No. But you should take time to learn about the medical coverage available to you through the HISD medical plan options as well as any other source available to you, such as your spouse’s medical benefits plan. Compare and consider the cost of coverage for each option. This can help you decide which coverage works best for you and your family.
You receive two ID cards. Your Aetna ID card contains medical information. This card lists a unique ID number (not your SSN) for medical claims purposes. If you enroll in one of the Consumer options, you use this card to access HealthFund funds by having your provider file claims directly with Aetna. You also receive an Express Scripts ID card to use when purchasing prescription drugs. This card has a unique ID number as well.
For more information, call Aetna at 877-224-6857 (8 a.m. to 6 p.m. Central Time, weekdays (except holidays) or Express Scripts at 855-712-0331.
Copay — A copay is a set fee that you pay for certain services, such as prescription drugs. Copays also apply to doctor office visits and services performed during office visits under the Open Access option.
Coinsurance — For the Consumer options, this is the percentage of expenses for covered services that you pay after you meet your deductible and until you reach your annual out-of-pocket maximum. For example, for in-network care under the Consumer Plus Limited option, the coinsurance amount is 20 percent. For the Open Access option, it’s the percentage you pay for covered services other than doctor’s office visits.
A primary care physician is a provider who provides most of your primary and preventive care, and who is available to refer you to specialists if necessary. While there’s no requirement to designate a primary care physician and you can change providers at any time, most people have a primary care physician overseeing their care. While obtaining a referral to see a specialist isn’t necessary, primary care physicians can be a valuable resource in identifying the type of specialist you need to see and providing a list of specialty providers who might work well for you.
Pre-certification is the process of obtaining Aetna’s approval before certain health care services or procedures are performed. Pre-certification is required for all in-patient admissions and a number of outpatient services, including high tech radiology procedures, such as MRIs and CT scans. For a full list of services or supplies that require pre-certification or pre-notification, log on to Aetna Navigator or call Aetna at 800-333-4432, weekdays between 8 a.m. and 6 p.m. Central Time. Failure to get pre-certification when required results in a penalty of 50% before the appropriate coinsurance is applied or, in the case of high tech radiology, the procedure is not covered.
Although your provider may contact Aetna for authorization on your behalf, you’re ultimately responsible for making sure Aetna’s approval is obtained or the care or service you receive may not be covered.
If you’re unable to obtain pre-certification due to an emergency, report the emergency to Aetna as soon as possible to comply with this requirement.
It's important not to use hospital or standalone ERs for minor illnesses or injuries, even after hours, especially when you have the option of urgent care centers, walk-in retail clinics and the HISD Employee Health & Wellness Centers. Unnecessary trips to the ER cost everyone money. What's more, if you go to an out-of-network ER for a non-emergency, you may be billed for the entire balance.
You and your covered family members receive 100% coverage with no annual deductible for preventive care expenses.
Preventive care services help maintain health and prevent disease and include annual physicals, well-woman exams, prostate check ups, immunizations and more. If you’re not sure what’s considered preventive care, call Aetna customer service at 877-224-6857, available 8 a.m. to 6 p.m. Central Time, weekdays (except holidays).
Generally, no. Once you meet the out-of-pocket maximum amount, the plan pays 100% of all covered expenses you have for the rest of the year. This doesn’t include copays or non-covered expenses such as amounts over the set reimbursement limits for emergency care.
Yes. If you have HISD medical coverage as an active employee, that coverage is primary and Medicare is secondary. For more information, please contact Medicare.
As a participant in a Consumer or Select plan option, you can maximize your savings by using a health care flexible spending account (FSA) to pay expenses that aren’t covered, such as coinsurance amounts. If you’re enrolled in one of the Consumer options or the Select plan and choose to contribute to an FSA, you must use your HealthFund dollars first before you can use your FSA dollars. Please note: Effective January 1, 2017, HISD no longer supports the HealthFund. You may continue to use any funds you have left over from previous years to pay for eligible expenses as long as you are enrolled in an HISD Consumer or Select medical plan.
Call Aetna at 877-224-6857 8 a.m. to 6 p.m. Central Time, weekdays (except holidays)
All medical plan options offer network care through Aetna. You may request printed directories by calling Aetna; however, the most up-to-date information about providers can be found by logging on to Aetna Navigator and checking DocFind or by contacting Aetna member services at 877-224-6857 8 a.m. to 6 p.m. Central Time, weekdays (except holidays).
Remember that directory information is for reference only. Always verify the provider's address, phone number, specialty and any other information before making an appointment.