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AETNA – PPO 1000 – MISSOURI
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 |
| Application | PPO 1000 Application | PPO 1000 Application |
| Brochure | PPO 1000 Brochure | PPO 1000 Brochure |
| 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 |
| 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 |
| Deductible | Individual: $1,000, Family: $2,000 | Individual: $2,000, Family: $4,000 |
| 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. |
| Coinsurance Limit | Individual: $2,000, Family: $4,000 | Individual: $8,000, Family: $16,000 |
| Out-of-Pocket Maximum | (Deductible included) Individual: $3,000, Family: $6,000 | (Deductible included) Individual: $10,000, Family: $20,000 |
| Lifetime Maximum | $5,000,000 (Maximum applies to combined in and out of network benefits) | $5,000,000 (Maximum applies to combined in and out of network benefits) |
| Prescription Drugs | Pharmacy Deductible per Individual (does not apply to generic, maximum applies to combined in and out of network benefits)- $250. Generic (Oral Contraceptives included)- $15 copay deductible waived. Preferred Brand Name (Oral Contraceptives included)- $35 copay after deductible. Non-Preferred Brand (Oral Contraceptives included)- $50 copay after deductible. Calendar Year Maximum per Individual (Maximum applies to combined in and out of network benefits)- Unlimited. | Pharmacy Deductible per Individual (does not apply to generic, maximum applies to combined in and out of network benefits)- $250. Generic (Oral Contraceptives included)- $15 copay plus 50% deductible waived. Preferred Brand Name (Oral Contraceptives included)- $35 copay plus 50% after deductible. Non-Preferred Brand (Oral Contraceptives included)- $50 copay plus 50% after deductible. Calendar Year Maximum per Individual (Maximum applies to combined in and out of network benefits)- Unlimited. |
| Emergency Room | $100 Copay (waived if admitted) 80% after deductible | $100 Copay (waived if admitted) 80% after deductible |
| Adult Preventative Care | Annual Routine Gyn Exam (Annual Pap/Mammogram): $0 copay deductible waived. Preventive Health (Routine Physical) (Aetna will pay up to $200 per exam): $20 copay deductible waived. | 50% after deductible (Age and frequency schedule apply). |
| Child Preventative Care | $20 copay (Age and frequency schedule apply). | 50% after deductible (Age and frequency schedule apply). |
| Lab / X-Ray | 80% after deductible | 50% after deductible |
| Maternity | Not covered (except for pregnancy complications) | Not covered (except for pregnancy complications) |
| Physical Therapy | Physical/Occupational Therapy and Chiropractic Care ($25 Max- 24 visits per calendar year, Maximum applies to combined in and out of network benefits): 80% after deductible | Physical/Occupational Therapy and Chiropractic Care ($25 Max- 24 visits per calendar year, Maximum applies to combined in and out-of-network benefits): 50% after deductible |
| Skilled Nursing | 80% after deductible (in lieu of hospital, 30 days per calendar year). Maximum applies to combined in and out of network benefits. | 50% after deductible (in lieu of hospital, 30 days per calendar year). Maximum applies to combined in and out of network benefits. |
| Home Health Care | 80% after deductible (in lieu of hospital, 30 visits per calendar year) maximum applies to combined in and out of network benefits. | 50% after deductible (in lieu of hospital, 30 visits per calendar year) maximum applies to combined in and out of network benefits. |
| 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 | Hospital Admission: 80% after deductible, Outpatient Surgery: 80% after deductible | Hospital Admission: 50% after deductible, Outpatient Surgery: 50% after deductible |
| Optional Benefits | Individual Dental PPO Max Plan | Individual Dental PPO Max Plan |
