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Aetna Health Insurance in VIRGINIA – Health Plan Options

Aetna — PPO First Dollar 30

A comparison of the PPO First Dollar 30 offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $30 copay (Unlimited visits); Specialist Visit: $40 copay (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 70% after deductible (Unlimited visits); Specialist Visit: 70% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $30 copay (Unlimited visits); Specialist Visit: $40 copay (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 70% after deductible (Unlimited visits); Specialist Visit: 70% after deductible (Unlimited visits)
Deductible	Individual: $0, Family: $0	Individual: $5,000, Family: $10,000

Aetna — PPO First Dollar 40

A comparison of the PPO First Dollar 40 offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	Individual: $0, Family: $0	Individual: $7,000, Family: $14,000

Aetna — PPO 1000

A comparison of the PPO 1000 offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $20 copay, deductible waived (Unlimited visits); Specialist Visit: $30 copay, deductible waived (Unlimited visits)	Non-Specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductibleNon-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $20 copay, deductible waived (Unlimited visits); Specialist Visit: $30 copay, deductible waived (Unlimited visits)	Non-Specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductibleNon-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Deductible	Individual: $1,000, Family: $2,000	Individual: $2,000, Family: $4,000

Aetna — PPO 2500

A comparison of the PPO 2500 offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible up to out of pocket max. $0 once out of pocket max is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max is satisfied.
Office Visit	Non-specialist Office Visit: $30 copay deductible waived (unlimited visits), Specialist Visit: $40 copay deductible waived (unlimited visits).	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits).
Copay	Non-specialist Office Visit: $30 copay deductible waived (unlimited visits), Specialist Visit: $40 copay deductible waived (unlimited visits).	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits).
Deductible	Individual: $2,500, Family: $5,000	Individual: $5,000, Family: $10,000

Aetna — PPO 5000

A comparison of the PPO 5000 offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $40 copay, deductible waived (Unlimited visits); Specialist Visit: $50 copay, deductible waived (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $40 copay, deductible waived (Unlimited visits); Specialist Visit: $50 copay, deductible waived (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Deductible	Individual: $5,000, Family: $10,000	Individual: $10,000, Family: $20,000

Aetna — PPO Value 2500

A comparison of the PPO Value 2500 offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Visits 1-2 $30 copay, deductible waived; Visit 3+ 70% after deductible. Specialist and non-specialist share visit max(Unlimited visits); Specialist Visit: Visits 1-2 $30 copay, deductible waived; Visit 3+ 70% after deductible. Specialist and non-specialist share visit max (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 70% after deductible (Unlimited visits); Specialist Visit: 70% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Visits 1-2 $30 copay, deductible waived; Visit 3+ 70% after deductible. Specialist and non-specialist share visit max(Unlimited visits); Specialist Visit: Visits 1-2 $30 copay, deductible waived; Visit 3+ 70% after deductible. Specialist and non-specialist share visit max (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 70% after deductible (Unlimited visits); Specialist Visit: 70% after deductible (Unlimited visits)
Deductible	Individual: $2,500, Family: $5,000	Individual: $5,000, Family: $10,000

Aetna — PPO High Deductible 3000 (HSA Compatible)

A comparison of the PPO High Deductible 3000 (HSA Compatible) offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Deductible	Individual: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

Aetna — PPO High Deductible 5000 (HSA Compatible)

A comparison of the PPO High Deductible 5000 (HSA Compatible) offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	Non-Specialist Office Visit: 100% after deductible (unlimited visits), Specialist Visit: 100% after deductible (unlimited visits).	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits).
Copay	N/A	N/A
Deductible	Individual: $5,000, Family: $10,000	Individual: $10,000, Family: $20,000

Aetna — Preventive and Hospital Care 1250

A comparison of the Preventive and Hospital Care 1250 offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	Not covered	Not covered
Copay	Not covered	Not covered
Deductible	Individual: $1,250, Family: $2,500	Individual: $2,500, Family: $5,000

Aetna — Preventive and Hospital Care 3000 (HSA Compatible)

A comparison of the Preventive and Hospital Care 3000 (HSA Compatible) offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered (Unlimited visits); Specialist Visit: Not covered (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered (Unlimited visits); Specialist Visit: Not covered (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered (Unlimited visits); Specialist Visit: Not covered (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered (Unlimited visits); Specialist Visit: Not covered (Unlimited visits)
Deductible	Individual: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

Aetna — PPO First Dollar 30 with Dental

A comparison of the PPO First Dollar 30 with Dental offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70% up to out of pocket max. $0 once out of pocket max is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max is satisfied.
Office Visit	Non-specialist Office Visit: $30 Copay, Specialist Visit: $40 Copay	Non-specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductible
Copay	Non-specialist Office Visit: $30 Copay, Specialist Visit: $40 Copay	Non-specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductible
Deductible	Individual: $0, Family: $0	Individual: $5,000, Family: $10,000

Aetna — PPO First Dollar 40 with Dental

A comparison of the PPO First Dollar 40 with Dental offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	60% up to out of pocket max. $0 once out of pocket max is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max is satisfied.
Office Visit	Non-specialist Office Visit: $40 Copay, Specialist Visit: $50 Copay	Non-specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductible
Copay	Non-specialist Office Visit: $40 Copay, Specialist Visit: $50 Copay	Non-specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductible
Deductible	Individual: $0, Family: $0	Individual: $7,000, Family: $14,000

Aetna — PPO 1000 with Dental

A comparison of the PPO 1000 with Dental offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible up to out of pocket max. $0 once out of pocket max is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max is satisfied.
Office Visit	Non-Specialist Office Visit: $20 Copay deductible waived, Specialist Visit: $30 Copay deductible waived	Non-Specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductible
Copay	Non-Specialist Office Visit: $20 Copay deductible waived, Specialist Visit: $30 Copay deductible waived	Non-Specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductible
Deductible	Individual: $1,000, Family: $2,000	Individual: $2,000, Family: $4,000

Aetna — PPO 2500 with Dental

A comparison of the PPO 2500 with Dental offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible up to out of pocket max. $0 once out of pocket max is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max is satisfied.
Office Visit	Non-specialist Office Visit: $30 copay deductible waived (unlimited visits), Specialist Visit: $40 copay deductible waived (unlimited visits).	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits).
Copay	Non-specialist Office Visit: $30 copay deductible waived (unlimited visits), Specialist Visit: $40 copay deductible waived (unlimited visits).	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits).
Deductible	Individual: $2,500, Family: $5,000	Individual: $5,000, Family: $10,000

Aetna — PPO 5000 with Dental

A comparison of the PPO 5000 with Dental offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	Non-Specialist Office Visit: $40 copay deductible waived (unlimited visits), Specialist Visit: $50 copay deductible waived (unlimited visits).	50% after deductible (unlimited visits)
Copay	Non-Specialist Office Visit: $40 copay deductible waived (unlimited visits), Specialist Visit: $50 copay deductible waived (unlimited visits).	50% after deductible (unlimited visits)
Deductible	Individual: $5,000, Family: $10,000	Individual: $10,000, Family: $20,000

Aetna — PPO Value 2500 with Dental

A comparison of the PPO Value 2500 with Dental offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	Non-Specialist and Specialist Office Visit: Visits 1-2 $30 copay, deductible waived; Visits 3+ 70% after deductible. Specialist and Non-Specialist share visit max (unlimited visits).	Non-Specialist and Specialist Office Visit: 50% after deductible (unlimited visits).
Copay	Non-Specialist and Specialist Office Visit: Visits 1-2 $30 copay, deductible waived; Visits 3+ 70% after deductible. Specialist and Non-Specialist share visit max (unlimited visits).	Non-Specialist and Specialist Office Visit: 50% after deductible (unlimited visits).
Deductible	Individual: $2,500, Family: $5,000	Individual: $5,000, Family: $10,000

Aetna — PPO High Deductible 3000 (HSA Compatible) with Dental

A comparison of the PPO High Deductible 3000 (HSA Compatible) with Dental offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	Non Facility Services: 100% after deductible, Facility Services: 50% after deductible
Office Visit	Non-Specialist Office Visit: 100% after deductible (unlimited visits), Specialist Visit: 100% after deductible (unlimited visits).	Non-Specialist Office Visit: 100% after deductible (unlimited visits), Specialist Visit: 100% after deductible (unlimited visits).
Copay	Not Covered	Not Covered
Deductible	Individual: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

Aetna — PPO High Deductible 5000 (HSA Compatible) with Dental

A comparison of the PPO High Deductible 5000 (HSA Compatible) with Dental offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Deductible	Individual: $5,000, Family: $10,000	Individual: $10,000, Family: $20,000

Aetna — Preventive and Hospital Care 1250 with Dental

A comparison of the Preventive and Hospital Care 1250 with Dental offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	Not covered	Not covered
Copay	Not covered	Not covered
Deductible	Individual: $1,250, Family: $2,500	Individual: $2,500, Family: $5,000

Aetna — Preventive and Hospital Care 3000 (HSA Compatible) with Dental

A comparison of the Preventive and Hospital Care 3000 (HSA Compatible) with Dental offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered; Specialist Visit: Not covered	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered; Specialist Visit: Not covered
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered; Specialist Visit: Not covered	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered; Specialist Visit: Not covered
Deductible	Individual: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

Aetna — PPO 7500 with Unlimited Primary Care Visits plus Dental

A comparison of the PPO 7500 with Unlimited Primary Care Visits plus Dental offered by Aetna is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible ($0 once out-of-pocket max. is satisfied)	50% after deductible ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $30 copay, deductible waived (Unlimited visits); Specialist Visit: 80% after deductible (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $30 copay, deductible waived (Unlimited visits); Specialist Visit: 80% after deductible (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Deductible	Individual: $7,500, Family: $15,000	Individual: $10,000, Family: $20,000