Welcome to 2014 Enrollment, PSERS’ HOP Plan Members!

Aetna is pleased to offer Pennsylvania Public School Employee Retirement (PSERS) retirees and dependents our health insurance plans in select areas again this year. These plans can provide you and your eligible dependents with comprehensive and affordable medical and prescription drug coverage. Your Aetna plan options vary depending on where you live. Please refer to your HOP personalized statement for plan availability.

 

PSERS sponsors the Health Options Program (HOP) for their retirees, spouses or surviving spouses, and dependents. HOP is a voluntary program. You decide whether or not to join. HOP is funded by the premiums you pay for your benefits. Private health care insurers, like Aetna, provide your medical coverage and services.

 

Are you (or your Medicare eligible dependents) thinking about joining the HOP Aetna Medicare Plan (PPO) offered through HOP?

Medicare eligible retirees and dependents who reside in the following Pennsylvania counties (see a list of all counties) and some counties in Florida, Maryland, New Jersey and New York (see a list of counties) may select the HOP Aetna Medicare Plan (PPO) with Medicare Part D Prescription Drug coverage. Go to the PPO section for more information about this plan.


Are you (or your dependents) eligible for Medicare and already an existing HOP Aetna Medicare Plan (HMO) member?

Certain existing Aetna members and dependents in Pennsylvania, Florida, Maryland, New Jersey, and New York may have the ability to stay in our HOP Aetna Medicare Plan (HMO) with Medicare Part D Prescription Drug coverage. Go to the HMO section for more information about this plan.

 

Not Eligible for Medicare?

Learn more about the pre-65 retiree plan. You must be a PSERS HOP member or a dependent to be eligible for this plan.

 

What are some of the benefits of the new HOP Aetna MedicareSM Plan (PPO) - a Preferred Provider Organization?


The HOP Aetna MedicareSMPlan (PPO) offers comprehensive coverage, all in one plan, for new Medicare eligible retirees and dependents who reside in certain Pennsylvania counties (see a list of all counties) and some counties in Florida, Maryland, New Jersey and New York (see a list of counties). This plan covers a comprehensive array of services from annual wellness exams to preventive care and hospitalization. We also protect your health care dollars with predictable out-of-pocket plan limits and discounts on many health-related products and services.

Some of the benefits include:

  • Preventive care at no additional cost.
  • Freedom to use providers in and out of our nationwide network. (You may pay more when receiving services from out of network providers.)
  • Free health and wellness programs.
  • Discounts on gym memberships, weight loss programs, vision care, hearing aids and more.
  • Assurance that in-network doctors go through a detailed Aetna credentialing review process.
  • Access to Aetna’s large network of doctors, hospitals and other health care providers. Select the Find a Doctor link to see a list of providers in our network.
  • Aetna’s National Medical Excellence Program®, which provides additional resources to help you get the right care affordably if you have a complex injury or illness.
  • Online tools and a 24-hour toll-free health information line to help you stay informed.
  • Coverage for medical emergencies when traveling outside the United States.
  • Filling prescriptions at more than 65,000 network pharmacy locations all over the country or access Aetna Rx Home Delivery®

Learn more about the Aetna MedicareSM Plan (PPO) plan benefits

 

2014 Aetna MedicareSM Plan (PPO) plan PDF

2013 Aetna MedicareSM Plan (PPO) plan PDF

Review the HOP Aetna Medicare Open I Formulary (prescription drug list) PDF

Review the HOP Aetna Medicare Closed and Managed Standard Formulary PDF

 

 

What are some of the benefits of the HOP Aetna MedicareSM Plan (HMO) - a Health Maintenance Organization?

Existing Aetna members and dependents in Pennsylvania, Florida, Maryland, New Jersey, and New York may have the ability to stay in our HOP Aetna Medicare Plan (HMO) with Medicare Part D Prescription Drug coverage. You’ll enjoy a plan with limits on your out-of-pocket costs and low, predictable copayments.

Some of the benefits include:

  • No deductible.
  • Coverage for preventive care at no additional cost.
  • Medical coverage whenever you travel to another Aetna Medicare Plan service area with Aetna’s U.S. Travel Advantage Program (however, you must enroll by calling Aetna before you travel).
  • The ability to change your Primary Care Provider at any time, for any reason. In fact, you can change your PCP online at www.aetnanavigator.com.
  • Access to Aetna’s large, nationwide network of doctors, hospitals and other health care providers. Select the Find a Doctor link to see a list of providers in our network or call 1-800-248-7227, (TTY/TDD: 711), 8 a.m. to 8 p.m., 7 days a week.
  • Aetna’s National Medical Excellence Program®, which provides additional resources to help you get the right care affordably if you have a complex injury or illness.
  • Coverage for emergency medical treatments when traveling outside the United States.
  • Filling prescriptions at more than 65,000 network pharmacy locations all over the country or access Aetna Rx Home Delivery®

    You must use plan providers except in emergent or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor Aetna Medicare will be responsible for the costs.

Learn more about the Aetna MedicareSM Plan (HMO) plan benefits

 

2014 Aetna MedicareSM Plan (HMO) plan PDF

2013 Aetna MedicareSM Plan (HMO) plan PDF

Review the HOP Aetna Medicare Open I Formulary (prescription drug list) PDF

Review the HOP Aetna Medicare Closed and Managed Standard Formulary PDF

 

 

Aetna ExtrasSM

As an HOP Aetna Medicare plan member, you’re entitled to discounts, programs, services, tools and information—all extras—to help protect your health and health care dollars.

 

At home products - Get discounts on products and services for your home and family, such as the Omron 7 Series™ Upper Arm Blood Pressure Monitor. You can track your blood pressure when you need to, accurately and easily.


Books - Save on books, DVDs and more through the American Cancer Society Bookstore, the Mayo Clinic Bookstore and Pranamaya.


Fitness - Save on gym memberships* and name-brand home fitness and nutrition products that support your healthy lifestyle with services provided by GlobalFit®.


Hearing - Get discounts on hearing exams, hearing aids, batteries, repairs and other hearing aid services. You can also get these discounts even though you have a Hearing Aid Reimbursement benefit. Check your plan requirements first.


Natural products and services - Save on specialty health care products and services, including online consultations.

  • The ChooseHealthy®** program: Get a discount off standard charges for acupuncture, chiropractic, massage therapy and nutrition services. Also save off the manufacturer’s suggested retail price on health and wellness products.

    - You must have a valid Aetna ID card to receive the discounts from participating natural therapy professionals.

    - Natural therapy professionals are located in all 50 states plus Washington, D.C.
  • Vital Health Network (VHN): Save off the retail price of an online consultation with a VHN doctor for one topic. Save additionally off the retail price for an online consultation for additional topics.

Oral health care - Get discounts on Waterpik® water jet flossers and Epic Dental cavity-fighting products.


Vision - Save on eye exams, frames, lenses, contact lenses and solutions, LASIK surgery, sunglasses and more. You can also get these discounts even though you have an Eyewear Reimbursement benefit. Check your plan requirements first.


Weight management - Get discounts on the CalorieKing® Program*** and products, Jenny Craig® weight loss programs, and Nutrisystem® weight loss meal plans.††


Additional discounts - You may also be eligible for the following discounts which are available:

  • Aging with Grace™ elder care assistance program - Get a membership discount for this program that provides education and can help coordinate and assist with senior care options.
  • LifeStation® Medical Alert Systems - Save on a medical alert system from LifeStation which provides help 24 hours a day, 7 days a week with the push of a button. You may select from a device, pendant or bracelet.

* Participation is for new gym members only. If you belong to a gym now or belonged recently, call GlobalFit to see if a discount applies.

** The ChooseHealthy program is made available through American Specialty Health Systems, Inc. (ASH Systems), a subsidiary of American Specialty Health Incorporated (ASH). ChooseHealthy is a federally registered trademark of ASH and used with permission herein.

*** If you're already a CalorieKing member and want to get the Aetna discounted membership price, you will need to terminate your current CalorieKing Account and rejoin.

Plus the cost of food. Plus the cost of shipping, (if applicable). Offer applies to initial enrollment fee only and is valid only at participating Centers and through Jenny Craig At Home. Each offer is a separate offer and can be used only once per Member. No cash value. Restrictions apply.

†† The Aetna discount offers do not apply to any plan in which you’re already enrolled. To receive the discounted rate, you must wait until your current plan ends.


For more information and access to extra-value discounts, go to Aetna's secure member website and select Coverage & Benefits, then Discounts.


Discount offers provide access to discounted services and are not part of an insured plan or policy. Aetna does not endorse any vendor, product or service associated with these discount offers. Vendors are independent of Aetna, not agents or employees thereof. Discount offers are not guaranteed and may be discontinued at any time. Aetna makes no payment to the discount vendors. The member is responsible for the full cost of the discounted services. Aetna may receive a percentage of the fee you pay to a discount vendor. While this material is believed to be accurate as of the production date, it is subject to change.


The products, services and discounts described above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Aetna Medicare grievance process.



Health and wellness programs

  • Aetna Silver & Fit Exercise & Healthy Aging Program - The program gives you the most important thing of all - the opportunity to be healthier. Enjoy a health club membership, included at no extra cost, to savings on home workout kits and educational information about working out and fitness. Visit the Silver & Fit website to learn more and find fitness centers in your area.
  • Aetna Health ConnectionsSM Disease Management - Provides access to individualized clinical programs for diabetes, stroke, heart failure and coronary artery disease. It can help you learn to manage your chronic health conditions and achieve your optimal state of health. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional.
  • Annual preventive reminders - Mailers that help you remember to get important vaccinations, like flu shots and colorectal cancer screenings.
  • Women's health reminders - Timely screening reminders for breast and cervical cancers.
  • Nurse case managers - Get personalized support for chronic and/or serious health conditions from specially trained medical professionals.
  • Informed Health® Line††† - Talk directly with experienced nurses about thousands of health topics using our 24-hour toll-free number.
  • Healthy lifestyle coaching - Speak to a licensed professional by phone to develop a specific program based on your health needs; learn how to manage weight and/or stress, quit smoking and maintain good health.
  • National Medical Excellence Program® - Offers access to our national Institutes of ExcellenceTM Transplant Network for transplants and transplant-related services. It includes medical management through the recovery period. Case management is also provided for members with rare or complex conditions requiring specialized treatment.
  • Member Outreach - Get help with preadmission calls for elective hospital admissions, proactive discharge planning and post-discharge calls.
  • Patient safety through care considerations - Get timely alerts and additional reminders that can help you stay healthy. These messages may warn you of potentially dangerous drug combinations, or remind you of important tests and screenings.

    ††† While only your doctor can diagnose, prescribe or give medical advice, the Informed Health Line nurses can provide information on more than 6,000 topics. Contact your doctor first with any questions or concerns regarding your health care needs. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professionals.

Health and wellness tools

  • Aetna Navigator® - This secure members-only tool is available 24 hours a day, 7 days a week. Among its many uses, you can print a temporary ID card, access claims and coverage information and more online.
  • Aetna SmartSourceSM - You can get specificinformation based on where you live and your particular health plan
  • Aetna InteliHealth® - Here you'll find interactive information from Harvard Medical School, Columbia Dental School and others
  • DocFind® - Here you can Locate physicians and hospitals in Aetna's Medicare Advantage network and other participating health care professionals in your area. Search by name, zip code, city, state, specialty and/or hospital affiliation.
  • Health risk assessment tools - Assess your health care needs and manage health conditions
  • Personal health record - Keep track of health information online and get tips on alternative therapies

Centers for Medicare & Medicaid Services (CMS) Fraud Information

Información de fraude para el Centro de Servicios de Medicare y Medicaid (CMS)

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Let's Talk. Call us at 1-800-307-4830 (TTY/TDD: 711)
We're available from 8 a.m. to 8 p.m., 7 days a week.