Aetna Medical Plans

Find providers, manage claims, access your ID card, and more through your Aetna member portal at Aetna.com.

There are two Aetna plans to choose from:

• Aetna HDHP

• Aetna PPO

The plans cover the same types of healthcare services and supplies, but have different plan design features, such as copays, coinsurance, deductible amounts, and other out-of-pocket costs. To determine which plan best meets your and your family’s needs, consider the plan design features that are important to you, review your cost when you access services, and know your share of costs from your paycheck.

Is my doctor in-network?

You’ll save money by using Aetna’s network of providers. You can confirm if your provider is in-network with Aetna by following the instructions here for the PPO and HDHP plan networks (the network is called Aetna Open Access Managed Choice). If you have additional questions, reach out to Aetna at 833-554-1545.

Aetna Open Access Managed Choice HDHP

The Aetna HDHP has two parts: a high-deductible, HSA-compatible medical plan and a tax-advantaged Health Savings Account (HSA).

This plan may be right for you if:

• You rarely need to see a doctor; an annual checkup is usually it for the year.

• You feel comfortable paying for a large health expense that costs almost as much as your deductible.

• You want the opportunity to accumulate savings for future healthcare expenses, with the HSA’s triple tax advantage and the option to invest once your balance reaches $1,000.

• You plan to use network providers for your care, but like having the option to go out of the network.

Here’s how it works:

Health Savings Account (HSA)

• Samsara contributes $1,000 to your HSA (employee-only coverage) or $2,000 (if you cover one or more family members), divided equally across your pay periods.

• You can contribute your own money to your HSA, too, through pretax payroll deductions.

• Use your HSA funds to pay for eligible healthcare expenses, including your annual deductible.

• To participate, you must be enrolled in the Aetna HDHP, have no other healthcare coverage (including Medicare), and not be claimed as a dependent on someone else’s tax return. You and your spouse also cannot participate in a Healthcare FSA (you can both participate in a Limited Purpose FSA).

Doctors and other healthcare providers

• Go to any provider, but you pay less when you use Aetna network providers. (These are doctors, hospitals, therapists, and other healthcare providers who have contracted with Aetna to furnish services and supplies for a negotiated charge.)

Cost sharing between you and the plan

• You pay $0 for in-network preventive care and preventive prescription drugs.

• For all other care, you must meet the annual deductible before the plan cost sharing begins. Prescription drug costs count toward your deductible.

• Once you meet the annual deductible, the plan pays 100% of eligible in-network medical expenses. Prescription drugs have a copay.

You can review the full plan design and benefits of the Aetna HDHP plan here. Also, be sure to review all the details about Health Savings Accounts here.

Aetna Open Access Managed Choice PPO plan

With the Aetna PPO, you may go to any provider, but you pay less when you use Aetna network providers.

This plan may be right for you if:

• You and your family are frequent users of medical care.

• You mostly use network providers, but you would like to have access to out-of-network providers in certain circumstances.

Here’s how it works:

Doctors and other healthcare providers

• Go to any provider, but you pay less when you use Aetna network providers.

• Informed Choice is included in the plan. When you choose a provider with the Quality & Effective Care badge in Aetna Smart Compare, you pay a $10 office visit copay (vs. $20) and a single $1,000 copay for knee, hip, or shoulder replacement surgery.

Cost sharing between you and the plan

• You pay $0 for eligible preventive care and preventive prescription drugs.

• For in-network office visits, you’ll have a copay for visits to a primary care provider, specialist, walk-in clinic, or urgent care.

• For many other services, such as hospital stays, diagnostic tests, and outpatient surgery, you must meet the annual deductible before the plan pays benefits. Your expenses count toward both the in-network and out-of-network deductible.

• Once you reach the annual deductible, you’ll pay 10% coinsurance for eligible in-network services until you reach your annual out-of-pocket maximum.

You can review the full plan design and benefits of the Aetna PPO plan here.

Aetna Programs (Available to all Samsara Aetna members)

Travel and Lodging Reimbursement

• if there is no in-network provider within 100 miles of your home, employees may be eligible to get To get reimbursed for travel and/or lodging costs

• The lodging reimbursement is $50 per night per patient. If the patient is traveling with a companion, such as a spouse or partner, reimbursement will be up to $100 per night. Total travel and lodging reimbursement is limited to $5,000 per trip.

• FAQs and Reimbursement Form

Aetna Concierge - 833-554-1545

• Personal health care assistant to locate providers, understand your benefits, estimate out of pocket costs, and more.

24 Hour Nurse Line - 800-556-1555

• Talk to a registered nurse for information about tests, procedures and treatment options, 24 hours a day, 7 days a week for free.

Minute Clinic - cvs.com/minuteclinic

• Access to convenient, local walk-in clinics located inside select CVS Pharmacy and Target stores, treating a variety of illnesses, injuries, and conditions. Aetna PPO: $20 copay, no deductible. Aetna HDHP: you pay the full cost until you meet your deductible, then the plan pays 100%.

Teladoc - Teladoc.com/Aetna 

• 24/7 access to talk to a doctor, therapist, or medical expert anywhere you are by phone or video. You can request visits three ways: online, via the Teladoc app or by phone. You can speak to a doctor on demand in minutes, or schedule a time that’s more convenient.