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Active Members Information: HMO


  • The Custom HMO offers a limited network of providers and facilities
  • Custom HMOs cover medical services as set forth in the PEBTF Plan Document
  • Treatment for medical services must be coordinated by a Primary Care Physician (PCP)
  • $5 copayment for PCP office visits (for general practitioners, family practitioners, internists and pediatricians)
  • $10 copayment for specialist office visit
  • $50 copayment for urgent care visit
  • $150 copayment for emergency room visit (waived if the visit leads to an inpatient admission to the hospital)

For more information, refer to your Summary Plan Description or contact PEBTF.

PEBTF Custom HMO West – Aetna
PEBTF Custom HMO Central – Aetna Provider Directory:
PEBTF Custom HMO Southeast – Aetna
PEBTF Custom HMO Northeast – Geisinger: Provider Directory: