to Plan - Pre-certification Penalty

Guidance Material for Plan Participants

Pre-enrollment Checklist

Member Care Options 

Healthcare 101 - Understanding your options

ActiveHealth

Both Aetna and Empire Blue Cross offer access to ActiveHealth that provides you with various resources intended to help you take better care of yourself, including coaching and health assessments.

ActiveHealth Overview

ActiveHealth Flyer

ActiveHealth Flyer 2

Mental Health 

Mental Health Awareness Guidebook

Parent and Caregiver Mental Health Guidebook

Behavioral Health Overview

Fertility Treatments 

Special Care for a Special Time - Aetna Infertility Facility List

Infertility Member Flyer

UnitedHealthcare Global Assistance & Risk

UnitedHealthcare Global Assistance & Risk is a facility available to Aetna and Empire Blue Cross subscribers when they are 100 or more miles away from home. UnitedHealthcare Global Assistance & Risk is a programme providing emergency medical assistance management — including coordinating emergency evacuation and repatriation — and other travel assistance services.

FAQs

What is the coverage for fertility treatment under the Aetna plan? 

Artificial insemination is limited to six treatments per lifetime; advanced reproductive technology is limited to $25,000 per lifetime for medical expenses and $10,000 per lifetime for pharmacy expenses, including specialty medications covered by the plan.

Does Aetna cover egg freezing?

Egg freezing is covered as part of a treatment plan under the Advanced Reproductive Technology subject to a lifetime maximum of $25,000.

Does the Aetna plan provide worldwide coverage, and may I consult out-of-network providers?

Yes, the Aetna plan covers out of network providers. In addition, the plan does cover you around the world.

Does Aetna cover hospitalization in the Dominican Republic?

Yes, hospitalizations abroad (including DR) are covered under Aetna International.

What kind of video consultations are available with Aetna?

Behavioral Health video consults and telemedicine consults are available. In addition, you can use Teladoc which is Aetna’s telemedicine provider for video consultations.

How to contact Aetna

Aetna logo

Domestic:

Call +1 800 784 3991 for support with any questions, concerns or issues.

International:

Email aiservice@aetna.com for support with any questions, concerns or issues.

General information:

If you are looking for additional information or specific details related to your individual plan, please login on the Aetna PPO Member Page via the Aetna Member Login Page.

Updates

Aetna’s pharmacy prior authorization

Aetna introduces Rx prior authorization status emails to begin on 7th May, 2021. For more information, please visit the more elaborate Update Description.

Aetna's enhanced Explanation of Benefits (EOB)

Aetna is introducing an enhanced digital Explanation of Benefits (EOB). For more information, please visit the more elaborate Update Description.