CSC Preferred Access – In-Area Feature

Open access to care providers with no referrals required.

How the In-Area Feature works

When you need care, you have a choice:

You may visit an in-network provider.

You may make an appointment directly with a primary care provider, specialty care provider or other health care provider who belongs to Aetna's network – no referral is required.

When you visit an in-network provider:

• You will pay a flat fee, called a copay, for services such as office visits.
• You will be required to meet a deductible before the plan begins to pay benefits for other types of services. The plan will then pay a percentage of covered expenses (called coinsurance).
• You'll have a higher level of coinsurance reimbursement for services, such as hospitalization, x-ray and lab.
• Provider is responsible for precertification requirements.
• The provider will file the claim.

You may visit an out-of-network provider.

You also may make an appointment directly with a primary care provider, specialty care provider or other health care provider who does not belong to Aetna's network – no referral is required.

When you use an out-of-network provider:

• You must meet a higher deductible each year before the plan starts to pay benefits.
• After you meet the deductible, the plan will pay a percentage of the remaining expense (coinsurance). This percentage will be lower than it would be if you used an in-network provider. In addition, the plan's benefit will be based on the reasonable and customary charge for a given service. If the reasonable and customary charge is lower than the actual charge, you must pay the difference.
• You must call Aetna to start precertification for certain types of care.
• You may be required to file your own medical claims.