Aetna PPO Health Plan
Aetna, a CVS Health company, is one of the nation’s leading diversified health care benefits companies, servicing approximately 39 million people. Their nationwide network provides access to over 5,700 hospitals and more than 700,000 primary care doctors and specialists.
Aetna’s Joint Claim Administration (JCA) provides a unique program for organizations that self-administer their medical plan, or work with a third-party administrator. Aetna provides claims repricing, provider payment, care management and network management. The group/third-part administrator handles benefit determination, eligibility and other member services.
Aetna leverages technology to promote participant health and contain costs. Aetna technology finds gaps in care and counter-indicated care. Participant health records, such as doctor visits, prescription drugs lab results are reviewed and compared to evidence-based best practices. Action alerts are sent to the participant’s doctor if anything is identified.
Aetna has extensive online and mobile tools to help participants make better-informed health care decisions, including:
- Personal health records
- Health assessments
- Appointment scheduling
- Hospital and physician-specific information on clinical quality