Medical Plan Information
Aetna and Inova have formed a unique partnership to offer your medical plan, which includes programs and resources that can help you lead a healthier life and become a more informed health care consumer.
Here are a few basic things to remember about your medical plan:
A provider network of about 1.2 million health care professionals and more than 5,700 hospitals* throughout the U.S.
Not having to choose a PCP, nor do you need referrals to visit specialists.
Aetna Institutes of Excellence and Institutes of Quality are part of the provider network.
The Aetna Institutes are a network of high-performing hospitals, clinics and health care facilities that offer specialized care. These institutes focus on bariatric, cardiac and orthopedic surgeries, as well as on transplant support and infertility services.
*Information as of July 30, 2020.
Aetna Institutes of Excellence help patients who are facing a transplant or going through treatment for infertility. To be selected, a health care facility must meet quality criteria for:
- Number of procedures
- Success rates
- Cost-effective care
- How often patients return to the hospital
- Rates of complications
Aetna Institutes of Quality provide bariatric, cardiac and orthopedic procedures. We select hospitals that meet certain standards of quality and cost efficiency. We measure many factors, such as:
- How satisfied patients are
- Level of care
- How often people return to the hospital after surgery
To see a list of facilities and specialists, visit the provider search tool and follow the prompts to enter your search criteria.
In addition, you can access online tools that will help you learn about the quality of your providers, compare costs, see what you'll pay before you get care and much more.
All of your health benefits and health insurance plan information and cost-savings tools are in one place — your member website, formerly known as Aetna Navigator. Once you register, you'll be able to find quality care, see a cost estimate of what you'll pay before you go to the doctor or hospital, learn about your plan's coverage details, get an ID card, access wellness programs and much more. Register or log in to your member website now.
If you want help using the cost of care tools or any of the resources available on your member website, watch this video.
Member Payment Estimator tells you what you may owe for a certain doctor, hospital, test or procedure. You can use it to compare costs* between up to 10 health care providers at once. You'll avoid surprises. And you'll save money.
Once you log in to your member website the tool knows your plan details like copays and deductibles. It knows if the doctor or hospital you want to use is in the network. It then gives you an estimate of what you and your plan would pay at that moment in time for that service.
Click on the sections below to learn more about the medcial programs and tools available to you.
Your Medical Plan Resources
Sometimes your health question can't wait; take advantage of these tools and resources that are available.
Questions and answers to general medical questions and more information on your medical plan.
Included Medical Programs & Tools
Highlights of your medical plan include:
- Preventive care for checkups, screenings, vaccines, prenatal care and more* are covered at 100% when provided in network.
- Other in-network services are covered at 90% of the plan allowance. The remaining 10% is the coinsurance amount for which you are responsible, after deductible.
- You may receive treatment from out-of-network providers, but you will pay more for such care. Find out more about the cost of care by using the resources and tools in your secure member website.
- Vision benefits are provided through Aetna VisionSM Preferred.
Prescription drug benefits are provided through CVS Caremark.
*A full list of preventive services is available at https://www.healthcare.gov/what-are-my-preventive-care-benefits/.
New to the plan and your doctor not in the network? Already getting treatment?
It’s rare, but it can happen. That’s why we include the Transition of Care provisions with the plan. If you are a new plan entrant and already in an active course of treatment through a doctor who’s not in your new plan’s network, you may be able to continue seeing that doctor at in-network rates for an additional 90 days after the plan begins. That will give you enough time to finish your treatment or find a new doctor in the network.
Examples of those who qualify for Transition of Care:
- Pregnant women in the 2nd or 3rd trimester or newly delivered mothers
- Cancer patients receiving chemotherapy
- Those receiving kidney dialysis
To find out more about the Transition of Care process, please call Member Services at 1-888-236-6249.
Ask your doctor to join the network
You can nominate your doctor to join the network:
- Just call Member Services at 1-888-236-6249 and speak to a representative.
- Or, have your doctor call 1-888-632-3862 to begin the application process.
The Aetna In Touch Care℠ program offers you personalized one-on-one nurse support when you need it most.
Our clinical nurse team will reach out to assist you and your family. We can help with everything from health questions to medical referrals. And our predictive technology will detect issues early. That way we not only support you today, but help you prepare for tomorrow.
- One-on-one phone calls with a trusted family nurse
- Digital personal health record, health decision support and wellness videos
- Customized health action plans based on your needs and preferences
If you would like to self-refer or just have questions about the program, please call 1-877-243-2752, 8 a.m. to 6 p.m. ET. or log in to your member website to get started. a.m. to 7 p.m. ET.
Innovation Health Multi-Disciplinary Care Team
If you are at high risk for potential health issues, the Multi-Disciplinary Care Team can help you manage chronic conditions and get you the support needed to lower your risks for certain diseases. Meeting with you in person, the team is able to identify your needs and in collaboration with your primary care physician, create and individualized care plan.
Have questions or would like to self-refer? Just call 1-888-236-6249, 8 a.m. to 5 p.m. ET.
Find a Doctor
Search the network for doctors, hospitals and other health care providers
Going in network makes better sense!
We know you value your options; that’s why we give you choices. But, when you use network doctors and hospitals, you’ll have the added advantage of affordable, patient-centered quality health care. And, your out-of-pocket share of the costs is lower when you use network doctors.
Find out if your doctor is in the network
Before you enroll, visit the provider search tool and follow the prompts to enter your search criteria.
The provider search tool lists all the doctors, specialists, hospitals, labs and other health care providers that participate your new plan’s network. The provider search tool is also more than just a list of doctors. With a simple click, you can also get driving directions and find information about doctors such as:
- Office locations
- Medical school attended
- Board certification
- Languages spoken
The provider search tool is updated every day so you have always have the latest information on participating doctors and facilities.
Doctor not in the network? See if you qualify by clicking on the Transition of Care tab of this page.