Aetna – PPO First Dollar 40 – KANSAS

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
Application	PPO First Dollar 40 Application	PPO First Dollar 40 Application
Brochure	PPO First Dollar 40 Brochure	PPO First Dollar 40 Brochure
Copay	PPO First Dollar 40	PPO First Dollar 40
Office Visit	PPO First Dollar 40	PPO First Dollar 40
Deductible	Individual: $0, Family: $0	Individual: $7,000, Family: $14,000
Coinsurance	PPO First Dollar 40	PPO First Dollar 40
Coinsurance Limit	Individual: $12,500, Family: $25,000	Individual: $5,500, Family: $11,000
Out-of-Pocket Maximum	PPO First Dollar 40	PPO First Dollar 40
Lifetime Maximum	PPO First Dollar 40	PPO First Dollar 40
Prescription Drugs	PPO First Dollar 40	PPO First Dollar 40
Emergency Room	PPO First Dollar 40	PPO First Dollar 40
Adult Preventative Care	PPO First Dollar 40	PPO First Dollar 40
Child Preventative Care	$40 copay (Age and frequency limits apply)	PPO First Dollar 40
Lab / X-Ray	60% after deductible	50% after deductible
Maternity	PPO First Dollar 40	PPO First Dollar 40
Physical Therapy	PPO First Dollar 40	PPO First Dollar 40
Skilled Nursing	PPO First Dollar 40	PPO First Dollar 40
Home Health Care	PPO First Dollar 40	PPO First Dollar 40
Mental Health	Not covered except for severe, biologically based mental or nervous disorders and associated treatment of drug and alcohol dependencies	Not covered except for severe, biologically based mental or nervous disorders and associated treatment of drug and alcohol dependencies
Hospital Care	PPO First Dollar 40	PPO First Dollar 40
Optional Benefits	Individual Dental PPO Max Plan	Individual Dental PPO Max Plan

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