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Aetna – PPO High Deductible 3000 (HSA Compatible) – MARYLAND
A comparison of the PPO High Deductible 3000 (HSA Compatible) 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 | PPO High Deductible 3000 (HSA Compatible) Application | PPO High Deductible 3000 (HSA Compatible) Application |
| Brochure | PPO High Deductible 3000 (HSA Compatible) Brochure | PPO High Deductible 3000 (HSA Compatible) Brochure |
| Copay | Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (Unlimited visits) | Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 80% after deductible (Unlimited visits); Specialist Visit: 80% after deductible (Unlimited visits) |
| Office Visit | Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (Unlimited visits) | Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 80% after deductible (Unlimited visits); Specialist Visit: 80% 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) | 80% 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 | Individual: $3,000, Family: $6,000 (Includes deductible) | Individual: $12,500, Family: $25,000 (Includes deductible) |
| Lifetime Maximum | $3,000,000 per insured (Maximum applies to combined in and out-of-network benefits) | $3,000,000 per insured (Maximum applies to combined in and out-of-network benefits) |
| Prescription Drugs | Pharmacy Deductible: 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 (Maximum applies to combined in and out-of-network benefits): Unlimited | Pharmacy Deductible: Integrated Medical/Rx Deductible; Generic (Oral Contraceptives Included): 80% after Medical/Rx Deductible; Preferred Brand (Oral Contraceptives Included): 80% after Medical/Rx Deductible; Non-Preferred Brand (Oral Contraceptives Included): 80% after Medical/Rx Deductible; Calendar Year Maximum (Maximum applies to combined in and out-of-network benefits): Unlimited |
| Emergency Room | $0 copay after deductible | $0 copay after deductible |
| Adult Preventative Care | Annual Routine Gyn Exam (No waiting period, no calendar year max., Annual Pap/Mammogram): $0 copay, deductible waived; Preventive Health - Routine Physical (Aetna will pay up to $200 per exam, Maximum applies to combined in and out-of-network benefits, No waiting period): $20 copay, deductible waived (Includes lab work and X-rays) | 80% after deductible (Age limitations apply) |
| Child Preventative Care | 100% after deductible (Age limitations apply) | 80% after deductible (Age limitations apply) |
| Lab / X-Ray | 100% after deductible | 80% after deductible |
| Maternity | Maternity - Inpatient Facility Services: 100% Inpatient Facility Services coverage after deductible for the mother and the newborn for a minimum of 48 hours for an uncomplicated vaginal delivery and 96 hours for an uncomplicated cesarean birth; Maternity - Professional Services: Coverage for complications of pregnancy | Maternity - Inpatient Facility Services: 80% Inpatient Facility Services coverage after deductible for the mother and the newborn for a minimum of 48 hours for an uncomplicated vaginal delivery and 96 hours for an uncomplicated cesarean birth; Maternity - Professional Services: Coverage for complications of pregnancy |
| Physical Therapy | Physical/Occupational Therapy and Chiropractic Care (24 visits per calendar year, Maximum applies to combined in and out-of-network benefits): 100% after deductible (Aetna will pay a max. of $25 per visit) | Physical/Occupational Therapy and Chiropractic Care (24 visits per calendar year, Maximum applies to combined in and out-of-network benefits): 80% after deductible (Aetna will pay a max. of $25 per visit) |
| Skilled Nursing | 100% after deductible (in lieu of hospital, 30 days per calendar year, Maximum applies to combined in and out-of-network benefits) | 80% 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% after deductible (in lieu of hospital, 40 visits per calendar year, Maximum applies to combined in and out-of-network benefits) | 80% after deductible (in lieu of hospital, 40 visits per calendar year, Maximum applies to combined in and out-of-network benefits) |
| Mental Health | 60 days partial hospitalization; Outpatient: not less than 80% first 5 visits (CYM); 65% 6th-30th visit; 50% 31st visit on. Benefits cover mental illness, emotional, drug and alcohol abuse. Treat same as physical illness, no separate LTM. | 60 days partial hospitalization; Outpatient: not less than 80% first 5 visits (CYM); 65% 6th-30th visit; 50% 31st visit on. Benefits cover mental illness, emotional, drug and alcohol abuse. Treat same as physical illness, no separate LTM. |
| Hospital Care | Hospital Admission (Includes complications of pregnancy): 100% after deductible; Outpatient Surgery: 100% after deductible; Urgent Care Facility: 100% after deductible | Hospital Admission (Includes complications of pregnancy): 80% after deductible; Outpatient Surgery: 80% after deductible; Urgent Care Facility: 80% after deductible |
| Optional Benefits | Individual Dental PPO Max Plan | Individual Dental PPO Max Plan |