Medical - Aetna
About Your Benefits
The State Employee Health Plan (SEHP) offers four medical plans (Plans A, C, J, and N) for Active State Employees, Non State Employer Group, and NON-MEDICARE Eligible Retiree/Direct Bill Members.
The Deductible, Coinsurance, and Out-of-Pocket (OOP) maximums differ among the plans and your medical benefits have no lifetime maximum.
Your medical and pharmacy Out-of-Pocket maximums are combined. Prescription benefits for all four plans are provided by CVS Caremark.
All Plans include 100% coverage for preventive services when using a Network provider, including services like annual preventive exams, age-appropriate immunizations, mammograms, colonoscopies, etc.
Network vs. Non Network Providers
Network Providers accept the plan allowance as payment in full and save you money. Non Network Providers have not agreed to accept the plan allowance. This means that in addition to your required Out-of-Pocket cost, any amount above the plan allowance will be your responsibility. Out-of-Pocket maximums which include deductibles, coinsurance, and copays accumulate separately for Network and Non Network providers.
Telehealth with Teladoc
Aetna offers telehealth services through Teladoc. Teladoc provides 24/7 access to healthcare and medical advice by phone, video, or app. Visit the Teladoc website to see if a telehealth appointment is right for you.
Earn Rewards with Healthcare Bluebook
Did you know that prices for the same medical procedure vary dramatically depending on where you go?
The State Employee Health Plan gives you FREE access to Healthcare Bluebook to help you find high-quality care at a Fair Price™. It’s easy! Use Healthcare Bluebook’s website or mobile app to shop for medical procedures and find Fair Price™ (green) facilities in your area that could save you thousands of dollars.
Plan Year 2023
- 2023 Aetna Enrollment Information
- Aetna Enrollment Guide
- Teladoc Plan A
- Teladoc Plans C, J, and N
- Aetna Website & Mobile App
- Aetna 24-Hour Nurse Line
- Dependent Documentation Requirements
- Adding a Newborn