Aetna CDHP with a national PPO network
This plan provides a fund that pays for care before you do – plus, no referrals
2026 Biweekly rates for zip code 20002
These rates do not apply to all Enrollees. If you are in a special enrollment category, please refer to the PSHB Program website or contact the agency which maintains your health benefits enrollment.
| Aetna HealthFund® CDHP | Code | Biweekly Premium |
|---|---|---|
| Self Only: | L7A | $284.21 |
| Self +1: | L7C | $671.83 |
| Self & Family: | L7B | $630.34 |
How your CDHP works
STEP 1: You get a medical fund
This is the amount you get at the start of the plan year to pay for your health care. You pay nothing for covered services until the medical fund is gone. Any unused amounts roll over from year to year, unless you switch health plans or leave the plan.*
| How much do you get in your medical fund? | Medical Fund | Dental Fund |
|---|---|---|
| Self Only: | $1,000 | $300 |
| Self Plus One or Self and Family: | $2,000 | $600 |
The full fund amount is available on day 1 for you to use!**
STEP 2: You may have a deductible
A deductible is the amount you need to pay out of your pocket for covered services after you've used up all the medical fund for the year.
| What is your deductible amount? | In-network | Out-of-network |
|---|---|---|
| Self Only: | $1,000 | $1,500 |
| Self Plus One or Family: | $2,000 | $3,000 |
STEP 3: You may have coinsurance
Coinsurance is how much the Plan and you pay for health care expenses. It is a shared amount. We pay the larger part. You pay the smaller part.
Coinsurance starts after you have used up the medical fund and met your deductible.
| What is your coinsurance amount? | We pay | You pay |
|---|---|---|
| In network: | 85% | 15% |
| Out of network: | 60% | 40% |
To pay the least out of pocket, use network providers. (Doctors, hospitals and labs are examples of providers.)
Plus- MinuteClinic® or Walk in clinic - $0 after deductible (In network)
- CVS Health® Virtual Care™ - $0 after deductible
You get in-network preventive care at no additional cost to you!
Examples include wellness screenings and exams, dental cleanings and routine eye exams.
If you see network providers for services like these, nothing comes out of your pocket (or the Fund).
Grow the medical fund by up to $100!
Log in to your member website and fill out a health assessment. Then complete one online wellness program to earn $50. You can also earn an additional $50 for completing your biometric screening.
Built-in pharmacy, dental and vision benefits, too
| Type of coverage | What you get |
|---|---|
| Pharmacy coverage, when Medicare is not primary |
|
| Dental |
|
| Vision |
|
Aetna HealthFund CDHP Prescription drug benefits when you’re enrolled in Medicare Part A and/or B: Aetna Medicare Rx offered by SilverScript
Members with Medicare Part A and/or Part B primary will be automatically enrolled into Aetna Medicare Rx® offered by SilverScript®. This is a Medicare Part D prescription drug option offering significant savings. Your drugs will still be covered, but copays and coinsurance are lower. See benefits below.| Benefit | What you'll pay |
|---|---|
| 30-day Supply through Retail |
|
| 90-day Supply through Retail or Mail |
|
| Out of Pocket Maximum for prescription drugs | Once you have paid $2,000 in out of pocket costs for covered prescription drugs, you will pay $0 for covered prescription drugs for the remainder of the calendar year under this Medicare Part D Prescription Drug Plan. This $2,000 will also apply to the medical plan’s total calendar year out-of-pocket maximum. |
2025 Aetna CDHP Plan PSHBP Formularies
Download 2025 PSHB plan summary for Aetna CDHP Plan with Aetna Medicare Rx offered by SilverScript (PDF)
Download 2025 PSHB Prescription Drug Formulary for Aetna CDHP Plan with Aetna Medicare Rx offered by SilverScript (PDF)
Download 2025 PSHB Evidence of Coverage for Aetna CDHP Plan with Aetna Medicare Rx offered by SilverScript (PDF)
Download 2025 PSHB Prescription Drug Supplemental Benefit (PDF)
Aetna Medicare Rx Resources and Contact Information
Call Members Services at 1-833-251-9749 (TTY: 711), Monday through Friday, 8 AM to 8 PM ET or go online at Caremark.com
Why choose Aetna CDHP?
- Large nationwide Aetna PPO Network
- Coverage in network or out — and no referrals needed for covered services
- A medical fund to help you pay for care; any unused dollars roll over to the next plan year
- 24 hour / 7 days a week access to doctors via video with CVS Virtual Care
- Discounts on eyewear, LASIK laser eye surgery, gym memberships, massage, acupuncture, weight-loss programs and more.
*The most you can roll over is $5,000 (Self Only) or $10,000 (Self Plus One or Self and Family).
**If you join after open enrollment season, the amount of the Fund will be prorated.
***A formulary is a list of generic and brand-name drugs your health plan prefers.
**** For specialty drug information, see the federal plan brochure
*****If you choose the brand name drug over the generic equivalent, you will owe the corresponding copay plus the difference between the generic and brand name costs. Please see the plan brochure for details.
Aetna and CVS Pharmacy® are part of the CVS Health® family of companies.
This is a brief description of the features of this Aetna health benefits plan. Before making a decision, please read the Official Plan brochure(s). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.
For a complete list of other participating pharmacies log in to your member website to use our provider search tool. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services.
DISCOUNT OFFERS ARE NOT INSURANCE.They are not benefits under your insurance plan. You get access to discounts off the regular charge on products and services offered by third-party vendors and providers. Aetna makes no payment to the third parties — you are responsible for the full cost. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts.
The Aetna Medicare Rx offered by SilverScript (EGWP) retiree pharmacy coverage is an enhanced Part D Employer Group Waiver Plan that is offered as a single integrated product. The enhanced Part D plan consists of two components: basic Medicare Part D benefits and supplemental benefits. Basic Medicare Part D benefits are offered by Aetna Medicare Rx offered by SilverScript (EGWP) based on our contract with CMS. We receive monthly payments from CMS to pay for basic Part D benefits. Supplemental benefits are non-Medicare benefits that provide enhanced coverage beyond basic Part D. Supplemental benefits are paid for by plan sponsors or members and may include benefits for non-Part D drugs. Aetna Medicare Rx offered by SilverScript (EGWP) reports claim information to CMS according to the source of applicable payment (Medicare Part D, plan sponsor or member).
Aetna Medicare Rx offered by SilverScript is a group standalone Medicare Prescription Drug Plan (PDP). This plan is offered by SilverScript Insurance Company, which has a Medicare contract. SilverScript Insurance Company and Aetna are affiliated companies. Enrollment in the plan depends on Medicare contract renewal.
Due to legislation in Arkansas, effective January 1, 2026, you may not be able to utilize the following services within the state of Arkansas, unless a court takes action: CVS Retail, CVS Caremark Mail Service, CVS Specialty, and OMNI Care long term pharmacies.
Aetna's Drug Guide is subject to change.
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