Using a PPO Plan
With a Preferred Provider Organization (PPO) plan, you have greater flexibility and choice to use both in-network and out-of-network providers. However, you are encouraged to receive services from the Aetna network doctors, specialists and facilities. By doing so, you obtain a higher level of benefit than if services were rendered from an out-of-network provider. Also, claim forms are submitted to the plan on your behalf when services are received from within the network. Additional information regarding use of a PPO plan includes:
- You and any enrolled dependent(s) are permitted to visit any doctor or facility without a referral from a Primary Care Physician (PCP)
- Certain services, such as doctor’s visits, may require fixed-dollar payment up front, referred to as a copayment
- Before the plan will pay certain medical expenses, you may be required to pay a plan specific amount, referred to as a deductible
- Once the deductible has been fulfilled, the plan will pay a large percentage of the cost of your care, known as coinsurance. You are then financially responsible for the remaining cost up to the out-of-pocket maximum
Find an In-Network Provider
You can find an Aetna provider by going online to www.AetnaResource.com/p/FresnoUSD. Scroll down and click on the Find an Aetna Choice POS II Provider purple button. Within the Continue as a guest section, enter your location and click Search. You can then type the name or type of provider you are looking for within the What do you want to search for section. Press Enter, and a list will be provided based on your search parameters. You can then filter and sort results specific to your needs, such as language, gender preference, and provider type.
NOTE: It is important to use Aetna’s dedicated microsite for the District’s plan when searching for medical providers. The use of any other site, including Aetna.com, will provide inaccurate results based on our plan structure. In addition, please keep in mind the following services and providers are not part of your Aetna network through the District’s PPO plans, even though you may see them listed in the online directory:
- Acupuncture
- Chiropractic
- Dental
- Mental health
- Pharmacy
- Substance abuse
- Sutter Health Systems providers
- Vision
Visit www.JHMBHealthConnect.com/locating-network-providers for details on finding providers for these specific services.
Free Preventive Health Care
The Federal Health Care Reform law requires insurance companies to cover in-network preventive care services in full, saving you money and helping you maintain your health. Such preventive services include:
- Preventive care doctor’s visits
- Annual checkups
- Well-baby and child visits
- Several types of immunizations and screenings
To confirm your preventive care services are covered, refer to your Plan Booklet or associated Evidence of Coverage.