Aetna Value Plan
National PPO network, wellness credits, low rates and 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 Value Plan | Code | Biweekly Premium |
|---|---|---|
| Self Only: | L7D | $374.12 |
| Self +1: | L7F | $863.77 |
| Self & Family: | L7E | $838.89 |
Your 2025 benefits
| Plan Details | What you pay In the network |
What you pay Out of network |
|---|---|---|
| Yearly Deductible | $700 Self Only $1,400 Self Plus One or Family |
$1,400 Self Only $2,800 Self Plus One or Family |
| Preventive Care | $0
(no deductible) |
50% (after deductible) |
| Primary care visit | $25 (no deductible) |
50% (after deductible) |
| Specialist visit | $40 (no deductible) |
50% (after deductible) |
| CVS Health® Virtual Care™ | $0 (no deductible) |
|
| MinuteClinic® | $0 (no deductible) |
50% (after deductible) |
| Maternity | 20% (after deductible) |
50% (after deductible) |
| Prenatal Care | $0 (no deductible) |
50% (after deductible) |
| Hospital Care | 20% (after deductible) |
50% (after deductible) |
| Other services
(Like inpatient and outpatient hospital procedures) |
20% (after deductible) |
50% (after deductible) |
Aetna Value Plan prescription drug benefits when Medicare is not primary
See AetnaFedsPostal.com/pharmacy for participating pharmacies.| Prescription drugs
(for a 30-day supply at a retail pharmacy) |
What you pay In the network |
What you pay Out of network |
|---|---|---|
| Preferred Generic* | $10 (no deductible) |
50%** |
| Preferred Brand-name*** | 30% up to $600 (no deductible) |
50%** |
| Non-preferred (generic or brand)* | 50% up to $600 (no deductible) |
50%** |
| Preferred specialty drugs**** | 50% up to $600 | 50%** |
| Non-Preferred specialty drugs**** | 50% up to $1,200 (no deductible) |
50%** |
Note: You don’t need to meet a deductible for prescription drugs. Just pay your copay or coinsurance (as noted below).***
90-day supply through mail-order service or CVS Pharmacy®:
$20 preferred generic, 30% preferred brand $1200 max, 50% non-preferred (generic or brand) $1200 maximum
You’ll generally pay less for a 3-month supply than for 3 separate 1-month supplies.
Aetna Value Plan Prescription drug benefits when you’re enrolled in Medicare Part A and/or B: Aetna Medicare Rx offered by SilverScript
Members with Medicare Part A and/or Part B primary will be automatically enrolled into Aetna Medicare Rx® offered by SilverScript®. This is a Medicare Part D prescription drug option offering significant savings. Your drugs will still be covered, but copays and coinsurance are lower. See benefits below.| Benefit | What you'll pay |
|---|---|
| 30-day Supply through Retail |
|
| 90-day Supply through Retail or Mail |
|
| 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. |
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
Earn Wellness Incentive Credits
- Step 1: Get preventive care like routine physicals, flu shots and biometric screenings.
- Step 2: Earn $50 in wellness credits for each activity (up to $250 for Self Only or $500 for Self Plus One or Family coverage).
- Step 3: Use those credits to pay your deductible or medical coinsurance costs.
Why choose the Aetna Value Plan?
- Large nationwide Aetna PPO Network
- Low monthly premium costs
- Deductible does not apply to office visits or for prescriptions.
- Earn up to $250/self or $500/self plus one and family in wellness credits
- Acupuncture and chiropractic care are covered!
- 24 hours a day / 7 days a week access to doctors via phone or video with Teladoc® health services†
- Discounts on eyewear, LASIK laser eye surgery, gym memberships, massage, acupuncture, weight-loss programs and more
*Formulary is a list of generic and brand-name drugs your health plan prefers.
**Plus the difference between the plan allowance and billed amount.
*** Your plan requires the use of generic medication when a generic equivalent exists. 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.
****For specialty drug information, see the official plan brochure.
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 official plan 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.
Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Incentive-based activity awards will only be given for completing select wellness programs as determined by the plan sponsor. 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.
For information about our plans available through the Federal Employees Dental and Vision Insurance Program (FEDVIP), please visit our Dental PPO Plan site or our Aetna Vision™ Preferred site.
