Aetna Open Access® Plan
National network of doctors, predictable costs, no referrals
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.
| Aetna Open Access® HMO Plan | Code | Biweekly Premium |
|---|---|---|
| Self Only: | G8D | $109.14 |
| Self +1: | G8F | $212.14 |
| Self & Family: | G8E | $231.52 |
Your 2025 benefits - DC, MD, Northern VA
| Plan Details | Basic Option (YOU PAY) | |
|---|---|---|
| Preventive care copay | $0 | |
| Primary care visit copay | $25 | |
| Specialist visit copay | $55 | |
| CVS Virtual Care | $0 | |
| MinuteClinic® or Walk in Clinic | $0 | |
| Prenatal Care | $0 | |
| Inpatient hospital care | 20% of the plan allowance | |
| Outpatient facility copay | $350 | |
| Emergency room copay | $200 | |
| Urgent care center copay | $50 | |
| Lab/X-ray/diagnostic services | $25 PCP / $55 specialist ($100 for certain tests) | |
| Prescription drug copays
(for a 30-day supply at a retail pharmacy) See AetnaFedsPostal.com/Pharmacy for a list of participating pharmacies. |
||
| Preferred Generic formulary* | $10 | |
| Preferred Brand-name formulary* | 50% up to $200 maximum | |
| Non-preferred (generic or brand name)* | 50% up to $300 maximum | |
Your plan requires the use of generic medication when a generic equivalent exists.**Get a 90-day supply for $20 for preferred generic drugs, 50% up to $400 max for preferred brand name drugs, 50% up to $600 max for non-preferred (generic or brand name) drugs through our mail order drug program or at a participating retail pharmacy. |
||
| Aetna Medicare Rx offered by SilverScript® for eligible Medicare members | ||
Members with Medicare Part A and/or Parts primary will be automatically enrolled into the Open Access plan with Aetna Medicare Rx offered by SilverScript. With this Part D prescription drug plan option, it could mean significant savings in prescriptions costs. Your drugs will still be covered, but copays and coinsurance are lower. See benefits section below for more information. |
||
| Built-in Vision | ||
| Routine eye exam copay | $55 | |
| Money toward prescription eyewear | You get $100 every 24 months | |
| Discounts on eyeglasses, contacts, eye exams and more | Included | |
Built-in dental, too
Use our Advantage Dental Network. Call 800-537-9384 (TTY:711) to select a dentist OR to switch to our larger PPO network at no additional cost. It's your choice!
Basic - Pay a $5 copay for cleanings, fillings and X-rays when you visit your primary care dentist (PCD).
PPO - After a $20 deductible per member, cleanings, fillings, and X-rays are covered at 100% with network dentists.***
Open Access Basic Option 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 $4; Standard $5 Preferred Brand: $40 Non-Preferred Brand: $100 Specialty: 25%; max $150 |
|---|---|
| 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 $8; Standard $10 Preferred Brand: $80 Non-Preferred Brand: $200 Specialty: Limited to one month supply |
| Out of Pocket Maximum for prescription drugs | Once you have paid $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 under this Medicare Part D Prescription Drug Plan. 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 Open Access HMO Basic Option PSHBP Formularies
Download 2025 PSHB plan summary for Open Access HMO Basic option with Aetna Medicare Rx offered by SilverScript (PDF)
Download 2025 PSHB Prescription Drug Formulary for Open Access HMO Basic option with Aetna Medicare Rx offered by SilverScript (PDF)
Download 2025 PSHB Evidence of Coverage for Open Access HMO Basic option 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
For more information and benefits for Open Access High Option members, see: Aetna Medicare Rx offered by SilverScript plan details page
Why choose the Aetna Open Access plan?
- Large nationwide Aetna Network
- 24 hours a day / 7 days a week access to doctors via video with CVS Health Virtual Care
- Built-in dental and vision coverage
- Predictable costs
- No referrals to network specialists
- Discounts on eyewear, LASIK laser eye surgery, gym memberships, massage, acupuncture, weight-loss programs and more
*A formulary is a list of generic and brand-name drugs your health plan prefers.
** If you choose the brand name drug over the generic equivalent, you will owe the corresponding copay plus the difference between the generic and brand name costs. Please see the plan brochure for details.
*** Out of Network for cleanings, composite fillings and X-rays – you pay 50% of negotiated rate plus any difference between our allowance and the billed amount.
†Teladoc® is covered at the member cost share.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).
This is a brief description of the features of this Aetna health benefits plan. Before making a decision, please read the Plan's applicable Federal brochure(s). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. Teladoc® is not available to all members. Teladoc and Teladoc physicians are independent contractors and are not agents of Aetna. Visit Teladoc.com/Aetna for a complete description of the limitations of Teladoc services. Teladoc, Teladoc Health and the Teladoc Health logo are registered trademarks of Teladoc Health, Inc. 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.
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.