Aetna Medical Plans
The Aetna HMO and PPO Plans
You have the choice of either the Aetna HMO or the Aetna Open Choice PPO as the medical plan for you and your eligible family members. Both plans offer comprehensive medical coverage, with low copays for physician office visits, prescriptions and most preventive care covered at 100%. Please review the information below to assist you in making your plan selections.
At the bottom of this page you will find a brief description of the HMO and PPO plan models to help you understand the differences between the two types of plans.
For plan summary information on the Aetna HMO and PPO plans, please click on Aetna Plans.
Please click on the Prescription Information link to review information on the Save a Copay Program, certain prescription precertification requirements and access to the mail order prescription information.
Health Care Reform Addition of Women’s Contraceptive Drugs and Devices
Please click on Women’s Contraceptive Drugs and Devices List to learn of what contraceptives have been approved for your access at no copay due to the Patient Protection and Affordable Care Act (Health Care Reform). You may have your doctor write a prescription for those drugs and devices listed on this sheet and there will be no copay required.
Provider Directory Info
Please click on the Provider Directory Info link to access information to guide you in selecting your providers through Aetna’s provider directories.
Aetna Wellness Programs
Aetna offers a variety of wellness programs to help you attain optimal health benefits for you and your family. Please click on Wellness Programs for more information on these valuable programs.
Protected Health Information (PHI) Authorization Form
There may be instances when you will need a representative from Garnett-Powers & Associates to assist you with claims or billing inquiries for you or your enrolled dependents. In order for a representative to intercede on your behalf with an insurance carrier or health care provider, you must complete an Authorization for Release of PHI Form Form. Due to mandates within the Health Insurance Portability and Accountability Act of 1996, we are not allowed to assist you unless you have completed the form. If you do require assistance, please click on the link, complete the form and either email it to NUPFBP@garnett-powers.com, or fax to 949-583-2929.
Descriptions of Medical Plan Models Offered
Following are brief descriptions providing information regarding the HMO and PPO plan models available. Please read these so you may gain an understanding of the fundamental differences between the HMO and PPO.
What is an HMO Plan?
- This plan offers a broad spectrum of benefit coverage with a higher degree of managed care
- Under the Health Maintenance Organization (HMO) model, the member chooses a Primary Care Physician (PCP) contracted with the HMO plan at the time of enrollment
- The PCP becomes the gatekeeper of that member's healthcare needs
- If the member is in need of treatment from a Specialist or is in need of an In-Patient or Outpatient procedure, he/she must obtain a referral from their PCP prior to any type of consultation or treatment. If the referral is not obtained, no benefits will be paid
- There is no Out-of-Network benefit
- In the event of a life/limb-threatening emergency, the member should dial 911 and all medical care will be covered. Once the patient is stabilized, the HMO will require that the patient be transferred to an In-Network facility
- HMO premiums as well as the out of pocket expenses (i.e. deductible, co-payments, etc.) tend to be lower than their PPO counterpart due to the contractual element of capitation.*
What is a PPO Plan?
- The Preferred Provider Organization (PPO) offers much more flexibility and choice than the HMO plan
- Under the traditional PPO plan, the member does not have to choose a Primary Care Physician (PCP) at the time of enrollment
- There is an In-Network and Out-of-Network component
- The In-Network benefits (deductible, coinsurance, etc.) will offer greater coverage than the Out-of-Network benefits
- At the time of service, the member has the ability to seek care from a Specialist, without having to obtain a referral from a PCP
- The contractual agreement between the PPO Plan and the Provider is on a discounted fee for service basis. This means that the provider who participates in the network has agreed to provide their service on an agreed upon discounted fee. The Provider who is not in the network will not agree to that discounted fee and will typically charge a Reasonable and Customary fee. There is no capitation in a PPO contract
- PPO premiums tend to be higher than the HMO premiums due to the method of reimbursement and contractual agreements with the providers. Over the last three years, the difference in their pricing has diminished
- PPO plans offer the ultimate in flexibility as it relates to which provider the patient is allowed to seek treatment from
* Capitation: The PCP is compensated by the HMO plan in the form of a monthly capitation fee for each member that signs up with him/her at the time of enrollment. The PCP has agreed to provide all primary care, as well as the cost for most Labs & X-rays for that capitated fee. Additionally, in the event that the PCP provides a referral to a Specialist, the PCP will pay the Specialist from that same capitation. Hospital charges and some Lab & X-ray procedures are typically paid outside of capitation.
Garnett-Powers & Associates, Inc. is pleased to offer a Northwestern University Postdoctoral Program Customer Service Representative, dedicated to this program. Please address benefit and enrollment questions to:
Garnett-Powers & Associates, Inc.
23361 Madero, Suite 240
Mission Viejo, CA 92691
Or call us Monday - Friday, 8 am - 5 pm Pacific Time
Toll free at 1-800-319-9557
Contact Northwestern Postdoc Program Services
We thank you for the opportunity to be of service to you and your family.
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Program and benefit information contained on this site has been deemed reliable, but can change without notice.