Aetna Value Plan
National PPO network, wellness credits, low rates and 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 Value Plan | Code | Biweekly Premium |
|---|---|---|
| Self Only: | L7D | $394.95 |
| Self +1: | L7F | $913.08 |
| Self & Family: | L7E | $889.71 |
Your 2026 benefits
| Plan Details | What you pay In the network |
What you pay Out of network |
|---|---|---|
| Yearly Deductible | $700 Self Only $1,400 Self Plus One or Family |
$1,400 Self Only $2,800 Self Plus One or Family |
| Preventive Care | $0
(no deductible) |
50% (after deductible) |
| Primary care visit | $25 (no deductible) |
50% (after deductible) |
| Specialist visit | $40 (no deductible) |
50% (after deductible) |
| CVS Health® Virtual Care™ | $0 (no deductible) |
|
| Maternity | 20% (after deductible) |
50% (after deductible) |
| Prenatal Care | $0 (no deductible) |
50% (after deductible) |
| Hospital Care | 20% (after deductible) |
50% (after deductible) |
| Other services
(Like inpatient and outpatient hospital procedures) |
20% (after deductible) |
50% (after deductible) |
Aetna Value Plan prescription drug benefits when Medicare is not primary
See AetnaFedsPostal.com/pharmacy for participating pharmacies.| Prescription drugs
(for a 30-day supply at a retail pharmacy) |
What you pay In the network |
What you pay Out of network |
|---|---|---|
| Preferred Generic* | $10 (no deductible) |
50%** |
| Preferred Brand-name*** | 30% up to $600 (no deductible) |
50%** |
| Non-preferred (generic or brand)* | 50% up to $600 (no deductible) |
50%** |
| Preferred specialty drugs**** | 50% up to $600 | 50%** |
| Non-Preferred specialty drugs**** | 50% up to $1,200 (no deductible) |
50%** |
Note: You don’t need to meet a deductible for prescription drugs. Just pay your copay or coinsurance (as noted below).***
90-day supply through mail-order service or CVS Pharmacy®:
- $20 preferred generic
- 30% preferred brand $1200 max
- 50% non-preferred (generic or brand) $1200 maximum
You’ll generally pay less for a 3-month supply than for 3 separate 1-month supplies.
Aetna Value Plan 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 pay $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. This $2,000 will also apply to the medical plan’s total calendar year out-of-pocket maximum. |
2025 Aetna Value Plan PSHBP Formularies
Download 2025 PSHB plan summary for Aetna Value Plan with Aetna Medicare Rx offered by SilverScript (PDF)
Download 2025 PSHB Prescription Drug Formulary for Aetna Value Plan with Aetna Medicare Rx offered by SilverScript (PDF)
Download 2025 PSHB Evidence of Coverage for Aetna Value 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
Earn Wellness Incentive Credits
- Step 1: Get preventive care like routine physicals, flu shots and biometric screenings.
- Step 2: Earn $50 in wellness credits for each activity (up to $250 for Self Only or $500 for Self Plus One or Family coverage).
- Step 3: Use those credits to pay your deductible or medical coinsurance costs.
Why choose the Aetna Value Plan?
- Large nationwide Aetna PPO Network
- Low monthly premium costs
- Deductible does not apply to office visits or for prescriptions.
- Earn up to $250/self or $500/self plus one and family in wellness credits
- Acupuncture and chiropractic care are covered!
- 24 hours a day / 7 days a week access to doctors via phone or video with Health services
- Discounts on eyewear, LASIK laser eye surgery, gym memberships, massage, acupuncture, weight-loss programs and more
*Formulary is a list of generic and brand-name drugs your health plan prefers.
**Plus the difference between the plan allowance and billed amount.
*** Your plan requires the use of generic medication when a generic equivalent exists. 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.
****For specialty drug information, see the official plan brochure.
This is a brief description of the features of this Aetna health benefits plan. Before making a decision, please read the Plan's official brochure(s). All benefits are subject to the definitions, limitations, and exclusions set forth in the official plan brochure. CVS Virtual Care™ services are only available in the USA. Limitations may apply based on services and location.
For a complete list of participating pharmacies go to AetnaFeds.com and use the 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.
Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Incentive-based activity awards will only be given for completing select wellness programs as determined by the plan sponsor. 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.
Aetna's Drug Guide is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change.
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.
For information about our plans available through the Federal Employees Dental and Vision Insurance Program (FEDVIP), please visit our Dental PPO Plan site or our Aetna Vision™ Preferred site.
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