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Aetna – Managed Choice Open Access Value 1500 – CALIFORNIA
A comparison of the Managed Choice Open Access Value 1500 offered by Aetna is detailed out below for both Network and Non-Network coverage.
| Network | Non-Network | |
|---|---|---|
|
||
| Network | See Provider | See Provider |
| Application | Managed Choice Open Access Value 1500 Application | Managed Choice Open Access Value 1500 Application |
| Brochure | Managed Choice Open Access Value 1500 Brochure | Managed Choice Open Access Value 1500 Brochure |
| Copay | Non-specialist Office Visit: 75% after deductible, Specialist Visit: 75% after deductible | Non-specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductible |
| Office Visit | Non-specialist Office Visit: 75% after deductible, Specialist Visit: 75% after deductible | Non-specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductible |
| Deductible | Individual: $1,500, Family: $3,000 | Individual: $3,000, Family: $6,000 |
| Coinsurance | Non-specialist Office Visit: 75% after deductible, Specialist Visit: 75% after deductible | Non-specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductible |
| Coinsurance Limit | Individual: $3,500, Family: $7,000 | Individual: $7,000, Family: $14,000 |
| Out-of-Pocket Maximum | (Deductible included) Individual: $5,000, Family: $10,000 | Individual: $10,000, Family: $20,000 (Includes deductible) |
| 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)- $1,000. Generic (Oral Contraceptives included)- $20 copay deductible waived. Preferred Brand Name (Oral Contraceptives included)- $40 copay after deductible. Non-Preferred Brand (Oral Contraceptives included)- Not covered (Aetna Discount Applies). Calendar Year Maximum per Individual (Maximum applies to combined in and out of network benefits)- $5,000. | Pharmacy Deductible per Individual (does not apply to generic)- $1,000. Generic (Oral Contraceptives included)- $20 copay plus 50% deductible waived. Preferred Brand Name (Oral Contraceptives included)- $40 copay plus 50% after deductible. Non-Preferred Brand (Oral Contraceptives included)- Not covered. Calendar Year Maximum per Individual (Maximum applies to combined in and out of network benefits)- $5,000. |
| Emergency Room | $100 copay (waived if admitted) 75% coinsurance after deductible | $100 copay (waived if admitted) 75% coinsurance 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)- $50 copay deductible waived. | 50% after deductible (Age and frequency schedule apply) |
| Child Preventative Care | $50 copay (Age and frequency limits apply) | 50% after deductible (Age and frequency schedule apply) |
| Lab / X-Ray | 75% 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- 75% after deductible ($25 Max per visit- 24 visits per calendar year, Maximum applies to combined in and out of network benefits). | Physical/Occupational Therapy and Chiropractic- 50% after deductible ($25 Max per visit- 24 visits per calendar year, Maximum applies to combined in and out of network benefits). |
| Skilled Nursing | 75% 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 | 75% 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: 75% after deductible, Outpatient Surgery: 75% after deductible | Hospital Admission: 50% after deductible, Outpatient Surgery: 50% after deductible |
| Optional Benefits | Individual Dental PPO Max Plan | Individual Dental PPO Max Plan |