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BENEFITS

MEDICAL INSURANCE

Aetna | HMO Value Plan
With the Value Network Health Maintenance Organization (HMO) plan, you must choose a Primary Care Physician (PCP) or medical
group within the Aetna Value Network for all of your covered family members. All of your care must be directed through your PCP
or medical group. Any specialty care you need will be coordinated through your PCP and will generally require a referral or
authorization. You will receive benefits only if you use the doctors, clinics, and hospitals that belong to the medical group in which
you are enrolled, except in the case of an emergency. This plan uses a smaller network of the most cost effective providers to
provide lower per paycheck premiums. Please note that it is your responsibility to ensure that all family members choose providers
from the Aetna Value Network HMO.

Aetna | HMO Full Plan
This plan works just like the Value Network but uses a larger network of providers in the Aetna Full Network. Since this plan offers
more provider options, you will experience higher per paycheck premiums.

Aetna | PPO Plan
The Aetna Preferred Provider Organization (PPO) plan allows you to direct your own care. You are not limited to the physicians
within the network and you may self-refer to specialists. If you receive care from a physician who is a member of the Open Access
Managed Choice (OAMC) Network, a greater percentage of the entire cost will be paid by the insurance plan. You may also obtain
services using a non‐network provider; however, you will be responsible for the difference between the covered amount and the
actual charges and you may be responsible for filing claims.

Plan Differences Value Network HMO Full Network HMO OAMC/PPO
CA only CA & AZ CA & Out-of-State

Employee Premiums $ $$ $$$
Out-of-Pocket Costs $ $ $$
Cost Sharing Contribution, Copay Contribution, Copay Contribution, Copay,
Deductible, Coinsurance
Network Size   

In-Network Benefits ✓ ✓ ✓
Non-Network Benefits Emergency only Emergency only ✓

Access to Providers Managed by Your PCP Managed by Your PCP Managed by You
- Primary Care Physician Required Required Not Required
- Referral for Specialist Required Required Not Required

Finding a Medical Provider
Go to http://www.aetna.com/docfind/home.do or call (877) 350-2217 for HMO or (877) 204-0431 for PPO.
• HMO Value Plan: Refer to the State Based Plan, then select (CA) Aetna Value Network HMO.
• HMO Full Plan: Refer to the Aetna Standard Plans, then select HMO.
• PPO Plan: Refer to the Aetna Open Access Plans, then select Managed Choice POS (Open Access).

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