• Medical & Pharmacy Plan

Aetna

The Navigators Health Plan

The Navigators has a self-funded medical plan, which means that we pool premium contributions from our members to pay the medical and pharmacy claims of our Navigators family. We partner with Aetna International to administer our claims and provide member customer service.

Aetna specializes in global health care so that members can find health care providers almost anywhere around the world. By selecting Aetna, The Navigators seeks to provide its employees with a smooth transition between their U.S. and overseas health care needs.

This Aetna partnership provides a higher standard of care and services to all Aetna members. These services include pre-trip planning, coordination of care, medical evacuation and/or emergency assistance. These benefits and more can be accessed by calling the customer service number on your Aetna Medical ID Card.

High Deductible Health Plan (HDHP)

To provide the best quality health care at affordable rates, The Navigators offers an HDHP medical plan. The HDHP allows employees to pay for eligible health expenses tax-free through their own health savings account (HSA). HSA funds can be used to pay for medical expenses before an employee meets their deductible, for medical expenses shared with The Navigators through coinsurance and even for other eligible health expenses not covered under the medical plan (dental, vision, etc.).

  • Part 1: HDHP
    • Preventive care covered at 100% (no deductible)
    • Lower premiums due to high deductible
    • Protection from costs of serious illness/injury once you meet the deductible
  • Part 2: HSA
    • Employee-owned account
    • Funded by the employee
    • Covers routine medical expenses before you meet the deductible

Medical Plan Resources

Use these resources to maximize your medical benefits:

This is only a brief summary of benefits. Detailed information can be found in your benefit plan documents, available in our Document Library.

Don’t Forget Your Preventive Care

Our medical plan covers routine preventive care services at 100% in-network or overseas, with no deductible or coinsurance. Services are those deemed customary and standard for preventive care by Aetna. To see your customized Preventive Health Schedule, log on to www.aetna.com, then select “Stay Healthy” and scroll down to “Health Information Tools.” In general, preventive screenings are those intended to test for indicators of a disease and are not a diagnosis or treatment of a suspected or identified illness. During some preventive screenings, your provider may order additional tests or procedures for diagnosis or treatment, such as the removal of polyps during a colonoscopy. These additional measures may be subject to the deductible and/or coinsurance.

*The out-of-network amount paid is the “reasonable and customary” charge. Your actual out-of-pocket cost may be greater if your provider does not accept this amount.

Your health care plan includes the convenience of accessing your prescription medications at any licensed pharmacy in the world. You can also receive up to a 12-month supply of covered medications at a participating U.S. pharmacy or through the U.S. mail.

Generic Drugs: Generic drugs contain the same effective ingredients and meet the same purity standards as their brand-name counterparts. The Navigators Health Plan covers 100% of the cost of select generic preventive medications and the deductible is waived. View qualifying medications.

Dispense as Written: If you intend to use a brand drug instead of generic, your doctor must document your medical necessity in order for it to be covered.

Step Therapy: Your doctor must first prescribe a generic or less costly drug and then document the medical necessity before moving to a more specific drug.

This is only a brief summary of benefits. Detailed information can be found in your benefit plan documents, available in our Document Library.

*$1,000 in preventive care is included in this figure, which does not apply to the member deductible or coinsurance.

With Aetna’s telemedicine offerings, you have 24/7 access to experienced doctors for telephone and video consultations no matter where you are.

  • Teladoc:* Virtual care support available to members in the United States
  • vHealth:** Virtual care support available to members outside the United States

*Teladoc services vary according to plan type. Refer to your plan documents for more information.
**vHealth by Aetna is currently available to eligible members in a number of territories around the world including India, Asia Pacific, UAE and UK.

In Touch Care Program

This program provides one-on-one personalized nurse support for you and your family. Providing the support you need when you need it most, your dedicated nurse will:

  • Be a trusted advisor for improving your health and ensuring you receive proper care
  • Get to know your family and medical history
  • Monitor your health and identify issues before they begin
  • Help you overcome daily stressors
Your CARE Team

When you have questions about your health, you can call Aetna’s Care and Response Excellence (CARE) team to get answers. These clinicians are available around the clock to help with:

  • Pre-trip planning
  • Coordinating routine and urgent medical care worldwide
  • Locating providers and specialists
  • Getting medical devices or prescription medications
  • Coordinating and supervising medical evacuations

Aetna’s CARE team can communicate with you by phone, email or text messaging — whichever way works best for you.

Other Resources

Other tools available to help you manage your health and wellness include:

  • Online wellness programs
  • Discount programs
  • Second opinion services
  • Emergency assistance services
Customer Service

The Aetna International Member Service Center is available 24 hours a day, 7 days a week to assist you with any questions that you have regarding your plan.

Group # 706366

(855) 829-9558 (toll-free)

(813) 775-0449 (direct)

Email: aiservice@aetna.com

Member Websites

www.aetna.com

  • Estimate your health care costs with the Member Payment Estimator tool before seeking treatment
  • Find US health care professionals and facilities that participate in your plan using DocFind
  • View detailed claim status and Explanation of Benefits (EOB) statements

www.aetnainternational.com

  • Look up international providers
  • Request direct settlement to avoid filing a claim
  • File a claim and submit supporting documentation
Mobile Apps

Aetna Health (use when you’re in the US)

  • Find doctors, hospitals, urgent care centers and walk-in clinics in the United States
  • Estimate your costs
  • Track your claims
  • Access your digital ID card

Aetna International (use when you’re outside the US)

  • Submit your claims
  • Search for doctors and hospitals outside of the United States
  • Find forms, health care resources and more

Just search for the app you need in the Apple App Store or Google Play to download.

This Health Plan Guide provides the basic information you need to use your health plan to the fullest.

There are an array of other resources and plan documents available in our Document Library, so you can dive further into the details.

Questions on your benefits?

HR Benefits Department

benefits@navigators.org

(719) 594-2441

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