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Aetna – Preventative and Hospital Care 3000 (HSA Compatible) with Dental – MISSISSIPPI
A comparison of the Preventative and Hospital Care 3000 (HSA Compatible) 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 | Preventative and Hospital Care 3000 (HSA Compatible) with Dental Application | Preventative and Hospital Care 3000 (HSA Compatible) with Dental Application |
| Brochure | Preventative and Hospital Care 3000 (HSA Compatible) with Dental Brochure | Preventative and Hospital Care 3000 (HSA Compatible) with Dental 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 | 50% after deductible |
| Coinsurance Limit | Individual: $2,000, Family: $4,000 | Individual: $4,000, Family: $8,000 |
| Out-of-Pocket Maximum | (Deductible included) Individual: $5,000, Family: $10,000 | (Deductible included) Individual: $10,000, Family: $20,000 |
| 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- Not applicable. Generic (Oral Contraceptives included)- Aetna discount available. Preferred Brand Name (Oral Contraceptives included)- Aetna discount available. Non-Preferred Brand (Oral Contraceptives included)- Aetna discount available. 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 Name (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% after deductible | $100 copay (waived if admitted) 80% after deductible |
| Adult Preventative Care | Annual Routine Gyn Exam (Annual Pap/Mammogram)- $0 copay, deductible waived. Preventive Health (Routine Physical) ($200 maximum)- $35 copay, deductible waived. | 50% after deductible (Age and frequency limits apply). |
| Child Preventative Care | $35 Copay (Age and frequency limits apply). | 50% after deductible (Age and frequency limits 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 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: 80% after deductible, Outpatient Surgery: 80% after deductible | Hospital Admission: 50% after deductible, Outpatient Surgery: 50% after deductible |
| Optional Benefits | Preventative and Hospital Care 3000 (HSA Compatible) with Dental | Preventative and Hospital Care 3000 (HSA Compatible) with Dental |