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.
How Aetna Choice POS II Plan Works
Under the Aetna Choice POS II Plan, you may receive care from any licensed health care provider. You are not required to select a primary care physician (PCP) and no referrals are required for specialty care. When you need care, simply choose the appropriate doctor and make an appointment.
The Aetna Choice POS II 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 in-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 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.
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 Network
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.
Is the Aetna Choice POS II Right for Me?
You should choose the Choice POS II plan if:
- You are willing to pay higher out-of-pocket costs in exchange for more choice. This includes higher per paycheck premiums.
- You need open access to any licensed health care provider.
- You are open to controlling your health care costs by using in-network providers and receiving higher benefits.
- You want to be able to visit specialists without getting referrals from a PCP.
Review your claims and expenses for the previous year at www.aetna.com. (login required). Reviewing your medical expenses may help you determine the coverage that is best for you and your family.