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Aetna Public Employees Plan
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Contact Information

Toll-Free Phone: 1-800-222-9205
TTY/TDD Phone: 1-800-628-3323
Find a Provider
Visit the Plan's Website

Benefit Summary

Annual Costs 2009 Coverage 2010 Coverage

Annual deductible

None

$250/person
$750/family

Annual out-of-pocket maximum

Enrollee pays $750 per person/$1,500 per family

$2,000/person
$6,000/family

Annual prescription drug deductible

Does not apply

Does not apply
Medical Benefits 2009 Coverage 2010 Coverage

Ambulance services

    

(air)

$100 copay per trip

$100/trip

(ground)

$75 copay per trip

$75/trip

Diagnostic tests, laboratory, and X-rays

$10 copay per visit to diagnostic imaging facilities

Covered in full if part of an office visit

Enrollee pays $0 when part of an office visit, otherwise $25

Durable medical equipment, supplies, and prostheses

Enrollee pays 20% coinsurance

20%

Emergency room (copay waived if admitted)

$75 copay per visit

$75

Hearing

    

(routine annual exam)

Covered in full under preventive care benefit; one exam per calendar year

Enrollee pays $0

(hardware)

$800 maximum plan payment every 36 months for hearing aid, and rental/repair combined

Enrollee pays any costs above $800, allowed every 36 months for hearing aid and rental/repair combined

Hospital services

    

(inpatient)

$200 copay per day (maximum $600 per person per calendar year)

$200/day ($600 max/year per person)

(outpatient)

$100 copay for facility fees per surgery or procedure; surgeon, anesthesiologist, etc., covered in full

$100

Mental health care

   

(outpatient)

$10 copay per visit, up to 50 visits per year

$25

Obstetric care

    

(inpatient)

Enrollee pays inpatient hospital copay for mother only

Enrollee pays $200/day ($600 max/year)

(outpatient)

Covered in full after $10 copay for first visit

$25 first visit, then $0

Office visits

$10 copay per visit

$25

Physical, occupational, and speech therapy (per-visit cost for 60 visits/year combined)

Inpatient
Does not include massage therapy (see massage therapy benefit)

Includes neurodevelopmental therapy

Enrollee pays inpatient hospital copay

Outpatient
$10 copay per visit, up to 60 visits per calendar year

 

$25

Prescriptions

    

tier 1 (retail pharmacy, 30-day supply)

$10 copay (generic)

$20

tier 2 (retail pharmacy, 30-day supply)

$25 copay (preferred brand)

$40

tier 3 (retail pharmacy, 30-day supply)

$40 copay (nonpreferred brand)

Enrollees pay more for Tier 3 drugs that have a generic equivalent. The plan pays as if the enrollee purchased the generic; the enrollee pays the rest

$60

tier 1 (mail order, 90-day supply)

$20 copay

$40

tier 2 (mail order, 90-day supply)

$50 copay

$80

tier 3 (mail order, 90-day supply)

$80 copay

Enrollees pay more for Tier 3 drugs that have a generic equivalent. The plan pays as if the enrollee purchased the generic; the enrollee pays the rest

$120

Preventive care

Covered in full

Enrollee pays $0

(See Certificate of Coverage or check with plan for full list of services)

Spinal manipulations (per-visit cost for 10 visits/year)

$10 copay per visit, up to 10 visits per year

$25

Vision care

    

(annual exam)

$10 copay per exam; one annual eye exam

$25

(glasses and contact lenses)

$150 maximum plan payment every 24 calendar months for frames, lenses, contacts, and fitting fees combined

Enrollee pays any costs above $150 every 24 months for frames, lenses, contacts, and fitting fees combined