 Aetna
Health Maintenance Organization (HMO)
With Aetna HMO, you work one on one with your primary
care physician (PCP), which can really help you and your PCP
better understand
your health care needs. You get a large network of doctors and
hospitals to choose from, and there are never any claim forms
to file.
When you enroll in Aetna HMO, you select a PCP for yourself
and each covered family member. Your PCP provides your routine
and
preventive care or treatment for illnesses and injuries, refers
you to specialists and obtains precertification when
needed, and files your claims for you. Benefits are paid only
when your PCP provides or refers your care (except for certain
emergency care services). If you seek care on your own, you
pay the entire cost.
To find providers, visit Aetna’s online
provider directory, DocFind®.
When prompted, select Aetna Standard Plans as your plan
category and HMO as your plan.
Aetna HMO Plan Highlights
Feature
|
Aetna HMO
|
Deductible
|
None
|
Annual out-of-pocket
maximum
|
None
|
PCP
|
Required
|
Referrals for specialty care
|
Required
|
Preventive care
|
Covered at 100% after $20 PCP/$30
specialist
copay
|
Office visit
|
Covered at 100% after $20 PCP/$30
specialist copay
|
Hospitalization
Inpatient
Outpatient
|
Covered at 100% after $350 copay
Covered at 100%
|
Emergency room
|
Covered at 100% after $100 copay
|
Urgent care
|
Covered at 100% after $100 copay
|
For additional information, please review the Aetna
HMO benefit summary
or visit Aetna.
|
