Teladoc, Teladoc Health and the Teladoc Health logo are registered trademarks of Teladoc Health, Inc. Visit /Aetna for a complete description of the limitations of Teladoc services. Teladoc and Teladoc physicians are independent contractors and are not agents of Aetna. Teladoc® is not available to all members. All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. Before making a decision, please read the Plan's applicable Federal brochure(s). This is a brief description of the features of this Aetna health benefits plan. †Teladoc® is covered at the member cost share.Īetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). *** Out of Network for cleanings, composite fillings and X-rays – you pay 50% of negotiated rate plus any difference between our allowance and the billed amount. Please see the plan brochure for details. ** If you choose the brand name drug over the generic equivalent, you will owe the corresponding copay plus the difference between the generic and brand name costs. *A formulary is a list of generic and brand-name drugs your health plan prefers. Paper brochures can be ordered by mail here. PPO - After a $20 deductible per member, cleanings, fillings, and X-rays are covered at 100% with network dentists.*** It's your choice!īasic - Pay a $5 copay for cleanings, fillings and X-rays when you visit your primary care dentist (PCD). Call 80 (TTY:711) to select a dentist OR to switch to our larger PPO network at no additional cost. ***ĭiscounts on eyeglasses, contacts, eye exams and more Your plan requires the use of generic medication when a generic equivalent exists. Or get a 90-day supply for only 2 copays, not 3, through mail-order service or available at a CVS Pharmacy®.įor specialty drug information, see the federal plan brochure. (for a 30-day supply at a retail pharmacy) See /pharmacy for list of participating pharmacies. $20 PCP / $35 specialist ($75 for certain tests)
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