Video Transcript
Aetna Anne Arundel County Government Education Session
Voiceover:
Hello, and welcome to Aetna's virtual education session for Anne Arundel County Government Employees and Non-Medicare Eligible Retirees. During this presentation, we will be reviewing your network, the pre-certification process, going over some member tools and your microsite, reviewing plan highlights, and additional benefits, as well as going over your resources and contacts.
Voiceover:
The two medical plans that went into effect on January 1st, 2022 were the Open Access Aetna Select HMO-EPO plan and the Aetna Open Choice PPO plan. As a reminder, this did not affect your prescription drug coverage, which continues to be provided by CVS Caremark. If you have any pharmacy related questions, please make sure to contact CVS Caremark at 1-866-409-8521.
Voiceover:
Let's talk about how you can check to see if your providers are in the Aetna network. We have a custom provider search tool that you may access at aacounty.aetna.com. Using this tool, you can check both the HMO-EPO plan and/or the PPO plan to see if the doctors, hospitals, and other healthcare providers you currently use are in network on each plan. In the tool, you can search using a doctor facility's name, by a city, state, or zip code convenient to you, specialty, common procedure type, or by a specific condition.
Voiceover:
If your provider is not currently in network, we encourage you to submit a network request to us at annarenetworkrequests@aetna.com. This includes all provider types, such as facilities, primary care physicians and specialists. Please make sure to include the complete name, address, and phone number of the provider. Contact your provider as well to request that they join the Aetna network.
Voiceover:
Once we receive a request to the Anne Arundel network request mailbox, we will reach out to the provider listed in the request. The provider will have a few steps to go through in order to join the Aetna network. The provider completes an application on the Aetna website. Once Aetna receives the application, Aetna will send a contract to the provider. The provider will then return the signed contract to Aetna. The final step is credentialing, which entails an internal verification of the provider's licenses, certificates, background. This takes about 60 to 90 days to complete.
Voiceover:
Next, we will discuss the pre-certification process. Some procedures and services require pre-certification or pre-authorization. Participating providers are responsible for requesting pre-certification on your behalf, and will handle the process directly with Aetna. To provide some insight, providers may submit these requests in the following ways: they can enter the request electronically through the physician portal, call directly to Aetna, or fax in the request. All requests are issued a reference number at the time of submission. If Aetna requires clinical information to make a medical necessity determination, the provider can submit the requested clinical information electronically or via fax. Please know that Aetna does not penalize you as the member when your doctor fails to pre-certify.
Voiceover:
For certain pre-certifications, Aetna has contracted with eviCore healthcare, a specialty medical benefits management company to administer them. These include diagnostic cardiac, sleep management, and cardiac implantable devices, or pacemaker. Providers are able to obtain realtime authorizations by either entering the request electronically through the eviCore portal, calling eviCore directly, or faxing in the request. Once the request is received, eviCore reviews the request and makes a decision. We have streamlined the pre-certification process for high tech, radiology and interventional pain management. Prior authorization is not required for these services, but they would still need to meet medical necessity requirements.
Voiceover:
As an Aetna member, you have access to personalized member tools, one of which is your personal Aetna member website. This site is a central location for you to access information on your medical plan. You can view your health plan summary, view the status of and manage your claims, search for providers and procedures, get cost estimates prior to receiving a service, track your progress toward your annual deductible and out-of-pocket maximum, access a digital copy of your ID card, as well as get recommended health actions based off of your profile. If you have not yet registered, all you need to do is to go to www.aetna.com. Click register now, and follow the prompts to complete the registration process, using the information printed on your Aetna ID card.
Voiceover:
In addition to the Aetna member website, you also have access to the Aetna Health app. This allows you to view all of the same personalized information about your plan as the Aetna member website, but right in the palm of your hand, wherever you are. You can either register for the first time directly through the app, or use the same login information as your Aetna member website if you register there first, or vice versa.
Voiceover:
Let's review some plan highlights from the two plans that went into effect on January 1st, 2022. The first plan is the Open Access Aetna Select HMO-EPO plan. This plan is an in-network only plan, which means that these benefits apply only when you visit an in-network provider or facility for services. However, this plan does give you access to our national network of providers. So you're not limited to stay within Maryland.
Voiceover:
There is a very low deductible, only $100 if you enroll as an individual, or $200 if you were also enrolling dependence on your plan. As a reminder, a deductible is the amount you need to pay out of your pocket first, during a plan year before the plan begins to pay claims. The deductible and any other payments you make out of your own pocket will count towards your annual out-of-pocket maximum, $1,100 for individuals or $3,600 for families. In other words, once you have paid that amount out of your own pocket, we will take care of paying the rest of your claims for the remainder of the plan year.
Voiceover:
Office visits with your primary care physician or specialists are both only a $15 copay. This copay, however, does not apply to any preventive care visits. All preventive care visits are covered at 100%, and your deductible is also waived. Inpatient hospital visits are covered at 100% after you have met your deductible. Visits to an urgent care facility are a $35 copay, and emergency visits are a $75 copay. If you need lab work or x-rays, they're covered at 100% deductible waived. As a note, this is a plan enhancement from your original benefits. This benefit enhancement is retroactive to January 1st, 2022. Finally, any chiropractic or short-term rehabilitation services are only a $15 copay. Please note that on this plan, short-term rehabilitation is limited to 150 visits per year.
Voiceover:
The second plan is the Aetna Open Choice PPO plan. This plan provides you with both in and out-of-network benefits. Here, you can see a side-by-side comparison of the in-network versus out-of-network coverage you will get under this plan. You'll notice that utilizing in-network providers will result in the lowest cost to you. At the in-network level, you have either a $125 individual or $250 family deductible. You're out-of-pocket maximum is also only $500 on an individual plan or $1,000 on a family plan. Office visits with your primary care physician remain at a $15 copay, similar to the HMO-EPO plan, and specialists are just a little bit more at $35 per visit.
Voiceover:
If you need an inpatient hospital care, you'll be responsible for 5% of the total allowable charge after meeting your deductible. Urgent care is a $35 co-pay, and should you need to go to the emergency room, that's $75. Just like in the HMO-EPO plan, ambulatory services are covered at 100% percent, and your deductible is waived on this PPO plan. Both chiropractic and short-term rehabilitation are $35 per visit. On this plan, you do get a higher visit limit with short-term rehabilitation at 300 visits per year.
Voiceover:
If you find yourself in a situation where you need to see an out-of-network provider, the Aetna Open Choice PPO plan offers you the flexibility to do so with considerable coverage. Your deductible still remains relatively low at $500 for individual plans and $1,000 for family plans. Your annual out-of-pocket maximum for individual and family plans is $1,500 and $3,000 respectively. Please note that both your out-of-network deductible and out-of-pocket maximum are separate from your in-network deductible and out-of-pocket maximum.
Voiceover:
The rest of your out-of-network benefits mainly function on a coinsurance basis. As you can see on this chart, office visits with your primary care physician and specialists, including any preventive care visits, inpatient hospital care, chiropractic visits, and short-term rehabilitation are a 30% coinsurance after you meet your out-of-network deductible. This means that you would be responsible for 30% of the allowable charge of each visit or service received. However, visits to an urgent care facility or emergency room remain the same as your in-network benefit level at $35 and $75 respectively.
Voiceover:
As an Aetna member, you have access to a number of additional benefits outside of the benefits you will already receive in your medical plan. At Aetna, we recognize the importance of having options for accessing care. This is why we have made sure to include Teladoc as an available telemedicine service to you. With Teladoc, you can connect with board-certified doctors, therapists, and specialists, wherever you are by phone or by video. For the same cost to seeing your primary care physician or PCP, everyday care is available 24/7 to help diagnose and treat non-emergency conditions, including the flu, sinus infections, and sore throats just to name a few. You can also talk to a therapist seven days a week between 7:00 AM and 9:00 PM local time, also for the same cost as seeing your PCP. If you have a skin concern, you can connect with the dermatologist at the same cost as your specialist copay. By uploading images of a skin issue, you will be able to get a custom treatment plan within two days for conditions, including eczema, acne, rashes, and more.
Voiceover:
Want even more options for care? As an Aetna member, you can get low cost or no cost care at CVS MinuteClinics when you need, including nights and weekends. MinuteClinics are located inside select CVS Pharmacy and Target locations. It's a great option for anyone seeking to treat a variety of illnesses, injuries, and conditions such as allergies, ear infections, flu-like symptoms, bug bites or stings, and more. When medically appropriate, MinuteClinic providers can also administer vaccines and write prescriptions.
Voiceover:
This brings us to the end of the presentation. Should you have any questions, you may refer to the following resources and contacts available to you. If you have questions about specific medical benefits or determining if your current doctors are in-network with either plan, you may call your dedicated Aetna member services line at 1-855-222-2774. You may also access plan information and use the provider search tool on the Aetna Anne Arundel County microsite at aacounty.aetna.com. For any questions regarding eligibility, who you are covering on your plan, and any other general benefits questions, please contact the Anne Arundel County benefits team. If you have any pharmacy related questions, please remember to contact CVS Caremark at 1-866-409-8521. To submit a request for a provider to join the Aetna network, email annearundelnetworkrequests@aetna.com.
Voiceover:
Thank you so much for joining this presentation today and for making us a part of your health journey.
