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Aetna – Managed Choice Open Access High Deductible 3000 (HSA Compatible) with Dental – COLORADO
A comparison of the Managed Choice Open Access High Deductible 3000 (HSA Compatible) with Dental offered by Aetna is detailed out below for both Network and Non-Network coverage.
| Network | Non-Network | |
|---|---|---|
|
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| Network | See Provider | See Provider |
| Application | Managed Choice Open Access High Deductible 3000 (HSA Compatible) with Dental Application | Managed Choice Open Access High Deductible 3000 (HSA Compatible) with Dental Application |
| Brochure | Managed Choice Open Access High Deductible 3000 (HSA Compatible) with Dental Brochure | Managed Choice Open Access High Deductible 3000 (HSA Compatible) with Dental Brochure |
| Copay | 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) |
| 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) |
| Deductible | Individual: $3,000, Family: $6,000 | Individual: $6,000, Family: $12,000 |
| 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. |
| Coinsurance Limit | Individual: $0, Family: $0 | Individual: $6,500, Family: $13,000 |
| Out-of-Pocket Maximum | (Deductible included) Individual: $3,000, Family: $6,000 | (Deductible included) Individual: $12,500, Family: $25,000 |
| 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: Integrated Medical/Rx Deductible, Generic (Oral Contraceptives Included): 100% after Medical/Rx deductible, Preferred Brand (Oral Contraceptives Included): 100% after Medical/Rx deductible, Non-Preferred Brand (Oral Contraceptives Included): 100% after Medical/Rx deductible, Calendar Year Maximum per individual (maximum applies to combined in and out-of-network benefits): $5,000. | Pharmacy Deductible per individual: Integrated Medical/Rx Deductible, Generic (Oral Contraceptives Included): 50% after Medical/Rx deductible, Preferred Brand (Oral Contraceptives Included): 50% after Medical/Rx deductible, Non-Preferred Brand (Oral Contraceptives Included): 50% after Medical/Rx deductible, Calendar Year Maximum per individual (maximum applies to combined in and out-of-network benefits): $5,000. |
| Emergency Room | $0 after deductible | $0 after deductible |
| Adult Preventative Care | Annual Routine Gyn Exam (Annual Pap/Mammogram): $0 copay deductible waived, Routine Physical: $20 copay deductible waived Aetna will pay up to $200 per exam (includes lab work and X-rays). | 100% after deductible (Age and frequency schedule apply). |
| Child Preventative Care | Managed Choice Open Access High Deductible 3000 (HSA Compatible) with Dental | 100% after deductible (Age and frequency schedule apply). |
| Lab / X-Ray | 100% 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: 100% after deductible 24 visits per calendar year $600 Calendar Year Maximum (maximum applies to combined in and out-of-network benefits. | Physical/Occupational Therapy and Chiropractic: 50% after deductible 24 visits per calendar year $600 Calendar Year Maximum (maximum applies to combined in and out-of-network benefits). |
| Skilled Nursing | 100% 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 | 100% (in lieu of hospital) 80 visits per calendar year, maximum applies to combined in and out-of-network benefits. | 75% (in lieu of hospital) 80 visits per calendar year, maximum applies to combined in and out-of-network benefits |
| Mental Health | Mental Health (Inpatient): Serious, Biologically Based: 100%, Non-Serious, Non-Biologically Based: 100%; Mental Health (Outpatient): Serious, Biologically Based: 100%, Non-Serious, Non-Biologically Based: 100%. | Mental Health (Inpatient): Serious, Biologically Based: 50%, Non-Serious, Non-Biologically Based: 50%; Mental Health (Outpatient): Serious, Biologically Based: 50%, Non-Serious, Non-Biologically Based: 50%. |
| Hospital Care | Hospital Admission: 100% after deductible; Outpatient Surgery: 100% after deductible; Urgent Care Facility: 100% after deductible | Hospital Admission: 50% after deductible; Outpatient Surgery: 50% after deductible; Urgent Care Facility: 50% after deductible |
| Optional Benefits | Managed Choice Open Access High Deductible 3000 (HSA Compatible) with Dental | Managed Choice Open Access High Deductible 3000 (HSA Compatible) with Dental |