Plus PPO Plan for Employees
The Plus PPO Plan is a Preferred Provider Organization (PPO) plan administered by Aetna. A PPO plan offers:
- freedom of choice among in-network providers
- lower out-of-pocket costs (copay only for most in-network office visits)
- a strong emphasis on preventive health with preventive services and medications covered at 100% on this plan
- ability to lower your copay by selecting and visiting the Primary Care Provider (PCP) listed on your ID card or another provider in the same practice (you can find instructions on updating your PCP here)
- You can also enjoy a lower copay by visiting a Preferred Provider. These providers have been identified by the Plan as providers who are committed to improved access to high-quality, affordable health care. When you select and see one of these providers you will pay the lowest copay for an office visit.
If you have questions, please call Aetna Health Concierge at 833-690-1037 (TTY: 711), Monday through Friday, 8:00am - 5:00pm ET.
Plus PPO Plan Important Documents
- 2026 Plus PPO Plan Benefits Booklet
- 2026 Plan Comparison Chart
- 2026 Preventive Services Summary
- 2026 Uniform Summary of Coverage
- 2026 Comprehensive Formulary Drug List
- 2026 Preferred Drug List
- 2026 Preventive Medications List
For more information regarding these benefits and what is covered, please call Aetna Health Concierge at 833-690-1037.
2026 Plus & Standard PPO Plans Rate Sheets
- Active Subscribers
- Active Subscribers Who Are Medicare Primary Due to Upcoming Retirement
- 12-Month RIF Subscribers
- Active Subscribers Whose Dependent is Medicare Primary Due to ESRD
- Active Employees, Eligible Part-Time, Job Share and Leave of Absence Subscribers
Members indicated as 50% or 100% contributory notes the percentage of the premium for which they are responsible.
Medical Policies
Although your Benefits Booklet provides a good overview of what services and products are available to you under the PPO plans, the medical policies provide detailed information around the circumstances under which certain services and products are and are not covered. Medical policies can be found here on the Aetna website*.
If any of the State Health Plan medical policies conflict with the Aetna medical policies, the State Health Plan medical policies will prevail.
Prior Authorization
Certain services require prior review and certification before they can be covered by your plan. Providers are responsible for submitting the required documentation. Providers can visit the links below for more information.
Appeals
If you disagree with the way a claim has been handled, you can request an appeal or grievance review. For the complete appeals process, please click here.