CARNEGIE INSTITUTION OF WASHINGTON: Aetna Choice® POS II Coverage Period:. Urgent care $50 copay/visit, deductible doesn't apply 30% coinsurance No coverage for non-urgent use. Aetna directly by calling the toll free number on your Medical ID Card, or by calling our general toll free number at 1-888-982-3862. Aetna Choice POS II The Aetna Choice POS II Plan is a network plan that gives you the freedom to select any licensed provider when you need care. It provides the highest level of benefits. This plan offers both in-network and out-of-network benefits; however, the plan’s reimbursement is higher when you use an in-network provider. What you pay for care received in network. Doctor office visits: 20% after deductible per visit for PCP / 20% after deductible per visit for Specialist; Hospital Stay: $500 copay/day first 5 days per stay; Emergency Room: 20% after deductible (waived if admitted) Urgent Care: 20% after deductible; What you pay for care received out of network. Aetna is here for you during the coronavirus (COVID-19) pandemic, no matter what. Learn about extra benefits and well-being resources just for you, find testing locations, get answers to the most frequently asked questions regarding COVID-19 and tips to stay safe, and much more. Aetna Choice POS II Health Savings Account (HSA) The Aetna Choice POS II Health Savings Account (HSA) is a high-deductible health plan, or “ HDHP. ” The Aetna Choice POS II HSA combines traditional medical coverage with a tax-free health savings account and consists of these key components: You must pay the deductible before the plan begins to pay.
Aetna Choice POS II Health Savings Account (HSA)
The Aetna Choice POS II Health Savings Account (HSA) is a high-deductible health plan, or “HDHP.” The Aetna Choice POS II HSA combines traditional medical coverage with a tax-free health savings account and consists of these key components:
- You must pay the deductible before the plan begins to pay. The deductible is the amount of eligible medical and prescription drug expenses you must pay each plan year before the plan begins to pay a percentage of those expenses.
- 100% coverage for preventive care when provided by an in-network physician. There is no cost to you or your account.
- Lower monthly premiums than traditional health insurance plans.
- A Health Saving Account (HSA) savings account established through the Benefit Strategies that can be used to pay health care expenses. You and Carnegie can deposit tax-free contributions (subject to federal limits).
All the features and benefits of Aetna Choice POS II HSA are designed to make health care expenses more manageable for employees. Additionally, using this plan can save you money overall with the interest earned and tax advantages given to deposits and qualified withdrawals in an HSA.
How the Plan Works
The Aetna Choice POS II HSA Plan has two levels of benefits:
- In-Network Benefits - When you use in-network providers, you pay a fixed dollar amount, called a copayment (or copay), for doctor’s office visits and routine exams. For other services, you pay a lower deductible and the plan pays a larger share of your expenses. In addition, the network provider files claims for you and takes care of the plan’s precertification requirement(s) for hospital admissions.
- Out-of-Network Benefits - If you decide to use an out-of-network provider, you will receive a lower level of benefits and you must meet a higher deductible. The plan pays a smaller share of your expenses. In addition, you must file your own claims and call Aetna when your doctor recommends care that must be precertified.
Staying In-Network
- While you are free to use any provider, you save money when you use in-network providers.
- If your doctor refers you to another provider (such as a specialist), be sure to ASK if the provider belongs to the network. If he or she doesn’t, benefits will be paid at the lower, out-of-network level AND only up to what Aetna determines to be the reasonable charge for the service. You’ll be billed for any amount that exceeds the reasonable charge.
- The Aetna Choice network is large and comprehensive. It consists of primary care physicians and specialists ranging from cardiologists, podiatrists, and OB/GYNs to oncologists, ophthalmologists, and orthopedists. Facilities such as hospitals, urgent care centers, and labs also belong to the network. To find preferred providers near you visit www.aetna.com.
Prescription Drug Benefits
When you enroll in one of the Aetna medical plan options, you’ll automatically have prescription drug coverage through Aetna and Express Scripts. This program includes a Formulary Management Program that uses a “four-tier” copayment approach to covered drugs and is designed to control cost for you and the plan. Click here to learn more about prescription benefits.
High Deductible Plan Right for Me?
A high-deductible health plan can be a good option for those who need only preventive care and do not expect to need to pay for prescriptions or frequent visits to the doctor. But they can also make sense for someone with a chronic condition since there are often no additional copays and coinsurance payments once the deductible has been met. Review your claims and expenses for the previous year at www.aetna.com. (You will need to log in to see your claims and expenses). Reviewing your medical expenses may help you determine the coverage that is best for you and your family.
Aetna Choice POS II HSA Plan Resources
Aetna Copay Information
Aetna Choice POS II HSA Plan Tools
Does Aetna Choice Pos Ii Require Referral
THIS PLAN ENDS ON DECEMBER 31, 2020
With Aetna Choice POS II plan, you may select any physicians and hospitals in and outside the plan's network. Selecting this plan will give you the freedom to continue seeing your current doctor if your doctor isn't part of the Aetna Choice POS II network.
Keep in mind that if your physician is not part of the plan's network, you will have to pay more for each visit, submit a claim for reimbursement and/or pay for the entire visit. If your current doctor is not in the Aetna Choice II POS network, Aetna will work with you to transition your care to an Aetna network provider.
The Patient Protection and Affordable Care Act (also known as the Health Care Reform law) requires that you receive a Summary of Benefits and Coverage (SBC). The SBC is designed to help you understand and evaluate your health plan choices. Digital copies provided in the Resource section on this page. Paper copies are also available, free of charge, from the Postdoc Benefits Office by calling 650-724-9490.