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Aetna – PPO 1000 – LOUISIANA
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: 70% after deductible, Specialist Visit: 70% after deductible |
| Office Visit | Non-Specialist Office Visit: $20 Copay deductible waived, Specialist Visit: $30 Copay deductible waived | Non-Specialist Office Visit: 70% after deductible, Specialist Visit: 70% 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 | $5,000,000 per member lifetime (Maximum applies to combined in and out of network benefits). | $5,000,000 per member lifetime (Maximum applies to combined in and out of network benefits). |
| Prescription Drugs | Pharmacy Deductible per Individual, Maximum applies to combined in and out-of-network benefits): $250, Generic (Oral Contraceptives Included): $15 copay deductible waived, Preferred Brand/Non-Preferred Brand (Oral Contraceptives Included): $25/$40 Copay after deductible, Calendar Year Maximum per Individual (Maximum applies to in and out-of-network benefits): $5,000. | Pharmacy Deductible per Individual, Maximum applies to combined in and out-of-network benefits): $250, Generic (Oral Contraceptives Included): $15 copay plus 30% deductible waived, Preferred Brand/Non-Preferred Brand (Oral Contraceptives Included): $25/$40 Copay plus 30% after deductible, Calendar Year Maximum per Individual (Maximum applies to in and out-of-network benefits): $5,000. |
| Emergency Room | $100 Copay (waived if admitted) 80% after deductible$100 Copay (waived if admitted) coinsurance 80% | $100 Copay (waived if admitted) 80% after deductible$100 Copay (waived if admitted) coinsurance 80% |
| Adult Preventative Care | Annual Routine Gyn Exam (Annual Pap/Mammogram): No Copay deductible waived. Preventive Health (Annual Physical- No deductible, copayment or coinsurance applies to eligible dependent children to age 18 for childhood immunizations) ($200 per calendar year, Maximum applies to combined in and out-of-network benefits): $20 Copay deductible waived. | 100%, deductible waived. Age and frequency schedule apply |
| Child Preventative Care | $0 Copay, deductible waived. Age and frequency schedule apply | 100%, deductible waived. Age and frequency schedule apply |
| Lab / X-Ray | 80% after deductible | 50% after deductible |
| Maternity | Not Covered | Not Covered |
| Physical Therapy | Physical/Occupational Therapy and Chiropractic Care (24 visits per calendar year, Maximum applies to combined in and out of network benefits): 80% after deductible | Physical/Occupational Therapy and Chiropractic Care (24 visits per calendar year, Maximum applies to combined in and out of network benefits): 50% after deductible |
| 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 except for Mental or Nervous disorders with Origins of Demonstrable Organic Disease | Not Covered except for Mental or Nervous disorders with Origins of Demonstrable Organic Disease |
| Hospital Care | Hospital Admission: 80% after deductible (Maternity and pregnancy related expenses are not covered, except for complications of pregnancy), Outpatient Surgery: 80% after deductible. | Hospital Admission: 50% after deductible (Maternity and pregnancy related expenses are not covered, except for complications of pregnancy), Outpatient Surgery: 50% after deductible. |
| Optional Benefits | Individual Dental PPO Max Plan | Individual Dental PPO Max Plan |