How the PPO Options work

The PPO Options are network-based options that utilize the Aetna Choice POS II network. BP offers three PPO Options: HealthPlus, Standard and Health+Savings.

The Health+Savings Option is a high deductible health plan (HDHP) that offers comprehensive medical coverage when you need it. This plan costs less per paycheck than for other medical options, in exchange for having a higher deductible amount. You must meet the deductible before the Option pays any benefits, other than certain preventive care.

When you enroll in the Health+Savings Option, you’re automatically enrolled in a Health Savings Account (HSA), a tax-preferred account that you will own and which will help you save for future health expenses. See Health Savings Account (HSA) for more details about how HSAs work.

In the HealthPlus and Health+Savings PPO Options, you receive lower-cost health care services once you meet the plan’s deductible. However, in order to be eligible for the HealthPlus and Health+Savings Options, you and your covered spouse/domestic partner are each required to earn a minimum of 1,000 wellness points by completing various wellness activities associated with the BP Wellness Program.* To learn more about the available activities in the BP Wellness Program and their associated points, visit the Wellness section of LifeBenefits.

The PPO Options give you a choice when it comes to getting medical care. You can go to:

  • Any network provider. That is, any licensed doctor, nurse, therapist, hospital, lab or other health care facility that has been designated as part of its network — and receive a higher level of benefit for a covered service. It is your responsibility to confirm that a provider or facility is part of the Aetna Choice POS II network.
    • If a provider practices at multiple locations, he/she may not be considered an in-network provider at each location. Confirm with your provider that he/she is in the network at the location you intend to visit before receiving care. If you use a network provider for an expense that is not covered under a PPO Option, the provider may charge you for the provider’s undiscounted rates unless you have signed a waiver prior to receiving the treatment or service(s) agreeing to pay for non-covered services.
  • Any out-of-network provider. That is, any licensed doctor, nurse, therapist, hospital, lab or other health care facility that has not been designated as part of its network — and receive a lower level of benefit. (Note: A provider will still be considered out-of-network if the provider is an Aetna NAP provider but not in the Aetna Choice POS II network. See National Advantage Program (NAP) for more information.)

Whether you see a network provider or an out-of-network provider, each PPO Option covers a broad range of medical services and supplies once you meet your deductible, as well as preventive care services that don’t require you to meet your deductible. Each PPO Option also includes a Prescription Drug Program, administered by Express Scripts, Inc. (ESI). In the Health+Savings PPO Option, you must meet your medical plan deductible before you receive plan coverage for all formulary brand preventive prescriptions and all non-preventive prescriptions.

* New hires or newly eligible employees in their initial year of coverage under HealthPlus or Health+Savings are not required to accumulate 1,000 wellness points until the following calendar year.

Primary doctors

Under the HealthPlus and Health+Savings PPO Options, you will pay lower office visit copays for network providers who are considered primary doctors than for those who are considered specialists. Under the Health+Savings PPO Option, you must meet your medical plan deductible before copays are applicable.

Primary doctors are:

  • Family practitioners.
  • General practitioners.
  • Internists.
  • Pediatricians.
  • Obstetricians/Gynecologists (OB/GYNs).

When you enroll in a PPO, you are not required to designate a primary doctor or have your primary doctor's referral to see a specialist.

How to choose a network provider

To learn more about the providers who participate in the Aetna Choice POS II Network, access BP's custom DocFind website or call Aetna Member Services at 1-866-436-2606.

Keep in mind that network providers occasionally change, so you will want to make sure the provider you choose is still in the network and at the location you would like to visit before you make an appointment. For the most up-to-date information, including whether a provider is accepting new patients, call the provider.
If Aetna determines in a particular case that there is no viable Aetna Choice POS II network provider option available, Aetna may treat a non-network provider as if it were an in-network provider until a viable Choice POS II network provider becomes available. In order for this special treatment to apply, the alleged provider deficiency must be raised with Aetna Member Services in advance of treatment and Aetna must agree with the special treatment.

If your dependents live away from home

To determine whether your dependents will be able to access the PPO network providers, you must call the Aetna Member Services Center. If the representative determines that your dependent(s) do not have access to PPO Option network providers, you may enroll yourself and all your eligible dependents in the OOA Option by calling the BP HR & Benefits Center. You must contact the BP HR & Benefits Center each annual enrollment period to elect this option or another OOA option if your dependent continues to live away from home.

If you elect a PPO Option and your covered dependent seeks care from out-of-network providers, those expenses will be subject to the PPO out-of-network deductible and the lower out-of-network benefit level.

Transition care benefits

If you are receiving treatment for a pregnancy or undergoing an active course of treatment from an out-of-network provider (either before coverage begins or if your provider decides to leave the network during the plan year), you may be eligible for transition care benefits. Transition care benefits are paid at the higher, network level of benefits for a limited period of time so you can complete an active course of treatment. At the end of that time, you will have the choice of seeing a network provider and receiving the higher, network level of benefits or continuing to see your out-of-network provider at the lower, out-of-network level of benefits.

If any of the following circumstances exist, you may qualify for transition coverage:

  • Patient is confined to an inpatient facility.
  • Patient has completed 27 weeks of pregnancy and has begun receiving prenatal care.
  • Patient is in a post-operative period.
  • Patient has a chronic, degenerative or disabling disease or condition.
  • Patient is terminally ill and anticipated to have less than twelve months to live.
  • Patient is a candidate for, or recipient of, an organ or bone marrow transplant.
  • Patient is in the process of staged surgery (i.e., cleft palate repair).
  • Patient is in an active course of treatment with a behavioral health provider (one visit within 30 days prior to coverage).

If you think you may qualify for transition coverage benefits, you should call Aetna Member Services to request a review of your situation. Once a review is completed, you will be notified in writing whether or not your request for coverage under transition coverage provisions is approved.

 

Publication date: April 2019

 

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