Aetna
Health Plan
Beyond preventive care, your coverage includes many ways to get care and support, like wellness coaching and personalized management programs for chronic conditions.
Aetna Health Plan Highlights
Beyond preventive care, your coverage includes many ways to get care and support, like wellness coaching and personalized management programs for chronic conditions.
Learn about the key benefits of your plan and download your Aetna Plan Details.
Plan details effective August 1, 2025.
Medical & Preventive Care
Free Primary Care Visits
There is no cost* to see your primary care provider (PCP). You can see your PCP for wellness check-ups and when you’re sick. Your coverage also includes virtual care options, so you can get care from the comfort of home.
*Visits with your PCP have no co-pay, however if your doctor orders tests or lab work, you may have to pay a co-pay on those services.
Low-Cost Urgent and Emergency Care
Urgent care is a low-cost option for non-emergency issues like minor injuries or flu symptoms when your doctor isn’t available. If you can’t get a same-day appointment with your doctor or have immediate health needs, your closest Aetna urgent care center is an affordable solution.
CVS Health®
Your plan also includes care through CVS Health®, giving you access to on-demand, mental health and primary care virtually with the option of being seen in person.
Emergency room visits should be used for serious conditions like chest pain, difficulty breathing or severe injuries.
A deductible or co-pay may apply.
Medical Visit Co-pays (in-network) | |
|---|---|
Primary Care Provider / Online Visits | $0 Co-Pay |
Urgent Care Visits | $15 Co-Pay |
Emergency Room Visits | $200 Co-Pay |
Specialty Visits | $15 Co-Pay |
Prescription Benefits
Prescription medication (Rx)
Aetna uses the Sav-Rx Retail Pharmacy Network for prescription benefits, which includes 75,000 pharmacies nationwide. It’s important to present your Sax-Rx ID card at your pharmacy.
Once you receive your Sav-Rx card in the mail, visit savrx.com to register for an account and access your prescription benefits. For questions, contact Sav-Rx at 1-800-228-3108.
Insulin: Preferred generic (Tier 1)/preferred brand (Tier 2)/non-preferred (Tier 3) $0/$0/$25 co-pay Inhalers &
EPI Pens: preferred generic (Tier 1)/preferred brand (Tier 2)/non-preferred (Tier 3) $8/$25/$35 co-pay
Rx Co-pays | Pharmacy – 30-day Supply | Mail Order – 90-day Supply |
|---|---|---|
Generic Contraceptives* | $0 | $0 |
Value-Based Drugs** | $4 | $8 |
Preferred Generic | $8 | $16 |
Preferred Brand | $25 | $50 |
Non-Preferred | $50 | $100 |
*If you work for a religious-based organization, your health plan excludes contraceptive coverage as permitted under the religious exemption of the Affordable Care Act. However, you will receive these at no cost to you (and without taking any additional action) from Kaiser Permanente, as long as you are enrolled in a health plan. **Value-based drugs are generic medications for treating various health conditions.
Additional Benefits
Mental Health
Get help navigating major life events or managing issues like stress or depression. Aetna provides comprehensive support, including:
Professional care, medication, group therapy and more.
Access to free apps like AbleTo and Headspace Care (for one-on-one coaching).
- Virtual assessments and e-visits to review your symptoms and get options that are right for you.
Explore resources in the link above or get started with Alma to find an in-person or virtual provider that matches your needs, identity and language.
Mental Health Visits
Outpatient: $0 co-pay
Inpatient: $0 co-pay, per day for up to 5 days per admit. Pre-authorization required or will not be covered.
Vision
Get comprehensive eye care, including one free eye exam and $600 for vision hardware (like lenses, frames and contacts) every 12 months. Choose from a wide selection of quality eyewear to match your style and budget—plus, enjoy free adjustments and repairs anytime.
Wellness Coaching & Programs
Wellness coaching is available at no cost and doesn’t require a referral. Get one-on-one support from a wellness coach to help you eat healthier, reduce stress, stay active, manage your weight, quit smoking and more.
If you’re managing a chronic condition like diabetes or high blood pressure, your plan also includes personalized care team support (referral required) and easy-to-use apps and programs.
Simple Steps to A Healthier Life is an online health coaching program for all ages. You can choose the area of health you’d like to focus on, including weight management, eating healthy and reducing stress.
To get started, log into the Aetna member website to complete a health assessment.
Massage, Chiropractic & Acupuncture
Chiropractic and acupuncture therapy are available at a $0 co-pay. Visit limits apply. See plan details.
Massage therapy is available a $15 co-pay for up to 20 self-referred visits per year. See plan details.
These services can help treat and prevent muscle and joint pain. Be sure to confirm your provider accepts your insurance when scheduling.
Naturopathy
Naturopathy visits: $0 co-pay.
Naturopathy uses natural remedies like nutrition, and lifestyle changes to support your health.
Physical Therapy
Physical therapy is available for a $15 co-pay per visit.
Visit limits apply and referral is required. See plan details.
Physical therapy can help you recover from injury, manage pain, and improve movement. To find a physical therapist, call 1-855-736-9469 or log in to your Aetna Member Portal to request a referral from your primary care doctor and find an in-network physical therapist.
You also get access to Hinge Health, a physical therapy app available to you at no-cost. The program provides all the tools you need to get pain relief from the comfort of home. Sign up today to access a care team and get an exercise and stretching program personalized to you.
No referral is needed for Hinge Health.
Women's Reproductive Health
Reproductive Health Visits are a $0-$15 co-pay per visit.
Preventative visits are a $0 co-pay. Other co-pay amounts depend on the diagnosis coding.
Contraceptives are available for a $0 co-pay*.
$0 co-pay for FDA-approved prescription and over-the-counter contraceptive drugs, devices and products.
Abortion Services** are a $0 cost share
for both in and out of network, inpatient and outpatient settings as well as medication.
Hey Jane
is a telehealth clinic that offers safe, affordable, and convenient reproductive & sexual health care. You can get abortion pills, vaginal infection treatments and birth control delivered by mail.
*If you work for a religious-based organization, your health plan excludes contraceptive coverage as permitted under the religious exemption of the Affordable Care Act. However, you will receive these at no cost to you (and without taking any additional action) from Kaiser Permanente, as long as you are enrolled in a health plan.
**Aetna members who need abortion or infertility care and reside in a state where such services are not supported may travel to a location where these services are legal and available. Travel and lodging benefits will be extended to support those seeking these services. To receive coverage for telemedicine medical abortion, a member must be enrolled in the plan and in accordance with Aetna’s clinical policy, a member may only receive a medication abortion up to 10 weeks gestation.
Gender-Affirming Care
Aetna offers inclusive, gender-affirming care in a safe, supportive environment. Services include hormone therapy, mental health support, surgical procedures and more.
Expanded Coverage
Aetna is your primary medical plan, but your healthcare coverage also includes these additional benefits:
Choice of Dental Coverage
You can choose from two dental plans and decide which one is best for you. Both options include routine exams, orthodontia benefits and broad provider networks.
Use the chart to compare plans and review your potential out-of-pocket costs for common services in the plan summaries.
 |  | |
|---|---|---|
Annual Maximum Benefit | $5,000 | None |
Deductible | $0 | $0 |
Routine Exams | Covered In Full | Covered In Full |
Orthodontia Benefits | Yes | Yes |
Provider Network | Delta Dental has a broad network of providers, including in rural areas. You’ll want to find a Delta Dental PPO dentist to maximize your benefit. | Willamette Dental has many convenient locations in western Washington, making it easy to find a Willamette dentist if you live along the I-5 corridor. |
Find a Dentist Near You | 1-800-554-1907 DeltaDentalWA.com | 1-855-433-6825 willamettedental.com |
Hearing Benefits
Through EPIC Hearing, you and your kids can get a no-cost annual hearing exam with consultation from an in-network provider and up to $3,000 of hearing hardware with extended warranty per ear every 36 months.
Family-building, Reproductive & Midlife Care
Get benefits for every stage of life, from fertility and family-building to pregnancy, postpartum and menopause. Get coverage for the latest treatments, personalized support from dedicated Patient Care Advocates (PCAs) and in-person or virtual care. And now you can get up to $15,000 for adoption-related expenses (lifetime benefit).
Aetna Plan Details
See a full breakdown of your medical and dental plans, including out-of-pocket costs, benefits, and coverage for prescriptions, visits and treatments.
Common Terms
Learn the definitions of common insurance terms to help you better understand your plan benefits.
Resources and Support
Health Benefits Customer Service
Get help with questions about coverage, eligibility, applying and more.
Customer service is available Monday-Friday, 8 a.m. to 6 p.m.
1-877-606-6705
In-language support available.
Live Chat Support
Log in to your Health Benefits Account for chat support.
SEIU775BG-caregiver@magnacare.com
Can’t contact customer service during business hours?
Email and get a response within 2 business days.
Aetna
Member Services:
1-855-736-9469
Mental Health Services
1-800-424-4047
24 Hour Nurse Line
1-800-556-1555
Find the Right PCP
1-888-982-3862
Member Language Assistance
1-855-736-9469
myseiu.be/aetna-language
Dental
Delta Dental
1-800-554-1907
deltadentalwa.com
Willamette Dental
1-855-433-6825
myseiu.be/willamette
Other Benefits
EPIC Hearing
1-866-956-5400
myseiu.be/epic
Progyny (Fertility and Family-building)
1-877-363-5638
myseiu.be/progyny
In-language Support
Contact Health Benefits Customer Service and you’ll be connected to someone who speaks your language and can help you apply for and manage your benefits.
After enrollment, language support is available through Aetna member services.
Health Benefits Account
- Check your eligibility for health benefits.
- Apply for or manage healthcare coverage.
- Get live chat support.
- Access plan documents & forms.
Health Benefits Support
Get help with coverage, eligibility, applying and more by visiting the support page or calling Customer Service at 1-877-606-6705.
Coverage for Kids
If you work 120 hours or more per month, your kids get all the same great benefits you do, including emotional well being, orthodontia, wellness visits and much more.
Healthcare Coverage Eligibility
Learn about how to qualify for healthcare coverage for you or your kids and how the hours you work effect your coverage.
Common Healthcare Coverage Terms
Learn the definitions of common insurance terms and definitions to better understand your insurance plan.