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AETNA – PPO 1000 – Tennessee
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 | 50% after deductible |
| Coinsurance Limit | Individual: $1,500, Family: $3,000 | Individual: $1,500, Family: $3,000 |
| Out-of-Pocket Maximum | (Deductible included) Individual: $2,500, Family: $5,000 | (Deductible included) Individual: $3,500, Family: $7,000 |
| Lifetime Maximum | see brochure | see brochure |
| Prescription Drugs | Generic (Oral Contraceptives Included)- $15 Copay deductible waived, Preferred Brand Name (Oral Contraceptives included)- $25 copay after deductible, Non-Preferred Brand (Oral Contraceptives Included)- $40 copay after deductible, Calendar Year Maximum per Individual- Unlimited, Pharmacy Deductible per Individual (does not apply to generic)- $250 (Maximum applies to combined in and out of network benefits) | Generic (Oral Contraceptives Included)- $15 Copay plus 50% deductible waived, Preferred Brand Name (Oral Contraceptives included)- $25 copay plus 50% after deductible, Non-Preferred Brand (Oral Contraceptives Included)- $40 copay plus 50% after deductible, Calendar Year Maximum per Individual- Unlimited, Pharmacy Deductible per Individual (does not apply to generic)- $250 (Maximum applies to combined in and out of network benefits) |
| Emergency Room | $100 Copay (waived if admitted) 80% after deductible | $100 Copay (waived if admitted) 80% after deductible |
| Adult Preventative Care | Annual Routine Ob/Gyn Exam (Annual Pap/Mammogram): No Copay-deductible waived. Preventive Health (Annual): ($200 per exam) $20 copay- deductible waived | 50% after deductible (Age and frequency schedule apply). |
| Child Preventative Care | $20 copay, deductible waived(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 | Not Covered |
| Physical Therapy | 80% after deductible, Aetna will pay a max. of $25 per visit. Maximum 24 visits per calendar year, applies to combined in and out of network benefits. | 50% after deductible, Aetna will pay a max. of $25 per visit. Maximum 24 visits per calendar year, applies to combined in and out of network benefits. |
| 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, 30 visits per person per calendar year. Maximum applies to combined in and out of network benefits. | 50% after deductible, 30 visits per person per calendar year. Maximum applies to combined in and out of network benefits. |
| Mental Health | Not Covered | Not Covered |
| Hospital Care | Hospital Admission: 80% after deductible, Outpatient Surgery: 80% after deductible | Hospital Admission: 50% after deductible, Outpatient Surgery: 50% after deductible |
| Optional Benefits |
