Benefits Handbook

Aetna Choice POSII Broad network is available nationally. Aetna Premier Care Network (APCN) Narrow network is available in select geographies.

Using the network is not mandatory, except in instances of infertility care, 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 $3,300 Deductible Plan). If you use an out-of-network provider, you will be reimbursed 60% (50% under the $3,300 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.

There is a specialty network of providers specific to infertility treatments and services, through WINFertility ("WIN"). Please refer to the "Is there a network of providers for infertility-related treatment?" question for information on finding and utilizing in-network providers for infertility treatment and services.

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 third party administrator and network.

Important: In-network participating providers can change at any time; therefore, the network information you gather may not be accurate for all or part of the plan year. You will NOT be permitted to change your medical plan election during the plan year, even if any or all of your providers stop participating in any network at any point during the plan year.

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 Aptia365 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:

Note: If you want to enroll in a narrow network, be sure to check that your providers participate in the narrow network. You can do this by following the instructions above. Please note that if you're enrolled in a broad network and want to switch to a narrow network, you should follow the instructions for searching for narrow network participating providers. Important: If you're currently enrolled in a broad network, DO NOT log into your Aetna medical plan account to look for narrow network providers. If you do log into your Aetna medical plan account, you'll see only providers who participate in the Aetna broad network. You should follow the instructions above to check for Aetna narrow network providers.

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.

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 third party administrator and network.

Important: In-network participating providers can change at any time; therefore, the network information you gather may not be accurate for all or part of the plan year. You will NOT be permitted to change your medical plan election during the plan year, even if any or all of your providers stop participating in any network at any point during the plan year.

There is a network of providers under WINFertility ("WIN's") network focused on infertility related treatments. WIN is a specialty infertility network.

Providers in the WIN network can be found at https://managed.winfertility.com/mmc-2 or by downloading the WINFamily app.

Note: Only providers who are participating in WIN's network are covered. There is no coverage if you use an out-of-network provider for infertility-related treatments.

There is a pharmacy network associated with this Plan with CVS Caremark®. 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 Prescription Drug Benefits Manager, with CVS Caremark®, provides an online directory of network pharmacies available at www.caremark.com.

To locate an in-network retail pharmacy:

Or call CVS Caremark® at +1 844 449 0362 for more information.

Yes. WIN's pharmacy network will provide all prescription drugs related to infertility treatments.

There is NO out-of-network infertility-related prescription drug coverage under the WINFertility program.

To locate an in-network pharmacy for your infertility prescriptions:

All of the pharmacies listed can mail the infertility prescriptions to your home, but there are retail pick-up options available in many areas as well.

Once your prescription order has been received by WIN, in the Review Rx screen, the "Select Best Pharmacy for Selected Drugs" tool will help identify the pharmacy closest to you (when retail pick-up is available) and match you with the best priced in-network pharmacy that has the infertility medications in your order in stock.

Your WIN Nurse Care Advocate will discuss the prescription process with you, as well as any preferred formulary drugs and treatment authorizations needed prior to processing any associated prescriptions. Your WIN Nurse Care Advocate also has access to the "Select Best Pharmacy for Selected Drugs" tool to help you find the closest pharmacy to you (when retail pick-up is available) with the best prices for your prescription.

Download the WINFamily App on the App store or Google Play using app code: MMC18 to view and manage your prescriptions directly in the app, including a cost-estimator tool to help you locate where the medications can be dispensed at the lowest price.