March 21, 2010

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Aetna – Managed Choice Open Access Value 2500 with Dental – NEVADA

A comparison of the Managed Choice Open Access Value 2500 with Dental offered by Aetna is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Application Managed Choice Open Access Value 2500 with Dental Application Managed Choice Open Access Value 2500 with Dental Application
Brochure Managed Choice Open Access Value 2500 with Dental Brochure Managed Choice Open Access Value 2500 with Dental Brochure
Copay Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Visit 1-2 $30 copay, deductible waived. Visit 3+ 70% after deductible (Unlimited visits); Specialist Visit: Visit 1-2 $30 copay, deductible waived. Visit 3+ 70% after deductible (Unlimited visits, Specialist and Non-Specialist share visit max.) Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible; Specialist Visit: 50% after deductible (Unlimited visits)
Office Visit Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Visit 1-2 $30 copay, deductible waived. Visit 3+ 70% after deductible (Unlimited visits); Specialist Visit: Visit 1-2 $30 copay, deductible waived. Visit 3+ 70% after deductible (Unlimited visits, Specialist and Non-Specialist share visit max.) Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible; Specialist Visit: 50% after deductible (Unlimited visits)
Deductible Individual: $2,500, Family: $5,000 Individual: $5,000, Family: $10,000
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: $5,000, Family: $10,000
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 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: $500 per individual (Does not apply to generic); Generic (Oral Contraceptives Included): $15 copay, deductible waived; Preferred Brand (Oral Contraceptives Included): $35 copay after deductible; Non-Preferred Brand (Oral Contraceptives Included): $50 copay after deductible; Calendar Year Maximum (Maximum applies to combined in and out-of-network benefits): $5,000 per individual Pharmacy Deductible: $500 per individual (Does not apply to generic): Generic (Oral Contraceptives Included): $15 copay plus 50%, deductible waived; Preferred Brand (Oral Contraceptives Included): $35 copay plus 50% after deductible; Non-Preferred Brand (Oral Contraceptives Included): $50 copay plus 50% after deductible; Calendar Year Maximum (Maximum applies to combined in and out-of-network benefits): $5,000 per individual
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 (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): $50 copay, deductible waived (Includes lab work and X-rays) 70% (Age and frequency limits apply)
Child Preventative Care $50 copay (Age and frequency limits apply) 70% (Age and frequency limits 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 (24 visits per calendar year, Maximum applies to combined in and out-of-network benefits): 70% after deductible (Aetna will pay up to $25 per visit max., Maximum applies to combined in and out-of-network benefits) Physical/Occupational Therapy and Chiropractic Care (24 visits per calendar year, Maximum applies to combined in and out-of-network benefits): 50% after deductible (Aetna will pay up to $25 per visit max., 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; Urgent Care Facility: $50 copay, deductible waived Hospital Admission: 50% after deductible; Outpatient Surgery: 50% after deductible; Urgent Care Facility: 50% after deductible
Optional Benefits Managed Choice Open Access Value 2500 with Dental Managed Choice Open Access Value 2500 with Dental