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Aetna – PPO Value 10000 with Dental – MARYLAND
A comparison of the PPO Value 10000 with Dental offered by Aetna is detailed out below for both Network and Non-Network coverage.
| Network | Non-Network | |
|---|---|---|
|
||
| Network | See Provider | See Provider |
| Application | PPO Value 10000 with Dental Application | PPO Value 10000 with Dental Application |
| Brochure | PPO Value 10000 with Dental Brochure | PPO Value 10000 with Dental Brochure |
| Copay | Non-Specialist and Specialist Office Visit: Visits 1-2 $30 copay, deductible waived; Visits 3+ 70% after deductible. Specialist and Non-Specialist share visit max (unlimited visits). | Non-Specialist and Specialist Office Visit: 50% after deductible (unlimited visits). |
| Office Visit | Non-Specialist and Specialist Office Visit: Visits 1-2 $30 copay, deductible waived; Visits 3+ 70% after deductible. Specialist and Non-Specialist share visit max (unlimited visits). | Non-Specialist and Specialist Office Visit: 50% after deductible (unlimited visits). |
| Deductible | Individual: $10,000, Family: $20,000 | Individual: $10,000, Family: $20,000 |
| Coinsurance | 70% 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: $2,500, Family: $5,000 | Individual: $2,500, Family: $5,000 |
| Out-of-Pocket Maximum | (Deductible included) Individual: $12,500, Family: $25,000 | (Deductible included) Individual: $12,500, Family: $25,000 |
| Lifetime Maximum | $1,000,000 (Maximum applies to combined in and out of network benefits) | $1,000,000 (Maximum applies to combined in and out of network benefits) |
| Prescription Drugs | Pharmacy deductible per individual: $500 (does not apply to generic), Generic (Oral Contraceptives Included): $20 copay deductible waived, Preferred Brand (Oral Contraceptives Included): $40 copay after deductible, Non-Preferred Brand (Oral Contraceptives Included): Not covered, Calendar Year Maximum per individual (maximum applies to combined in and out-of-network benefits): $5,000. | Pharmacy Deductible per individual (does not apply to generic): $500, Generic (Oral Contraceptives Included): $20 copay plus 50% deductible waived, Preferred Brand (Oral Contraceptives Included): $40 copay plus 50% after deductible, Non-Preferred Brand (Oral Contraceptives Included): Not covered, Calendar Year Maximum per individual (Maximum applies to combined in and out-of-network benefits): $5,000. |
| Emergency Room | $100 copay (waived if admitted), 70% coinsurance after deductible | $100 copay (waived if admitted), 70% coinsurance after deductible |
| Adult Preventative Care | Annual Routine Gyn Exam (Annual Pap/Mammogram, no waiting period, no calendar year max.): $0 copay deductible waived, Preventive Health - Routine Physical: $50 copay deductible waived (Aetna will pay up to $200 per exam, includes lab work and X-rays). | 50% after deductible (Age and frequency schedule apply) |
| Child Preventative Care | $50 copay (Age and frequency schedule apply) | 50% after deductible (Age and frequency schedule apply) |
| Lab / X-Ray | 70% 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 Care: 70% after deductible, Aetna will pay up to $25 per visit max (24 visits per calendar year maximum applies to combined in and out-of-network benefits). | Physical/Occupational Therapy and Chiropractic Care: 50% after deductible, Aetna will pay up to $25 per visit max (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. | 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 | 70% after deductible (in lieu of hospital) 30 visits per calendar year, maximum applies to combined in and out-of-network benefits. | 50% 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: 50% after deductible, Outpatient Surgery: 50% after deductible |
| Optional Benefits | PPO Value 10000 with Dental | PPO Value 10000 with Dental |