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Aetna – Managed Choice Open Access Value 2000 – GEORGIA
A comparison of the Managed Choice Open Access Value 2000 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 2000 Application | Managed Choice Open Access Value 2000 Application |
| Brochure | Managed Choice Open Access Value 2000 Brochure | Managed Choice Open Access Value 2000 Brochure |
| Copay | Non-Specialist Visits 1-6 $40 copay, ded. Waived; Visits 7+ 70% after ded. Specialist Visits 1-6 $50 copay, ded. Waived; Visits 7+ 70% after ded. Specialist and Non-Specialist share visit max. | Non-Specialist: 70% after deductible, Specialist: 70% after deductible |
| Office Visit | Non-Specialist Visits 1-6 $40 copay, ded. Waived; Visits 7+ 70% after ded. Specialist Visits 1-6 $50 copay, ded. Waived; Visits 7+ 70% after ded. Specialist and Non-Specialist share visit max. | Non-Specialist: 70% after deductible, Specialist: 70% after deductible |
| Deductible | Individual: $2,000, Family: $4,000 | Individual: $4,000, Family: $8,000 |
| Coinsurance | 70% 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: $2,000, Family: $4,000 | Individual: $2,000, Family: $4,000 |
| Out-of-Pocket Maximum | (Deductible included) Individual: $4,000, Family: $8,000 | (Deductible included) Individual: $6,000, Family: $12,000 |
| 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)- $200. 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 (Maximum applies to combined in and out of network benefits)- Unlimited. | Pharmacy Deductible per Individual (does not apply to generic)- $200. Generic (Oral Contraceptives included)- $15 copay plus 70% deductible waived. Preferred Brand Name (Oral Contraceptives included)- $25 copay plus 70% after deductible. Non-Preferred Brand (Oral Contraceptives included)- $40 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) deductible waived | $300 copay (waived if admitted) deductible waived |
| Adult Preventative Care | Annual Routine Gyn Exam (Annual Pap/Mammogram)- $0 copay deductible waived. Preventive Health (Aetna will pay up to $200 per exam)- $40 copay deductible waived. | 70% after deductible (Age and frequency schedule apply). |
| Child Preventative Care | $40 copay (Age and frequency schedule apply). | 70% after deductible (Age and frequency schedule apply). |
| Lab / X-Ray | 70% after deductible | 60% after deductible |
| Maternity | Not Covered | Not Covered |
| Physical Therapy | Physical/Occupational Therapy and Chiropractic- 70% 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 | 70% 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 | 70% 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: 70% after deductible, Outpatient Surgery: 70% after deductible | Hospital Admission: 60% after deductible, Outpatient Surgery: 60% after deductible |
| Optional Benefits | Managed Choice Open Access Value 2000 | Managed Choice Open Access Value 2000 |