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Aetna – Preventive and Hospital Care 3000 (HSA Compatible) – MICHIGAN
A comparison of the Preventive and Hospital Care 3000 (HSA Compatible) offered by Aetna is detailed out below for both Network and Non-Network coverage.
| Network | Non-Network | |
|---|---|---|
|
||
| Network | See Provider | See Provider |
| Application | Preventive and Hospital Care 3000 (HSA Compatible) Application | Preventive and Hospital Care 3000 (HSA Compatible) Application |
| Brochure | Preventive and Hospital Care 3000 (HSA Compatible) Brochure | Preventive and Hospital Care 3000 (HSA Compatible) Brochure |
| Copay | Not covered | Not covered |
| Office Visit | Not covered | Not covered |
| Deductible | Individual: $3,000, Family: $6,000 | Individual: $6,000, Family: $12,000 |
| Coinsurance | 80% 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: $2,000, Family: $4,000 | Individual: $4,000, Family: $8,000 |
| Out-of-Pocket Maximum | Individual: $5,000, Family: $10,000 (Includes deductible) | Individual: $10,000, Family: $20,000 (Includes deductible) |
| Lifetime Maximum | $3,000,000 (Maximum applies to combined in and out of network benefits) | $3,000,000 (Maximum applies to combined in and out of network benefits) |
| Prescription Drugs | Pharmacy Deductible per Individual: Not applicable, Generic (Oral Contraceptives Included): Not covered (Aetna Discount Applies), Preferred Brand (Oral Contraceptives Included): Not covered (Aetna Discount Applies), Non-Preferred Brand (Oral Contraceptives Included): Not covered (Aetna Discount Applies), Calendar Year Maximum per individual (Maximum applies to combined in and out-of-network benefits): Not applicable. | Pharmacy Deductible per Individual: Not applicable, Generic (Oral Contraceptives Included): Not covered, Preferred Brand (Oral Contraceptives Included): Not covered, Non-Preferred Brand (Oral Contraceptives Included): Not covered, Calendar Year Maximum per individual (Maximum applies to combined in and out-of-network benefits): Not applicable. |
| Emergency Room | $100 copay (waived if admitted) 80% coinsurance after deductible. | $100 copay (waived if admitted) 80% 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: $35 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 | $35 copay (Age and frequency schedule apply) | 50% after deductible (Age and frequency schedule apply) |
| Lab / X-Ray | Not covered | Not covered |
| Maternity | Not covered (Except for pregnancy complications) | Not covered (Except for pregnancy complications) |
| Physical Therapy | Not covered | Not covered |
| 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 (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 | Not covered |
| Hospital Care | Hospital Admission: 80% after deductible; Outpatient Surgery: 80% after deductible; Urgent Care Facility: Not covered | Hospital Admission: 50% after deductible; Outpatient Surgery: 50% after deductible; Urgent Care Facility: Not covered |
| Optional Benefits | Individual Dental PPO Max Plan | Individual Dental PPO Max Plan |