Point of Service (POS) plans

Lowest out-of-pocket costs.

When accessing health services through this tier, you get the care you need from providers and hospitals in our Performance Network. Your primary care physician, or PCP, coordinates all of your care.

Tier 1 highlights

• Your PCP is your main point of contact for when accessing Tier 1 benefits. They’ll handle your care, coordinate any treatments, and more.
• Referrals may be needed when seeing a specialist within the Tier 1 network.
• This tier requires less paperwork — for example, claims — and less member responsibility than other tiers.
• Preventive care services are offered at no extra cost.
• Copays or coinsurance costs apply for most other care visits and services.

Higher out-of-pocket costs.

With Tier 2, you can get care from the Aetna Open Choice PPO^® provider network — with no referral needed. It’s important to remember that when you choose to get care from the Aetna Open Choice PPO provider network, your out-of-pocket costs will be higher.

Use the tool below to search for an Aetna provider. Enter your ZIP code, then select the Open Choice PPO plan.

Tier 2 highlights

• You can make appointments directly with providers in the Aetna Open Choice PPO network — no referral required.
• Copays or coinsurance costs apply to every visit and service, in addition to your deductible.
• You’ll need to get precertification before you can receive certain services from an Aetna Open Choice provider.

Highest out-of-pocket costs.

Members can receive care from any care provider in the U.S., including physicians, specialists, hospitals or laboratories. Certain services may require precertification, or approval from Sharp Health Plan.

Tier 3 highlights

• This option has the highest cost share but offers more flexibility and allows for care anywhere.
• Referrals are not required; however, there will be more paperwork on your part, including claims and precertification.
• Out-of-pocket costs could apply.

Lowest out-of-pocket costs.

When accessing health services through this tier, you get the care you need from providers and hospitals in our Choice Network. Your primary care physician, or PCP, coordinates all of your care.

Tier 1 highlights

• Your PCP is your main point of contact for when accessing Tier 1 benefits. They’ll handle your care, coordinate any treatments, and more.
• Referrals may be needed when seeing a specialist within the Tier 1 network.
• This tier requires less paperwork — for example, claims — and less member responsibility than other tiers.
• Preventive care services are offered at no extra cost.
• Copays or coinsurance costs apply for most other care visits and services.

Higher out-of-pocket costs.

With Tier 2, you can get care from the Aetna Open Choice PPO^® provider network — with no referral needed. It’s important to remember that when you choose to get care from the Aetna Open Choice PPO provider network, your out-of-pocket costs will be higher.

Use the tool below to search for an Aetna provider. Enter your ZIP code, then select the Open Choice PPO plan.

Tier 2 highlights

• You can make appointments directly with providers in the Aetna Open Choice PPO network — no referral required.
• Copays or coinsurance costs apply to every visit and service, in addition to your deductible.
• You’ll need to get precertification before you can receive certain services from an Aetna Open Choice provider.

Highest out-of-pocket costs.

Members can receive care from any care provider in the U.S., including physicians, specialists, hospitals or laboratories. Certain services may require precertification, or approval from Sharp Health Plan.

Tier 3 highlights

• This option has the highest cost share but offers more flexibility and allows for care anywhere.
• Referrals are not required; however, there will be more paperwork on your part, including claims and precertification.
• Out-of-pocket costs could apply.