Aetna Saver Plan
A low cost, easy to use plan
2025 Biweekly rates for zip code 20002
These rates do not apply to all Enrollees. If you are in a special enrollment category, please refer to the PSHB Program website or contact the agency which maintains your health benefits enrollment.
| Open Access® HMO - High Option | Code | Biweekly Premium |
|---|---|---|
| Self Only: | HXD | $69.06 |
| Self +1: | HXF | $145.14 |
| Self & Family: | HXE | $158.05 |
Your 2025 benefits
| Plan Details - In network only | You Pay |
|---|---|
| Preventive care | $0 |
| Routine Physical | $0 (one per calendar year) |
| Deductible | $1,000 (self only)/$2,000(self plus one or self and family) |
| Primary care visit | 30% after deductible |
| Specialist visit | 30% after deductible |
| CVS Health® Virtual Care™ | $55 until the deductible is met; $0 after deductible for general medical |
| MinuteClinic® or Walk In clinic | $0 |
| Maternity | 30% after deductible |
| Prenatal Care | $0 |
| Hospital Care | 30% after deductible |
| Inpatient hospital | 30% after deductible |
| Outpatient surgery | 30% after deductible |
| Emergency room | 30% after deductible |
| Urgent care center | 30% after deductible |
| Lab/X-ray/diagnostic services | 30% after deductible |
| Prescription drugs
(for a 30-day supply at a retail pharmacy) See AetnaFedsPostal.com/pharmacy for participating pharmacies. | After deductible |
| Preferred Generic drugs | $10 |
| Preferred Brand-name drugs | 50% |
Your plan requires the use of generic medication when a generic equivalent exists. |
|
Aetna Medicare Rx offered by SilverScript® for eligible Medicare members
Members with Medicare Part A and/or Parts B primary will be automatically enrolled into the Aetna Saver Plan with Aetna Medicare Rx offered by SilverScript. This is a Medicare Part D prescription drug plan option offering significant savings in prescriptions costs. See benefits below.Aetna Saver Plan with Aetna Medicare Rx offered by SilverScript benefits
| Retail pharmacy (30-day supply of a covered drug) with Aetna Medicare Rx offered by SilverScript |
Preferred Generic: $0 Generic: Preferred $5; Standard $6 Preferred Brand: $45 Non-Preferred Brand: $100 Specialty: 25%; max $600 |
|---|---|
| Mail order pharmacy or CVS Pharmacy® (90-day supply of a covered drug) with Aetna Medicare Rx offered by SilverScript. See AetnaFedsPostal.com/pharmacy for a listing of all participating pharmacies. | Preferred Generic: $0 Generic: Preferred $10; Standard $12 Preferred Brand: $90 Non-Preferred Brand: $200 Specialty: Limited to one month supply |
| Out of Pocket Maximum for prescription drugs | Once you pay $2,000 in out of pocket costs for covered prescription drugs, you will pay $0 for covered prescription drugs for the remainder of the calendar year. This $2,000 will also apply to the medical plan’s total calendar year out-of-pocket maximum. |
You might save by using mail order or CVS Pharmacy. You'll pay only two copay amounts for a 90-day supply.
2025 Aetna Saver Plan PSHBP Formularies
Download 2025 PSHB plan summary for Aetna Saver Plan with Aetna Medicare Rx offered by SilverScript (PDF)
Download 2025 PSHB Prescription Drug Formulary for Aetna Saver Plan with Aetna Medicare Rx offered by SilverScript (PDF)
Download 2025 PSHB Evidence of Coverage for Aetna Saver Plan with Aetna Medicare Rx offered by SilverScript (PDF)
Download 2025 PSHB Prescription Drug Supplemental Benefit (PDF)
Aetna Medicare Rx Resources and Contact Information
Call Members Services at 1-833-251-9749 (TTY: 711), Monday through Friday, 8 AM to 8 PM ET or go online at AetnaRetireeHealth.com/PSHBP
Why choose the Aetna Saver plan?
- Large nationwide Aetna Network
- 24 hour / 7 days a week access to doctors with CVS Health Virtual Care
- No referrals to network specialists
- Discounts on eyewear, LASIK laser eye surgery, gym memberships, massage, acupuncture, weight-loss programs and more
Aetna and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies.
This is a brief description of the features of this Aetna health benefits plan. Before making a decision, please read the Plan's official brochure(s). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. CVS Virtual Care™ services are only available in the USA. Limitations may apply based on services and location.
For a complete list of other participating pharmacies log in to your member website to use our provider search tool. Includes select MinuteClinic services. Not all MinuteClinic services are covered. Please consult benefit documents to confirm which services are included. This benefit is not available in all states. For your best health, we encourage you to have a relationship with a primary care physician or other doctor. Tell them about your visit to MinuteClinic, or MinuteClinic can send a summary of your visit directly to them. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services.
DISCOUNT OFFERS ARE NOT INSURANCE. They are not benefits under your insurance plan. You get access to discounts off the regular charge on products and services offered by third-party vendors and providers. Aetna makes no payment to the third parties — you are responsible for the full cost. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts. Discount vendors and providers are not agents of Aetna and are solely responsible for the products and services they provide. Discount offers are not guaranteed and may be ended at any time. Aetna may get a fee when you buy these discounted products and services. Vision care providers are contracted through EyeMed Vision Care. LASIK surgery discounts are offered by the U.S. Laser Network and Qualsight. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services.
Pharmacy clinical programs such as precertification, step therapy, and quantity limits may apply to your prescription drug coverage. Aetna's Drug Guide is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change.