MMC Benefits Handbook
Networks
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.
Network provider lists can change, so take the time to review the networks to determine which networks your health care providers participate in before choosing a carrier and network.
Finding your ZIP code in the provider search does not mean that you are eligible for a narrow network; you must confirm you're eligible for a narrow network in the Mercer Marketplace Benefits Enrollment Website. Aetna determines the ZIP codes that are included within their narrow network.
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 under 2021 Plan Providers, select Aetna Premier Care Network (APCN) Choice POS II/ Open Access Managed Choice 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 may use a pharmacy in the network as well as out-of-network to receive coverage under this Plan.
Note that when you go to a pharmacy that's out-of-network, you need to submit a claim form for reimbursement. Refer to "How do I file a prescription drug claim form?" in the Filing a Claim section for more information.
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:
Or call Express Scripts at +1 800 987 8360 for more information.