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Aetna Public Employees Plan

Contact Information

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

Benefits Summary

Annual Costs 2012 Coverage
  Member Pays

Deductible

 

Out-of-pocket maximum

 

Prescription drug deductible

 
Medical Benefits 2012 Coverage
  Member Pays

Ambulance

 

Per trip, air

 

Per trip, ground

 

Diagnostic tests, laboratory, and x-rays

 

Durable medical equipment, supplies, and prostheses

 

Emergency room (Copay waived if admitted)

 

Hearing

 

Hardware

 

Routine annual exam

 

Home health

 

Hospital services

 

Inpatient

 

Outpatient

 

Mental health care

 

Outpatient

 

Obstetric care

 

Inpatient

 

Outpatient

 

Office visit

 

Chemotherapy

 

Mental health

 

Primary care

 

Radiation

 

Specialist

 

Urgent care

 

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

 

Prescription drugs

 

Mail order (up to a 90-day supply) Value tier

 

Mail order (up to a 90-day supply) Tier 1

 

Mail order (up to a 90-day supply) Tier 2

 

Mail order (up to a 90-day supply) Tier 3

 

Retail pharmacy (up to a 30-day supply) Value tier

 

Retail pharmacy (up to a 30-day supply) Tier 1

 

Retail pharmacy (up to a 30-day supply) Tier 2

 

Retail pharmacy (up to a 30-day supply) Tier 3

 

Preventive care

 

Spinal manipulations

 

Vision care

 

Exam (annual)

 

Glasses and contact lenses