Answers to frequently asked questions about our new medical and prescription
drug plan administrator coming in 2025.
Does this transition to Aetna administration impact me?
My medical ID card has the Blue Cross/Blue Shield, the Baylor Scott &
White or PHP/Cigna logo:
Yes, this change impacts you. Your medical and prescription drug plan will
transition to Aetna administration effective Jan. 1, 2025. The medical plans you’re offered, coverage levels and plan design
are not changing. You will receive new ID cards. Visit
MyChooseWell.Aetna.com during open enrollment to review the Aetna provider and pharmacy directories
and prescription drug formulary.
My medical ID card has the Blue Shield of California logo:
Yes, this change impacts you. Your 2025 medical plan stays with Blue Shield of CA, but
your prescription drug plan will move to Aetna administration effective
Jan. 1, 2025. You will receive new ID cards. Visit
MyChooseWell.Aetna.com during open enrollment to review the Aetna pharmacy directory and prescription
drug formulary.
New Aetna resources
What resources are available to me right now?
Visit MyChooseWell.Aetna.com to:
Preview the current Aetna provider directory and pharmacy directory, * based on the providers, clinics, facilities and pharmacies that are currently
contracted with Aetna. Some Providence and affiliated providers are in
the process of contracting with Aetna and will be added to the provider
directory as they are contracted. We expect all Providence facilities
and providers to be in network for our caregiver plans.
Review the current Aetna prescription drug formulary. *
Review general information on transition of care. If you or your enrolled family member are receiving active medical treatment
that will continue into 2025 for health conditions such as cancer, transplant
or in the third trimester of pregnancy and your provider will not be in-network
for 2025, transition of care will be available beginning in December.
*While we are providing these initial resources now, the Aetna provider
and pharmacy directories and prescription drug formulary are subject to
change at any time. During 2025 open enrollment (Oct. 30–Nov. 15),
please review the Aetna provider directory and prescription drug formulary
again to identify that your provider is part of the network going into
2025 and how your specific medication(s) may be covered for 2025.
Who can I contact if I have questions?
For assistance with the Aetna provider/pharmacy directory, prescription
drug formulary search or general questions about transition of care, call
the Aetna Service Advocate team** at 833-529-1661, weekdays, 8 a.m. to
6 p.m. PT.
For questions about your current Choose Well health and insurance benefits
and eligibility, call the Benefits Service Center at 888-615-6481, weekdays,
7:30 a.m. to 6 p.m. PT.
**Aetna Service Advocates do not have access to your personal information
or 2025 benefits enrollment data until December, so they are unable to
answer specific questions about your medical plan enrollment or benefits
at this time.
Open enrollment
When is 2025 benefits open enrollment?
Open enrollment will be Oct. 30-Nov. 15, 2024. You will receive an open
enrollment mailer at your home mailing address in late October.
Any changes you submit during open enrollment will be effective Jan. 1, 2025.
2025 medical, dental and vision rates
Will my medical plan rates change for 2025?
2025 medical rates will be available via MyChooseWell.org in late October.
HealthEquity accounts
Will my HealthEquity card funds continue to be available, or will they
be forfeited?
The health reimbursement and health savings accounts offered with our HRA
or HSA medical plans are not included in this medical plan administration
change. These accounts are administered by HealthEquity and the balances
will rollover in 2025 for caregivers who remain enrolled in the same plan
they are currently enrolled in (for example, caregivers currently enrolled
in the HRA medical plan and remain enrolled in the HRA for 2025.)
Health incentive
Do I still need to earn my points for the 2025 health incentive?
Yes, there is no change to the health incentive program to earn your 2025
health incentive.
Prescription drug plan administration change for Blue Shield HMO members
What is changing for my prescription drug plan for 2025?
Effective Jan. 1, 2025, Aetna will replace Express Scripts as the prescription
drug plan administrator for the Blue Shield of California HMO plans. There
is no change to your medical plan – Blue Shield of California will
continue to administer the HMO medical plans.
How can I find out which pharmacies are currently in the Aetna network?
You can use the current Aetna pharmacy directory to assist you with planning
for 2025. Be sure to check back during open enrollment for any updates
to the pharmacy directory, as the pharmacy directory is subject to change
at any time.
How can I find out if my prescription medication is currently in the Aetna
formulary?
You can use the current Aetna prescription drug formulary to assist you
with planning for 2025. Be sure to check back during open enrollment for
any updates to the prescription drug formulary, as the formulary is subject
to change at any time.
About the change to Aetna administration
What is changing?
Aetna will become the third-party administrator (TPA) for our caregiver
medical and prescription drug plans beginning Jan. 1, 2025.
Here’s what is changing for 2025:
If you are enrolled in the
HRA, HSA, EPO or PPO medical plan =
your medical and Rx will be administered by Aetna
If you are enrolled in the
Blue Shield HMO medical plan (where available in S CA)
your medical will continue to be administered by Blue Shield of CA HMO
your Rx will transition to be administered by Aetna (administered by Express Scripts in 2024)
What is a third-party administrator (TPA)?
A TPA is engaged to handle certain administrative functions for self-funded
medical and pharmacy benefit plans. Aetna, as the new TPA, will perform
streamlined administrative services for claims processing, network administration,
customer service and utilization and care management for medical, surgical,
mental and behavioral health and prescription drugs benefits. Aetna will
administer the benefits in accordance with the plan design and various
regulations governing the plans.
What does this mean for me?
Nothing is changing this year. During open enrollment in the fall, you’ll
have the opportunity to review and update your benefits for 2025. The
medical plans you’re offered, coverage levels and plan design are
not changing, but there will be some differences in the provider network
and prescription drug formulary.
Why is Providence changing from Providence Health Plan (and Baylor Scott
& White in Texas) for our medical and pharmacy plan administration?
Operating nationwide, Aetna is one of the largest and most diversified
health care benefits companies. Aetna offers robust member support through
advocacy, an integrated medical and behavioral health network, care management
and 24/7 access. We believe that Aetna’s scope and scale will offer
streamlined and enhanced benefit services to our caregivers and their
family members.
Will this change affect my current benefits for 2024?
The change to Aetna in 2025 will not affect your benefits in 2024.
When can I expect more detailed information about this transition?
Open enrollment will be Oct. 30-Nov. 15, 2024. You will receive an open
enrollment mailer at your home mailing address in late October.
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