Aetna PPO

Plan Description

Aetna PPO Group #837032

If you select the Aetna - PPO, your Medical and Prescription Drug benefits are described on the Aetna website and in a separate benefit booklet prepared by Aetna. Your Dental, Vision, Chemical Dependency, Member Assistance Program, and Death benefits are described in the Summary of Benefits Booklet. You can request an Aetna PPO Coverage benefit booklet free of charge from the Plan Manager.

Eligibility Requirements

Employees participating in the Sacramento Area Electrical Workers Health and Welfare plan and do not live in the service areas of the Kaiser or Western Health Advantage HMO.

The Aetna PPO Plan has a $1,500 per person/$4,500 per family annual deductible. Therefore, before Aetna will pay any benefits, you must incur and pay at least $1,500 of medical expenses.

Claims Procedures

Claim forms must be completed in all instances in order to receive benefits. Claim forms may be obtained by calling or writing the Plan Manager. After completing the claim form, mail or bring it, together with the itemized billing from the Service Provider, to the Plan Manager for processing. If you require any assistance, the Plan Manager will gladly help you.

Claims will be paid in the following manner:

    • Upon presentation to the Plan Manager of the completed claim form and itemized bill for a covered charge, a check will be made payable to you by the Plan Manager on behalf of the Trust.
    • In the event you assign payment of a claim to the hospital or provider in writing, the check will be made payable to the assignee.
    • Vision claims are processed and paid by an independent provider at:
    • Vision Service Plan
      P.O. Box 997105
      Sacramento, CA 95889-7105
      Telephone: (800) 877-7195
      TDD: (800) 428-4833
    • Dental claims are processed and paid by an independent provider at:
    • Delta Dental Plan of California
      P.O. Box 7736
      San Francisco, CA 94120-7736
      Telephone: (888) 335-8227
    • For Kaiser Permanente - HMO, Western Health Advantage – HMO or Aetna – PPO enrollees, present your ID card to your provider or pharmacy at the time of service.