Texas Health Aetna Select Plan 1000

Texas Health Aetna Select Plan 1000 (plan option ends Dec. 31, 2022)

Plan overview

The Texas Health Aetna Select Plan 1000 is an EPO plan. Employees who enroll in this plan have set copays for health care services such as doctor’s office visits or Urgent Care visits. When you need hospital care or MRIs, CTs or PET scans, you must pay your deductible before the plan pays part of the bill (called co-insurance).

IMPORTANT NOTE: In order to enroll in this plan option, you must have an address listed in the HR system that is in one of these counties.  

Where you can go for care

  • Network Doctors: This plan option has a narrow network made up of a select, local group of primary care doctors and specialists in the Dallas-Fort Worth area in Texas Health Aetna’s Open Access EPO Plus network. 
  • Network Hospitals: This plan option has a narrow network made up of a select, local group of hospitals in the Dallas-Fort Worth area in Texas Health Aetna’s Open Access EPO Plus network. 
  • Out-of-Network: There is no coverage under this plan option for services or care you receive from a doctor or hospital that is not in network unless it is for a true emergency.

To find a doctor or facility in the Texas Health Aetna network:

  1. Visit texashealthaetna.com
  2. Select “Click here to find a doctor” under the Find a Doctor section
  3. Enter your home location (zip, city, county, or state) and click “Search”
  4. Under Select a Plan, choose “Employer Plan — Open Access EPO Plus” as your plan and click “Continue”

To get the most up to date information, please contact Texas Health Aetna member services at 1-877-MyTHRLink (1-877-698-4754), prompt 1.

What you pay for care

Plan
Features

Texas Health Aetna Select Plan 1000

Texas Health Aetna Open Access EPO Plus Preferred Network
Doctors, Hospitals, and Free-standing Facilities

Network

Local, narrow network with select providers

Deductible

$1,000 individual / $3,000 family

Medical and Rx Out-of-Pocket Maximum1

$6,850 individual / $13,700 family

Office Visits

$30 copay for PCP; $50 copay for specialist

Maternity Office Visits

$30 copay for initial office visit; no cost for additional visits

Inpatient Hospital Care

10% after deductible

Virtual Care Services: Anytime MD

$0

Emergency Room

$200 copay, then 10% after deductible

Urgent Care Center

$50 copay

Outpatient Surgery2

Office visit copay applies; 10% after deductible if not in doctor’s office

Routine Physicals3

$0

Well-Woman/Man Exams3
(Including Pap Test or PSA Test)3

$0

Well-Child Care3
(Including Immunizations)3

$0

Colonoscopy3

$0

Mammography4

$0

Outpatient Diagnostic Lab & X-ray (Excluding MRI, CT, PET Scans)2

No additional charge if processed in doctor’s office;
10% after deductible if not in doctor’s office

MRI, CT & PET Scans2

10% after deductible

Outpatient Therapy5

$30 per visit

1 Maximum includes deductible, co-insurance, and copays for medical care and prescriptions.

2 When your doctor requests tests or services such as lab work, X-rays, MRIs, CT scans, physical therapy, or rehabilitation at a free-standing facility that isn’t affiliated with a hospital, you should check
to make sure they are in-network. Check with your insurance carrier to verify whether a facility and/or doctor is covered under your plan and to learn how much your coinsurance would be.

3 Well exams are covered in full if the claims administrator determines the physical is for preventive care. Additional screenings or services will be considered diagnostic services and will be covered after you pay the applicable copay or deductible and coinsurance. At the time of your preventive care visit, if other services are performed that are not preventive services, as determined by the claims administrator, they will not be paid at 100% even if they are submitted as part of a claim for preventive care.

4 One per year is covered. You pay the coinsurance for additional mammograms.

5 Up to a combined total of 60 visits per year are covered for outpatient physical, occupational, and speech therapy. Pulmonary and rehabilitation services are covered up to 20 visits. Up to 36 cardiac rehabilitation visits are covered.

 

What you pay each paycheck

To view the 2022 costs per paycheck, click here. 

Features of the plan

There are a variety of cool (and some free) features that come with this plan option. You can find a full list of features here.

Tips

Check out these tips that can help you get the care that is right for you while keeping your costs down.  

WHO DO I CONTACT WITH QUESTIONS?