Under the High Value and Select Value PPO Plans, you pay a copay for many services. For others you must first meet your annual deductible. After meeting your annual deductible, you and the plan share expenses up to the out-of-pocket maximum. Once you meet your out-of-pocket maximum, the plan pays 100% of eligible expenses. The out-of-pocket maximum does not include the annual deductible, copays, non-covered expenses, expenses over reasonable and customary/negotiated fees, penalties for failing to precertify when required, chiropractic charges, or your share of the cost for treatment of mental illness and substance abuse.

You may use any licensed provider for health care services. However, you’ll receive a higher level of benefits by using network providers.

Aetna administers the High Value and Select Value PPO plans in 2009  and provides the network throughout most of the United States, except in certain areas. If you live in one of the following locations or you are an employee of ACS Recoveries, your PPO plan is administered by and your network is provided by Great West in 2009:

• - Siskyou County (Yreka), CA;
• - Denver, CO;
• - Minneapolis/St. Paul, MN;
• - Portland (including Happy Valley), OR;
• - South Dakota; and
• - Washington state.

In addition to receiving increased benefits, there are several other advantages to using network providers:

• - Providers agree to charge negotiated rates; you are not responsible for amounts over reasonable and customary charges.
• - You pay a copay for each doctor office visit.
• - These providers typically handle any necessary precertifications and file claim forms for you.

The network consists of doctors, hospitals and other health care providers who have agreed to provide medical services in accordance with negotiated rates and designated standards. To join a network, a provider must meet certain essential criteria.

Questions about your employee benefits or other Human Resources issues? Contact the Workplace Solutions Center at (888) 471-2271.