Medical Plan Comparisons

What should I consider when choosing between the PPO, HMO, and HealthFund plan options? The premium rates are not the only things to consider when choosing a medical plan. There are significant differences between the plans that should be looked at. Here are some factors to consider:

1) Choice of doctors and facilities - While most doctors in the Aetna network are in–network for all Aetna plans, a few are not. If you are considering the HMO, make sure your current physician(s) is in the HMO network. If you are joining the HMO and want to choose a new primary care physician, make sure that physician is accepting new patients.

2) Medical management - The HMO plan has a higher level of medical management, meaning that some tests or prescription drugs may take longer to be approved, more substitutes may be suggested, and more tests may be denied, relative to the Open Access PPO Plan or Aetna HealthFund.

3) Price - The HMO premium rate is lower, and generally, out-of-pocket costs are less, than the other two plans.

4) Out-of-state coverage - Generally on the HMO plan, out-of-state coverage for the employee is limited to emergency treatment. If you have a dependent living out-of-state or moving out of state during the year, and are considering the HMO, call your local campus Benefits Office.

5) Medical procedure availabilty - Some elective procedures may be available only under a particular plan. Bariatric surgery (obesity reduction) is currently covered only under the HMO plan.

6)Pre-existing conditions - The HMO plan has no pre-existing condition restrictions. In some instances where individuals have had no prior group insurance coverage immediately before enrolling, the other Aetna plans may have pre-existing condition limitations.