MMC Benefits Handbook
Aetna Choice POSII Broad network is available nationally. Aetna Premier Care Network (APCN) Narrow network is available in select geographies.
Is there a network of doctors and hospitals that I have to use?
Using the network is not mandatory, but generally, you will receive a higher reimbursement when using the network. If you use an in-network provider, you will be reimbursed 80% (70% under the $2,850 Deductible Plan). If you use an out-of-network provider, you will be reimbursed 60% (50% under the $2,850 Deductible Plan) of reasonable and customary charges for covered expenses after the Plan's deductible has been met.
In the event that you receive care from an out-of-network doctor (such as an anesthesiologist) while being treated at an in-network facility, benefits will be paid at the in-network level.
The network includes general practitioners, as well as specialists and hospitals. These network providers are selected by and contracted with the Claims Administrator.
Where can I get a directory that lists all the doctors and hospitals in the network?
The doctors and hospitals in the network are listed in a provider directory. The Claims Administrator provides an online directory of providers or you may call the Claims Administrator.
Call Member Services at +1 866 210 7858 or visit aetna.com. On the Aetna website:
- Select Find a doctor. Under Guests, select Plan from an employer.
- Under Continue as a guest, enter ZIP Code, City or State. Specify your preferred distance range and select Search.
- For the Narrow Network: Under Select a Plan, scroll down to Aetna Premier Care Network and check 2020 Aetna Premier Care Network (APCN) Choice POS II and select Continue.
- For the Broad Network: Under Select a Plan, scroll down to Aetna Open Access Plans and check Aetna Choice POS II (Open Access) and select Continue.
- Enter the provider's name or specialty—or search by category.
Is there a network of providers for mental health treatment?
There is a network of mental health providers. Providers in the network are listed in a provider directory. The Claims Administrator provides an online directory available at www.aetna.com. You may also call the Claims Administrator.
Is there a network of pharmacies?
There is a pharmacy network associated with this Plan. You must use a pharmacy in the network to receive coverage under this Plan.
The Pharmacy Benefits Manager provides an online directory of network pharmacies available at http://www.express-scripts.com/.
To locate an in-network retail pharmacy:
- Go to express-scripts.com.
- Login or create an account.
- Find a pharmacy.
Or call Express Scripts at +1 800 987 8360 for more information.