IQVIA Benefits Handbook
IN-NETWORK BENEFITS
Aetna has selected a group of health care professionals and facilities for the Choice POS II network. All providers in the network must meet certain quality criteria established by Aetna. The network monitors the quality of service patients receive through regular practice reviews, site visits, chart reviews and numerous other measures.
When you receive in-network care, the following benefit features apply:
  • You are covered at 100% for eligible preventive care.
  • Physician office visits are subject to a copay in the $400 Deductible PPO Plan and $900 Deductible PPO Plan; the deductible doesn't apply. In the $1,850 Deductible Plan with HSA and $2,850 Deductible Plan with HSA you pay coinsurance after the deductible is met.
  • Pre-certification for inpatient hospitalizations and certain outpatient services are managed by the doctors for you.
  • The doctors have agreed to accept negotiated fees that are generally lower than what you would pay out-of-network; as a result, Maximum Reimbursable Charges (MRC) do not apply.
Kaiser's exclusive network of providers allows members to access all services under one roof, including primary and specialty care, lab, X-ray and pharmacy.  All providers in the network must meet certain quality criteria established by Kaiser. The network monitors the quality of service patients receive through regular practice reviews, site visits, chart reviews and numerous other measures.
When you receive in-network care, the following benefit features apply:
  • You are covered at 100% for eligible preventive care.
  • Physician office visits are subject to a copay in the $400 Deductible PPO Plan and $900 Deductible PPO Plan; the deductible doesn't apply. In the $1,850 Deductible Plan with HSA and $2,850 Deductible Plan with HSA you pay coinsurance after the deductible is met.
  • Pre-certification for inpatient hospitalizations and certain outpatient services are managed by the network doctors for you. If you are using out-of-network providers, you are responsible for the pre-certification and you will incur a financial penalty if you do not obtain the pre-certification.
To find a doctor in the network:
  • Aetna: Go to www.aetna.com/docfind. (If you're not registered to use www.aetna.com, click "Log In/Register." You will need to enter your member ID, which is located on your ID card, first and last name, date of birth, zip code and an email address. Then, click "Continue" and follow the prompts to set up your account.) Once you're logged in, click "Find Care," on the welcome page.
  • Kaiser: Go to https://healthy.kaiserpermanente.org. (If you're not registered to use https://healthy.kaiserpermanente.org, click "Register." Then click "I have a Kaiser Permanente plan and want to use online services." You will need to enter your first and last name, date of birth, preferred language, region and medical record number (MRN) from your ID card. Note: Northern CA employees do not need to include the "11" prefix in the MRN.) Once you're logged in, click "Coverage and Costs."
If you need any assistance locating a provider in the network, call Aetna at 800-726-4366 or Kaiser at 800-464-4000.