Fresno Unified School District and the Joint Health Management Board offer two PPO plan options—Plan A and Plan B—both administered by Delta Health Systems and utilizing the Aetna® provider network.
Please see the details below concerning how the plans operate, including information on how to find a medical provider in the network.
Your PPO Plan
PPO stands for a Preferred Provider Organization plan. These plans allow you flexibility in using either in-network or out-of-network providers, though you are primarily encouraged to receive services from the Aetna network doctors, specialists, and facilities. This allows you to obtain a higher level of benefit than if your services came from an out-of-network provider. Receiving services from within the network also means that claim forms will be submitted to the plan on your behalf when doing so.
Additional information regarding use of a PPO plan:
- You and any enrolled dependent(s) are permitted to visit any doctor or facility without a referral from a Primary Care Physician (PCP).
- Certain services, such as doctor’s visits, may require a fixed-dollar upfront payment, referred to as a copayment.
- Before the plan will pay certain medical expenses, you may be required to pay a plan-specific amount, referred to as a deductible.
- Once the deductible has been fulfilled, the plan will pay a large percentage of the cost of your care, known as coinsurance. You will then be financially responsible for the remaining cost up to the out-of-pocket maximum.
How To Find an Aetna Network Provider
You can find an Aetna provider by going to Aetna’s dedicated microsite and following these steps:
- Scroll down and click on the Find an Aetna Choice POS II Provider button.
- Within the Continue as a guest section, enter your location and click Search.
- You can then type the name or type of provider you are looking for within the What do you want to search for section.
- Press Enter, and a list will be provided based on your search parameters.
- You can then filter and sort results specific to your needs, such as language, gender preference, and provider type.
NOTE: It is important that you use Aetna’s dedicated microsite for the District’s plan when searching for medical providers. The use of any other site, including Aetna.com, will provide inaccurate results due to our plan structure.
In addition, please keep in mind the following services and providers are not part of your Aetna network through the District’s PPO plans, even though you may see them listed in the online directory:
• Acupuncture
• Chiropractic
• Dental
• Mental health
• Pharmacy
• Substance abuse
• Sutter Health Systems providers
• Vision
Visit the JHMB Find A Provider page for details on finding providers for these specific services.
For a complete listing of services covered by your medical plan, please refer to your Evidence of Coverage (EOC) or plan booklet.
