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Aetna – Managed Choice Open Access 1500 – CONNECTICUT
A comparison of the Managed Choice Open Access 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 1500 Application | Managed Choice Open Access 1500 Application |
| Brochure | Managed Choice Open Access 1500 Brochure | Managed Choice Open Access 1500 Brochure |
| Copay | Non-Specialist Office Visit: $25 copay deductible waived (Unlimited visits), Specialist Visit: $35 copay deductible waived (Unlimited visits) | Non-specialist Office Visit: 70% after deductible (Unlimited visits), Specialist Visit: 70% after deductible (Unlimited visits) |
| Office Visit | Non-Specialist Office Visit: $25 copay deductible waived (Unlimited visits), Specialist Visit: $35 copay deductible waived (Unlimited visits) | Non-specialist Office Visit: 70% after deductible (Unlimited visits), Specialist Visit: 70% after deductible (Unlimited visits) |
| Deductible | Individual: $1,500, Family: $3,000 | Individual: $3,000, Family: $6,000 |
| Coinsurance | 80% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied. | 60% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied. |
| Coinsurance Limit | Individual: $1,500, Family: $3,000 | Individual: $7,000, Family: $14,000 |
| 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)- $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)- $250. Generic (Oral Contraceptives included)- $15 copay plus 70% deductible waived. Preferred Brand Name (Oral Contraceptives included)- $35 copay plus 70% after deductible. Non-Preferred Brand (Oral Contraceptives included)- $50 copay plus 70% after deductible. Calendar Year Maximum per Individual (Maximum applies to combined in and out of network benefits)- Unlimited. |
| Emergency Room | $300 copay (waived if admitted) | $300 copay (waived if admitted) |
| 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, in and out of network combined): $25 copay deductible waived. | 70% after deductible (Age and frequency schedule apply). |
| Child Preventative Care | $25 copay (Age and frequency schedule apply). | 70% after deductible (Age and frequency schedule apply). |
| Lab / X-Ray | 80% after deductible | 60% after deductible |
| Maternity | Not Covered | Not Covered |
| Physical Therapy | Physical/Occupational Therapy and Chiropractic- 80% 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- 60% after deductible ($25 Max per visit- 24 visits per calendar year, Maximum 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 | 60% 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 | 60% 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: 60% after deductible, Outpatient Surgery: 60% after deductible |
| Optional Benefits | Individual Dental PPO Max Plan | Individual Dental PPO Max Plan |