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PRODUCTS
SYSTEMS
NARROW NETWORKS
ORDER OF BENEFITS RULE
PROGRAMS
100

THIS PLAN ONLY HAS OUT OF NETWORK LEVEL OF BENEFITS

WHAT IS TRADITIONAL CHOICE

100

THIS SYSTEM ALLOWS YOU TO ACCESS THE MEMBER'S WEBSITE

WHAT IS MY ASSISTANT/IAM PORTAL

100

Program is a narrow network of physicians and hospitals. This program adds 9 additional specialties to the 12 Aexcel specialties

WHAT IS SAVINGS PLUS?

100

A member is a dependent child covered by parents that are separated or divorced.

What is Dependent Child/Parents Separated/ Divorced/Not Living Together Rule?

100

The program:

  • Helps eligible members have a healthy term delivery
  • Is voluntary
  • Offers case management (CM) to members who are 42 weeks gestation or less when the member’s plan has the program and the member meets CM requirements

AETNA MATERNITY PROGRAM

200

PPO IS ANOTHER NAME FOR 

WHAT IS OPEN CHOICE?
200

THIS SYSTEM ALLOWS YOU TO CREATE OUTBOUND LETTERS FOR MAIL

OBC- OUTBOUND CORRESPONDENCE

200

A Program that was developed to allow an Aetna contracted healthcare system to act as both the employer (plan sponsor) and the network provider.

WHAT IS HBS, HOME HOST, IDS, OR HOSPITAL VERTICAL

200

A member is covered under two medical plans. One plan is willing to coordinate and the other plan is not.

What is COB Rule vs. No COB Rule?

200

This program gives support and services to terminally ill members and their families. This includes:

  • Info
  • Nurse case management support
  • Online tools

AETNA COMPASSIONATE CARE PROGRAM

300

WHEN ADDED TO A PLAN THIS ELIMINATES THE REQUIREMENT OF A PCP OR REFERRAL 

WHAT IS OPEN ACCESS?
300

THIS IS THE SYSTEM YOU USE TO TAKE CALL, LOOK UP BENEFITS AND CLAIMS. 

ASD

300

An arrangement between hospital systems, provider groups or any combination of these that is designed to coordinate the overall care for their patients

What is ACO?

300

A member is covered under two medical plans with one of the plans being a COBRA plan.

What is Continuation Rule (also known as COBRA)?

300

The program offers one-on-one coaching sessions, educational materials and web-based interactive tools to help members quit tobacco use, manage weight, deal more effectively with stress, and learn about proper nutrition and physical fitness. Rewards are available for completing certain program activities.

What is Healthy Lifestyle Coaching?
400
THIS HAS A FULL RANGE OF MEDICAL MANAGEMENT PROGRAMS AND SERVICES, LIKE WELLNESS AND DISEASE MANAGEMENT

WHAT IS AETNA HEALTH CONNECTIONS?

400

THIS IS THE SYSTEM YOU USE TO SEND EMAILS AND TEXT MESSAGES TO A MEMBER

AGENT TOOL

400

Uses existing networks to give the best medical cost savings in each market. It is designed to appear as one plan

What is APCN?

400

A member is a subscriber under two active medical plans (actively employed for both employers).

What is Longer/Shorter Rule?

400

This program:

  • Helps employers enhance the health and performance of their employees
  • Puts an emphasis on these items to help members make positive health changes:

    • Awareness of lifestyle behaviors and risks
    • Prevention
    • Behavior change programs
  • Gives an easy approach to creating a health assessment profile that generates a personalized health risk summary specific to each participant
  • Directs participants to choose from a variety of available online coaching programs to guide them through healthy lifestyle changes 

What is Simple Steps to a Healthier Life?

500

A FEATURE THAT ALLOWS MEMBERS ACCESS TO CERTAIN MEDICAL SERVICES AND SPECIALISTS WITHOUT A REFERRAL

WHAT IS DIRECT ACCESS?
500

THIS IS A SYSTEM/SITE THAT YOU WOULD USE WHEN A MEMBER HAS A QUESTION ON A SPECIFIC PROCEDURE. YOU WOULD NOT GO OVER THE INFO WITH THE MEMBER YOU WOULD EMAIL THEM AND ADVISE THEM TO GO OVER IT WITH THEIR PROVIDER. 

WHAT IS CPB.

500

Using twelve designated specialties, this program incorporates benefit tiering.

What is AEXCEL?

500

A member is a dependent child covered by parents that are married/not separated or divorced.

What is Dependent Child/Parents Not Separated or Divorced Rule?

500
  • 24/7 phone help
  • Broad provider networks
  • Child and elder care resources
  • Counseling sessions
  • Critical event stress support
  • Education resources
  • Legal and financial services
  • Management sessions
  • On-site trainings and programs
  • Web resources

What is Aetna Resources for Living?