Please see Section 3, How You Obtain Care, for more information. WebIf you sign up for a dental and/or vision plan during the 2022 Open Season, your coverage will begin on January 1, 2023. WebBenefits and Premiums are effective January 1, 2023 through December 31, 2023 SUMMARY OF BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY Primary Care Physician (PCP): You have the option to choose a PCP. Some subtypes have five tiers of coverage. The LASIK discount is only available from U.S. Laser Network by calling 1-800-422-6600. You may obtain care from any licensed eye care provider. Lens Options (covered in addition to base lens): Standard Polycarbonate lenses (shatter-resistant), Lens Options (covered in addition to base lens): Standard Scratch resistant coating, Lens Options (covered in addition to base lens): Standard Anti-reflective coatings, Lens Options (covered in addition to base lens): UV Protection and Tint (Solid or Gradient), Lens Options (covered in addition to base lens): Photochromic lenses- lenses are clear indoors and darken outside, Lens Options (covered in addition to base lens): Standard progressive lenses, Lens Options (covered in addition to base lens): Premium progressive lenses Tiers 1-3, Lens Options (covered in addition to base lens): Other premium progressive lenses, 80% of charge less $120 allowance + $20 copay, Any frame available at the provider location, Nothing for frames up to the $300 plan allowance, Frame Greater than $300: pay any amount after a 20% discount, Nothing for frames up to the $160plan allowance, Frame Greater than $160: pay any amount after a 20% discount, Standard Contact Lens Fit & Follow-up(includes applications of clear, soft, spherical, daily-wear contact lenses for single-vision prescriptions) - once every calendar year, Premium Contact Lens Fit & Follow-up(Includes the application of toric (astigmatism .62D or higher in the contact lens), multifocal/monovision, post-surgical and gas permeable lenses. Under certain circumstances, you may also continue coverage for a disabled child 22 years of age or older who is incapable of self-support. Because of the tax benefits an FSA provides, the IRS requires that you forfeit any money for which you did not incur an eligible expense and file a claim in the time period permitted. We cannot guarantee the availability of every specialty in all areas. Services for the deaf and hearing-impaired; National Medical Excellence Program; Summary of Benefits for the Aetna Advantage Plan - 2023 You have 30 days from the date you received our final decision to request a third party review. Children and dependent unmarried persons must be under age 21 if they are not a student, under age 23 if they are a full-time student, or incapable of self-support because of a mental or physical incapacity. Your enrollment carries over from year to year, unless you change it. Lenses Standard Plastic single vision, lined bifocal, lined trifocal and lenticular lenses. You may use your - once every calendar year, You will receive a 15% discount off the cost over $170 for convention, High Ametropia exceeding 10D or +10D in meridian powers, Keratoconus when vision is not correctable to 20/30 in either or both eyes using standard spectacle lenses, Vision improvement other than Keratoconus when vision can be corrected two lines of improvement on the visual acuity chart when compared to the best corrected standard spectacle lenses. WebEmployee benefits are an essential part of your compensation package and there are a variety of programs and tools available. This also includes stepchildrenand foster children who live with you in a regular parent-child relationship. Free pain treatment and prevention. WebSCHEDULE OF BENEFITS Effective 01/01/2023 i. The enrollment and premium administration system for FEDVIP. Reported anonymously by Aetna employees. We'll give employers the information they need. Employee's Birthdate (MM/DD/YYYY) 6. That's why we made it easy for you to estimate your out-of-pocket costs ahead of time. A co-payment is a fixed amount of money you pay to the provider when you receive services. You must also actively reenroll in a health care or limited expense account during the NEXT Open Season to be carryover eligible. Discounts on non-covered services may not be available through all providers, or in all states. Self Only: A Self Only enrollment covers only you as the enrolled employee or annuitant. Web2023 Precert List Participating provider precertiication list for Aetna Effective July 1, 2023 This document is a quick guide for your oice to use for precertiication with patients enrolled in Aetna health plans. Call 1-877-459-6604. You may use your FEDVIP rules and FEHB rules for family member eligibility are NOT the same. This process is also known as prior authorization or prior approval. You will also receive 20% off any out-of- pocket costs over your frame allowance and a savings of 15% on any balance over your conventional contact allowance. 2. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. OPM negotiates benefits and rates with each carrier annually. When billing, you must use the most appropriate code as of the effective date of the submission. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. There are two ways for you to save at thousands of locations through Hearing Care Solutions or Amplifon Hearing Health Care. Employee's Name. An eligible family members coverage also ends upon the effective date of the cancellation. View jobs Aetna, a CVS Health Company Pay & Benefits reviews Review this company Job Title All Location United States 6,195 reviews Ratings by category Clear 3.6 Work-Life Balance 3.6 Pay & Benefits 3.2 Job Security & Advancement 3.2 Management 3.4 Culture Sort by Helpfulness Rating Date Language ; NRLN National Retiree Legislative Network is a non-profit organization originated by Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. The following are also NOT available under FEDVIP plans: If you are planning to enroll in an FSAFEDS Health Care Flexible Spending Account (HCFSA) or Limited Expense Health Care Flexible Spending Account (LEX HCFSA), you should consider how coverage under a FEDVIP plan will affect your annual expenses, and thus the amount that you should allot to an FSAFEDS account. Reported anonymously by Aetna employees. If you are enrolled in Self and Family coverage, each of your eligible family members is also entitled to these benefits, if they are also listed on the coverage. It also has examples of how much you might pay out of pocket for certain health services. WebHow your medical plan works 2023 Medical plans and pharmacy 12 Contact information Learn more about your benefits Visit the Washington DC Government Employee Health Insurance Website at AetnaDCGov.com. The State Employee Health Plan (SEHP) offers four medical plans (Plans A, C, J, and N) for Active State Employees, Non State Employer Group, and NON-MEDICARE Eligible Retiree/Direct Bill Members. The SBC shows you how you and the plan would share the cost for covered health care services. A qualifying life event (QLE) is an event that allows you to enroll, or if you are already enrolled, allows you to change your enrollment outside of an Open Season. The SBC shows you how you and the plan would share the cost for covered health care services. Any charges in excess of the benefit, dollar, or supply limits stated in this brochure; Any exams given during your stay in a hospital or other facility for medical care; Eye surgery for the correction of vision, including radial keratotomy, LASIK and similar procedures; Special vision procedures, such as orthoptics, vision therapy or vision training; Vision services or supplies which do not meet professionally accepted standards; Duplicate or spare eyeglasses or lenses or frames for them; Special supplies such as nonprescription sunglasses and subnormal vision aids; Any vision service, treatment or materials not specifically listed as a covered service; Services and materials that are experimental or investigational; Services and materials which are rendered prior to your effective date; Services and materials incurred after the termination date of your coverage unless otherwise indicated; Services and materials not meeting accepted standards of optometric practice; Services and materials resulting from your failure to comply with professionally prescribed treatment; Any charges for failure to keep a scheduled appointment; Any services that are strictly cosmetic in nature including, but not limited to, charges for personalization or characterization of prosthetic appliances; Services or materials provided as a result of intentionally self-inflicted injury or illness; Services or materials provided as a result of injuries suffered while committing or attempting to commit a felony, engaging in an illegal occupation, or participating in a riot, rebellion or insurrection; Charges for copies of your records, charts, or any costs associated with forwarding/mailing copies of your records or charts; State or territorial taxes on vision services performed; Medical treatment of eye disease or injury; Special lens designs or coatings other than those described in this brochure; Two pairs of eyeglasses in lieu of bifocals; Services not performed by licensed personnel; Professional services you receive from immediate relatives or household members, such as a spouse, parent, child, brother or sister, by blood, marriage or adoption. CalPERS is the largest purchaser of public employee health benefits in California, and the second largest public purchaser in the nation after the federal government. The Deductible, Coinsurance, and Out-of-Pocket (OOP) maximums differ among the plans and your medical benefits have no WebIf you sign up for a dental and/or vision plan during the 2022 Open Season, your coverage will begin on January 1, 2023. Covered services or payment for covered services to which enrollees and covered family members are entitled to the extent provided by this brochure. Children include legally adopted children, stepchildren, and pre- adoptive children. All Rights Reserved. It is only a partial, general description of plan or program benefits and does not constitute a contract. Want to work here? WebAbout Your Benefits. Newly-Eligible Employees. Members will receive a discount of 15% off retail or 5% off promotional prices at providers in the US Laser network. If youre in a Medicare Advantage plan, your plan name is listed on your member ID card. It will give you an overview of all the coverage and benefits youll get from your Aetna plan. 4. WebFederal Employees Health Benefits Plans - Aetna - Get the health plan that gets you. WebThe 2022 Resource Guide A listing of telephone and contact information for questions you have on your benefits; Aetna a generic link to all that Aetna as a corporation has to offer; An introduction to CVS How CVS views itself and the post-Aetna-acquisition situation. Do you want to continue? Premium deductions will start with the first full pay period beginning on/after January 1, 2023. Date of Retirement 7. Get advice from registered dietitians with nutrition services. For more information on family member eligibilityvisitthe website atwww.opm.gov/healthcare-insurance/dental-vision/ or contact your employing agency or retirement system. Residents outside of New Jersey, New York, or Pennsylvania should call (800) 535-6689. embers will receive a discount of 15% off retail or 5% off promotional prices at providers in the US Laser network. 1. It also has examples of how much you might pay out of pocket for certain health services. If you live in an area with limited access to a network provider and you receive covered services from an out-of-network provider, we will pay the same benefit level as if you utilized the services of an in-network provider. It explains your benefits. For language services, please call the number on your member ID card and request an operator. If you are enrolled in an FEHB plan, it is important to bring your FEHB identification card to every vision appointment because most FEHB plans offer some level of vision benefits, (includes applications of clear, soft, spherical, daily-wear contact lenses for single-vision prescriptions) - once every calendar year, (Includes the application of toric (astigmatism .62D or higher in the contact lens), multifocal/monovision, post-surgical and gas permeable lenses. October 24 November 11, 2022 Featured updates MDLIVE Get access to virtual mental health visits by phone or video chat through an MDLIVE Board Certified therapist or psychiatrist. Or, members can save $800 and get a free LASIK exam at featured LasikPlus Vision Centers for a limited time. You may enroll in a dental plan or a vision plan, or both. Under circumstances where a sponsor is not an enrollee, a TEI family member may accept responsibility to self-certify as an enrollee and enroll TEI family members, TRICARE-eligible individual (TEI) family member. You may enroll within 60 days after you become eligible as: Your enrollment will be effective the first day of the pay period following the one in which BENEFEDS receives and confirms your enrollment. Skip to main content. Aetna Federal Plans. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. FL, GA, MO, NC, NV, TX: 1-844-374-5217 (TTY: 711), AZ (Non Banner|Aetna): 1-844-374-5217 (TTY: 711), AZ (Banner|Aetna): 1-844-374-5218 (TTY: 711), VA (Non Innovation Health): 1-844-374-5217 (TTY: 711), VA (InnovationHealth): 1-844-374-5219 (TTY: 711), Off exchange (non-HMO): 1-888-802-3862 (TTY: 711), Off exchange (HMO): 1-866-529-2517 (TTY: 711). The maximum benefit payment for services received. Members will receive a discount of 15% off retail or 5% off promotional prices at providers in the US Laser network. If you want to enroll or change your enrollment in this plan, please visit. If you do not intend to leave our site, close this message. Aetna Inc. and itsitsaffiliated companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. the sponsor or primary enrollee leaves active duty. Discounts on non-covered services may not be available through all providers, or in all states. WebCoverage Period: 01/01/2023-12/31/2023 Coverage for: Individual + Family | Plan Type: EPO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The recommended dose for Syfovre is 15 mg (0.1 mL of 150 mg/mL solution) administered by intravitreal injection to each affected eye once every 25 to 60 days. Both the High and Standard vision options include out-of-network benefit coverage. Cancer patients suing Aetna Life Insurance Co. over its coverage of proton beam therapy won initial approval for a class settlement requiring the CVS Health Corp. unit to pay up to $3.4 million.. You are responsible for covered charges up to our negotiated plan allowance. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. ii. In addition, Broward Health will contribute $300 (for Employee Only/Employee & Child coverage) and $600 The following persons are not eligible to enroll in FEDVIP, regardless of FEHB eligibility or receipt of an annuity or portion of an annuity: You must use BENEFEDS to enroll or change enrollment in a FEDVIP plan. The member's benefit plan determines coverage. All SBCs must follow a standard format. Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. NOTE: Contact Lenses, Choose eyeglasslenses or contact lenses every calendar year.You cannot use both benefits within the samecalendar year. This process is also known as prior authorization or prior approval. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Visit www.opm.gov/dental or www.opm.gov/visionfor more information. And Aetna will submit your eligible FSAFEDS out-of-pocket expenses electronically, so you dont have to. If the provider you use is not part of our network, benefits will be considered out-of-network. You can also review your list of covered drugs (if applicable), plan details, video and more, all online. WebCover Page Page numbers referenced within this brochure apply only to the printed brochure Aetna Dental www.aetnafeds.com 1-800-554-2042 2023 IMPORTANT: Rates Changes for 2023 Summary of Benefits A Nationwide Dental PPO Plan You are now being directed to the CVS Health site. Month, 2. Or call us at 1-888-238-6258 (TTY: 711), Monday through Friday, 8 AM6 PM ET. Contact us 1-855-347-6899 for the names of participating. Self Plus One: A Self Plus One enrollment covers you as the enrolled employee or annuitant plus one eligible family member whom you specify. Please refer to Section 4, Your Cost for Covered Services, for the maximum benefit payment for services received in limited access areas or out-of-networkand Section 6, International Services and Supplies, for services received outside the United States or Puerto Rico. You should carry your ID Card with you at all times. This Aetna Vision Plan and all other FEDVIP plans are not a part of the Federal Employees Health Benefits (FEHB) Program. The address for our administrative office is: Aetna VisionFederal Plans PO Box 550 Blue Bell, PA 19422-05501-855-347-6899www.aetnafeds.com. In some cases, due to local regulations or business practices, the doctor may be independent of the retail location. Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). Coverage for a new employee who enrolls in the Plan may begin either the first day of employment, or the first day of the month following the first day of employment. WebYou get the total package: Local, flexible, integrated and affordable benefits. WebAetna benefits and perks, including insurance benefits, retirement benefits, and vacation policy. Active . Children and dependent unmarried persons must be under age 21 if they are not a student, under age 23 if they are a full-time student, or incapable of self-support because of a mental or physical incapacity. The following chart lists the QLEs and the enrollment actions you may take: Qualifying Life Event: MarriageFrom Not Enrolled to Enrolled: YesIncrease Enrollment Type: YesDecrease Enrollment Type: NoCancel: NoChange from One Plan to Another: Yes, Qualifying Life Event: Acquiring an eligible family member (non-spouse)From Not Enrolled to Enrolled: NoIncrease Enrollment Type: YesDecrease Enrollment Type: NoCancel: NoChange from One Plan to Another: No, Qualifying Life Event: Losing a covered family memberFrom Not Enrolled to Enrolled: NoIncrease Enrollment Type: NoDecrease Enrollment Type: YesCancel: NoChange from One Plan to Another: No, Qualifying Life Event: Losing other dental/vision coverage (eligible or covered person)From Not Enrolled to Enrolled: YesIncrease Enrollment Type: YesDecrease Enrollment Type: NoCancel: NoChange from One Plan to Another: No, Qualifying Life Event: Moving out of regional plan's service areaFrom Not Enrolled to Enrolled: NoIncrease Enrollment Type: NoDecrease Enrollment Type: NoCancel: NoChange from One Plan to Another: Yes, Qualifying Life Event: Going on active military duty, non- pay status (enrollee or spouse)From Not Enrolled to Enrolled: NoIncrease Enrollment Type: NoDecrease Enrollment Type: No (enrollee deployment), Yes (spouse deployment)Cancel: YesChange from One Plan to Another: No, Qualifying Life Event: Returning to pay status from active military duty (enrollee or spouse)From Not Enrolled to Enrolled: YesIncrease Enrollment Type: NoDecrease Enrollment Type: NoCancel: NoChange from One Plan to Another: No, Qualifying Life Event: Returning to pay status from Leave without payFrom Not Enrolled to Enrolled: Yes (if enrollment cancelled during LWOP)Increase Enrollment Type: NoDecrease Enrollment Type: NoCancel: NoChange from One Plan to Another: Yes (if enrollment cancelled during LWOP), Qualifying Life Event: Annuity/ compensation restoredFrom Not Enrolled to Enrolled: YesIncrease Enrollment Type: NoDecrease Enrollment Type: NoCancel: NoChange from One Plan to Another: No, Qualifying Life Event: Transferring to an eligible position*From Not Enrolled to Enrolled: NoIncrease Enrollment Type: NoDecrease Enrollment Type: NoCancel: YesChange from One Plan to Another: No. The effective date of these Open Season enrollments and changes will be set by OPM. 1. Some TRICARE beneficiaries may not be eligible to enroll in both. a previously ineligible employee who transferred to a covered position; a survivor annuitant if not already covered under FEDVIP; or. Fraud increases the cost of health care for everyone and increases your Federal Employees Dental and Vision Insurance Program premium. Reprinted with permission. If you require the services of a specialist and one is not available in your area, please contact us for assistance. FEHB Temporary Continuation of Coverage (TCC) enrollees, Anyone receiving an insurable interest annuity who is not also an eligible family member, There is no time limit for a change based on moving from a regional plans service area; and. Retinal imaging (also known as fundus photography) - When available at a participating providers office, members will pay no more than $39 for this service. Life and AD&D Insurance. Or call us at 1-888-238-6258 (TTY: 711), Monday through Friday, 8 AM6 PM ET. Healthy at home The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). WebThe basics about your health coverage Under the Affordable Care Act (ACA), you must receive a Summary of Benefits and Coverage (SBC) document. Up to 40% discount off additional pairs of prescription glasses and sunglasses. WebFederal Employees Health Benefits Plans - Aetna - Get the health plan that gets you. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. The settlement allows 142 patients who were denied coverage for head, neck, or brain cancer between June 2017 and October 2020 to receive individual Heres a snapshot of some of our lesser-known employee benefits, available to all eligible members of our workforceincluding frontline employees in our fulfillment center network. Coverage for a newly -eligible employee, who enrolls in the Plan within 30 days of first Members should discuss any matters related to their coverage or condition with their treating provider. IF: You have medical coverage through FEHB and Aetna's FEDVIP vision planTHEN: Present your FEHB ID card at the time of service as the FEHB plan will pay benefits first, IF: Youhave vision coverage through a non-FEHB plan and Aetna Vision coverage under FEDVIP (covered through a spouse)THEN: Aetna Vision is the primary payor and your non-FEHB plan is secondary. Participating doctorsprovide a comprehensive exam that focuses on your eyes and overall wellness, including dilation as necessary. Understanding vision benefits can be confusing. If you're not a member yet, look up doctors in our provider directory. How to Enroll. In case of a conflict between your plan documents and this information, the plan documents will govern. Children include legally adopted children, stepchildren, and pre-adoptive children. Aetna Vision doctors verify your eligibility, plan coverage and obtain authorization from Aetna Vision. WebFederal Employees Health Benefits Plans - Aetna - Get the health plan that gets you. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.
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