DCHR – employee benefits

DCHR employee benefits Aetna HMO Plan Aetna PPO Plan Open Choice PPO Aetna Consumer Driven Health Plan CDHP with Open Choice PPO

Get to know how
your health plan works:

HMO Plan: Visit any in-network doctor of your choice

You can visit any doctor, provider or facility in network when you choose the Aetna HMO Plan.

You must stay in network in order to receive coverage. There is no coverage for out-of-network providers. To find an in-network doctor, visit log in to www.aetnanavigator.com and select “Find a Doctor or Facility” on the left hand side of the home page.

Your options for getting care when you need it:

Option #1: Visit your primary care physician (PCP)

A PCP is the doctor you go to first. Your PCP helps you learn about your health and how to manage it.

  • See your PCP for routine checkups or when you are sick or injured.
  • You can choose any PCP from our network. You can change your PCP at any time.
  • For most services, you pay a copay (a specific dollar amount) at the time of your care.

Option #2: Go directly to any in-network doctor

Make an appointment with any doctor or specialist in the Aetna network.

  • You never need a referral.
  • You must see network providers to receive benefits through this plan.

PPO Plan: Visit any doctor — in network or out of network

The Aetna Open Choice PPO Plan gives you two options for visiting your doctor.

Option #1: Visit any network doctor

You do not need to select a PCP, nor do you need a referral to visit different doctors or specialists in Aetna’s network. Because in-network doctors have agreed to offer discounted rates, you will pay less for their services.

Option #2: Go to any licensed doctor

You may visit any licensed doctor you choose. You can also see out-of-network doctors without a referral. You will pay more for using an out-of-network doctor. Also, you may have to:

  • Get approval from Aetna before receiving certain services.
  • File your own claims.

CDHP: Take charge of your healthcare costs

With the Aetna Consumer Driven Health Plan (CDHP) with Open Choice PPO, you’re in control of your health care costs — a consumer-driven health plan puts you, the consumer, in the driver’s seat.

You get the protection of a medical plan plus a tax-free health savings account (HSA) to help you pay for qualified expenses. After you pay the annual deductible, the plan pays a percentage of covered services. You can use the money in your HSA to pay your share of the costs. Or you can choose to pay out of pocket and save your account for future expenses. The HSA is part of your health plan and is separate from a Flexible Spending Account (FSA).

Here’s how to get the most out of your CDHP plan:

Step 1: Build your Health Savings Account (HSA)

PayFlex® administers your account. Log in to www.payflex.com to manage your HSA.

  • The total maximum allowed deposits for 2018 are $3,450 per individual and $6,900 per family. If you’re age 55 or older, you can make an additional $1,000 “catch-up” contribution.
  • Your HSA earns interest. You have investment options once your balance reaches $1,000.
  • Funds roll over from year to year.

Step 2: Shop smart for health care

Find a doctor and know the cost of care by using the tools located on www.aetnanavigator.com.

Step 3: Visit your doctor and pay your share

  • Preventive care is covered at 100 percent.
  • Pay your share of other covered health care services.
  • Pay until you reach the out-of-pocket maximum.
  • After that, the CDHP pays for covered services. You pay nothing.

What is One Medical and why join?

One Medical is a membership-based primary care practice and the first place to go for everything about your health. No matter the issue, big or small, just start here and they’ll take care of the rest. Expect the highest quality care and an approach focused on getting to know you as a patient and a person.

With same-day appointments at any of 60 locations nationally and free virtual care around the clock, One Medical is there when you need them. Services include preventive screening, anxiety and stress management, and care for acute or chronic conditions, digestive disorders, sports injuries, allergies, asthma, diabetes, women’s health, men’s health, and travel health.

What this means for you:

  • Aetna covers the complete cost of membership, normally up to $199 a year per person, for you, your spouse, and any dependents 14-26.
  • One Medical doctors are in-network with the Aetna medical plans.
  • You’ll need to sign up to activate your membershipafter January 1st email clientservices@onemedical.com or call any DC One Medical office for more information on how to sign-up.

Washington, DC and Virginia Locations

  • Adams Morgan
  • Union Station
  • Dupont Circle
  • Metro Center
  • Farragut Square
  • Tyson’s Corner

Help your HSA funds last longer

Getting care in the Aetna network will always cost less than getting out-of-network care. But you could save even more by comparing costs at different in-network facilities before you go.

The Member Cost Estimator tool makes it easy. It factors in your plan details to find out how much you’ll pay. To use this tool, log in to www.aetnanavigator.com. Then, click “Managing Your Costs.”

For more information about your health plan, download our Welcome Guide.