Information relevant to the approval of an access plan
An insurer’s preferred provider benefit plan (PPBP) or exclusive provider benefit plan (EPBP) network is required to have licensed providers in sufficient number, size, and geographic distribution to meet the medical and health care needs of enrollees.
When the network of contracted providers cannot meet all enrollees’ medical and health care needs, the insurer must file an access plan.
An access plan documents how an insurer will ensure health care that is necessary, but not available through contracted providers, will be available to enrollees and describes what steps the insurer will take to increase its contracted providers to improve its network adequacy.
When out-of-network providers are utilized due to a insurer’s use of an access plan, out-of-pocket expenses are applied to the enrollee’s out-of-pocket maximums, and providers are paid at the usual and customary or agreed upon rate.
For detailed information about each insurer's access plan, please visit the insurer's website.
Approved PPBP network access plans
Insurer: Aetna Life Insurance Company
Plans:
- Aetna Life Insurance Company - PPO based Network
- Sears PPO Narrow Pharmacy Network
- Aetna Aexcel - South Texas Markets (Austin, Houston, and San Antonio)
- Aetna Aexcel - El Paso Market
- Aetna Aexcel - Dallas Market
- Aetna Savings Plus - San Antonio Market
- Aetna Savings Plus - Austin Market
- Aetna Savings Plus - Houston Market
- Aetna Open Choice PPO and Managed Choice POS
- Aetna Value Performance Network
- PPO Community Plan - Austin
- PPO Community Plan - San Antonio
- Quality Partners in Care (QPIC) ACO San Antonio Network